Introduction to OSHA

Directorate of Training and Education OSHA Training Institute

Lesson Overview Purpose:  To provide workers with introductory

information about OSHA Topics:

1. Why is OSHA important to you? 2. What rights do you have under OSHA? 3. What responsibilities does your employer have

under OSHA? 4. What are OSHA standards? 5. How are OSHA inspections conducted? 6. Where can you go for help?

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Topic 1: Why is OSHA Important to You?  4,405 workers were killed on the

job in 2013 (3.2 per 100,000 full- time equivalent workers)

 An average of nearly 12 workers die every day

 797 Hispanic or Latino workers were killed from work-related injuries in 2013

 Nearly 3.0 million serious workplace injuries and illnesses were reported by private industry employers in 2012

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OSHA Makes a Difference

• Worker deaths in America are down–on average, from about 38 worker deaths a day in 1970 to 12 a day in 2013.

• Worker injuries and illnesses are down–from 10.9 incidents per 100 workers in 1972 to 3.0 per 100 in 2012.

 OSHA stands for the Occupational Safety and Health Administration, an agency of the U.S. Department of Labor

 OSHA’s responsibility is to improve worker safety and health protection

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 On December 29, 1970, President Nixon signed the OSH Act

 This Act created OSHA, the agency, which formally came into being on April 28, 1971

History of OSHA

OSHA’s Mission

 The mission of OSHA is to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.

 Some of the things OSHA does to carry out its mission are: ◦ Developing job safety and health standards and

enforcing them through worksite inspections ◦ Providing training programs to increase knowledge

about occupational safety and health

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Topic 2: What Rights Do You Have Under OSHA?  You have the right to: ◦ A safe and healthful workplace ◦ Know about hazardous chemicals ◦ Report injury to employer ◦ Complain or request hazard correction from employer ◦ Training ◦ Hazard exposure and medical records ◦ File a complaint with OSHA ◦ Participate in an OSHA inspection ◦ Be free from retaliation for exercising safety and

health rights

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Worker Rights

Handout #1: OSHA Poster

 Have you seen this poster at your place of

work?  Why was OSHA created?

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 Worker Protection is Law: The Occupational Safety and Health Act of 1970 (OSH Act)

 OSHA was created to provide workers the right to a safe and healthful workplace

 It is the duty of the employers to provide workplaces that are free of known dangers that could harm their employees

 This law also gives workers important rights to participate in activities to ensure their protection from job hazards

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Your Right to…

 Employers must have a written, complete hazard communication program that includes information on:  Container labeling,  Safety Data Sheets (SDSs), and  Worker training.  The training must include the

physical and health hazards of the chemicals and how workers can protect themselves

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Your Right to…

The Hazard Communication Standard (HCS) requires chemical manufacturers, distributors, or

importers to provide Safety Data Sheets (SDSs) (formerly known as

Material Safety Data Sheets or MSDSs) to communicate the

hazards of hazardous chemical products. As of June 1, 2015, the HCS will require new SDSs to be

in a uniform format.

 OSHA’s Recordkeeping rule requires most employers with more than 10 workers to keep a log of injuries and illnesses

 Workers have the right to report an injury* and review current log

 Workers also have the right to view the annually posted summary of the injuries and illnesses (OSHA 300A)

Your Right to…

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*It is against the OSHA law to retaliate or

discriminate against a worker for reporting an injury or illness

 Workers may bring up safety and health concerns in the workplace to their employers without fear of discharge or discrimination

 OSHA rules protect workers who raise concerns to their employer or OSHA about unsafe or unhealthful conditions in the workplace

Your Right to…

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 Workers have a right to get training from employers on a variety of health and safety hazards and standards that employers must follow

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Your Right to…

 Some required training covers topics such as, chemical hazards, equipment hazards, noise, confined spaces, fall hazards in construction, personal protective equipment, along with a variety of other subjects

 Training must be in a language and vocabulary workers can understand

 1910.1020: right to examine & copy records  Examples of toxic substances and harmful

physical agents are: ◦ Metals and dusts, such as, lead, cadmium, and

silica ◦ Biological agents, such as bacteria, viruses, and

fungi ◦ Physical stress, such as noise, heat, cold, vibration,

repetitive motion, and ionizing and non-ionizing radiation

Your Right to…

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 Workers may file a confidential complaint with OSHA if they believe a violation of a safety or health standard, or an imminent danger situation, exists in the workplace

 Workers may request that their name not be revealed to the employer

 If a worker files a complaint, they have the right to find out OSHA’s action on the complaint and request a review if an inspection is not made

Your Right to…

Note: Often the best and fastest

way to get a hazard corrected

is to notify your

supervisor or

employer.

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 Employee representative can accompany OSHA inspector

 Workers can talk to the inspector privately  Workers may point out hazards, describe

injuries, illnesses or near misses that resulted from those hazards and describe any concern you have about a safety or health issue

 Workers can find out about inspection results, abatement measures and may object to dates set for violation to be corrected

Your Right to…

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 Workers have the right to be free from retaliation for exercising safety and health rights

 Workers have a right to seek safety and health on the job without fear of punishment

 This right is spelled out in Section 11(c) of the OSH Act

 Workers have 30 days to contact OSHA if they feel they have been punished for exercising their safety and health rights

Your Right to…

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 Provide a workplace free from recognized hazards and comply with OSHA standards

 Provide training required by OSHA standards  Keep records of injuries and illnesses  Provide medical exams when required by OSHA

standards and provide workers access to their exposure and medical records

 Not discriminate against workers who exercise their rights under the Act (Section 11(c))

 Post OSHA citations and hazard correction notices  Provide and pay for most PPE

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Employer Responsibilities (cont.)

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REPORTING AND RECORDING CHECKLIST Employers must:  Report each worker death to OSHA  Report each work-related hospitalization,

amputation, or loss of an eye  Maintain injury & illness records  Inform workers how to report an injury or

illness to the employer  Make records available to workers  Allow OSHA access to records  Post annual summary of injuries & illnesses

Topic 4: What are OSHA Standards? OSHA standards are:  Rules that describe the

methods employers must use to protect employees from hazards

 Designed to protect workers from a wide range of hazards

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Four Groups of OSHA Standards

General Industry* Construction

Maritime Agriculture

*General Industry is the set that applies to the largest number of workers and

worksites

Where there are no specific standards, employers must comply with the General Duty Clause of the OSH Act.

OSHA Standards (cont.)

These standards also:  Limit the amount of hazardous chemicals,

substances, or noise that workers can be exposed to

 Require the use of certain safe work practices and equipment

 Require employers to monitor certain hazards and keep records of workplace injuries and illnesses

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Most Frequently Cited OSHA Standards

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OSHA’s website provides information regarding the most frequently cited standards

Click: Frequently Cited OSHA Standards to view current data

 “Select number of employees in establishment,” select ALL or one of the options listed

 “Federal or State Jurisdiction,” select Federal or, from the dropdown menu, a specific state

 “NAICS,” enter ALL for all Industry groups, or enter a valid 2 to 6 digit code for a specific Industry from the NAICS Manual

 Shown are search results for: All sizes of establishments, in Federal jurisdiction, with a Construction NAICS code of “23”

Common Most Frequently Cited Standards: Fall Protection; Hazard Communication; Scaffolding; Respiratory Protection; Electrical; Powered Industrial Trucks; Ladders

 The OSH Act authorizes OSHA compliance safety and health officers (CSHOs) to conduct workplace inspections at reasonable times

 OSHA conducts inspections without advance notice, except in rare circumstances (e.g. Imminent Danger)

 In fact, anyone who tells an employer about an OSHA inspection in advance can receive fines and a jail term

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Different Types of OSHA Inspections

 Imminent danger  Fatality or hospitalizations  Worker

complaints/referrals  Targeted inspections—

Local Emphasis Program (LEP), National Emphasis Program (NEP), particular hazards or industries

 Follow-up Inspections

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VIOLATION TYPE PENALTY

WILLFUL A v io la tio n th a t th e e m p lo y e r in te n tio n a lly a n d k n o w in g ly c o m m its o r a v io la tio n th a t th e e m p lo y e r c o m m its w ith p la in in d iffe re n c e to th e la w .

O S H A m a y p ro p o s e p e n a ltie s o f u p to $ 7 0 ,0 0 0 fo r e a c h w illfu l v io la tio n , w ith a m in im u m p e n a lty o f $ 5 ,0 0 0 fo r e a c h w illfu l v io la tio n .

SERIOUS A v io la tio n w h e re th e re is s u b s ta n tia l p ro b a b ility th a t d e a th o r s e rio u s p h y s ic a l h a rm c o u ld re s u lt a n d th a t th e e m p lo y e r k n e w , o r s h o u ld h a v e k n o w n , o f th e h a za rd .

T h e re is a m a n d a to ry p e n a lty fo r s e rio u s v io la tio n s w h ic h m a y b e u p to $ 7 ,0 0 0 .

OTHER-THAN-SERIOUS A v io la tio n th a t h a s a d ire c t re la tio n s h ip to s a fe ty a n d h e a lth , b u t p ro b a b ly w o u ld n o t c a u s e d e a th o r s e rio u s p h y s ic a l h a rm .

O S H A m a y p ro p o s e a p e n a lty o f u p to $ 7 ,0 0 0 fo r e a c h o th e r-th a n -s e rio u s v io la tio n .

REPEATED A v io la tio n th a t is th e s a m e o r s im ila r to a p re v io u s v io la tio n .

O S H A m a y p ro p o s e p e n a ltie s o f u p to $ 7 0 ,0 0 0 fo r e a c h re p e a te d v io la tio n .

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 Give an example of a reason why OSHA would conduct an inspection at your workplace

 What are the types of OSHA violations?

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 Sources within the workplace/worksite  Sources outside the workplace/worksite  How to file an OSHA complaint

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 Employer or supervisor, co-workers and union representatives

 Safety Data Sheet (SDS) for information on chemicals

 Labels and warning signs  Employee orientation manuals or other

training materials  Work tasks and procedures instruction

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 OSHA website: http://www.osha.gov and OSHA offices (you can call or write)

 Compliance Assistance Specialists in the area offices

 National Institute for Occupational Safety and Health (NIOSH) – OSHA’s sister agency

 OSHA Training Institute Education Centers  Doctors, nurses, other health care providers  Public libraries  Other local, community-based resources

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How to Raise a Concern

Handout #7: Identifying Safety and Health Problems

in the Workplace

 Review handout to become more aware of workplace hazards

 Discuss if anyone has discovered safety and/or health problems in the workplace/site

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 Download the OSHA complaint form from OSHA’s website

 File the complaint online ◦ Workers can file a complaint ◦ A worker representative can file a complaint

 Telephone or visit local regional or area offices to discuss your concerns

 Complete the form – be specific and include appropriate details

 OSHA determines if an inspection is necessary  Workers do not have to reveal their name

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Handout #8a: General Industry

 Each group reviews the handout and discusses the industry-specific scenario

 Groups need to determine what information would be important to include in their complaint

 Have the class discuss the group’s results: ◦ What was included in the complaint? ◦ What was added to the complaint?

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Handout #8b: Construction

 Each group reviews the handout and discusses the industry-specific scenario

 Groups need to determine what information would be important to include in their complaint

 Have the class discuss the group’s results: ◦ What was included in the complaint? ◦ What was added to the complaint?

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Handout #8c: Maritime Industry

 Each group reviews the handout and discusses the industry-specific scenario

 Groups need to determine what information would be important to include in their complaint

 Have the class discuss the group’s results: ◦ What was included in the complaint? ◦ What was added to the complaint?

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 What are some resources inside the workplace that will help you find information on safety and health issues?

 What are some resources outside the

workplace that will help you find information on safety and health issues?

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This lesson covered:  The importance of OSHA, including the

history of safety and health regulation leading to the creation of OSHA and OSHA’s mission;

 Worker rights under OSHA;  Employer responsibilities;  OSHA standards;  OSHA inspections; and  Safety and health resources, including how to

file a complaint.

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Thank You!

Workers’ Compensation Insurance: A Primer for Public Health

Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Workers’ Compensation Insurance: A Primer for Public Health

Workers’ Compensation Insurance: A Primer for Public Health

David F. Utterback, Alysha R. Meyers,

Steven J. Wurzelbacher

Department of Health and Human Services Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

January 2014

Workers’ Compensation Insurance: A Primer for Public Healthii

This document is in the public domain and may be freely copied or reprinted.

Disclaimer

Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH). In addition, citations to Web sites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these Web sites. All Web addresses referenced in this document were accessible as of the publication date.

Ordering Information

To receive documents or other information about occupational safety and health topics, contact NIOSH: Telephone: 1–800–CDC-INFO (1–800–232–4636) TTY: 1-888-232-6348 Email: [email protected] Or visit the NIOSH Web site at www.cdc.gov/niosh

For a monthly update on news at NIOSH, subscribe to NIOSH eNews by visiting www.cdc.gov/niosh/eNews.

DHHS (NIOSH) Publication No. 2014–110 January 2014

Workers’ Compensation Insurance: A Primer for Public Health iiiWorkers’ Compensation Insurance: A Primer for Public Health

Foreword

Occupational safety and health research and surveillance are essential for the prevention and control of injuries, illnesses and hazards that arise from the workplace. Research and surveil- lance can fill gaps in knowledge about where hazards exist and what interventions are effective at preventing workplace injuries, illnesses and fatalities. Workers’ compensation insurance records are a resource used for these primary prevention purposes. In addition, workers’ compensation records may be used for early detection of health outcomes in populations of workers which is part of secondary prevention. They may also be used to help identify effective medical treatment which is part of tertiary prevention. Workers’ compensation insurance covers nearly all workers in the U.S. and provides those who are injured or become ill as a result of work with medical treatment, a portion of lost wages, and a lump sum for some permanent impairments. Nonetheless, there are limitations to conducting studies that rely on workers’ compensation records since not all injuries and illnesses result in claims being filed. Furthermore, the data that are collected are not readily combined if obtained from multiple sources since requirements vary substantially among the states. The National Institute for Occupational Safety and Health (NIOSH) joined with a number of public and private sector co-sponsors to convene two workshops on the use of workers’ com- pensation data for occupational safety and health. Creation of this document was suggested at the second workshop as a means to describe elements of the workers’ compensation insurance programs in the U.S. and the potential to utilize the records for public health purposes.

Public health agencies, the workers’ compensation industry, trade associations and the state-level programs share interests in utilizing these data to protect workers from occupational injuries and illnesses. To help facilitate these goals, NIOSH has created a Center for Workers’ Compensation Studies. Further information on the center may be obtained at http://www.cdc.gov/niosh/topics/ workerComp/CWCS/.

John Howard, M.D. Director National Institute for Occupational Safety and Health Centers for Disease Control and Prevention

Workers’ Compensation Insurance: A Primer for Public Healthiv

Acknowledgements

We thank the participants at the Use of Workers’ Compensation Data for Occupational Safety and Health Workshop that was held in Washington, DC in June 2012 for suggesting that a docu- ment like this primer be developed. Many of those participants and other stakeholders provided essential input on the scope and contents of this primer. We also thank the internal and external reviewers for their valuable comments.

Acronyms and Abbreviations

AASCIF – American Association of State Compensation Insurance Funds ACORD – Association for Cooperative Operations Research and Development ACS – American Community Survey AIA – American Insurance Association CBP – County Business Patterns CDC – Centers for Disease Control and Prevention CES – Current Employment Statistics CFOI – Census of Fatal Occupational Injuries CFR – Code of Federal Regulations CPS – Current Population Survey DHHS – Department of Health and Human Services EDI – Electronic Data Interchange FEIN – Federal Employer Identification Number FROI – First Report of Injury FTE – Full-time Equivalent HIPAA – Health Insurance Portability and Accountability Act IAIABC – International Association of Industrial Accident Boards and Commissions ICD – International Classification of Disease IRS – Internal Revenue Service MSHA – Mine Safety and Health Administration NAICS – North American Industry Classification System NASI – National Academy of Social Insurance NAIC – National Association of Insurance Commissioners NCOIL – National Conference of Insurance Legislators NCCI – National Council on Compensation Insurance NIOSH – National Institute for Occupational Safety and Health OES – Occupational Employment Statistics OIICS – Occupational Injury and Illness Classification System OSHA – Occupational Safety and Health Administration PCIAA – Property and Casualty Insurers Association of America PEO – Professional Employment Organizations QCEW – Quarterly Census of Employment and Wages SDS – Supplementary Data System SIC – Standard Industrial Classification System SOC – Standard Occupational Classification System SOII – Survey of Occupational Injuries and Illnesses TPA – Third-party Administrator WCIO – Workers’ Compensation Insurance Organizations WCRI – Workers’ Compensation Research Institute

Workers’ Compensation Insurance: A Primer for Public Health vWorkers’ Compensation Insurance: A Primer for Public Health

Table of Contents Foreword ...................................................................................................................................................... iii

Acknowledgements .................................................................................................................................... iv

Acronyms and Abbreviations .................................................................................................................. iv

1. Introduction ............................................................................................................................................ 1

2. Background ............................................................................................................................................. 2

3. Brief History of Workers’ Compensation in the U.S. .......................................................................... 4

4. Workers’ Compensation Insurance Benefits ........................................................................................ 7

5. Workers’ Compensation Insurance Providers ................................................................................... 11

6. State Workers’ Compensation Agencies .............................................................................................12

7. Third-Party Administrators .................................................................................................................13

8. Types of Policies ....................................................................................................................................13

9. Policy Premiums ....................................................................................................................................18

10 Workers’ Compensation Records .......................................................................................................19

11. Standardized Codes and Systems in Workers’ Compensation ......................................................21

12. Loss Prevention ..................................................................................................................................22

13. Workers’ Compensation Associations ..............................................................................................23

14. Public Health Research and Surveillance .........................................................................................25

15. Public Health Regulations ..................................................................................................................26

16. Breaking through Barriers .................................................................................................................27

References ...................................................................................................................................................29

Tables Table 1 ...........................................................................................................................................................8

Table 2 .........................................................................................................................................................14

Table 3 .........................................................................................................................................................16

Appendices Appendix A: Workers’ Compensation Primer Glossary .....................................................................35

Appendix B: Preparing for Engagement ................................................................................................41

Workers’ Compensation Insurance: A Primer for Public Health

Workers’ Compensation Insurance: A Primer for Public Health 1Workers’ Compensation Insurance: A Primer for Public Health

1. Introduction

The purpose of this document is to help public health researchers and practitioners, particu- larly those in occupational safety and health, to broaden their understanding of workers’ compensation insurance, relevant aspects of the insurance industry records, and the potential uses of that information for public health pur- poses. Workers’ compensation insurance has been established in all states to provide income protection, medical treatment, and rehabilita- tion for employees who are injured or become ill as a result of work. Workers’ compensation claims and medical treatment records along with other information resources have been used to conduct occupational safety and health research and surveillance and to identify intervention needs. Several government agencies and private organizations sponsored two workshops in September 2009 and June 2012 on the use of workers’ compensation data for occupational safety and health purposes. The workshops featured discussions of opportunities for collabo- ration in the analysis of workers’ compensation data in order to help reduce the risks of occupa- tional injuries and illnesses. Participants included representatives from private insurance carriers, insurance associations, self-insured corporations, academic institutions and government agencies. Presentations in the first workshop described differences among state laws, proper interpreta- tion of common industry terms, proprietary interests in insurance data, public release of internal analyses, methods for linking workers’ compensation records with other health and employment records, and independent analysis of claims data by health scientists, economists and government agencies [NIOSH 2010; Utterback et al. 2012]. One of the principal messages from the first workshop was that even though workers’ compensation records are primarily designed and used by the insurance industry to administer claims, public health investigators are interested in them for prevention and control of

occupational injuries and illnesses. The interested parties have different perspectives on the value and potential uses of workers’ compensation data. Relationships would need to build trust and respect for the various stakeholder perspectives to foster collaboration. The second workshop included discussions of six draft white papers along with 35 platform and poster presentations on research with workers’ compensation data [NIOSH 2013a]. Although much progress is being made in understand- ing the merits of workers’ compensation data resources, significant limitations exist. For example, these data appear to constitute an incomplete record of occupational injuries and

illnesses at the state level. While standards for col- lecting and compiling the data exist, they are not uni- versally used. Some fields on the record forms are often blank or incomplete and essential information

for public health purposes, such as occupation, race, ethnicity, and duration of employment, may not be recorded. Multiple parties add data to the records at various stages as claims work their ways through the employees, employers, medical facilities, third-party administrators and state agencies. Nonetheless, important public health research can be conducted with available data as long as the limitations and their effects on generalizability are considered. At the end of the second workshop, some com- mented that the public health and the insurance communities may have different interpretations of terms in common usage and overcoming that barrier might be facilitated by a summary of the workers’ compensation industry and a crosswalk of terminology used by each group. A team began work on this document as a result.

Following the background and brief history of the workers’ compensation programs in the U.S., this primer describes: (1) benefits and premiums; (2) the relationship between premiums and safety incentives; (3) roles of insurers, state agencies and third party administrators; (4) types of policies;

Two workshops on the use of workers’ compensation data for public health purposes have been held and proceedings are available.

Workers’ Compensation Insurance: A Primer for Public Health2

(5) claims and other workers’ compensation insur- ance information on medical treatments, costs and disability status; (6) limitations of current industry data standards; (7) loss prevention programs; and (8) public health research, sur- veillance and regulations. A glossary of workers’ compensation terms begins on page 35 and a guide for prospective research and surveillance projects follows on page 41.

2. Background The economic and social burden of occupational injuries and illnesses can only be roughly esti- mated [Leigh and Marcin 2012; Leigh 2011]. Uncertainties are due to many factors including: (1) workers receive only a portion of regular wages through workers’ compensation; (2) occupational illnesses are frequently not compensated; (3) medical treatment costs for many occupational injuries are paid by other insurance; (4) insurance data are fragmented; and (5) data are protected for proprietary and personal identification purposes. No central repository for workers’ compensation claims information exists in the U.S.

The National Academy of Social Insurance (NASI), a non-governmental organization, produces an annual report on workers’ compensation insurance. The most recent version, Workers’ Compensation Benefits, Coverage, and Costs, 2010, states that workers’ compensation insurance covered more than 124 million U.S. workers at a total estimated cost to employers of $71 billion in 2010 [Sengupta et al. 2012]. Total insured medical payments to providers and insured cash benefits to workers were estimated at $28.1 billion and $29.5 billion, respectively.

Most workers’ compensation insurance car- riers are private entities except for exclusive state insurance funds in North Dakota, Ohio, Washington and Wyoming. Also, twenty states offer state-sponsored nonprofit competitive insurance companies or state licensed mutual insurance plans, some to only selected portions

Workers’ compensation data are likely to be more complete for acute injuries and more representative of population risks than occupational illness data.

of the market such as those employers that are unable to obtain insurance coverage in the vol- untary market. There are typically dozens if not hundreds of private carriers in each state. Large employers in the U.S. are often self-insured under rules established by the states.

Workers’ Compensation Records Workers’ compensation insurance, in various forms, covers in excess of 90% of the U.S. wage and salary workers [Sengupta et al. 2012]. Ideally, each workplace injury or illness requiring medical care covered by workers’ compensation would result in a record being created for the claim. The primary purpose for the record is to ensure proper payment to injured or ill workers and to the medical providers. Yet the record may contain useful information for public health purposes on the nature of the injury or disorder, the part- of-body, the event or exposure, industry sector, occupation, and the worker’s ability to continue working or disability status. Descriptive contents

may provide additional information on materials related to the event such as biological, chemical, ergo- nomic or physical hazards.

Medical records for workers’ compensation cases can provide further information

about the extent and severity of the injury plus information about the injured workers such as gender, age, race/ethnicity, and other chronic health conditions that may exacerbate an injury. Workers’ compensation medical records also identify disabilities that result from the occupa- tional injuries or illnesses and billing records can contain information on treatments and costs for the medical portion of the claims.

Insurance carriers and self-insured entities are required to provide state government agencies with claims information that is used for admin- istrative requirements such as oversight and to conduct hearings for adjudication of disputes. The level of detail and quality of information vary among the data providers. Nonetheless, in each state, a government agency has longitudinal data that may be suitable for public health research and

Workers’ Compensation Insurance: A Primer for Public Health 3Workers’ Compensation Insurance: A Primer for Public Health

surveillance purposes. It is noteworthy that the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule exempts workers’ compensation medical information from its disclosure restrictions.1 If information from multiple sources or jurisdic- tions could be combined, workers’ compensation insurance records would permit better analysis and tracking of occupational injuries and some diseases. In public health, use of these tracking systems is called surveillance. (See box for a defi- nition.) Health scientists, economists, and others use large surveillance data sets for informative analyses of trends in incidence and costs, identification of health hazards associated with new technologies, evaluation of injury and illness preven- tion program effectiveness, and to provide employers with information needed to protect their workforce.

Limitations on Records Utility For public health research and surveillance pur- poses, workers’ compensation data are likely to be more representative of population risks for acute injuries than they are for occupational illnesses. Some investigators have used limited workers’ compensation data to estimate the frequency, magnitude, severity, and cost of compensated injuries and to examine trends over time. Several papers at the 2012 workshop described deficien- cies in workers’ compensation records for injury and illness surveillance purposes, even for more severe injuries such as amputations, fractures and concussions [NIOSH 2013a].

C ombining workers’ compensation data from a number of jurisdictions is a major

technical challenge. Each state legislature and the District of Columbia establish workers’ compensation requirements2 with significant variations. For example, states vary in the cov- erage of compensable cumulative injuries such as carpal tunnel syndrome, levels of payments for partial and total disability, both temporary and permanent, and the minimum number of days away from work to qualify for wage- replacement compensation. In many states, employers with small numbers of employees, temporary employees and other groups, such

as farm employees, are excluded from coverage requirements. Certain groups of workers such as railroad, longshore, many maritime and all Federal employees are covered by rules established at the national level. Special compensation funds have been established at the Federal level for atomic weapons workers and for those disabled by black lung disease.

Another factor that makes it difficult to combine data from multiple sources is the lack of national data standards. For example, although some nationally standardized data coding systems are available, such as Occupational Injury and Illnesses Classification System (OIICS), and North American Industry Classification System (NAICS), they are not universally used across the states. In fact, workers’ compensation rate- making bodies like the National Council on Compensation Insurance (NCCI) and several state rating bureaus use coding systems that pre-date OIICS and NAICS systems. These coding systems are discussed in subsequent chapters.

The U.S. Centers for Disease Control and Prevention (CDC) defines public health surveillance as the “ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practices, closely i n t e g r a t e d w i t h t h e t i m e l y dissemination of these data to those who need to know.”

1More on the exclusion of workers’ compensation medical records from the HIPAA Privacy Rule can be found at http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/workerscomp.html

2This document uses “requirements” as a substitute term for legislation, statutes, rules and regula- tions since the sources for the legal obligations vary among the states.

Workers’ Compensation Insurance: A Primer for Public Health4

Furthermore, access to workers’ compensation data can be difficult to obtain. Insurance carriers are usually private businesses that manage very large data sets in integrated, proprietary systems. These data are generally not shared with external groups. Some insurance organizations like NCCI routinely collect standardized data from insurance carriers in many states but their contracts protect the proprietary interests of the contributing carriers and restrict data uses to issues directly related to estimating or recommending insur- ance premium rates for establishments within industries. Only one private insurance entity, The Liberty Mutual Research Institute for Safety, has published extensive peer-review articles related to injury and illness prevention based on workers’ compensation records [Courtney 2010].

E v e n w h e n c o n d u c t - ing analyses of workers’ compensation data from a single state, there are c h ar a c t e r i s t i c s of t h e workers’ compensation data that limit its utility. Multiple researchers have reported limitations on the utilization of workers’ compensation for occupational injury and illness research and surveillance. Azaroff, et al. [2002] described a number of filters that limit the reporting and filing of cases and the subsequent development of a medical record or workers’ compensation claim following a workplace injury or illness. Several investigators have reported much less than full participation in workers’ compensation for occupational injuries and illnesses with up to half or more of the compensable claims going unreported [Biddle et al. 1998; Rosenman et al. 2000; Fan et al. 2006; Scherzer et al. 2008; Lipscomb et al. 2009].

Leigh [2012] estimated that only 21% of the total economic burden of occupational injuries and illnesses was paid by workers’ compensation insurance carriers. Others describe the diffi- culty in estimating the portion of the burden that is shifted to other social and health insur- ance programs [Boden et al. 2001] such as when workers with occupational injuries and illnesses

Each state has its own set of rules about which employers are required to obtain workers’ compensation insurance.

file disability claims with the Social Security Administration [O’Leary et al. 2012].

3. Brief History of Workers’ Compensation in the US Following European examples from the 19th century, states in the U.S. began to develop

workers’ compensation laws in the early 1900’s to address the increasing risks of occupational injuries and illnesses associated with the industrial revolution. Initial laws in several states were declared unconstitutional

but, in 1911, Wisconsin became the first state to establish a workers’ compensation system that withstood constitutional challenges in the courts. By 1920, most states and territories3 had followed suit. Mississippi was the last state to adopt a workers’ compensation law in 1948.4 These laws provide partial benefits to affected workers and protect employers from tort suits for occupational injuries and illnesses in nearly all cases. This “grand bargain” circumvents lengthy, expensive trials where the burden of proof was on the employee and removed a source of financial uncertainty for the employer.

Since the beginning of workers’ compensation programs in the U.S., nearly all employers have

3References to state workers’ compensation laws in this document should be read to include the territories of Guam and the Virgin Islands plus the District of Columbia, all of which have sepa- rate statutes and regulations.

4For greater details on the history and development of workers’ compensation laws in Europe and the U.S., readers are directed to http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC. pdf, http://eh.net/encyclopedia/workers-compensation/, http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1888620/, or http://www.aascif.org/public/1.1.1_history.htm

Workers’ Compensation Insurance: A Primer for Public Health 5Workers’ Compensation Insurance: A Primer for Public Health

been required to have insurance to cover pay- ments for: (1) medical costs resulting from occupational injuries and some occupational illnesses suffered by workers; and (2) partial replacement of injured or ill workers’ lost wages, also known as indemnity. Death benefits are paid to survivors for occupational fatalities. These benefits are paid only for claims where workers were injured or became ill due to conditions that “arise out of and in the course of employment,” with restrictions that vary substantially among the 50 states due to legislation and case law. In return for this coverage, employers are granted immunity from employee law suits (tort litiga- tion) for nearly all occupational injuries and illnesses. Thus workers’ compensation insurance is structured to be the sole employee remedy for restitution subsequent to occupational injuries and illnesses. Some exceptions exist for willful injuries and gross negligence.

Mandatory Coverage Each state has its own set of requirements about which employers are compelled to obtain workers’ compensation insurance. Varying factors are generally the industry sector of the employer, the minimum number of employees, length of employment, and, in some cases, the familial relationship of the employee with the employer. The minimum number of employees requiring provision of workers’ compensation coverage varies between one and five across the states. Some states exclude agricultural employers with less than a specified number of employees. Some states exclude self-employed workers while other states provide an option for their coverage. Some states exclude corporate officers in limited liability corporations without other employees. Other states have specific workers’ compensation rules for industry sectors such as mining and construction. The employment relationships of employers with employees versus contractors are clearly defined in many states.5

Since the enactment of Texas workers’ compensa- tion legislation in 1913, employers in that state have been allowed to voluntarily participate in workers’ compensation insurance coverage. Those employers who choose to opt out of coverage are not protected from tort suits by the injured or ill workers, or by surviving family members in case of fatalities. Any medical expenses are the responsibility of the injured or ill workers. No payments are required for the workers’ lost earnings for the duration of their recovery period or for permanent disabilities. More recently, Oklahoma legislation that was enacted in May 2013 allows employers to opt out of workers’ compensation insurance. In this state, employers who opt out are required to have an internal compensation program for occupational injuries and illnesses that is consistent with Employee Retirement Income Security Act (ERISA) [Oklahoma Insurance Department 2013].

Basis for Insurance Premiums Throughout the history of workers’ compensation in the U.S., premiums for insurance policies have been determined by a set of factors related to employer risks, primarily the mix of occupational classes they employ. Employers are assigned to work classifications6 according to state-sanctioned rating bureau guidelines. In general, employers in classifications with greater injury and illness risks and loss costs have higher “manual rates.” For example, a roofing contractor generally has a higher manual rate than a bank. Recommended or specified manual rates must be approved by the state regulators in most cases. Additionally, those employers which qualify for experience rating and that have a history of greater injury and illness claims and costs within the risk classes are charged even higher premiums through the application of an experience modification factor. Those employers with fewer claims and lower loss costs benefit from lower premiums.

5For greater details on workers’ compensation trends and individual state requirements, readers are directed to the annual NASI report [Sengupta et al. 2012] and the annual report produced by the U.S. Chambers of Commerce [U.S. Chamber of Commerce 2012].

6The classifications do not directly correspond to Standard Industry Classification (SIC) or NAICS codes or occupational classification systems, such as the Standard Occupation Classes (SOC).

Workers’ Compensation Insurance: A Primer for Public Health6

Motivations for Prevention From the beginning of workers’ compensa- tion insurance laws in the U.S., the experience modification factor was intended to encour- age employers to invest in safety. A history of elevated claims frequencies and costs results in higher insurance premiums for the employer. Adoption of effective safety strategies reduces occupational injuries and illnesses which should decrease future premiums. Additionally, many states have enacted legislation that requires carri- ers to provide premium discounts for the presence of employer-based leading indicators such as safety and health programs which meet specific criteria. Moreover, most carriers provide loss prevention ser- vices to client employers in order to limit escalation of claims costs and insurance premiums. Some states, for example Texas, Missouri and Arkansas, mandate that insurance carriers provide loss prevention services to clients and many specify that the services shall be provided at no additional cost beyond the annual premium.

Recent Changes in the Industry and Market The workers’ compensation insurance market is dynamic. Both the nature of work and work- force are changing. In recent years, the mix of industries and technologies in the U.S. have changed and the workforce is aging [Restrepo and Shuford 2011] and increasingly non-English speaking [Hakimzadeh and Cohn 2007] and obese [Ostbye et al. 2007; Trogden et al. 2007; Schmid et al. 2012]. In the past couple of decades, there have been substantial changes in state laws that affect workers’ comp ens ation p olicies and procedures. Workers’ compensation insurance requirements on issues such as managed care organizations, limited physician choice, voca- tional rehabilitation, minimum standards of care, and restrictions on treatment options have been enacted in many states. Meanwhile, medical costs for claims have escalated [Shuford et al. 2009]

and litigation of claims is common in many states [Willborn et al. 2012].

Changes in the relationships between employees and employers have created needs for newer workers’ compensation insurance policy types. For example, contingent work arrangements through temporary employment agencies and professional employer organizations (PEO) are becoming more common [Smith et al. 2010]. These emergent work arrangements can compli- cate coverage and incentives for injury prevention. PEOs primarily have provided human resource

and management services to client employers although they increasingly employ workers in other industries. PEOs result in co-employ- ment by the host agency and the client employer. Newer workers’ compensation policy arrangements have

been developed for PEOs and similar employment leasing organizations [Shuford 2013] since a single host agency may employ workers at different times in industries with various risk classifications. In contrast, workers who are employees of a temporary agency are covered under the workers’ compensation policy for that agency, not that of the client employer. Independent contractors, which are defined in the workers’ compensa- tion statutes in many states, are not covered by the policy of the contracting employer, e.g. the general contractor at a construction site. Also,

independent contractors which are self-employed persons are qualified for workers’ compensation insurance in some, but not all, states. Each of these arrangements can blur the responsibility for provision of workers’ compensation

coverage and has resulted in a lack of coverage for some workers.

Insurance Industry Resources Many organizations produce information that is used by various parts of the workers’

New types of workers’ compensation insurance policies have been devel- oped to cover the recent changes in the relationships between employees and employers.

The relationship between claims frequencies and costs and the employers’ premium is intended to encourage investments to reduce the risk of injuries and illnesses.

Workers’ Compensation Insurance: A Primer for Public Health 7Workers’ Compensation Insurance: A Primer for Public Health

compensation insurance industry. The U.S. Department of Labor formerly compiled reports on benefits and costs and annual summaries of changes in state workers’ compensation require- ments. They also employed regional experts on workers’ compensation. The federal efforts have shifted and some of the products have been replaced by private or nonprofit entities such as NASI and a number of others. For example, a biannual report that compares the average cost of workers’ compensation insurance per $100 of employer payroll among states is published by the State of Oregon [Oregon Department of Consumer and Business Services 2012]. The roles and contributions of a number of these insurance organizations appears later in this document.

Effectiveness of State Laws The comparative impact of the various state requirements has been a source of debate over the entire history of workers’ compensation in the U.S. Federalization of the programs has been suggested from time to time. The Occupational Safety and Health Act in 1970 created the National C om m i s s i on on St ate Workers’ Compensation Laws which, after public meetings and comment period, proposed Federal minimum standards for state programs if the states did not substantially improve their laws. Related Congressional actions failed to pass. The Commission did develop a set of recommenda- tions for the state programs.7 Changes in state requirements subsequent to those recommenda- tions have been periodically reviewed which indicate partial adoption by each of the states.8

According to national surveillance data, the fre- quency and rate of occupational injuries have declined over the past several decades [Sengupta

et al. 2012; U.S. Bureau of Labor Statistics 2012]. In 2010, employer costs for workers’ compensa- tion benefits as a proportion of payroll were at the lowest level in 30 years [Sengupta et al. 2012]. There has also been a general trend across the states to limit compensation for disabled workers [Spieler and Burton 2012]. Whether the surveil- lance trends are due to reduced injuries, increases in underreporting, or other factors is the subject of ongoing research.

4. Workers’ Compensation Insurance Benefits

Payments for workers’ compensation claims can be for employee medical treatment, loss of wages (indemnity), vocational rehabilitation, perma- nent disability, and death. The rules for the level of payment vary tremendously among the states with a few exceptions. First, all medical expenses

are the responsibility of the insurance provider without co-payment by the claim- ant but may be subject to legislated time limits and to medical fee schedules. These covered costs include the initial treatment and subsequent treatments plus

physical therapy or vocational rehabilitations. Second, indemnity payments to the worker who misses work for greater than the minimum waiting period are provided tax-free. Third, most states provide wage replacement payments for the initial waiting period after lost work time exceeds a number of days that is set by the individual states (Table 1). For example, if the initial waiting period for indem- nity payments is five calendar days, payments for that initial period would be made once the lost work time on that claim exceeds a separate minimum period such as 21 calendar days. This latter minimum time period is called the retroactive period.

7http://www.workerscompresources.com/National_Commission_Report/national_commis- sion_report.htm

8http://www.ncbi.nlm.nih.gov/pubmed/15182746, http://www.ssa.gov/policy/docs/ssb/v65n4/v65n4p24.pdf http://www.workerscompresources. com/, National_Commission_Report/National_Commission/1-2004/Jan2004_nat_com.htm

Payments for workers’ compensa- tion claims cover employee medical treatment, loss of wages, vocational rehabilitation, permanent disability and death.

Workers’ Compensation Insurance: A Primer for Public Health8

Table 1. Waiting period for claimant to receive wage replacement benefits and the retroactive period which, if exceeded, results in payment for the waiting period

State Waiting Period (days) 1 Retroactive (days) 2

AL 3 21 AK 3 28 AR 7 14 AZ 7 14 CA 3 14 CO 3 14 CT 3 14 DE 3 7 DC 3 14 FL 7 21 GA 7 21 HI 3 ID 5 14 IL 3 14 IN 7 21 IA 3 14 KS 7 21 KY 7 14 LA 7 42 ME 7 14 MD 3 14 MA 5 21 MI 7 14 MN 3 10 MS 5 14 MO 3 14 MT 4 NE 7 42 NV 5 6 NH 3 14 NJ 7 7 NM 7 28 NY 7 14 NC 7 21

Workers’ Compensation Insurance: A Primer for Public Health 9Workers’ Compensation Insurance: A Primer for Public Health

Table 1. Waiting period for claimant to receive wage replacement benefits and the retroactive period which, if exceeded, results in payment for the waiting period

State Waiting Period (days) 1 Retroactive (days) 2

AL 3 21 AK 3 28 AR 7 14 AZ 7 14 CA 3 14 CO 3 14 CT 3 14 DE 3 7 DC 3 14 FL 7 21 GA 7 21 HI 3 ID 5 14 IL 3 14 IN 7 21 IA 3 14 KS 7 21 KY 7 14 LA 7 42 ME 7 14 MD 3 14 MA 5 21 MI 7 14 MN 3 10 MS 5 14 MO 3 14 MT 4 NE 7 42 NV 5 6 NH 3 14 NJ 7 7 NM 7 28 NY 7 14 NC 7 21

Table 1. Waiting period for claimant to receive wage replacement benefits and the retroactive period which, if exceeded, results in payment for the waiting period (continued)

ND 5 5 OH 7 14 OK 3 OR 3 14 PA 7 14 RI 3 SC 7 14 SD 7 7 TN 7 14 TX 7 14 UT 3 14 VT 3 10 VA 7 21 WA 3 14 WV 3 7 WI 3 7 WY 3 9

1The minimum number of days away from work to qualify for indemnity payments, also known as the waiting period.

2If away from work for a number of days in excess of the retroactive period, claimant qualifies for indemnity payment for the waiting period.

Source: 2011 Chambers of Commerce Workers’ Compensation Laws, Chart IX, (see caveats pp. 78 – 79 in reference)

Workers’ Compensation Insurance: A Primer for Public Health10

Temporary Disabilities Temporary and permanent disability benefits can be in the form of partial or total benefits. Temporary partial benefits would be merited when workers are away from work beyond the specified minimum period but able to return to work in a limited capacity that would partially affect their income. Temporary total disability benefits occur when the worker is unable to be employed in any capacity for a period of time that exceeds the specified waiting period. Many states have set time limits on temporary total disability indemnity payments such as 104 weeks. These benefits may convert to temporary partial benefits if the worker is able to return to work part- time for limited periods or if able to complete work in another position at a lower pay rate. Permanent Disabilities Permanent partial disability payments are awarded for workers who may no longer return to work with sufficient capacity to perform their prior duties or if they lose part or all of the function of a specific body part due to a work-related amputation or other disability. The loss of a body part or function is often compensated based on a fee schedule such that a set multiplier of the average wage is paid either as a lump sum or over a period of time. Many states also provide permanent partial coverage for disfigurement of the face or other body parts.

The extent of permanent partial disability is deter- mined by the degree of impairment at the point of “maximal medical improvement” in order to settle the case. Impairment is usually determined according to medical references such as the American Medical Association Guides to the Evaluation of Permanent Impairment [Cocchiarella and Anderson 2001].

Permanent total disability indemnity payments are made to those workers who can no longer be employed in any capacity. Depending on the state, these payments may continue until retirement age, for the life of the individual, or until disability

payments are received from another source such as the Social Security Administration.

In some cases, the portions of the disability that are attributed to work and non-work conditions can factor in the amount of the disability payment. For example, in some jurisdictions, a worker who is disabled as a result of occupational exposures to a respiratory hazard may have their benefits reduced if a non-occupational exposure, such as smoking, is demonstrated to have contributed to the impairment.

Death benefits are paid to survivors of the worker who was killed on the job. The level of benefits usually varies with the number of dependents. Although generally a function of the average weekly wage, death benefits are often limited by a minimum and maximum amount but may last for the lifetime of the surviving spouse or until dependent children attain 18 years of age or older in certain cases.

Settlement of Claims Lump sum settlements, also known as negotiated settlements or compromise and release agreements, in lieu of limited periodic payments, have been increasing for disabilities covered by workers’ com- pensation insurance. These agreements are reached between the disabled employee, the employer and the insurance provider. In some states, settlements may cover only indemnity portions of a claim, with future medical benefits provided, while others allow payouts for future medical care (including Medicare set-asides,9 if appropriate). Often times, the settlements must be approved by a state workers’ compensation authority.

Claim Costs and Reserves Claims that are not settled through mutual agree- ment remain open until all payments for medical treat- ments, rehabilitation and

indemnity have been completed and the worker returns to work, reaches the maximum indemnity period or retirement age or dies. As a result, the cost of a claim can continue to grow. Future

9Medicaid set-asides for occupational injuries and illnesses are explained at http://www.medicare. gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/ workers-comp-payments.html.

Future obligations on a claim are handled in the form of reserves that are established for open ended claims.

Workers’ Compensation Insurance: A Primer for Public Health 11Workers’ Compensation Insurance: A Primer for Public Health

obligations on a claim are handled in the form of reserves that are established for open ended claims and are dependent on the nature of the injury and the likelihood of the rehabilitation of the worker. Reserves typically represent estimates of the most likely future cost of the claim, which approximates the mode of the distribution of claims of that type, rather than the mean.

With the open-ended nature of longer duration claims, insurance carriers often value (estimate cost of ) the claims based on the payments made to date, the payments plus reserves, or the pay- ments plus reserves as of a certain period of time, such as 30 months after the date of injury. Claims can also be valued using “factor-adjusted” methods that calculate costs by applying actu- arial loss development factors that attempt to estimate the ultimate payout amounts for the claims. For the “factor-adjusted” method, reserves therefore represent the mean future cost of claims of the same type. This method is applied to groups of claims and is used by insurance underwriters for analyzing aggregated claims for loss trends. A potential drawback with “factor-adjusted” methods is that their values are usually higher than the actual values of the individual claim (since the mean is always higher than the mode and median in claim cost distributions) [Wurzelbacher et al. 2013]. Some carriers use yet other cost valuation methods.

5. Workers’ Compensation Insurance Providers

The workers’ compensation insurance industry is complex with total per annum expenditures in excess of $70 billion [Sengupta et al. 2012]. The primary types of groups in the industry include insurance carriers, state regulatory agencies, third-party administrators and numerous trade organizations. Insurance providers may be privately-held corpora- tions, mutual corporations (owned by the policy holders), and state or Federal agen- cies. All states except North Dakota permit self-insurance for qualified employers [U.S. Chamber of Commerce 2012].

Insurance Providers and Policies The insurance providers are regulated by indi- vidual state requirements. Even nationwide insurance carriers must follow the require- ments in each of the states where they offer coverage. In most states, private insurance carriers compete in the regulated voluntary market. Twenty states offer alternatives to the private insurers in the form of non-profit state-sponsored insurance programs. In addi- tion, state funds are the exclusive providers of workers’ compensation insurance in four states – North Dakota, Ohio, Washington and Wyoming.

Insurance providers employ a range of special- ists such as actuaries, adjusters, underwriters, claims administrators and loss control con- sultants (see glossary). Brokers directly market insurance policies to employers and they may offer policies from a single insurance carrier or multiple competing carriers. Many private insurance providers specialize in spe- cific industry sectors in which they are most familiar with risks. Large national carriers offer insurance across diverse sectors but may still focus on certain industries. Many private insurance providers also offer other lines of coverage beyond workers’ compensation, such as property and liability.

Insurance providers typically issue annual policies. An employer may opt to change insurance carrier on the anniversary of the policy except in states with exclusive funds. Annual policies add to the competitiveness of the market yet they reduce the investment commitment of a carrier to client employers. For example, carriers are not likely to invest in cost reduction strategies such as safety equipment if the recovery of the investment would take several years to materialize.

Residual Market The residual market customarily consists of those employers that are unable to obtain insurance coverage in the voluntary market. The residual market usually serves newer employers without sufficient years of experience in workers’ com- pensation, employers with poor claims experience

Workers’ Compensation Insurance: A Primer for Public Health12

or employers in high-risk industries unable to obtain a policy to underwrite their potential losses. However, the residual market in some states may include employers that voluntarily participate when there are economic or services advantages. All 24 state-sponsored insurance programs provide coverage for their residual markets. A few of the state-sponsored government insurance pro- grams provide insurance coverage only to the residual market. Some states require the private insurance compa- nies in their markets to write proportionate coverage for the residual market employers in the form of assigned-risk pools. The Burton primer on workers’ compensation pro- vides additional details on the residual market and assigned-risk pools [Burton 2004].

6. State Workers’ Compensation Agencies

Each state has an agency that provides administrative services for workers’ compensation, has adjudicatory responsibilities in cases of disputes, and/or develops regulations and rules for the workers’ compensa- tion system consistent with the intent of legislative mandates. Portions of the agencies may operate as commissions, bureaus, or departments. They may be affiliated with other levels of government in the states such as labor, industry, insurance or commerce.

Collection of Records All states require that some portion of the workers’ c o m p e n s a t i o n c l a i m s records be reported to the agency by employers (Table 2). In some cases only indemnity claims are reported yet in others all claims (including medical only claims) are reported. More and more states have developed automatic Web (internet)-based or telemetric reporting systems that use standard forms and require the use of standardized codes

The residual market usually serves newer employers without sufficient experience in workers’ compensa- tion, employers with poor claims experience, or employers in high-risk industries unable to obtain a policy to underwrite their potential losses.

for fields in the forms. For example, the Workers’ Compensation Insurance Organization (WCIO) part-of-body, nature of injury or illness, and cause of incident codes are used in nearly all jurisdictions.

State agencies may be restricted by requirements in the portions of the workers’ comp ens at ion re cords which may be released to the public. In some states, those restrictions can extend to other in-state agencies as well. It bears repeating that

HIPAA Privacy Rule exempts workers’ compen- sation medical information from its disclosure restrictions.

Other Roles of State Agencies Many state agencies oversee special funds that provide benefits to injured or ill workers whose employer failed to obtain the legally required coverage. Most states also offer second injury funds which reimburse employers for certain claims paid to workers with pre-existing injuries. A few state agencies, e.g. Ohio and Washington, provide safety grants to offset some portion of an employer’s expenses for installation of safety equipment. Grants in other states, e.g. Massachusetts and Oregon, are made to support development of injury prevention training pro- grams (Table 3).

A few states have research c o m p o n e n t s i n t h e i r workers’ compensation agencies. These components may track expenditures, evaluate the implications of proposed legal changes, or consider other aspects of policy options. Many states, e.g. Florida [Florida Division of Workers’ Compensation 2011], develop annual reports for their agen-

cies that reveal the number of cases in various categories such as indemnity, medical-only and disallowed claims as well as the number of claims

All states workers’ compensation agencies require that some portion of the claims records be reported.

HIPPA Privac y Rule exempts workers’ compensation medical information from its disclosure restrictions. (See footnote 1)

Workers’ Compensation Insurance: A Primer for Public Health 13Workers’ Compensation Insurance: A Primer for Public Health

that are contested by the employer or the insurance provider. The reports may also describe recent changes to the requirements and the status of claims that are open and those that are closed. Other data may be pre- sented on the average cost of claims for various injury and illness types as well as the distribution of claims across industry segments.

Web (Internet) Services Most state agencies provide diverse services and extensive information via Web sites. Available services include injury, illness and death claim forms for employees and employers and the means to report suspected fraud. Proof of insurance cover- age by individual employers may be obtained in some states through their Web sites. The Web site information may describe the rights and responsi- bilities of employees, employers, insurance carriers, medical providers, and the state agency according to requirements in the state. Many states provide plain- language guides for employees and employers that explain claims processing and appeals. Ombudsmen in some states may be contacted through the Web sites to assist claimants.

Most state agencies also use Web sites to promote safe and healthful working conditions and to provide information on safety and health program aids that can be readily used by employers. Other infor- mation on participation in various programs associated with premium discounts or penalties is offered as well. Lists of insurance providers as well as consultants and third party administrators are available on many state sites. Training on the workers’ com- pensation requirements is often made available through the Web sites. Links to state statutes and regulations are common.

7. Third-Party Administrators

Third-party administrators (TPA) are insurance organizations other than the brokers, providers,

associations and the state agencies. TPAs provide a wide range of services. They often complete the actual claims forms and may be the direct payer of benefits to workers and to medical

providers. They can be the intermediary that reports the claim information to the respective state agency and they provide analytical reports to their clients. Self- insured businesses often employ TPAs for a diverse

range of claim and insurance services. TPAs may complete and otherwise process claim forms for the employer, pool or group including an initial determination of compensability. Complete risk management information systems are offered by some TPAs. In addition, they can provide services such as medical case management, medical bill review, and programs for the injured employee to return- to-work. Some TPAs provide investigation, subrogation and legal services to their clients. Pharmacy benefit management and Medicare set- aside services are some of the later additions to the TPA offerings. Yet others may provide loss pre- vention services and health and safety training for employees and employers. TPAs may also provide

clients with their required Occupational Safety and Health Administration (OSHA) logs for recordable injuries and illnesses.

8. Types of Policies

Workers’ compensation insurance policies vary in many ways. The most straightforward policies cover the claims costs due to a worker injury or illness experienced by a single employer at a single business establishment, i.e. location. Some employers have multiple establishments for a single policy and the risk classification for the individual establishments may be differ- ent, e.g. a manufacturer that also has a retail outlet. Yet other policies may cover workers at multiple establishments that change over time

Third-party administrators (TPA) are insurance organizations other than the brokers, providers, associations and the state agencies.

Increasing risk retention by the employer is accommodated by the following insurance or policy types: guaranteed cost, dividend, retrospective rating, deductible, and self-insurance.

Workers’ Compensation Insurance: A Primer for Public Health14

Table 2. Required employer reporting of injuries, illnesses and deaths to State Workers’ Compensation Bureaus.

State Medical Treatment beyond

1st Aid Provided1 Indemnity Only (Min. No.

Days)2,3

AL Y(3) AK Y AR Y AZ Y CA Y(1) CO Y(3) CT Y(1) DE Y DC Y FL Y GA Y(7) HI Y ID Y Y(1)4

IL Y(3) IN Y(1) IA Y(3) KS Y(1) KY Y(1) LA Y(7) ME Y(1) MD Y(3) MA Y(5) MI Y(7) MN Y(3) MS Y(5) MO Y MT Y NE Y NV Y NH Y NJ Y NM Y NY Y(1) NC Y(1) ND Y

Workers’ Compensation Insurance: A Primer for Public Health 15Workers’ Compensation Insurance: A Primer for Public Health

Table 2. Required employer reporting of injuries, illnesses and deaths to State Workers’ Compensation Bureaus (continued).

OH Y(7) OK Y OR Y(3) PA Y(1) RI Y Y(3) 4

SC >$500 Y(1) 4

SD Y Y(7) 4

TN Y TX Y(1) UT Y VT Y Y(1) 4

VA Y WA Y(1) WV Y WI Y(3) WY Y

1If Y, employers are required to report all claims that result in medical treatment beyond first aid to the workers’ compensation bureau. (In SC, all claims with >$500 in medical expenses must be reported.)

2Employers are required to report all claims for occupational injuries and illnesses for workers missing work for a period of time in excess of these values.

3All deaths due to occupational injuries or illnesses must also be reported in all states. 4Additional reporting required for disabilities in excess of the number of days indicated.

Source: 2011 Chambers of Commerce Workers’ Compensation Laws, Chart IX, (see caveats pp. 78 – 79 in reference)

Workers’ Compensation Insurance: A Primer for Public Health16

Table 3. States with statutes, rules and/or regulations about employer-based occupational safety and health program elements plus states with approved state OSHA Plans or consultation programs only, 2011

State OS&H Regulations States

Requirements

Employer Written Safety and Health Program

CA1, HI2, LA3, MN4, NE, NV5, NH5, NC6,WA

Employer/Employee Safety and Health Committee

AL7, CA4, CT8, MN9, MT10, NE, NV11, NH10, NC12, OR13, TN14, WA5

Insurer to Provide Loss Prevention Services

AR, CA, KS, MS, MO, MT, NM, OR, PA, RI, SD, TX

On-Site Inspection by Loss Prevention Services

AR15, CA16, DE17, NM18, NY19, RI20, TX21

Incentives

Premium Reduction for Safety Program Elements

CO, DE22, FL, HI, ME, NH, NM, NY, ND, OH, OK, PA, SD23, UT24, WI, WY25

Employer Penalty for Violation of Rule at Time of Injury

CA, IL, MA, MO, NC, WI

Safety Grant MA26, MN, NY, ND, OH, OR26,UT, WA

Registry of S&H Practitioners HI, LA, MO

State OSHA Plan AK, AZ, CA, CT27, HI, IL27, IN, IA, KY, MD, MI, MN, NV, NJ27, NM, NY27, NC, OR, SC, TN, UT, VT, VA, WA, WY

State Consultation Program Only

AL, AR, CO, DE, FL, GA, ID, KS, LA, ME, MA, MS, MO, MT, NE, NH, ND, OH, OK, PA, RI, SD, TX, WV, WI

Information in this table was obtained from Web sites of state legislatures and agencies. Due to the difficulty in locating statutes, rules, regulations and relevant case law, some information may have been omitted from the table. Further information may be obtained from the primary author.

1Reduced documentation requirements if <10 employees; <20 employees and not on high hazard list and experience modification is <1.1; or < 20 employees and on designated low-hazard list.

2If >24 employees 3If > 15 employees 4For high hazard industries on list 5If >10 employees

Workers’ Compensation Insurance: A Primer for Public Health 17Workers’ Compensation Insurance: A Primer for Public Health

6If experience modification factor is >1.5 7Upon written request of an employee 8If >25 employees or injury and illness rate greater than average for industry 9If > 25 employees or if in top 10% within industry lost-days rate or if top 25% of pure premium for all classes

10If >5 employees 11If >25 employees 12If >10 employees and experience modification factor >1.5 13Routine safety meetings also allowed 14If experience modification factor is >1.2 15Or other appropriate services if premium > $25,000, or if > $5,000 and loss ratio > 100%, or if loss ratio > 150%

16For targeted high hazard employers 17Fee is charged and employer required to participate in Workplace Safety Program discount 18If premium > $5,000, self-inspection is allowed 19If payroll > $800,000 and experience modification factor >1.2 20If premium > $25,000 and requested by employer 21If premium > $25,000 and loss ratio >1.0, or if premium > $5,000 and loss ratio > 2.5 22If premium > $3,161 23Unspecified penalty for establishments where deficiency has not been corrected at time of subsequent safety review

24If experience modification factor >1.0 or if 3-year loss ratio > 100% and if “work place safety program” not adopted after request from the insurer then 5% premium surcharge is allowed

25Based on reduced loss ratio attainment 26Grants available for training only 27Public sector employees only are covered by the state plan along with consultation program for most private businesses

Workers’ Compensation Insurance: A Primer for Public Health18

such as one for a company in the residential construction industry. If employees of the business routinely travel to other states, provisions that cover losses in the other states may be added to policies. If the business has employ- ees located in multiple states, multiple policies are typically required. With workers’ compensation records alone, it may be difficult to associate an injury or illness with an establishment when the policy covers multiple establishments.

In many states, employers are allowed to form groups or pools to obtain insurance in the voluntary markets or to combine as a self-insured entity. Membership in a group is usually restricted to similar industries. Other insurance arrangements include carve-outs, which are labor/management agreements,10 and captives, i.e. an insurance company that is wholly- owned by a single employer or a group of employers and provides insurance to the owners’ businesses.

Risk Retention Workers’ compensation insurance policies deter- mine the amount of risk the employer retains for workplace injuries and illnesses. Risk retention may increase employer interest in reducing potential losses through safety and health prevention since they could be responsible for payments on some claims. In order of increasing risk retention by the employer are the following insurance or policy types: guaranteed cost, dividend, retrospective rating, deductible, and self-insurance [Thamann and Reitz 2000]. For example, with a guaranteed cost policy, the loss to the employer in a given policy year can never be more than the policy premium. On the other hand, with large deductible policies, the employer is self-insured up to an amount of the deductible yet obtains an insurance policy for excess coverage purchased from a provider. The deduct- ible amounts may be per claim and/or aggregate and range from a few thousands of dollars to $1 million or more. Nonetheless, the carrier of the

excess coverage is, according to the state regula- tors, responsible for the entire claim amount. The carrier then obtains reimbursement from the client employer through an agreed mechanism.

Self-insurance is a form of insurance that is generally limited to larger employers which demonstrate to their state workers’ compensation regulating agency that they have the financial resources to make the equivalent of indemnity, medical and death benefit payments to their employees who suffer occupa- tional injuries and illnesses. Qualifications for self-insurance vary among the states. For example, some require surety bonds. In Ohio, an exclusive state program, self-insurance is permitted only for those employers with a minimum of 500 employees.

Other Policies As mentioned earlier, state-sponsored programs also provide insurance coverage for workers whose employer failed to obtain the required insurance policy. Most states also provide special coverage for second injuries which reduces the financial disincentives of employing a worker with an existing disability.

9. Policy Premiums

Premiums for workers’ compensation insurance policies are determined by the risk classification of the insured employer, the size of the payroll, and in many cases, on the employer’s past claims experience. “Manual rates” or “base rates” are set for each of the industry risk classes by actuarial organizations like NCCI and are expressed as the cost of insurance per $100 in payroll. The manual rate is then adjusted using an experience modification factor for those employers who are sufficiently large to be rated based on their claims history. The premium setting process and related terms are more fully explained in other sources such as A Primer on Workers’ Compensation by John F. Burton, Jr.11

10“Carve out” has different meanings across the insurance industry. The definition used for workers’ compensation insurance carve outs in California may be found at http://www.dir. ca.gov/dwc/carveout.html.

11 Burton’s Workers’ Compensation Resource provides access to a wide range of relevant materials. http://workerscompresources.com/wp-content/uploads/2012/11/ND04A.pdf

Workers’ Compensation Insurance: A Primer for Public Health 19Workers’ Compensation Insurance: A Primer for Public Health

Experience Modification Factor In general, an employer’s history of increasing numbers of claims and costs leads to higher expe- rience ratings and higher overall premiums. The experience modification factor is usually affected more by the frequency of claims from the policy holder than by the total cost, although these rules vary among the states. The loss ratio is one of the factors used to calculate premiums and it is equal to the total costs for losses divided by total premiums paid. The loss ratio may be calculated for a single client, a risk class or for the insurance industry as a whole.

Other Premium Adjustments The premium may be further altered by discounts that are awarded for multiple reasons. For example, discounts may encourage certain activities such as an employer’s participation in a safety council, having joint labor management health and safety committees, or having documented safety and health programs. Some provide premium discounts for firms with drug and alcohol programs. Many mutual insurance companies provide divi- dends that effectively reduce the premiums.

10. Workers’ Compensation Records

Workers’ compensation claims records contain information that may be used to determine the frequency of injuries and illnesses plus indicators of morbidity severity such as medical treatments, their costs, hospitalizations, days away from work, types and percentages of disabilities, and reha- bilitation. As mandated by the individual state laws, parts of workers’ compensation records and record systems may be completed by employees, employers, medical providers, insurance carriers, third-party administrators, and the state agencies.

Premiums for workers’ compensation insurance policies are dependent on the risk classification of the employer, the size of the payroll, and in many cases, on the establishment’s past claims experience.

Not only can workers’ compensation records be used to determine the frequency of injuries and illnesses, but also disability status, medical treatments, their costs, hospitaliza- tions, days away from work, and rehabilitation.

The most common types of records are the claims forms for injury and illness and these are required in all states. Yet other potentially useful records may be collected and retained by the carrier. These additional records may describe employer safety and health programs, work-site inspections and other loss prevention activities. Records

may also exist on the current insurance status of individual employers, carrier enrollments to conduct business in the state, registrations of con- sultants and third-party administrators, adjudi- cations and appeals, and self-insurance applica-

tions, among others. Access to these records may be restricted by the applicable laws in each state. Individual investigators need to verify all legal restrictions in each state of interest. Standard Records The most common claims record is the first report of injury (FROI) form. The form col-

lects some demographic i n f o r m at i o n o n t h e injured or ill employee, disability status, and contact information for the employer, insurance carrier, and medical pro- vider. Many states use the standard FROI developed through the Electronic

Data Interchange (EDI) by the International Association of Industrial Accident Boards and Commissions (IAIABC). An example of the EDI form and instructions can be accessed at the Missouri Department of Labor and Industrial Relations Web site.12 Three versions of this form are now in use across the participating states. Forms used by yet other states contain similar information but the range of forms is too broad to list each one of them.

12One example of an EDI FROI can be found at http://labor.mo.gov/DWC/Forms/WC-1-EDI-AI.pdf.

Workers’ Compensation Insurance: A Primer for Public Health20

The EDI forms include sections on employee wage, gender, date of birth and date of hire, occupation, employment status, and number of dependents. The event fields include date, time of day, date employer was notified and date dis- ability began, type of injury and affected body part, and descriptive information on the equipment involved, worker activities, work process, sequence of events, and check boxes for use of personal protective equip- ment. Dates for return to work or for deaths are also listed on the form. The medical treatment provider is also identified and their address is listed along with a checklist for the level of treatment (from none to hospitalization), and future lost work time antici- pated. Many of the fields on the FROI use standard codes which are described below in section 11.

Subsequent reports of injury (SROI) for each claim may be completed at the time treatment is provided by a health care practitioner, when a benefit type is changed (e.g. from temporar y total to per- manent total disability), or when the claimant returns to work or dies. Thus, a series of reports may be available for each claim. A computerized record is generally used to combine the information from the claims record series. Billing forms from treatment providers are another set of records that provide important information. These forms list the treatment costs and may include information on diagno- sis and treatments (such as Current Procedural

The initiator of workers’ compen- sation claims has a major role in ensuring that all fields in the FROI form are accurately completed. The initiator may be the employer, injured employee, insurance broker, TPA, or a treating physician depend- ing on the state.

Information in the workers’ com- pensation records that is used for payment of workers and medical providers is likely to be more accu- rate and complete than other fields in the record systems.

Terminology codes) which may differ from the FROI and SROI. The differences may result from

additional medical testing or from aggravation of an existing condition such as an infection. Any changes in diagnosis should be recorded in the injury claim record system.

Another record system widely used in the U.S. is the Unit Statistical Report

that is provided by insurers to NCCI and other workers compensation data collection organiza- tions. These reports are initially valued at 18 months after policy effective dates and include premium and loss information on a state basis. Open claims are valued and reported annually for up to 10 years to track loss development.13, 14 Limitations of Record Information It is important to mention, once again, that the primary purpose for the injury and billing records

is the timely payment of the injured or ill workers and their medical providers. Therefore, information in these records that is used for these purposes is likely to be more robust than other fields in the record systems. For example, diag- nostic and treatment codes

are more likely to be accurate and complete than information on occupation and employment status, particularly for medical only claims. An estimated 80% of all claims are medical only [Sengupta et al. 2012]. The statutory days away from work time limits for “medical only” versus “lost time” claims vary significantly from one state to another (Table 2).

13set of slides that explain unit reporting is available at http://www.ncci.com/documents/DRW- 2008-Unit-Data-Reporting.pdf

14NCCI’s Statistical Plan for Workers Compensation and Employers Liability is applicable in Alaska, Alabama, Arizona, Arkansas, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia and West Virginia.

Workers’ Compensation Insurance: A Primer for Public Health 21Workers’ Compensation Insurance: A Primer for Public Health

The information in many claim records evolves over time and delays in availability are to be expected. Statutes of limitation are common for workers filing claims for an occupational injury or illness and often extend to 2 years in many states. Employers are required to report claims information to state agen- cies within specified periods that vary among states – usually less than 15 days (Table 2). Employers and insurers are also required to maintain claims records for time periods that vary among the states. Records maintenance is one of the primary services provided to employers by TPAs.

Many of the terms used in the workers’ compensa- tion industry have specific meanings. For example, the term “claim,” itself is subject to confusion as it is applied to the notification of the supervisor, notification of the insurer at the time of injury, the “first report” for the state workers’ compensation agency, or a request for arbitration on the part of the worker. Some of these terms are defined in the glossary (p. 35). For any set of electronic data, it is important to obtain the applicable data dictionary that specifically defines each data element and each code used. An historical dictionary may be essential for longitudinal data. Additional limitations on claims information are described in the Background section of this document.

Disallowed and Zero-Cost Claims Claims can be disallowed by insurance carriers or contested by the employer. The basis for denial is usually related to the degree of disability or the requirement that the injury or illness “arise out of and in the course of employment.” Disallowed claims may be appealed to administrative or judicial bodies depending on the state and may result in litigation which follows established procedures in each jurisdiction.

Zero-cost claims may also occur but these are not the same as disallowed claims. The claim may have been initiated yet the injury or illness did not result in medical treatment or in lost work time. At least one state, Ohio, allows employers to pay the initial treatment and/or indemnity cost up to specified limits. If the claim is paid

by the employer and remains within those limits, the claims records would indicate zero costs to the agency.

11. Standardized Codes and Systems in Workers’ Compensation

Numerous standardized data coding systems are utilized for workers’ compensation claims infor- mation. Some of these were specifically developed and adopted within the workers’ compensation industry while other coding systems such as NAICS and International Classification of Disease (ICD) were developed for other purposes.

Standard Systems There have been and are many attempts to stan- dardize data for workers’ compensation records. For example, WCIO led a collaborative effort to standardize codes for the part-of-body, nature of injury, and cause of event that are used across the workers’ compensation insurance industry including NCCI, IAIABC and the Association for Cooperative Operations Research and Development (ACORD) but not in all jurisdictions. NCCI coding systems for industry risk classifications and a number of other factors are used in about 40 jurisdictions. IAIABC in collaboration with a number of states developed standardized forms that utilize several different data coding structures. The standards and codes have changed over time and different release versions have been adopted by states.15 U.S. government coding systems are used extensively such as OIICS from the Bureau of Labor Statistics (BLS) and Federal Employer Identification Number (FEIN) from the Internal Revenue Service (IRS). The Standard Occupational Classification (SOC) and Standard Industry Classification (SIC) also continue to be used in some states.

Several states, e.g. California and New York, have developed their own codes for certain classes of workers’ compensation information. Crosswalks may be available for some of the

15http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3339

Workers’ Compensation Insurance: A Primer for Public Health22

coding systems. Unfortunately, the comparisons are often uncertain. For example, it is not always possible to identify unique ICD codes for the NCCI injury classification codes and the OIICS nature of injury codes do not correspond one- to-one with WCIO recommended codes.

Portions of the individual records may be completed by parties unfamiliar with various coding systems which may lead to errors. For example, many employers may not know the codes for the nature of injury although online guides are available in many jurisdictions. Multi-source documents may be more prone to errors and omissions.

12. Loss Prevention

Many insurance carriers have loss prevention programs to identify and describe the particular risks that exist at policyholders’ establishments, make recommendations for their abatement, and offer loss prevention16 services to help policyhold- ers manage these risks. They also assess risks that exist at establishments for which they contem- plate underwriting new policies. For current policyholders, the primary purposes for the loss prevention services are to reduce the frequency and severity of workers’ compensation claims and to improve the health and safety program of the client. Policyholders with higher premiums are more likely to receive routine loss prevention services from carriers than those with smaller premiums [Morin et al. 2013].

The provided services, which frequently are viewed as marketing tools to retain existing clients, may range from delivering relevant safety

In general, loss prevention programs identify and describe risks at policyholders’ establishments and make recommendations for their abatement.

and health pamphlets and brochures to full risk characterizations that include recommendations for remediation with follow up inspections. Most small employers would not receive site visits unless their claims experience indicated a need for intervention.

Mandated Prevention Programs All states have enacted legislation and developed related rules and regulations to reduce occupa- tional injury and illness risks. The strategies employed by the states vary extensively and may include employer safety and health program requirements and incentives, insurance carrier loss prevention activities, registries of authorized occupational health and safety practitioners, and employer or organizational grants for risk mitigation and worker training (Table 3).17 These inducements are often limited to those employ- ers with greater than a minimum number of employees, minimum qualifying premiums, elevated experience modification factors, or that appear on lists of high hazard industries. Twelve states require workers’ compensation insurance carriers to provide loss prevention services to many employers at no additional cost (Table 3). Requirement for these services is often limited to those policyholders with greater than a minimum number of employees, such as 25,

or with premiums above minimum thresholds such as $25,000.

C a r r i e r - b a s e d L o s s Prevention Programs Most large workers’ com- pensation insurance carriers

invest portions of their revenues in loss prevention programs [Dembe 1995; Nave and Veltri 2004; Ryan 2013] although the amounts or percent- ages are not readily available. According to one

16Note that “loss control” and “loss prevention” are terms that are often used interchangeably. In con- trast, the term “loss reduction” is typically used to refer to the management of costs and disability once an injury or illness has occurred through programs such as case management and return-to-work.

17States that do not appear in Table 3 list of prevention requirements or incentives are Alaska, Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Maryland, Michigan, New Jersey, South Carolina, Vermont, Virginia and West Virginia

Workers’ Compensation Insurance: A Primer for Public Health 23Workers’ Compensation Insurance: A Primer for Public Health

recent report, 13% of large workers’ compensation insurance clients, on average, receive loss control visits in a given year although that value varies widely by industry group (e.g. Manufacturing = 32%, Construction = 16%, Agriculture = 4%) [Ryan 2013]. For the most part, loss prevention programs collect information on hazards and other determinants of risks from employers either prior to the issuance of a policy, i.e. risk selection for underwriting, or as a means of providing services to existing clients. Depending on the size of the premium, loss prevention services may include conduct of site visits which frequently include walk-through inspections of facilities, interviews with employees, supervisors and managers, as well as reviews of the employer’s safety and health program elements. The report for the initial survey is shared with the carrier’s underwriting staff as well as a broker that may be involved in the transaction. These risk selection reports are considered privileged information and often only selected portions of the reports are shared with the client [Morin et al. 2013].

For new and existing clients, key elements of loss prevention reports, such as a description of the hazards identified and recommendations for their abatement, may be provided to the employer. The loss prevention staff may also communicate the need for improvements (such as specific training or documentation) to the employer’s health and safety programs. They may also provide specific services such as training employees, supervisors and managers and make training materials and model program elements available. Industrial hygiene and ergonomic surveys are included as needed. Afterwards, the loss prevention program may track progress through follow-up communications with the employer. The loss prevention professional may assist the employer in the completion of a safety grant application if they are available.

Loss prevention records are not standardized except perhaps within insurance providers. The availability of mobile technology applications

for loss prevention programs is increasing and may provide additional opportunities for data standards developments on hazards and employer health and safety program elements.

13. Workers’ Compensation Associations and Organizations

The workers’ compensation insurance industry is supported by a large number of professional and trade associations and other organizations that operate at the international, national, state and even local levels. Some are membership organiza- tions that provide professional services such as annual meetings, education and training. Some are research organizations that complete work

under contracts. Others are affiliations of state and provincial agency represen- tatives. Only a few of the longest-standing organi- zations will be mentioned here.

Two of the oldest workers’ compensation insur- ance industry associations are NCCI and IAIABC. These organizations date from the earliest state workers’ compensation programs in the U.S.

According to their Web site, NCCI “is the largest provider of workers’ compensation and employee injury data and statistics in the nation.” NCCI receives proprietary claims information from insurance carriers in their member states in the form of a Unit Statistical Data report which guides setting of manual rates for their client jurisdic- tions. To support the reporting system, NCCI in conjunction with WCIO has developed a number of standard coding schemes for nature of injury, event causation, and part-of-body. In addition, NCCI standard codes for industry, occupation and other factors are used by the nearly 40 affiliate jurisdictions. NCCI also conducts research and other analyses across a range of issues in the workers’ compensation insurance industry. Many of their reports may be accessed at https://www. ncci.com/nccimain/pages/default.aspx.

The workers’ compensation insurance industry is supported by many professional and trade associations that provide a range of services.

Workers’ Compensation Insurance: A Primer for Public Health24

The IAIABC mission statement is “to improve the efficiency and effectiveness of workers’ compensation systems throughout the world.” Among its published strategic principles are: “provide a forum for regulators, stakeholders and experts to share information and discuss issues and solutions; assist jurisdictions in identifying opportunities for reducing costs and improving the delivery of benefits; and develop, analyze, and promulgate standards and uniform practices.” IAIABC has published a number of important insurance industry documents and it sponsors and supports the EDI. Much of their information may be accessed at http://www.iaiabc.org/i4a/ pages/index.cfm?pageid=3277.

Other workers’ compensation organizations include WCRI whose mission statement is: “to be a catalyst for significant improvements in workers’ compensation systems, providing the public with objective, credible, high-quality research on important public policy issues.” The institute is an independent and not-for-profit organization providing peer-reviewed, objective information about workers’ compensation systems. Most of their documents are available to members only but some useful information may be found at http://www.wcrinet.org/about.html.

According to the NASI Web site, the academy is a nonprofit, nonpartisan and non-governmental organization led by the nation’s experts on social insurance. It evaluates programs and data to develop solutions to challenges on social insurance and economic security. NASI supports research and publishes documents on social insurance topics and produces an annual report on workers’ compensa- tion programs in the U.S. that may be obtained free of charge at http://www.nasi.org/about.

WCIO “is a voluntary association of statutorily authorized or licensed rating, advisory, or data service organizations that collect workers com- pensation insurance information in one or more states.” Members of the WCIO are managers of boards and agencies within the jurisdictions. Its forum supports development of electronic data transmission standards for insurers and rating/ advisory organizations. Additional information about WCIO and its range of products can be

found at https://www.wcio.org/Document%20 Library/AboutPage.aspx.

ACORD is an international organization that facilitates the development of open consensus data standards and standard forms for many segments of the insurance industry, and works with its members and partner organizations to drive implementation of those standards. Their information may be found at http://www.acord. org/Pages/default.aspx.

A couple of other organizations that are widely recognized in the insurance industry include: John F. Burton Jr.’s Workers’ Compensation Resource which provides access to data, research, and other information pertaining to workers’ compensation in the United States and other countries when possible. The resource offers open access to many publications such as the 1972 Report of the National Commission on State Workmen’s Compensation Laws. The extensive workers’ compensation information may be found at http://workerscompresources.com/. Dr. Burton also hosts an annual meeting for discussion of current workers’ compensation research.

The Liberty Mutual Research Institute for Safety (LMRIS) is a research organization funded by a private insurance company. For over 60 years, the institute has conducted scientifically rigor- ous, peer-reviewed research to improve worker safety and health. They conduct laboratory and field studies and publish records-based research using workers’ compensation data col- lected by Liberty Mutual Insurance. Extensive information on LMRIS can be found at http:// w w w. l i b e r t y mutu a l g roup. c om / om app s / ContentServer?pagename=LMGroup/Views/ LMG&ft=2&fid=1138356633468&ln=en

Other organizations that serve the workers’ compensation insurance industry include the American Association of State Compensation Insurance Funds (AASCIF), American Insurance Association (AIA), National Association of Insurance Commissioners (NAIC), National Conference of Insurance Legislators (NCOIL), and Property and Casualty Insurers Association of America (PCIAA).

Workers’ Compensation Insurance: A Primer for Public Health 25Workers’ Compensation Insurance: A Primer for Public Health

14. Public Health Research and Surveillance18

Public health is “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals” [Winslow 1920]. Fundamentally, public health relies on surveillance programs to describe the distribution of disease and injury, detect new and emerging diseases and disorders, target intervention activities to prevent their incidence, and monitor the effectiveness of those interventions. Workers’ compensation records may be used for public health research and surveillance activities. The terms “research” and “surveillance” have specific meaning in Federal public health activities which are briefly discussed here.

Research Federal regulations state that “research means a systematic investigation, i n c l u d i n g r e s e a r c h development, testing and evaluation, designed to de velop or cont r ibute to generalizable knowledge” [45 Code of Regulations (CFR) 46.102(d)]. Investigators performing public health research or surveillance activities have the responsibility to ensure that the research is conducted in a manner consistent with legal and ethical requirements. All research involving human participants that is conducted or supported by the U.S. Department of Health and Human Services (DHHS) must comply with DHHS Policy for Protection of Human Research Subjects [45 CFR part 46]. Investigators should consult with their local institutional review board for assistance with development of research or surveillance projects to insure that human subjects are appropriately protected.

Federal regulations state that “research means a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge” (45 CFR 46.102(d)).

Surveillance Public health surveillance is the systematic, ongoing collection, management, analysis, and interpretation of data followed by the dissemination of these data to public health programs to stimulate public health action [Thacker et al. 2012]. Surveillance systems can be used to monitor infectious and non- infectious diseases as well as injuries and deaths. Surveillance data can be primary in that they are collected for a specific public health purpose or they may be secondary in that the data were collected for other purposes yet they can be useful for tracking injuries, illnesses and deaths that occur in a defined population.

Occupational health surveillance is the tracking of workplace injuries, illnesses, hazards, and exposures. In the U. S., because there are no periodic national surveys of worker health,

o c c u p a t i o n a l h e a l t h s u r v e i l l a n c e r e m a i n s fragmented with substantial data gaps. However, the available surveillance data are used to guide efforts to improve worker safety and health and to monitor trends and progress over time [NIOSH 2013b]. Data

and information derived from surveillance can be used to:

(1) guide immediate action for important cases; (2) measure the burden of an injury, disease, or other health-related event or exposure, including changes in related factors; (3) identify populations at risk, including new or emerging health concerns; (4) guide the planning, implementation, and evaluation of programs to prevent and control injuries, disease, or adverse exposures; (5) evaluate policies and practices; (6) detect changes in health practices and the effects of the changes; (7) prioritize the allocation of health resources;

18For a thorough explanation of public health research and non-research as defined by CDC, please see http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health- research-nonresearch.pdf .

Workers’ Compensation Insurance: A Primer for Public Health26

Estimations of the populations at risk that are needed for rate calculations are likely to require information from record sets other than workers’ compensation.

(8) describe the clinical course of disease; and (9) provide a basis for epidemiologic research.

Workers’ compensation records, most commonly administrative claims data, are used for occupational surveillance. In some states, for example California (California Labor Code) and Washington (Department of Labor and Industries), workers’ compensation claims information is used to identify more hazardous industries or leading events for claims across all industries. Claims information has been used to establish priorities for loss prevention and other intervention actions [Silverstein et al. 2002; Bonauto et al. 2006; Anderson et al. 2013]. Yet other investigators have determined that workers’ compensation claims data are currently inadequate to characterize occupational injuries and illnesses in particular [Rosenman et al. 2000; Azaroff et al. 2002; Utterback et al. 2012].

Formerly, workers’ compensation claims information from a large number of states was collected by BLS for the Supplementary Data System (SDS), a non- representative sample of occupational injuries and illnesses. SDS contained discrepancies due to the quality of data retrieved from states and the variability of state laws on which injuries and illnesses were reported [National Research Council 1987]. The system was discontinued in the late 1980’s when the Survey of Occupational Injuries and Illnesses (SOII) along with the Census of Fatal Occupational Injuries (CFOI) were being developed.

Estimating Rates Rates of occupational injuries and illnesses require estimates of at-risk populations (a “denominator”). The denominator commonly used in the workers’ compensation industry is dollars of payroll. In public health, preferred denominators for rates are numbers of people or, in the case of occupational studies, full-time equivalent (FTE) workers. Data sets used to estimate the numbers of workers

within industries and/or occupations may be obtained from population household surveys such as the Current Population Survey (CPS) or the American Community Survey (ACS), or from employer establishment survey programs such as

Occupational Employment Statistics (OES), Current Employment Statistics (CES), or County Business Patterns (CBP). All of these data sources have broad coverage but exclude some types of workers. The Quarterly

Census of Employment and Wages (QCEW), which is nearly comprehensive and collected by states for unemployment insurance purposes does report the number of workers by establishments although it does not distinguish between full-time and part-time workers. The QCEW data may be adjusted to estimate FTEs with hours per industry data from the surveys listed above. In any case, the scope, exclusions, and restrictions on survey and state level data should be carefully examined and understood.

15. Public Health Regulations

Many Federal, state and local government regulations have been developed to address public health concerns. It is beyond the scope of this document to describe the myriad public health concerns that are regulated. Instead, we limit this description to those authorities where workers’ compensation data may be useful. The Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA) are two Federal agencies with regulatory mandates to protect the health and safety of workers in the U.S. OSHA and MSHA regulations are available through their respective Web sites and elsewhere.19, 20 Additionally, the US Environmental Protection Agency regulates pesticide hazards for agricultural workers.21 State and local health departments are

19http://www.osha.gov/law-regs.html 20http://www.msha.gov/30CFR/CFRINTRO.HTM 21http://www.epa.gov/agriculture/twor.html

Workers’ Compensation Insurance: A Primer for Public Health 27Workers’ Compensation Insurance: A Primer for Public Health

Regulations are perceived by many as essential to the protection of public health. Individuals may not have the knowledge or resources that are required to make deci- sions about personal exposure to potentially hazardous materials including chemical, ergonomic, physical and biological agents.

charged with protecting the health of all residents in their jurisdictions, and some health departments are active in workplace he a lt h and s afe t y and t r a ck i ng o c c up at i ona l illnesses and injuries. In fiscal year 2013, NIOSH provided funds to help s u p p o r t o c c u p at i o n a l health and safety surveillance programs in twenty-three states.22

Regulations are perceived by many as essential to the protection of public health. Individuals may not have the knowledge or resources that are required to make decisions about personal exposure to potentially hazardous materials including chemical, ergonomic, physical and biological agents. In the occupational arena, regulations are established by OSHA and MSHA to limit potential hazards through the use of interventions such as exposure limits, machine guarding, fall protection, trenching standards, medical screening and many more.

Regulations pertaining to workers’ compensation are established by the individual jurisdictions including the states, territories, and the District of Columbia, and the Federal government for its own employees. The states frequently require all employers including those self-insured for workers’ compensation to provide health and s a f e t y p r o g r a m s f o r t h e i r e s t a b l i s h m e n t s . These requirements vary substantially across the jurisdictions and many are augmented by occupational s a f e t y a n d h e a l t h requirements in departmen s of labor or similar agencies. Carrier-based loss prevention programs

t

recognition and control of hazards for which regulations apply. In addition to the insurance claims and medical information, records for these mandated activities may be useful for occupational safety and health research and surveillance.

16. Breaking through Barriers

Despite its limitations, research organizations, state-based surveillance programs, and workers’ compensation agencies and associations have used claims data for research and surveillance purposes. Collaborations have been mostly within states due to problems with combining data from multiple jurisdictions. Additional collaborations would create further opportunities to use workers’ compensation records and related information to prevent occupational injuries, illnesses and fatalities.

Overcoming some of the limitations would be possible with more systematic collection and analysis of workers’ compensation data across industries and occupations. Further standardization of data elements and coding schemes such as universal adoption of ICD medical codes and ICD-E external cause of injury

codes would be beneficial. Development of additional computer-based record systems would provide g re at e r o p p or t u n it i e s for m ore i n for m at i ve d a t a c o l l e c t i o n a n d interpretation. Advances in auto-coding of data by

computer systems, which rely on standard codes, would reduce the number of errors and missing

often assist employers in the

22The NIOSH funded surveillance programs in 2013 exist in the following states: California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin.

In some states, for example California and Washington, the workers’ compensation claims information is used to identify more hazardous industries or leading events for claims across all industries.

Workers’ Compensation Insurance: A Primer for Public Health28

data from the workers’ compensation insurance records. Effective searching of unstructured text fields has also improved [Lehto et al. 2009; Patel et al. 2012; Bertke et al. 2013].

Although systematic data analysis within a carrier’s operations contributes to risk management goals and client service, the information is not readily available to public health organizations. When made available, practitioners and researchers have used claims data for epidemiologic studies, to identify hazards, assess the effectiveness of controls, assign priorities for limited resources, and evaluate intervention programs.

Additional infor mation on e valuations of workplace safety and health programs, hazard monitoring and hazard exposure data, and observations of worksites are types of loss prevention information that could be standardized and made more useful for research and surveillance purposes. Over the past century and more, carrier-based and state agency workers’ compensation programs have used data to identify and evaluate risks for specific hazards across industry sectors.

When systematically available, workers’ compensation data has been used extensively for occupational safety and health research and surveillance [NIOSH 2010; Utterback et al. 2012; NIOSH 2013a] and they have supplemented the surveillance information available from other occupational resources.23 This primer provides background information for those interested in utilizing workers’ compensation data for prevention purposes.

23Descriptions of many data sources used for occupational surveillance may be accessed at http:// wwwn.cdc.gov/niosh-survapps/Gateway/DataSources.aspx.

Workers’ Compensation Insurance: A Primer for Public Health 29Workers’ Compensation Insurance: A Primer for Public Health

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Workers’ Compensation Insurance: A Primer for Public Health 35Workers’ Compensation Insurance: A Primer for Public Health

Appendix A: Workers’ Compensation Primer Glossary and Other Industry Terms

actuary – one who calculates insurance premiums, reserves and dividends

adjuster – see claims adjuster

appeal – right of an individual who received an adverse decision to seek review by a higher authority

assigned risk – an insured entity that would normally be rejected by commercial insurance carriers in the voluntary market but is designated for coverage by state law

audit – examination and verification of employer records on payroll

basic premium – portion of a standard retrospective insurance premium that covers administrative costs, fees and commissions

broker – business that sells insurance coverage to employers; may represent a number of insurance carriers

captive – insurance provider for a single business organization that is owned by that organization

carrier – organization acting as an insurer

carve-outs – labor/management agreements for insurance coverage of occupational injuries and illnesses (has various other meanings in the insurance industry as a whole)

case manager – insurer representative that oversees medical treatments for injury or illness claims

claim – application for insurance benefits due to occupational injury or illness

claim disallowance – insurer rejection of a claim for medical treatment or indemnity costs

claimant – person making a demand for payment of benefits

claims adjuster – insurer representative who investigates claims for authenticity and settlements

claims initiator – person who completes the initial claim form for compensation

deductible – a type of workers’ compensation insurance policy for which the initial loss to some specified limit is not reimbursed by insurance payment, i.e. the risk is retained by employer

Workers’ Compensation Insurance: A Primer for Public Health36

disability – condition that curtails a person’s ability to carry on normal pursuits

dividend plan – a type of workers’ compensation insurance policy for which the insured may receive funds back (a dividend) if losses are less than anticipated

doctor’s first report – initial claimant evaluation by physician which is required in some states

Electronic Data Interchange – developed several standard claim data reporting forms and was fostered by the IAIABC

exclusive funds – state-sponsored workers’ compensation insurance in jurisdictions where private insurance is not allowed

exclusive remedy – in workers’ compensation, the only recourse for worker injuries and illnesses

experience modification factor – multiplier adjustment to employer’s premium based on prior claims history in comparison with the average experience of the risk class, may be greater than or less than unity

first report of injury – initial form completed by claims initiator with detailed information on the claimant, employer, nature of injury, event description, and anticipated medical treatment needs

groups – similar industry employers that combine to share risks and insurance coverage; also may be employees that are covered under single insurance policy, e.g. group health insurance

guaranteed cost – a type of workers’ compensation insurance policy where the premium is the only cost to the employer

impairment – alteration of an individual’s health status; a deviation from normal in a body part or organ system and its functioning (Cocchiarella and Anderson 2001)

incurred losses – paid plus reserved claim costs, including medical and indemnity; experience modification ratings are based on incurred costs

indemnity payments – compensation for lost work time claim paid to covered injured or ill workers to partially replace lost wages

independent medical examiner – registered medical practitioners who provide impartial medical assessments

loss control – see loss prevention

loss development factor – prediction of future payments on open claims

loss prevention – actions to limit risk through hazard recognition and abatement and safety and health program evaluation; also known as loss control

Workers’ Compensation Insurance: A Primer for Public Health 37Workers’ Compensation Insurance: A Primer for Public Health

loss ratio – insured losses divided by premiums earned in a given period

loss reduction – activities to limit financial losses and disability after a claim is filed for an injury or illness; also known as medical or disability management

loss runs – employer-based information on prior claims experience

lost work days – accrual of time away from work due to an occupational injury or illness

managed care – enrolled medical services that focuses on care utilization and costs

manual rate – published rates, established by rating bureaus, for insured groups based on average costs for the group

medical only claim – workers’ compensation claim for medical treatment expenses and does not include lost work days meeting the minimum lost time requirement for indemnity payments

medical review board – state sanctioned group of medical practitioners that provides independent medical expertise on appropriate treatments, disability determination, and other science-based criteria

Medicare set-aside – allocation in a claim settlement to pay future medical expenses that would have been paid by Medicare

monopolistic funds – see exclusive funds

mutual insurance company – organization that issues insurance policies and is owned by its policyholders

net premium – total insurance premium after adjustments for experience modification and discounts

pools – multiple meanings but usually a collection of groups that share insurance coverage

professional employer organization (PEO) – firm that hires a client company’s employees, becoming the policy holder of record for workers’ compensation; this arrangement results in co-employment

pure premium – portion of manual rate that covers anticipated losses and loss adjustment expenses

rating bureau – state sanctioned private group that establishes permitted manual rates for insurance premiums

reciprocal group – association of employer entities that mutually share risks of economic losses

re-insurance – insurance purchased by an insurance carrier to limit risks

Workers’ Compensation Insurance: A Primer for Public Health38

reserve funds – accounting liability for the current value of future expected costs on a claim

residual market – portion of employers unable to obtain insurance coverage in the voluntary market

retrospective rating – a type of workers’ compensation insurance policy where the premium is based on the actual insured losses during the policy term

return-to-work – program to assist injured workers regain employment after a claim has been filed

risk group – see groups

risk retention – portion of possible future liability that is not covered by an insurance policy

scheduled benefit – pre-determined amount of payment for specified loss such as an amputation

Second Injury Fund – insurance provided for previously disabled workers

self-insured – a type of workers’ compensation insurance policy where the employer is responsible for its own losses associated with required risk coverage

single payer – for health insurance, a single entity, generally a government agency, is responsible for all insured costs

state funds – state government offered mandatory insurance; may be exclusive (monopolistic) in a few states or competitive in yet other states

subrogation – recovery of claim expenses from another responsible party

Supplemental Data System – survey of workers’ compensation claims information by Bureau of Labor Statistics in the 1970’s and 1980’s prior to the Survey of Occupational Injuries and Illnesses and the Census of Fatal Occupational Injuries

surety bond – financially backed guarantee to reimburse third party losses

surveillance – ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practices, closely integrated with the timely dissemination of these data to those who need to know

third-party administrator – insurance businesses that provide services to employers, brokers, insurers, and groups related to workers’ compensation claims

underwriter – one who selects risks to be solicited or rates the acceptability of risks

underwriting – to be responsible for financial losses in accordance with an insurance policy

Workers’ Compensation Insurance: A Primer for Public Health 39Workers’ Compensation Insurance: A Primer for Public Health

uninsured employer fund – state funds to cover losses when employer has failed to obtain required insurance

Unit Statistical Report – information on workers’ compensation loss experiences reported to a rating agency

value – estimates of current or future liability costs on a claim

voluntary market – competitive market for workers’ compensation insurance that exists in all but the 4 exclusive fund states

Workers’ Compensation Insurance: A Primer for Public Health

Workers’ Compensation Insurance: A Primer for Public Health 41Workers’ Compensation Insurance: A Primer for Public Health

Appendix B: Preparing for Engagement

In preparation for contacting the workers’ compensation data custodian, one should consider several issues and evaluate some available resources. For example, one should visit the Web site for the workers’ compensation program in the state to evaluate the available information such as annual reports and reporting forms. In addition, the Web sites have links to applicable statutes and regulations with explanatory guides for injured workers and their employers. Researchers and public health practitioners may also want to think about the issues below prior to approaching potential collaborating organizations who are workers’ compensation data custodians. If the state workers’ compensation Web sites does not provide specific information on their requirements, these issues may be addressed in direct communications with a knowledgeable agency official.

Study Background Questions

What are the proposed project concept and time commitments? Might provide examples from other jurisdictions

● Surveillance – ongoing analysis of longitudinal data ● Etiologic research – may be time limited relationship but usually longitudinal data

What data sources may be needed for the project? ● Public agencies – do they have a research unit or other organization with shared interest/

mission? ● Private – if restricted, can they share de-identified data, are they comprehensive?

Are there specific legal restrictions on data availability from state agencies?

Can data be examined or explored prior to collaboration commitment?

What are the possible mutual benefits for the collaborating organizations? ● Examine their existing products ● Review examples from other jurisdictions (e.g. Florida Annual Report) ● Reinforce experience with confidential handling of personal and other sensitive information ● Think about realistic needs for future information, assistance and review

How are data stored and what formats are used? ● Electronic: on line or downloaded (CD, DVD, hard drives, encryption?) ● Hard copy ● Incomplete data and historical gaps in data ● Denominator (population) data available for rate estimation (unemployment insurance agencies)?

Which, if any, standardized data coding systems and which versions are used (e.g. WCIO, OIICS, NCCI, NAICS, ICD E-codes)?

Is a data dictionary available?

Are narrative fields part of the records that may require data mining?

What are the proposed agreements for clearance of articles, reports and other products?

Workers’ Compensation Insurance: A Primer for Public Health42

Other State Coverage Questions

If the state publishes an annual report, what kind of information is captured in the report?

What exclusion criteria are used to decide which employers need to provide workers’ compensa- tion coverage for workers? For example

● Minimum employer size* ● Industry sector (e.g. agriculture)* ● Familial relationship of the employee with the employer* ● Self-employed workers* ● Corporate officers*

Are separate rules written for industries such as agriculture, construction or mining?

Does the state offer workers’ compensation insurance plans? If yes, for which employers?

Which employers, if any, are allowed to self-insure in the state?*

Does NCCI or another rating bureau collect standardized data from insurance carriers in the state?

Does the state require private insurance companies to write coverage for residual market employers?

Are employers in the state allowed to form groups or pools to obtain insurance in the voluntary markets?

Are employers in the state allowed to combine to create a self-insured entity?

Are carve-out arrangements permitted in the state?

What automatic, Web-based or telemetric reporting systems are used in the state?

Who can file a first report of injury?

What requirements exist related to managed care organizations in the state?*

What requirements govern the choice of treating physicians in the state?*

What requirements exist related to vocational rehabilitation in the state?*

What requirements restrict treatment options in the state?*

Has the state imposed any time or cost limits on compensation for disabled workers? If yes, what are they?*

*Answers to these questions can be found in the annual “Analysis of Workers’ Compensation Laws” produced by U.S. Chambers of Commerce

Workers’ Compensation Insurance: A Primer for Public Health

Delivering on the Nation’s promise: safety and health at work for all people through research and prevention To receive documents or other information about occupational safety and health topics, contact NIOSH

Telephone: 1-800-CDC-INFO (1-800-232-4636) TTY: 1-888-232-6348 email: [email protected]

or visit the NIOSH website http://www.cdc.gov/niosh/

For a monthly update on news at NIOSH, subscribe to NIOSH eNews by visiting http://www.cdc.gov/niosh/eNews.

DHHS (NIOSH) Publication No. 2014–110 January 2014

Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

NIOSH’s Office of Construction Safety and Health: Accomplishments in our First Four Years

BACKGROUND

Creation and function of CSH

Since its inception in December 2009, the Office of Construction Safety and Health (CSH) has

adhered to it mission in providing Institute‐wide senior scientific and administrative leadership

for construction research and related activities. CSH ensures that research elements from the

National Construction Center are fully integrated and included in all designs and plans for

construction research and its implementation. Together the CSH Director and Deputy Director

formulate the strategic vision and goals, develop proposals; guide the direction of the National

Occupational Research Agenda (NORA) Construction Sector Council; and implement research

plans that ensure that the construction research program is responsive to comments and

contributions from emerging research, the National Construction Center, stakeholders, external

reviewers, and the NIOSH Director.

CSH actively develops partnerships within NIOSH and among its external stakeholders, and

coordinates construction research and related activities among NIOSH divisions, labs and other

offices. It extends this coordination within and among the NIOSH‐funded National Construction

Center 1 and other extramural construction researchers, with the Directorate of Construction in

the Occupational Safety and Health Administration (OSHA), with OSHA's public Advisory

Committee on Construction Safety and Health (ACCSH), the OSHA Construction Alliance, and

with several trade associations.

Establishing the Construction Program Manager and Coordinator positions as dedicated full‐

time personnel within NIOSH through CSH has improved the Institute’s ability to align

1 CPWR—The Center for Construction Research and Training has successfully applied to serve as the National

Construction Center since 1994.

NIOSH CSH, Accomplishments, 2009‐2013, Page 1 of 27

construction resources with the its national priorities. It has improved coordination among the

NIOSH divisions and laboratories that are conducting research in construction, and has

improved, as well, the coordination between those divisions and the National Construction

Center. Much of this is accomplished through regular meetings with DLO representatives on the

Construction Steering Committee, as well as with direct meetings with construction researchers

and DLO management. Furthermore, this interaction has improved and enhanced the

integration of research conducted by extramural researchers supported through the NIOSH

Office of Extramural Programs. The personnel decision has led also to better management of

the work of the NORA Construction Sector Council.

Stewardship of NORA Construction Sector Council

The NORA Construction Sector Council was the first council to develop a national research

agenda in October 2008 (http://www.cdc.gov/niosh/nora/comment/agendas/construction/). This

was the first national effort to create an occupational safety and health research agenda for the

construction industry. Efforts are still underway to address the goal of answering the question:

“What information do we need to be more effective in preventing injuries and illnesses in

construction?” A description of research needs and information gaps was one important basis

for the agenda. The other basis was “research to practice” (r2p); specifically, a description of

how research findings could be used by construction stakeholders to bring about needed

changes in the industry. The NORA Construction Sector Council seeks to promote the most

important research, understand the most effective intervention strategies, and learn how to

implement those strategies to achieve sustained improvements in workplace practice.

Developing the National Construction Agenda provided a vehicle by which construction industry

stakeholders could describe the most relevant issues, gaps, and safety and health needs in the

industry. The resulting agenda consists of 15 research strategic goals designed to address ten

top problems in construction safety and health. These included seven “outcome” goals related

to important sources of injury or illness, and eight “contributing factor” goals related to

important influences that impact prevention and control measures throughout the industry. In

a recent analysis conducted by the NIOSH Office of Extramural Programs, the Construction

Sector had more strategic goals that were being addressed by both extramural and intramural

researchers when compared to the other sectors. The Construction Sector currently has 12 out

of its 13 active goals that are being addressed by either extramural or intramural researchers.

Beginning in 2010, the Manager and Coordinator of the NORA Construction Sector Council

oversaw the selection of two of the 15 goals for priority activity. All 15 goals are important and

relevant; however, making significant accomplishments in all areas within the decade is

daunting given budgetary realities and other considerations. The selected goals were Goal 1

(Reduce Construction Worker fatalities and serious injuries caused by falls to a lower level), for

NIOSH CSH, Accomplishments, 2009‐2013, Page 2 of 27

which a falls prevention campaign is an intermediate goal; and Goal 13 Increase the use of

“prevention through design (PtD)” approaches to prevent or reduce safety and health hazards

in construction, for which green jobs in construction is a component. The selection has allowed

the Council to better harness its energies and work collectively to make significant progress and

bring research accomplishments to the industry.

The Manager and Coordinator oversaw a mid‐decade review by the Sector Council of all 15

goals to determine progress toward meeting the goals. The review began in 2011, the half‐way

point in the decade‐long NORA effort. CSH and the NORA Construction Sector Council

undertook a review of efforts to date, which provided an opportunity to take stock of overall

developments; look at NORA projects and partnerships underway; examine the impact of the

economic recession on construction generally, and on safety and health developments in

construction; and to provide additional strategic direction and fine‐tuning. The report of the

mid‐decade review is available upon request.

Progress on each goal was assessed, and goals were categorized into:

Exploratory ‐ important issue but still defining problems and solutions

Developmental – some solutions are available but they are not ready for impact

Ready for Impact – sufficient solutions are available and we know what contractors

need to do for impact in the industry

Six goals fall into the ‘Ready for Impact’ category. The Construction Sector Council reviewed the

performance measures and roadmaps for each Ready for Impact strategic goal, and prepared a

mid‐decade report with the progress of each of these goals.

NORA Goals

Ready for Impact

6 Falls (1); Struck by (3); Silica (5); Culture (8); Disparities (12); PtD (13)

Developmental 7 Electrocution (2): Noise (4) Welding Fumes (6) MSD (7) S&H Management (9) Training (11) Surveillance (14)

Exploratory 2 Industry Organization (10) Engage the Media (15)

This categorization has proven effective in moving forward, assessing progress, and, more

importantly, assessing impact among the 15 second decade NORA goals in construction.

NIOSH CSH, Accomplishments, 2009‐2013, Page 3 of 27

ACCOMPLISHMENTS – Office of Construction Safety and Health

I. Construction Falls Prevention Campaign

In 2011, the rate of fatal injuries in construction was the second highest of

any U.S. industry. Within the industry, falls at construction sites are the

leading cause of death, accounting for 35% of deaths among private sector

construction workers (not including government or self‐employed workers)

in 2011; most of these deaths were attributed to falls from roofs, scaffolds,

and ladders. Deaths and injuries from falls represent a major, persistent,

yet preventable public health problem.

Under the auspices of the NORA Construction Sector Council, a campaign, national in scope, to

prevent falls among construction workers was conceived, developed and led to address one of

the NORA ‘Ready for Impact’ goals “Reduce Construction Worker fatalities and serious injuries

caused by falls to a lower level“ (Strategic Goal #1). The Sector Council identified the campaign

as one of two goals on which to focus. A National Construction Campaign Coordinating

Committee was formed with the charge to: (1) Explore how various campaigns have been used

to advance safety and health goals; (2) Gather basic information needed to identify and address

fundamental questions on planning and implementation of a construction fatality campaign;

and (3)Prepare options for discussion by the full NORA Construction Sector Council. The goal of

the campaign, in part, was to develop a national campaign aimed at construction contractors,

onsite supervisors, and workers to address and reduce falls, fall‐related injuries, and fall‐related

fatalities among construction workers. The scientific underpinnings of the campaign were

prepared during 2010‐2011 by Sector Council members working in groups, along with staff in

CSH, the NIOSH Communication and Research Translation Office (CRTO),2 the National

Construction Center and OSHA. The latter two are represented on the Council, and played key

roles in developing the campaign. The National Construction Center hired a social marketing

firm to prepare an environmental scan of construction fall prevention campaigns in the United

States and abroad. CSH hired the same social marketing firm to prepare a social marketing

plan. Because the campaign relies heavily on completed research, it is a major r2p endeavor.

The National Construction Center then hired the same social marketing expert to conduct focus

groups to test messages that could be used in a campaign. The campaign theme and messages

were determined by NIOSH, OSHA and the National Construction Center. The national

construction falls prevention campaign (also described as Safety Pays, Falls Cost) is a

remarkable accomplishment among NIOSH, OSHA and the NORA Construction Sector Council.

2 CRTO changed organizationally to become the Office of Communications (OC) in September 2014.

NIOSH CSH, Accomplishments, 2009‐2013, Page 4 of 27

The campaign kickoff was hosted by U.S. Department of Labor Secretary Hilda Solis on Workers

Memorial Day on April 26, 2012.

The National Construction Center hosts the non‐government principal web presence supporting

the campaign (http://www.stopconstructionfalls.com) and responds to inquiries about the

campaign through e‐mail ([email protected]). Their website contains fall prevention information

and materials, and allows stakeholders to share their own campaign success stories. Print

campaign materials are available through OSHA (www.osha.gov/stopfalls). Other resources,

including research findings, training aides and videos, are available on the three official

campaign websites: www.osha.gov/stopfalls/, www.cdc.gov/niosh/construction/stopfalls.html,

and www.stopconstructionfalls.com. OSHA’s campaign website, www.osha.gov/stopfalls/ is

now available in both English and Spanish.3 With simple language, clear illustrations, and easy‐

to‐follow instructions, our campaign materials include posters, factsheets, safety videos,

stickers, and public service announcements, spot‐the‐hazards cards.

The campaign was a re‐launched on Workers Memorial Day on April 28, 2013 with new

products for active dissemination, including a “Local Partners Manual” for persons or

organizations at the local, state or regional levels who wish to start their own local campaigns.

The National Association of Counties, for example, mentioned the campaign in their April 2013

newsletter (http://www.naco.org/newsroom/countynews/Current%20Issue/4‐8‐

2013/Pages/OSHA‐launches‐safety‐campaign‐to‐prevent‐falls.aspx). Having the information

about the campaign posted for city and county officials across the country, has been expected

to assist dissemination, especially at permit and registration offices where construction

contractors frequent. Several local areas have made the campaign a priority, and have created

innovative ways to disseminate campaign messages. Boston, Massachusetts and Montgomery

County, Maryland, for example, have worked with the public transportation systems to post

some of the campaign posters on busses, metro‐rail trains and highway digital billboards. State

agencies have been encouraged to support the campaign, and several have spearheaded their

state’s efforts in collaboration with NIOSH’s Fatality Assessment and Control Evaluation (FACE)

program.

The momentum of this extremely well‐received campaign has been such NIOSH, OSHA and the

National Construction Center agreed to add a third year (2014). The focus of the campaign in

Year 3 was expanded to all types of construction, and no longer focused only on residential

construction. In support of Year 3, NIOSH announced the campaign in CDC’s Morbidity and

Mortality Weekly Report (MMWR)

(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a7.htm?s_cid=mm6316a7_e). Also,

a video, “A construction framer talks about protecting his crew from falls”

3 Campaign fact sheets are available on the OSHA website in English, Spanish, Polish, Portuguese and Russian.

NIOSH CSH, Accomplishments, 2009‐2013, Page 5 of 27

(http://www.youtube.com/watch?v=MFthzInDdLQ&feature=youtu.be) was posted to the

NIOSH website in May 2014. The footage was taken on a visit to residential construction sites in

Phoenix, Arizona to which NIOSH was invited by a LeBlanc Building Company., Inc. based on

their practice of requiring all of their workers to use fall protection when working at height. A

national Construction Safety Stand‐Down (June 2‐6, 2014) was also added in Year 3. The stand‐

down was conceived as a voluntary event for employers to talk directly to employees about

hazards, protective methods, and the company’s safety policies, goals and expectations. CPWR

created an easy, cost‐free, day‐by‐day list of suggested activities that could be tailored to

individual jobsites, and posted these to www.stopconstructionfalls.com.

Impact: The research to support the strategic planning and execution of the national

construction falls prevention campaign was awarded the 2012 Thoth Award in the category of

Research/Evaluation from the Public Relations Society of America. The three campaign

websites (NIOSH, OSHA and CPWR) received over half a million page views in 2012. Campaign

partners and stakeholders also spread the campaign’s message to thousands of employers (the

primary target audience) and construction workers through blast e‐mails, radio and television

broadcasts, webinars, publications, trainings and outreach events.

The National Construction Center designed an evaluation plan for the campaign. The evaluation

of the campaign’s first year served three key purposes: (1) assess audience response to the

campaign messages and materials (focus groups); (2) document campaign reach (metrics); and

(3) examine partnership quality. The evaluation was conducted among small residential

construction contractors, owners, supervisors, and foremen to assess exposure to campaign

messages and materials at the four‐month point from the campaign launch. Conducted in

August 2012 in the Washington, DC metropolitan area, the evaluation findings suggested that

the campaign did not have a high level of awareness among contractors four months after the

campaign was first launched. Some summary recommendations informed by the focus group

results are included in Appendix I. Subsequent campaign efforts were aimed to improve

dissemination to the primary target audience.

To examine partnership quality, eight pre‐selected campaign partners (representing a range of

unions, academia, business and government) were surveyed to assess the success of campaign

partnerships in implementing the first year of the campaign. The summary conclusions from

this component of the evaluation are listed in Appendix I.

Some metrics of interest are visits to websites designed to support the construction falls

prevention campaign.

 51,676 products were downloaded from www.stopconstructionfalls.com in the first year of the campaign.

NIOSH CSH, Accomplishments, 2009‐2013, Page 6 of 27

 The three campaign websites hosted by NIOSH, OSHA and CPWR received over half a million page views in 2012.

 As of October 2014 NIOSH had 13,411 page views (9,880 visits) to its www.cdc.gov/niosh/construction/stopfalls.html. Five of the ‘top ten’ tweets from

Construction@NIOSH were centered on construction falls.

 As of October 2014, www.stopconstructionfalls.com hosted by National Construction Center CPWR had 900,215 page views (96,892 unique visits). The campaign also

generated 503 email inquiries and 62 campaign partners.

 A Facebook page “Stop Construction Falls” was developed for the campaign by a NORA Construction Sector Council member at Washington University School of Medicine in St.

Louis. The Facebook page has 315 ‘likes,’ and has reached 14 states in the U.S. and 44

countries worldwide.

 As of June 12, 2014, OSHA’s compilation of data indicated that 4,399 certificates were obtained online; that 729,032 workers were engaged through the stand‐downs; and

that there were 186,324 page views on the web page that OSHA developed for the

stand‐down (there were more than 282,770 views for campaign and stand‐down pages

together for during 03/17/14 to 06/11/14). The stand‐down page will be available

through mid‐July, so data collection will continue.

For Year 3 of the campaign and the stand‐down, we observed more and broader engagement

by contractors of all sizes. Safway (http://www.safwaygroup.com/) is the largest provider of

construction access equipment (e.g., scaffolds) in North America. Safway became a partner

with the construction falls prevention campaign in 2014

(http://www.safway.com/Press/newsDetail.asp?id=104). They invested approximately

$100,000 to adapt existing and develop new company‐specific campaign materials (e.g.,

mailers, promotional items) for their staff, trainees, and business partners.

All U.S. Air Force Ground Safety forces based in the United States and abroad participated in

the campaign (year 3) and the stand‐down, including through their training activities, audits,

internal newspaper articles, internal television network, posters, and briefings at the Air Force

Ground Safety Commander's calls. All 2,000 Air Force Ground safety professionals were

required to focus on fall protection awareness during the entire week of the stand‐down, with

an expectation that the 650,000 Ground Safety staff at every at Air Force base would be

reached.

The construction falls prevention campaign will continue distributing information and providing

outreach. This includes a partnership with two Latino groups facilitates distributing the Spanish

version of the falls prevention campaign materials.

NIOSH CSH, Accomplishments, 2009‐2013, Page 7 of 27

II. Nail Gun Safety

Dr. Hester Lipscomb at Duke University identified key risk factors associated with nail gun use

through a decade of NIOSH‐funded research,4 and demonstrated the effectiveness of trigger

and training interventions. Such interventions, however, have not been adopted by nail gun

manufacturers or users. There were no OSHA regulations, furthermore, that explicitly address

nail guns. In response to these practice gaps, the issue was brought before OSHA’s Advisory

Committee for Construction Safety and Health (ACCSH), and a work group was formed to

examine the issue in more detail. CSH worked with the work group co‐chairs to arrange for

presentations by Dr. Lipscomb so that she could share study findings. ACCSH eventually passed

a motion unanimously asking OSHA to develop guidance and/or regulations.

In addition, the NORA Construction Sector Council’s Strategic Goal

#3 (related to “struck by” incidents) addresses preventing these

injuries by developing guidance.1 NIOSH took the lead role in

working with OSHA to create co‐branded guidance for contractors to

address this goal. The NIOSH‐OSHA co‐branded document, Nail Gun

Safety: A Guide for Construction Contractors

(http://www.cdc.gov/niosh/docs/2011‐202/) was published in

September of 2011. The Spanish language version was published in

October 2012.

The publication provides the latest information on how nail gun injuries occur; descriptions of

worksite nail gun incidents; specific training recommendations; and practical advice that

contractors can use to prevent nail gun injuries. NIOSH and CPWR‐funded research, identifying

both the problem and effective interventions, was used substantially in the publication.

Expertise in both research and communication was used to customize content for the target

audience. For example, the Guide used sidebar sections to provide both key research findings

(“You should know”) and actual cases (“Worksite story”) to help convey key messages. A

dissemination plan was designed cooperatively by the National Construction Center, OSHA

Directorate of Construction, and CRTO and CSH in NIOSH.

Using some of the information in the Nail Gun Safety: A Guide for Construction Contractors in

June 2013, NIOSH released an innovative new publication, Straight Talk About Nail Gun Safety

(http://www.cdc.gov/niosh/docs/2013‐149/), which is also available in Spanish. The

publication was designed and developed by James Albers while he was with the Division of

Applied Research and Technology, and uses a comic format to illustrate the potential risks of

traumatic injury using nail guns, and how these risks can be reduced. Real‐life examples from

4 Through its responsibilities as the National Construction Center, CPWR hosts a research consortium of which Dr.

Lipscomb is a member.

NIOSH CSH, Accomplishments, 2009‐2013, Page 8 of 27

residential building construction are used to explain nail gun traumatic injury risks related to

the two different nail gun triggering systems and a variety of residential framing nailing

tasks. The information in this publication is based on focus group discussions with residential

building subcontractors, safety specialists and workers; NIOSH supported research; and Nail

Gun Safety: A Guide for Construction Contractors. As a safety awareness publication, Straight

Talk About Nail Gun Safety provides potential and new nail gun users with basic information to

help them recognize potentially unsafe conditions and nail gun features that increase the risk of

traumatic nail gun injury. The publication can be used in conjunction with safety training

required by OSHA, or to reinforce previous nail gun safety training.

Impact: By design, most requests for the Nail Gun Safety: A Guide for Construction Contractors

publication were routed through OSHA and NIOSH websites, respectively.

 As a result of effective dissemination efforts, the English version of the Nail Gun Safety: A Guide for Construction Contractors received 14,578 page views (10,606 visits) to the

NIOSH website while the Spanish version of the Guide received 1173 page views (874

visits). The English version of Straight Talk About Nail Gun Safety received 9,542 page

views (6,867 visits) to the NIOSH website, while the Spanish version of the comic

received 1,007 page views (724 visits).

 OSHA has had over 108,000 unique visitors at the OSHA website containing information about the Guide. OSHA printed 50,000 copies of the Guide initially in September 2011,

and has almost exhausted a second printing of 50,000.

 NIOSH, OSHA and the National Construction Center partnered to present a nail gun safety webinar under the auspices of the American Society of Safety Engineers (ASSE).

As part of the diffusion plan, a dedicated nail gun safety website (www.nailgunfacts.org) was

launched in October 2011 to provide additional videos, worker testimonials, and news reports

about nail gun injuries, training resources, and research information to construction audiences.

The website was developed and launched by Dr. Lipscomb and her carpenter colleagues. The

site is funded by the National Construction Center.

The NIOSH Office of Construction Safety and Health conducted an informal evaluation of the

Nail Gun Safety: A Guide for Construction Contractors by reaching out to nine stakeholders to

get feedback on the Guide, stories about its impact, or other ideas on dissemination. From what

we have heard, the Guide has been a real help to the industry. Members the Associated

General Contractors of America (AGC), an important stakeholder and member of the NORA

Construction Sector Council, expressed their pleasure with the document. In fact, one

contractor called it “the best document he has ever received from the [federal] government,”

and he said that he has made it required reading for all of his staff. The findings from this

evaluation are included in Appendix II.

NIOSH CSH, Accomplishments, 2009‐2013, Page 9 of 27

III. Green Jobs in Construction

Integrating Safety and Health into Green Construction: One of the six “Ready for Impact”

goals of the NORA Construction Sector Council relates to green construction (Goal 13.0:

Increase the use of “prevention through design” approaches to prevent or reduce safety and

health hazards in construction). Under the auspices of the NORA Construction Sector Council,

an ad hoc work group was formed with the charge go: (1) Explore strategies and tactics that are

or can be used to integrate safety and health into green building and construction initiatives in

the United States; (2) Review the draft NIOSH White Paper, “NIOSH Perspectives on Sustainable

Buildings: GREEN …AND SAFE,” and draft recommendations and other suggestions for action

among construction safety and health stakeholders, including members of the NORA

Construction Sector Council; (3) Explore other relevant green construction issues, not covered

in the NIOSH white paper, that might be appropriate for discussion and action among

construction safety and health stakeholders; and (4) Prepare options for discussion by the full

NORA Construction Sector Council.

NIOSH’s Prevention through Design (PtD) national initiative addresses design‐related

occupational injuries and illnesses by encouraging the elimination of hazards and minimizing

risks to workers across all industry sectors and settings. CSH has used PtD principals that

examine the potential for hazards throughout the life cycle of work premises, tools, equipment,

machinery, substances, and worker processes. This includes their construction, manufacture,

use, maintenance, and ultimate disposal or reuse. PtD has been the linchpin of NIOSH’s efforts

to integrate occupational safety and health into green and sustainable construction. Together,

the NIOSH Construction and PtD programs collaborate on efforts to increase the use of design

interventions to address safety and health hazards early in the pre‐design and design processes

in the construction sector. As part of the PtD initiative, CSH and its construction stakeholders

developed a framework to create awareness, provide guidance, and address occupational

safety and health issues associated with green jobs and sustainability efforts. CSH has taken a

number of key steps to advance this issue, articulating the case for why green construction

represents an opportunity to promote worker safety and health as a fundamental dimension of

true sustainability.

For example, CSH staff assisted in writing the entry to NIOSH’s Science Blog, “Going Green: Safe

and Healthy Jobs” (http://blogs.cdc.gov/niosh‐science‐blog/2010/01/green‐2/) was published

in January 2010 following the NIOSH “Making Green Jobs Safe” Workshop held in December

2009. At the Workshop, 170 representatives from the occupational safety and health and

environmental communities within industry, labor, academia, government agencies, and

nongovernment organizations met to consider how to emphasize that green jobs should be

NIOSH CSH, Accomplishments, 2009‐2013, Page 10 of 27

safe and healthy for workers. Several NORA Construction Sector Council members participated

in the Workshop, and found the discussions in the construction track to be very stimulating.

In addition, armed with its white paper, NIOSH formally approached the USGBC in February

2011 about the merits of integrating occupational safety and health generally, and PtD

specifically, into its Leadership in Energy and Environmental Design (LEED) rating system.

NIOSH, with colleagues from the NORA Construction Sector Council, prepared a ”credit‐by‐

credit” review of the 2009 LEED credits, and identified six credits that could be enhanced by

inserting additional language to the credit to address safety and health. Additional reference

material was also developed. NIOSH shared these materials with USGBC in 2011 and continues

to work with them on strategies to incorporate safety and health into now LEED version 4. The

USGBC is working with NIOSH to outline other modes by which the USGBC stakeholders can

become knowledgeable about the merits of integrating occupational safety and health into

other LEED credits (e.g., June 26, 2012 seminar on integrating occupational safety and health

into LEED by Christine Branche and Matt Gillen to USGBC headquarters staff in Washington,

DC). In January 2013, CSH participated in the USGBC’s Summit on Green Buildings and Human

Health. The Summit was very successful, and USGBC is open to including worker issues into

their initiatives. At USGBC’s invitation, NIOSH authored a blog that appears on their website.

This blog on “Green Building and Human Health” was co‐posted on the NIOSH Science blog in

June 2013.

In April 2013, CSH presented at the Good Jobs, Green Jobs Conference delivering a presentation

using a “Life Cycle Safety” approach to ensure that green buildings are safe buildings. In June

2013, CSH presented at the Associated General Contractors of America (AGC) Environmental

Conference delivering a presentation on integrating safety and health into green buildings and

rating systems. Also in June 2013, CSH presented at the American Society of Safety Engineers

(ASSE), Professional Development Conference delivering a presentation on integrating safety

and health into green construction. In November 2013, the CSH presented at the USGBC

National Conference (Greenbuild) on the topic of life cycle safety and its role in social equity

issues.

NIOSH CSH, Accomplishments, 2009‐2013, Page 11 of 27

NIOSH is working with Virginia Tech on designing a “safe roof design guide” to serve as stand‐

alone guidance material in the LEED version 4 Reference Guide or as input for several LEED

credits that relate to roofs and skylights. The safe roof design concepts presented in this guide

are aimed at owners, developers, and designers; they are to be used in the design phases.

There are specific design suggestions specific to roofs and tools and processes that designers

can use. NIOSH worked with Virginia Tech to develop a pilot credit (“Safe Roof Plan”) and is

discussing its potential use with USGBC.

On the state and local levels, the California Fatality Assessment and Control Evaluation (FACE)

program responded to a rash of deaths among construction workers installing solar panels by

producing a video and fact sheets about risks and preventive measures. These include using fall

protection systems and ensuring that lifts are available to hoist solar panels to the roof, so that

workers aren’t trying to manually carry panels up ladders. One of their digital stories,

“Preventing Falls Through Skylights,” won the 2012 APHA Digital Technology Award Contest.

Two of the co‐workers of the roofing supervisor who died tragically after he fell through a

skylight decided to be part of this digital story. They highlight the events that led up to his death

and explain what could have been done to prevent it. The moving video will be used by roofers

and others in trainings to prevent similar fatalities from occurring. This video was promoted as

a part of the 2013 Workers Memorial Day events commemorating workers who gave their lives

for their work and highlight efforts to prevent workplace deaths.

CSH views this as an important initiative that will take time to deliver results. CSH has

established a working relationship with the USGBC and expects this to provide insights and

perspectives on how best to move ahead. This effort faces many challenges such as the lack of

architect, designer or owner involvement in safety. The USGBC itself is in the process of

rethinking its approach to several issues now that LEED version 4 has been released and users

are commenting on it. Because the USGBC’s LEED is the most widely used rating system in

green construction, it makes our discussions with USGBC prodigious. NIOSH has made progress

in working with the USGBC and others to integrate worker health and safety into green building

design; more information can be found on our Prevention through Design site.

NIOSH CSH, Accomplishments, 2009‐2013, Page 12 of 27

ASSISTANCE WITH DISSEMINATION

IV. Residential Construction Safety Guard Rail System

Driven by the prevalence of fatalities and severe injuries caused by workers falling through roof

and floor openings, and existing skylights, NIOSH worked with residential carpenters to develop

a multi‐functional guardrail system that could be used in numerous work situations to prevent

workers from falling to lower levels. Researchers within NIOSH’s Division of Safety Research

(DSR) designed, developed, and patented (U.S. Patent No. 7,509,702, issued on March 29,

2009) a multi‐functional guardrail system that can be used on numerous residential and

commercial‐industrial work sites. This research is being led by Dr. Thomas Bobick5 and supports

NORA Construction Sector ‘Ready for Impact” Strategic Goal #1 to “Reduce Construction

Worker fatalities and serious injuries caused by falls to a lower level.” This guardrail system is

capable of providing protection to personnel who must work near (1) unguarded roof surfaces,

(2) unguarded skylights, (3) unguarded roof and floor holes, and (4) on stairs that have not yet

had handrails installed. The easy‐to‐install fall‐prevention system was designed to meet all

OSHA safety requirements for guardrails. Through extensive testing in NIOSH labs, the final

design will support more than twice the OSHA 200‐pound top‐rail strength requirement for a

worker falling against it. It can be used on commercial, industrial, and residential flat roofs, as

well as being adjustable to 7 different residential roof slopes (from 6‐in‐12 [27°] to 24‐in‐12

[63°]). In addition, four other variations were developed for installation on flat and vertical

surfaces that are unprotected, including staircases before the handrails are installed.

Impact: The impact of using the NIOSH guardrail system is an adaptable fall‐prevention system

that is readily available to improve safety conditions for residential and commercial

construction workers. The safety intervention can be installed to protect workers in situations

where fall protection is not normally used. From September 2011 to October 2012, a field

evaluation was conducted by the West Virginia University Safety and Health (WVUS&H)

Extension Office. One local WV residential contractor was evaluated during this time.6 The

contractor used the system on a variety of homes to meet the requirements of the OSHA fall‐

protection standards. Through a contract with NIOSH, the WVUS&H Extension Office provided

training in the use of the fall‐prevention system, using installation instructions developed by the

project team. The owners of the contracting firm commented that they normally do not use

guardrails during residential construction; however, after the training session, all crew

5 Dr. Bobick was chosen in 2013 as CDC’s Civilian Engineer of the Year.

6 During the field study, the contractor used the guardrail system, both externally on the roof and internally on

stairs and for internal edge protection.

NIOSH CSH, Accomplishments, 2009‐2013, Page 13 of 27

members felt very positive about using the system,7 and the contractor plans to continue using

the system in their home as well as a commercial business. Verbal feedback from workers and

management indicate high acceptance of this system.

V. Ladder Application

Falls from ladders are an important source of preventable construction injuries. Misjudging the

ladder angle is an important risk factor for a fall. If the ladder is set too steeply, it is more likely

to fall back or slide away during use, and if it is set too shallow then the bottom can slide out.

Researchers within NIOSH’s Division of Safety Research (DSR) designed and developed the first

NIOSH construction related application (app). This research is being led by Dr. Peter Simeonov

and supports NORA Construction Sector ‘Ready for Impact” Strategic Goal #1 to “Reduce

Construction Worker fatalities and serious injuries caused by falls to a lower level.” The NIOSH

Ladder Safety phone app is designed to improve extension ladder safety and has an angle of

inclination indicator making it easy to set an extension ladder at the proper angle of 75.5

degrees. This free and popular app became available in June 2013 through the NIOSH website

(http://www.cdc.gov/niosh/topics/falls/), the Apple App‐store

(https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewSoftware?id=658633912&mt=8), and the Android Market

(https://play.google.com/store/apps/details?id=gov.cdc.niosh.dsr.laddersafety). The science

that led to the development of the app received awards in 2014 from both NIOSH and the

Department of Health and Human Services.

The app’s inclination indicator allows most cell phones to provide both a visual and an

audible signal when the ladder angle is correctly set. NIOSH’s Division of Safety

Research tested and patented the concept of the app’s inclination indicator. They

compared existing ladder positioning methods and found that the indicator improved

both the accuracy and efficiency for ladder positioning. The Ladder Safety app also

includes other handy information about ladder safety, i.e., ladder selection, inspection,

accessorizing, and use. The science and research behind the development of the ladder

safety app can be found at http://www.cdc.gov/niosh/topics/falls/. A Spanish language

version of the Ladder Safety app has also been released.

7 Training included a hands‐on practice installing the system on three typical construction situations (sloped,

horizontal, and vertical orientations).

NIOSH CSH, Accomplishments, 2009‐2013, Page 14 of 27

VI. Safety Solutions – Home Building Booklet

Home building is physically demanding work and manual material handling may be the most

difficult part of the job. These activities increase the risk of painful strains and sprains and more

serious soft tissue injuries.

NIOSH’s Division of Applied Research & Technology designed and developed

Simple Solutions for Home Building Workers: A Basic Guide for Preventing

Manual Material Handling Injuries, which is also available in Spanish as

Soluciones Simples: Para los Trabajadores de la Construcción Residencial:

Guía Básica Para Prevenir Lesiones en el Manejo Manual de Materiales. This

project supports NORA Construction Sector Strategic Goal #7 to “Reduce

Construction Worker fatalities and serious injuries caused by falls to a lower

level.“

Simple Solutions for Home Building Workers was made available June 2013 as a web publication

for printing or download at http://www.cdc.gov/niosh/docs/2013‐111/ and

http://www.cdc.gov/spanish/niosh/docs/2013‐111_sp/. The publication was written especially

for young and less experienced home building workers. Original drawings and non‐technical

language are used to describe manual material handling injury risks and how these risks can be

reduced and/or eliminated for certain activities. It provides basic information about readily‐

available work practices and equipment that can help both new and experienced workers,

contractors and builders prevent serious manual material handling injuries.

VII. NIOSH Research Guidance Targeted Towards OSHA’s Needs

In March 2014, OSHA convened its informal public hearings for the proposed rule in

occupational exposure to respirable crystalline silica. NIOSH researchers provided testimony,

addressing the health effects of exposure to respirable crystalline silica based on its long history

of research and extensive efforts to develop recommendations and controls for preventing

worker exposures to silica. NIOSH researchers have studied the use of engineering control

technology for grinding concrete, sandblasting, rock drilling, hydraulic fracturing (fracking),

concrete floor polishing, cutting fiber cement siding, tuck pointing, and asphalt milling. In fact,

NIOSH construction researchers played a significant role in helping to develop Table 1 of

OSHA’s proposed rule concerning “Exposure Control Methods for Selected Construction

Operations.” NIOSH has also promoted the prevention of silicosis through model partnerships

and cooperative agreements with government, industry, labor and academia. NIOSH methods

research has shown that the proposed OSHA standard is measurable by techniques that are

valid, reproducible, attainable with existing technologies, and available to industry and

government agencies.

NIOSH CSH, Accomplishments, 2009‐2013, Page 15 of 27

NIOSH provided comments to the OSHA Request for Information (RFI) Standards Improvement

Project ‐Phase IV (SIP‐IV) published in the Federal Register (FR) in 2012 [77 FR 72781]. NIOSH

supports updating the decompression tables in Appendix A of the OSHA Underground

Construction, Caissons, Cofferdams and Compressed Air standards (29 CFR part 1926, subpart

S) in SIP‐IV (page 72783 of the RFI). Early studies by Kindwall et al. found that the OSHA

decompression tables were not sufficiently protective of worker health. Alternative

decompression tables are available that are more protective than the current OSHA tables.

NIOSH supported research to develop and test four new tables in 1981, including one based on

oxygen use, that are now accessible to the construction and safety and health community via a

new NIOSH topic page http://www.cdc.gov/niosh/topics/decompression/nioshDeveloped.html.

These tables, known as the “Edel‐Kindwall” tables, have been used for variances to the OSHA

standard and have been shown in laboratory and field trials to decrease the incidence of

dysbaric osteonecrosis (Downs and Kindwall 1986). Use of the alternative tables may be more

cost‐effective because (1) they reduce the need for time‐consuming variances; (2) they use

staged decompression and oxygen decompression which potentially shorten decompression

times for employees and employers; and (3) they may result in fewer health complications and

lower associated medical costs (Downs and Kindwall 1986). NIOSH is working with OSHA to

determine if additional data are needed to protect workers on tunneling projects at pressures

greater than 50 psi.

VIII. NIOSH Funded Extramural Research

NIOSH Extramural funded construction research continues to ensure relevant applied research,

translational research, and research‐to‐practice activities through a mix of investigator‐initiated

grants and cooperative agreements. NIOSH funding continues to stimulate quality research and

research‐to‐practice efforts for addressing new and ongoing challenges in the construction

sector.

Relationship with the National Construction Center

The National Construction Center provides national leadership and coordination on research‐

to‐practice (r2p) to effectively transfer research findings to construction stakeholders by: (a)

translating research recommendations and outputs for use by consensus organizations,

regulatory agencies, professional associations, and construction employers, unions, and

workers; (b) facilitating the adoption of or hastening the transfer of research recommendations

and outputs, technologies, and information into practice or to worksites; and (c) expanding the

body of knowledge about r2p in the construction sector. NIOSH intramural scientists consult

with scientists at the National Construction Center or with scientists who are part of its

collaborating network. CPWR—The Center for Construction Research and Training has

successfully applied to serve as the National Construction Center since 1994.

NIOSH CSH, Accomplishments, 2009‐2013, Page 16 of 27

In FY2010, CPWR began increasing its research‐to‐practice capabilities and capacity through an

r2p program supplement. One facet of the plan is improving program infrastructure for

distribution and support of r2p products to‐and with intermediary organizations. An

interagency workgroup is steering planning processes including coordination with NIOSH.

Outputs include Guidance for the selection of completed research ready for r2p (and triage

tool), ‘best practices’ information, specialty trade ‘toolkits’, CPWR Impact (tri‐fold) card, and

CPWR Data Brief (Hispanic worker injury data), and CPWR Update e‐bulletin.

In 2013 CPWR published the fifth edition of The Construction Chart Book: The U.S.

Construction Industry and its Workers. The Chart Book is widely regarded as a leading resource

for U.S. construction industry data and statistics and has been a go‐to reference for

construction stakeholders for 16 years. The Chart Book characterizes the changing American

construction industry and workforce, monitors the impact of such changes on worker safety

and health, and identifies priorities for future safety and health interventions. The Chart Book

includes statistics on traditional construction topics, but it also addresses green construction,

the aging workforce, employment projections, as well as OSHA inspections, violations, and

citations. It contains approximately 250 charts and tables on 55 topic pages.

From: The Construction Chart Book, Page 38, Chart 38a

The restructured eLCOSH.org was released in October 2012 containing a free national

repository of construction safety and health information. In 2013, the site broke 15 million page

views since its launch in 2000. The website provides user‐friendly safety and health

NIOSH CSH, Accomplishments, 2009‐2013, Page 17 of 27

information, in English and Spanish, for construction workers and others on a wide range of

topics and sources. Some 850 documents and videos, including more than 150 in Spanish, are

posted. eLCOSH is a global resource for construction safety and health training and

management documents, with more than 50 annotated site links provided. The eLCOSH

Facebook page has developed an avid community of active followers and over 10,000 Facebook

users “like” the page.

CPWR partnered with McGraw‐Hill Construction to survey hundreds of construction contractors

of various sizes and trades to learn about their safety management practices. Respondents,

drawn from McGraw‐Hill’s contractor research panel, participated in the survey in December

2012. Developing a site‐specific health and safety plan; analyzing potential site safety hazards

before construction begins; and assigning project safety personnel before construction begins

were the leading topics identified by contractors as especially effective methods by which to

increase project safety. While large firms reported extensive use of critical safety practices,

fully‐inclusive safety programs were much less common in smaller firms.

CPWR organized two national workshops: one on safety culture and climate and another on r2p

partnerships. CPWR took the lead responsibility for writing and publishing (April 2014) the

Safety Culture and Climate report stemming from that workshop, Safety Culture and Climate in

Construction: Bridging the Gap between Research and Practice, available online at CPWR’s

website. It also published several reports including an Intellectual Property Patent & Licensing

Guide for Construction Safety & Health Researchers.

NIOSH CSH, Accomplishments, 2009‐2013, Page 18 of 27

IX. SOCIAL MEDIA

Beginning in 2011, a study of the use of social media by CSH, conducted by NIOSH OC, as well as

work by the National Construction Center shaped efforts to disseminate outputs from NIOSH’s

construction program. It is now standard practice to use social media and to involve the

National Construction Center, as well as other partners such as OSHA where relevant, in

dissemination efforts.

Twitter

Outreach through social media, specifically, Twitter, has been important. As of October 2014, there were 12,400 followers for Construction@NIOSH. Of the 14 Twitter accounts associated with NIOSH, @NIOSHConstruct is the second most popular account in terms of followers, behind the main NIOSH account, @NIOSH. To understand more about the makeup of our followers, an evaluation of 2.5% of our followers was performed and showed:  50% in construction  22% personal accounts  13% other businesses  13% OSH practitioners  2% political/social/academic

As far as Twitter engagement, for every original tweet we’ve had on average about 4 interactions (retweets or replies). Interactions on Twitter are key indicators as to whether users on Twitter are responding to content. Five of the ‘top ten’ tweets were centered on construction falls and were sent out as part of our Construction Falls Prevention Campaign messaging. As far as Twitter reach, of the 135 different Twitter accounts that had either retweeted or replied to a @NIOSHConstruct tweet (during a sample 2 month period), there were 334,748 Twitter accounts following them.

Facebook

The National Construction Center has enhanced communication through development of two Facebook pages which as of October 2014 have a combined total of 14867 ‘likes’.

For the Construction Falls Prevention Campaign, a Facebook page “Stop Construction Falls” was developed by a NORA Construction Sector Council member at Washington University School of Medicine in St. Louis. The “Stop Construction Falls” Facebook page has 235 ‘likes’ and has reached 14 states in the U.S. and 44 countries worldwide.

NIOSH CSH, Accomplishments, 2009‐2013, Page 19 of 27

Appendix I – Construction Falls Prevention Campaign – Evaluation Summary Findings

As informed by the focus group results, moving forward with Safety Pays, Falls Cost campaign outreach strategies and products, we recommend the following:

Channels of Dissemination  Partner with home improvement stores such as Home Depot or Lowes to post and

disseminate campaign messages and materials.  Identify an OSHA or related official that is able to distribute campaign materials in

person and provide brief mini‐demonstrations on campaign topics.  Distribute products directly to contractors.  Hold events such as “construction safety block parties” where campaign products can be

distributed in‐person.

Product Types  Use real contractors in materials whose facial expressions match the copy of the

material.  Depict individuals who are in obvious physical discomfort if they are relaying a story in

which they were injured.  Provide materials that are easy to distribute such as stickers and business cards.  Laminate products such as one‐page information sheets so they have a long shelf‐life.  Keep copy brief and provide correct procedures (not only incorrect procedures).

Campaign Website  Reduce the amount of information on any one Page; create click‐thru Pages to specific

topics.  Create separate Pages for roofs, scaffolds and ladders.  Provide a search capability.  Place the compelling CPWR “Don’t Fall For It” video on the home page.  Either move the map on the home page or make it more active – e.g., show where users

can access campaign materials in their geographic region.  Add short safety video clips.

The following conclusions can be drawn from the Safety Pays, Falls Cost Campaign partner

interviewee and survey findings.

Partner Level of Effort  Partners reported primarily disseminating existing Safety Pays, Falls Cost Campaign

materials through their own media channels and by posting the stopconstructionfalls.com link on their websites.

 Partners reported that they had not, at least as of the writing of this document, produced special safety events as part of the Safety Pays, Falls Cost Campaign.

NIOSH CSH, Accomplishments, 2009‐2013, Page 20 of 27

Partner Receipt of Campaign Products  The disbursement of Safety Pays, Falls Cost Campaign materials to partners appears to

have occurred only on a one‐time basis.  Partners, across the board, did not appear to receive the same amount of products or

the same type of products.

Rewarding and Challenging Aspects of the Campaign  Partners reported feeling satisfied and rewarded for participating in a campaign to

promote height safety in the construction arena. They believed in the importance of the campaign and found it rewarding that their organization is part of a larger effort to promote construction safety.

 Partners reported feeling very gratified when there was evidence that campaign messages are being forwarded by other organizations.

 Partners reported feeling it will be challenging to sustain their participation in the Safety Pays, Falls Cost Campaign over time because they did not receive additional materials to distribute throughout the year.

 Partners reported challenges in finding vehicles and venues for delivering materials directly into the hands of small residential contractors and employees.

 Partners reported not knowing or being uncertain as to whether campaign messages, materials, and other products influence the way small residential contractors and their employees conduct their work duties.

Areas for Improvement  Some partners reported wanting to receive materials more frequently so that,

subsequently, they could distribute those materials and have much more touch‐points with the target audience.

 Some partners reported wanting materials emailed to them as frequently as weekly or monthly.

 Some partners reported wanting materials that provided motivators for small residential contractors to raise awareness of height‐safety procedures on construction sites including:

o Statistics on injuries and fatalities o Cost points associated with injuries resulting from work‐related falls

 Partners reported not having received any technical assistance. However, the challenges articulated by partners as to the difficulties in reaching small residential contractors indicate that they could use assistance in:

o Identifying possible locations in their communities that are frequented by small residential contractors and employees

o Exploring existing activities targeting small residential contractors and employees that partners could leverage to distribute messages, materials and products.

NIOSH CSH, Accomplishments, 2009‐2013, Page 21 of 27

Continued Partner Involvement after the Campaign’s First Year  Most partners reported intending to continue their involvement in the Safety Pays, Falls

Cost Campaign after the first year.  Most partners said that their organization’s involvement will be similar to that of the

first year of the campaign and mostly include distribution of campaign materials and website links.

 A couple of partners stated that their organizations will incorporate new strategies in their campaigns to disseminate messages, materials and products including:

o Transit ads o Tool box talks o Community outreach events o Medial outreach o Outreach to local apprenticeship programs and community health centers.

Recommendations for Potential Campaign Partners  Many partners suggested that potential partners with access to small residential

contractors and their employees included local chapters of national associations in the

industry such as local chapters of the National Roofing Contractors Association, the

Home Builders Association, and the National Safety Council.

NIOSH CSH, Accomplishments, 2009‐2013, Page 22 of 27

Appendix II – Nail Gun Evaluation: Findings

Several common themes emerged based on our stakeholder interviewees. This section will address these commonalities as well as cover some other key findings.

Spanish outreach Three of the nine stakeholders we reached out to were primarily focused on reaching Spanish‐ speaking construction workers. We wanted to ensure we were able to get feedback from this target audience since we developed a Spanish‐speaking version of the nail gun guide and actively worked to disseminate this guide to construction organizations focused on reaching Spanish‐speaking construction workers.

From talking to these three stakeholders, some significant findings are highlighted below.

El Nuevo Constructor (only Spanish‐language magazine in the construction industry): We thought this information would be of interest as we serve as a portal to Hispanic construction workers.

Hispanic Contractors Association de Tejas (largest contractors association in the country) When asked about reaching small and hard to reach residential contractors, our respondent mentioned that they have a have a program to try and reach this workforce called the “OSHA 10 hour marathon” where they train 400‐500 of these types of workers in a day. They are planning to distribute the nail gun safety guide to all of these workers at this training.

National Hispanic Construction Association There was some turnover in this organization during our survey period, but have since followed up with this organization and their new CEO is very interested in promoting the nail gun guidance document as well as any other safety documents for workers in the construction industry. After our initial conversation on the nail gun guide, he has since asked if his organization could be a formal partner in the construction falls prevention campaign.

Extending the reach One of our main objectives was to try and gauge how many people have seen this nail gun guide. We asked each of our stakeholders if they had further disseminated the nail gun guide and what methods did they use to extend the reach. All of the respondents said that upon receiving the email with the link to this new product, they then shared this resource within their organization and often times outside their organization. Each organization disseminated the information in a slightly different fashion. We’ve captured below how each organization further distributed the information in the nail gun guide.

NIOSH CSH, Accomplishments, 2009‐2013, Page 23 of 27

National Association of Home Builders (NAHB)

‐posted on our website & sent out via electronic newsletter to our members (140,000 members)

The Associated General Contractors of America (AGC)

‐included in our Safety & Health e‐newsletter which reaches ~ 10,000 people; ‐shared it with the Safety & Health Committee as a safety alert

Liberty Mutual Insurance  ‐devoted a quarterly construction newsletter to it  ‐ posted on our web ‐worked with a group of construction specialists to distribute (access 700 companies)

SkillsUSA  ‐sent to all 300,000 of our members (20% Hispanic/Latino) ‐sent to state directors who then sent out to their advisors and the schools/teachers

Carpenters' District Council of Greater St. Louis and Vicinity

‐sent it to all the carpenter training schools ‐take to the various job sites (several 100) ‐promote on www.nailgunfacts.org

National Hispanic Construction Association

‐incorporated into our November newsletter ‐posted in the “newflash” section of our website ‐posted update with link on our Facebook page

Hispanic Contractors Association de Tejas

‐posted on our website ‐sent via email blast to our members (2500 people, which includes about 90 OSHA 500 trainers)

El Nuevo Constructor ‐posted on our website ‐incorporated the update with the link into our weekly “info‐bulletin” that we send out

This information allowed us to get an estimate on how many people have heard of or seen the information in the nail gun guide which gives us a sense of the reach we’ve been able to have with this document. It also informed us on the various mechanisms construction stakeholders have in place to get messages out to their organizations. This could help shape future outreach dissemination strategies for our office by knowing the various ways people receive information across the construction industry.

Impressions Another area we were interested in gaining further insight was on each stakeholder’s impression of the nail gun guide. We were interested in any feedback they had or any feedback they had received on the content/layout of the document. All of the stakeholders mentioned a favorable impression. We wanted to highlight some of the actual impressions we heard in the below.

NIOSH CSH, Accomplishments, 2009‐2013, Page 24 of 27

NIOSH took the extra step to go out to the residential construction sites and capture images with these nail guns being used like they normally would be. This adds great value to the publication.

The part on actual accidents that occurred rings very true; I liked that you didn’t pull all the fatality accidents and have more of a mix.

The six steps to nail gun safety are practical and comprehensive.

I like the columns with useful terms you should know and worksite stories.

The photograph on the front page really helped get workers to share stories from guys they knew that had nail gun injuries and that’s what sold them on it.

The cover is really dramatic. It absorbs a person to read what’s inside. You don’t see “gore” you see the result.

NIOSH did a great job at the translation of this document to make it easily understandable by Spanish‐ speaking construction workers.

We heard from several respondents that the way the nail gun guide was written made complex information easily understandable. We also received a lot of positive feedback about the layout of the guide.

We did receive a few technical comments from one of the stakeholders that had experience working as a nail gun user. He offered a few potential modifications to include:

 The advice to keep your hand 12 inches away – may not be practical, often is 6 inches.  The advice on ‘only using the nail gun with the dominant hand’. You can operate with your non‐

dominant hand just like a cell phone. It doesn’t matter what hand when you hold it six hours a day.

 As far as the information on full sequential vs. single actuation: a table may be better for our guys. Most have a high school education or less and may have hard time understanding this aspect.

 Another aspect that wasn’t really covered that contributes to injury from nail guns is the air compressor. A lot of times they skip or double pass if there is too much pressure or not enough. Knowing the pressure required to operate the nail gun and how to make it happen with the tools you have is important.

How do we get workers to “pick it up and read it”? Besides this being a great document, we heard that the challenge really is on how we get people to “pick it up and read it”. A few of the respondents mentioned developing additional materials targeted at the average construction worker (simpler format, shorter read). One person even mentioned the need to develop this into a nail gun safety app where users could

NIOSH CSH, Accomplishments, 2009‐2013, Page 25 of 27

download the pertinent information onto a smart phone. Also we heard from a several respondents that we should look to develop this into a short video that could be accessed via YouTube. One organization said they’d be willing to work with us to develop an educational video on nail gun safety. A lot of construction workers just use YouTube to type in the topic they want to learn about and listen/watch someone tell them how to do whatever it is they’re interested in.

How to get to those small ‘hard‐to‐reach’ residential contractors?

 This is the biggest problem our industry faces.  .

A lot of our respondents mentioned that targeting the small ‘hard‐to‐reach’ residential contractors was also a challenge for their organizations. A common theme we heard was working at the local level with community organizations that these types of workers go to for trusted safety and health information & resources. We also heard that getting out this information in multiple ways is useful using different avenues and media outlets. One innovative idea we heard was getting a “NIOSH nail gun safety racecar”.

Who else should we reach out to? Several respondents mentioned NIOSH should reach our to Home Depot and Lowe’s at the national level. It was mentioned that Home Depot has a nail gun buyer’s guide that doesn’t mention triggers.  One of the respondents mentioned it would be nice to have this “cutting edge NIOSH

produced brochure to accompany the nail gun buyer’s guide.”  Another mentioned these stores should be “handing out this guide to those buying

framing tools”.

ISANTA (the International Staple, Nail, And Tool Association), the manufacturers of nail guns were also mentioned as an organization NIOSH should reach out to. Their nail guns are pictured in the nail gun guide.  “It’s in their best interest and their members’ best interest”.

Habitat for Humanity was an organization that was also mentioned for us to reach out to.

To target some of the “hard‐to‐reach” workers, we heard it would be worthwhile to find a way at the local level to reach out to community organizations where many of these workers go for educational materials.

All of the respondents mentioned that it was still too early to identify any cases of impact as far as behavior change of workers (switching to sequential triggers) due to the release of this new nail gun guidance document. Several respondents did mention that they will be incorporating

NIOSH CSH, Accomplishments, 2009‐2013, Page 26 of 27

this new nail gun guidance into their training curriculums. They mentioned they will be capturing feedback during their trainings and would share any stories of impact.

NIOSH CSH, Accomplishments, 2009‐2013, Page 27 of 27

1

Course Learning Outcomes for Unit I

Upon completion of this unit, students should be able to:

2. Apply Occupational Safety and Health Administration standards and related practices to construction. 2.1 Examine the impact and importance of the OSHA standards in the construction industry. 2.2 Identify employee and employer rights and responsibilities in the OSHA standards.

5. Discuss social demographic issues related to construction safety. 5.1 Recognize safe workplace challenges related to gender, age, and non-native English speakers.

7. Discuss workers' compensation programs as they apply to construction settings. 7.1 Explain the role of workers’ compensation programs in accident prevention on construction

sites.

Course/Unit Learning Outcomes

Learning Activity

2.1 Unit I Lesson Required Readings Unit I Assessment

2.2 Unit I Lesson Required Readings Unit I Assessment

5.1 Unit I Lesson Required Readings Unit I Assessment

7.1 Unit I Lesson Required Readings Unit I Assessment

Reading Assignment

Please read the following in the order they are listed below.

Read slides 1-28 in the presentation below.

Occupational Safety & Health Administration. (n.d.). Introduction to OSHA [PowerPoint presentation], Retrieved from https://www.osha.gov/dte/outreach/intro_osha/IntroToOSHA_ppt.pdf

Occupational Safety & Health Administration. (n.d.). Regulations (Standards – 29 CRF): State plans for the development and enforcement of state standards. Retrieved from https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9561

Occupational Safety & Health Administration. (n.d.). Regulations (Standards – 29 CRF): Construction work. Retrieved from https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9707

Centers for Disease Control & Prevention. National Institute of Occupational Safety and Health. (2011). Construction safety and health. Retrieved from http://www.cdc.gov/niosh/construction/about.html

UNIT I STUDY GUIDE

Introduction to Construction Safety

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Title Occupational Safety & Health Administration. (n.d.). Women in construction: Personal protective equipment.

Retrieved from https://www.osha.gov/doc/topics/women/ppe.html

Occupational Safety & Health Administration. (n.d.). Protecting temporary workers. Retrieved from https://www.osha.gov/temp_workers/

Occupational Safety & Health Administration. (2007). OSHA fact sheet: Hispanic outreach. Retrieved from https://www.osha.gov/OshDoc/data_Hispanic/hispanic_outreach.html

Occupational Safety & Health Administration. (n.d.). Young workers: You have rights!. Retrieved from https://www.osha.gov/youngworkers/hazards.html

Read pages 1-24 in the primer below.

Centers for Disease Control & Prevention. National Institute of Occupational Safety and Health. (2014). Workers’ compensation insurance: A primer for public health [Brochure], Retrieved from http://www.cdc.gov/niosh/docs/2014-110/pdfs/2014-110.pdf

Unit Lesson

Workplace Safety and OSHA

“Two workers die in construction accident.” “Crane collapses at downtown construction site.” “Worker falls to his death on construction site.” Headlines like these seem to be almost a daily occurrence. It is not just sensational headline writing—of the more than 4,000 worker fatalities in the U.S. in 2013, one in five (20%) were in construction (Occupational Safety & Health Administration [OSHA], n.d.-b). What is it about construction that makes it so dangerous? What do safety professionals need to know in order to develop effective accident prevention programs in this industry? In this course, we will focus on the information and tools that are available to address these questions. In order to better understand the current challenges, we first need to look back into the history of occupational safety in the United States.

The safety movement began in the United States in the 1800s as the introduction of new machines and equipment brought new dangers into the workplace. In the aftermath of the Triangle Shirtwaist Factory fire in New York City in 1910, safety became a focal point in most industries. Insurance companies wanting to cut the losses incurred by workplace accidents were the first to establish rules for safe work practices. Although the initial reason for improved safety was money, the efforts did greatly improve overall working conditions for

(Almeida, n.d.)

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Title

employees. Labor unions began to use workplace safety as part of their collective bargaining agreements. Industry associations developed safety standards to be adopted on a voluntary basis. Individual states passed laws to regulate some aspects of worker safety. In 1971, the Williams-Steiger Occupational Safety and Health Act became law and the Occupational Safety and Health Administration (OSHA) was established. OSHA was given the authority to develop and enforce workplace safety standards. The initial workplace standards, known as General Industry Standards, were published in Title 29 of the U.S. Code of Federal Regulations Part 1910, commonly annotated as 29 CFR 1910 (Johnson, 2013).

The first OSHA standards applied to all industries, but OSHA quickly recognized that not all industries were created equal. The maritime and construction industries, in particular, were faced with hazards unique to their operations; many organizations had already developed and adopted their own voluntary standards. To address the unique operations of these and other specialty industries, OSHA created additional industry- specific standards based on the voluntary standards already in place. The Construction Safety standards were issued in 1972 and are published at 29 CFR 1926. It is important to note that although construction activities have their own set of standards, they are not exempt from the General Industry standards in 29 CFR 1910. The construction standards are applied first, but if a particular workplace hazard is not covered in 29 CFR 1926 and is addressed in 29 CFR 1910, then the 1910 standard is applied. Twice as many standards to sort through!

OSHA also recognized the constitutional rights of individual states to create their own laws and regulations. The office provided a mechanism for states to receive approval for their own occupational safety and health standards as long as they provide equal or better protection for workers than the Federal OSHA standards. Currently, 26 States and Puerto Rico have OSHA-approved plans (OSHA, n.d.-a). In this course, we will focus on the OSHA Construction Standards published at 29 CFR 1926, but it is important to not lose sight of the General Industry Standards as well as the OSHA-approved state standards.

OSHA data indicates that one in five worker deaths were in construction. What is the leading cause of deaths in construction? Unfortunately, this is not a difficult question: falls are the cause in about 36% of all construction deaths (OSHA, n.d.-b). You might surmise that most efforts and resources are directed at preventing falls, but you may be surprised to learn about the number one OSHA citation.

The following were the top 10 most frequently cited standards by Federal OSHA in fiscal year 2013 (October 1, 2012 through September 30, 2013) (OSHA, n.d.-b):

1. Fall protection, construction (29 CFR 1926.501) 2. Hazard communication standard, general industry (29 CFR 1910.1200) 3. Scaffolding, general requirements, construction (29 CFR 1926.451) 4. Respiratory protection, general industry (29 CFR 1910.134) 5. Electrical, wiring methods, components and equipment, general industry (29 CFR 1910.305) 6. Powered industrial trucks, general industry (29 CFR 1910.178) 7. Ladders, construction (29 CFR 1926.1053) 8. Control of hazardous energy (lockout/tagout), general industry (29 CFR 1910.147) 9. Electrical systems design, general requirements, general industry (29 CFR 1910.303)

10. Machinery and machine guarding, general requirements (29 CFR 1910.212)

Workers’ Compensation

Like most industries, the primary goal of the construction industry is profit. There are many areas of cost to be considered, such as labor, taxes, insurance, materials, and capital. Labor rates are established by local scales, and taxes are determined by existing statutory law, but insurance is a cost that can be managed. Several specific types of insurance coverage are needed for a construction project: builder’s risk, commercial/general liability, pollution, professional liability, and workers’ compensation.

Workers’ compensation gives employees the right to be compensated following a work-related injury without the need for litigation. Before workers’ compensation laws were developed, an employee’s only recourse in the case of an on-the-job injury was to go through the court system, which sometimes proved to be a lengthy process. Now, all workers’ compensation laws provide pay and benefits, and cover medical costs, while encouraging accident prevention (Johnson, 2013). Workers’ compensation generally provides replacement of income for injured employees, rehabilitation of injured employees, help toward the prevention of future accidents, and allocation of costs. Fundamentally, workers’ compensation helps employees return to work as

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UNIT x STUDY GUIDE

Title soon as possible in order to maximize efficiency for the company (National Institute for Occupational Safety and Health [NIOSH], 2014).

Workers’ compensation insurance can be a major cost for a construction project. As workers’ compensation claims increase, so do the insurance premiums (remember that the insurance company is also in business to make a profit). The safety practitioner can make a significant contribution to cost reduction of a project through the application of sound accident prevention principles and a reduction in workers’ compensation claims. Compliance with the OSHA standards is just the beginning. Throughout the course, we will be discussing additional safe work practices that go beyond simple compliance and will help reach the goal of a construction project delivered on time and on budget.

References

Almeida, A. (n.d.). “I reckon everybody knows about this…” [Cartoon]. Retrieved from http://www.almeidacartoons.com/Safe_toons1.html

Johnson, D. (2013). DeWALT construction safety and OSHA handbook. Clifton Park, NY: Delmar.

National Institute of Occupational Safety and Health. (2014). Workers’ compensation insurance: A primer for public health [Brochure]. Retrieved from http://www.cdc.gov/niosh/docs/2014-110/pdfs/2014-110.pdf

Occupational Safety & Health Administration. (n.d.-a). Regulations (Standards – 29 CRF) Subpart A - list of approved state plans for enforcement of state standards. Retrieved from https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1 &p_keyvalue=1952

Occupational Safety & Health Administration. (n.d.-b). Commonly used statistics. Retrieved from https://www.osha.gov/oshstats/commonstats.html

Suggested Reading

Are you looking for more insight on the topics discussed in this unit? Access the items listed below to view videos and additional information to gain further insight and understanding.

Occupational Safety & Health Administration. (n.d.). 40 year history video [Video]. Retrieved from https://www.osha.gov/osha40/video/video.html

Occupational Safety & Health Administration. (2009). Reflections on OSHA’s history [Brochure]. Retrieved from https://www.osha.gov/history/OSHA_HISTORY_3360s.pdf

Occupational Safety & Health Administration. (n.d.). Links to state plans’ safety and health regulations. Retrieved from https://www.osha.gov/dcsp/osp/statestandards.html

Occupational Safety & Health Academy. (n.d.). All about calculating workers’ compensation premiums. Retrieved from http://www.oshatrain.org/notes/4anotes05.html

Occupational Safety & Health Administration. (n.d). Workers’ compensation costs of falls in construction. Retrieved from https://www.osha.gov/doc/topics/residentialprotection/2012_fall_costs/index.html

Learning Activities (Nongraded)

If your state has an OSHA-approved occupational safety and health plan, find some information about it on the Internet. Compare the state standards to OSHA. Are there areas where the state is more restrictive than OSHA? If your state does not have an approved plan, take a look at the state plans for California or Oregon and compare them to OSHA.

5

UNIT x STUDY GUIDE

Title Nongraded Learning Activities are provided to aid students in their course of study. You do not have to submit them. If you have questions contact your instructor for further guidance and information.

2/21/20, 11:09 AMOSHA Fact Sheet: Hispanic Outreach | Occupational Safety and Health Administration

Page 1 of 2https://www.osha.gov/OshDoc/data_Hispanic/hispanic_outreach.html

UNITED STATES DEPARTMENT OF LABOR

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Fact Sheet Hispanic Outreach OSHA has made immigrant workplace safety a priority within the agency and is committed to identifying ways to improve the safety and health of

immigrant and other hard-to-reach workers. While overall workplace fatalities have dropped 20 percent in the last decade, workplace fatalities among

Hispanic workers, especially those working in the construction industry, have risen almost 35 percent in the same period. OSHA is taking a multi-

pronged approach to improving safety and health for, and providing outreach and assistance to, the Hispanic community.

OSHA Hispanic Outreach Assistance

OSHA offers numerous Hispanic outreach compliance tools, programs and training resources to help employers and Spanish-speaking workers prevent and reduce injuries and illnesses in the workplace.

The OSHA website, www.osha.gov, provides access to OSHA's Spanish-language information and Hispanic compliance assistance outreach tools, programs and training resources including Hispanic-related web pages, electronic assistance tools, cooperative programs, training, and pages devoted to publications, fact sheets, videos, and much more. Hispanic outreach resources include:

Hispanic Employers and Workers Compliance Assistance Web Page. This web page is targeted to English-speaking and bilingual Hispanic employers, workers and others who wish to access OSHA's compliance assistance, outreach and training materials. OSHA en Español. A Spanish version of essential information on the OSHA website. Hispanic Outreach Module of the Compliance Assistance Quick Start. An online tool for employers to quickly identify OSHA's Hispanic outreach assistance resources, training and educational materials, and other information. Compliance Assistance Quick Start includes a Hispanic worker training section that addresses employee training issues and identifies Spanishlanguage resources available from OSHA, other federal agencies and nongovernmental organizations. OSHA Dictionaries. English-to-Spanish and Spanish-to-English dictionaries of general OSHA, general industry and construction industry terms. Electronic Compliance Assistance Tools. (eTools). OSHA’s eTools that have been translated into Spanish: Construction and Sewing and Related Procedures. OSHA Workplace Poster. OSHA's required poster translated into Spanish (OSHA 3167).

Publications. Employers may access numerous OSHA Spanish-language publications, brochures, Quick Cards, Safety Tips and fact sheets on a variety of topics including PPE, fall protection, workplace violence, bloodborne pathogens, heat/cold stress, trenching and excavation, hazard communication, tree trimming, landscaping, electrical safety, crystalline silica exposure and employee rights.

OSHA National Helpline. 1-800-321-OSHA Hispanic employers and Spanish-speaking workers can call OSHA toll-free and access the Spanish-language option for compliance assistance information and other assistance 24 hours a day. (Spanish-speaking operators are available 8 a.m. to 4:30 p.m.)

OSHA's Spanish-language Education and Training

OSHA offers a number of training and education programs to help Hispanic employers and workers improve their knowledge of safe and healthful work practices to comply with OSHA standards.

The OSHA Office of Training and Education has a variety of Hispanic outreach and training resources including: Education Centers located throughout the United States that offer numerous Spanishlanguage training courses. OSHA awards Susan Harwood Training Grants to nonprofit organizations, including colleges, universities and other educational institutions to provide safety and health training and education and other services to Hispanic and other hard-to-reach workers.

Occupational Safety and Health Administration CONTACT US FAQ A TO Z INDEX ENGLISH ESPAÑOL

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2/21/20, 11:09 AMOSHA Fact Sheet: Hispanic Outreach | Occupational Safety and Health Administration

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For more complete information:

Occupational

Safety and Health

Administration

U.S. Department of Labor www.osha.gov

(800) 321-OSHA

The OSHA Resource Center Loan Program offers over 35 video titles in Spanish on a variety of subjects including electrical safety, trenching and shoring, lockout/tagout, and PPE. Please see the complete OTI catalog of Spanish Safety Training Videos for additional information.

The OSHA Outreach Training Program has many authorized trainers who teach 10- and 30-hour orientation courses in construction and general industry standards.

OSHA's Regional/Area Offices periodically provide training to Hispanic workers, including the OSHA 10-hour construction course in Spanish. Please contact your respective Hispanic/ESL Coordinator for additional information.

OSHA's Cooperative Programs

OSHA’s free On-site Consultation Program helps small businesses (including those that employ Spanish-speaking workers in high-hazard industries like construction and meat packing, or have workers involved in hazardous operations) meet their obligations under the Occupational Safety and Health Act of 1970 and federal and state standards. This program is confidential and completely separate from the OSHA inspection effort. In addition, no citations are issued or penalties proposed. In many states, employers may participate in the OSHA Consultation Safety and Health Achievement Recognition Program (SHARP) which recognizes small employers who operate an exemplary safety and health management system.

OSHA's Alliance Program enables employers, labor organizations, trade or professional organizations, and educational institutions that share an interest in worker safety and health to collaborate with OSHA. OSHA maintains a listing of the national and regional/area office Alliances with a Hispanic outreach component including the National Federation of Independent Businesses and Region II's Community Action for Social Affairs. The OSHA 10-hour construction in Spanish course is periodically offered through the OSHA regional/area office Alliances.

The Voluntary Protection Programs (VPP) promote effective worksite-based safety and health. In the VPP, management, labor, and OSHA establish cooperative relationships at workplaces that have implemented a comprehensive safety and health management system. Approval into VPP is OSHA's official recognition of the outstanding efforts of employers and employees who have achieved exemplary occupational safety and health.

The OSHA Strategic Partnership Program (OSPP) moves away from traditional enforcement methods and embraces collaborative agreements. Through OSPP, OSHA and its partners agree to work cooperatively to address critical safety and health issues.

OSHA appointed Hispanic/English-as-Second- Language (ESL) Coordinators in each of the 10 OSHA regions to assist a variety of groups including employers, small businesses, trade associations, union locals, community and faith-based groups and Hispanic workers with outreach, education and training. Additionally, the coordinators promote OSHA's cooperative programs and resources such as Alliances.

This is one in a series of informational fact sheets highlighting OSHA programs, policies or standards. It does not impose any new compliance requirements. For a comprehensive list of compliance requirements of OSHA standards or regulations, refer to Title 29 of the Code of Federal Regulations. This information will be made available to sensory impaired individuals upon request. The voice phone is (202) 693-1999; teletypewriter (TTY) number: (877) 889-5627.

1/2007

UNITED STATES DEPARTMENT OF LABOR

Occupational Safety and Health Administration 200 Constitution Ave NW Washington, DC 20210 ( 800-321-6742 (OSHA) TTY www.OSHA.gov

FEDERAL GOVERNMENT

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2/21/20, 11:09 AMOSHA | Young Workers - Hazards | Occupational Safety and Health Administration

Page 1 of 2https://www.osha.gov/youngworkers/hazards.html

UNITED STATES DEPARTMENT OF LABOR

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Occupational Safety and Health Administration CONTACT US FAQ A TO Z INDEX ENGLISH ESPAÑOL

OSHA STANDARDS TOPICS HELP AND RESOURCES

young workers employers parents and educators

Home

Real Stories

Hazards

Resources

Contact Us

Check out OSHA's Fall Prevention

Campaign!

Check out OSHA's Campaign to Prevent

Heat Illness in Outdoor Workers

Young Workers

You have rights!

Retail/Grocery Stores/Convenience Stores

Equipment and machinery Heavy lifting Violent crime Repetitive hand motion Slippery floors

Food Service/Fast Food

Sharp objects Hot cooking equipment Slippery floors Electricity Heavy lifting Violent crime

Learn More >>

Janitorial/Cleanup/ Maintenance

Hazardous chemicals Slippery floors Heavy lifting Blood on discarded needles Electricity Vehicles

Learn More >>

Office/Clerical

Repetitive hand motion (computer work) Back and neck strain Stress

Learn More >>

Outdoor Work

Exposure to the sun Heat Landscaping Pesticides and chemicals Machinery and vehicles

Construction

Falls Machines and tools Hazardous materials Confined space Electricity

Young workers get injured or sick on the job for many reasons, including:

Unsafe equipment Inadequate safety training Inadequate supervision Dangerous work that is illegal or inappropriate for youth under 18 Pressure to work faster Stressful conditions

Workplace hazards associated with specific jobs are another major cause of injuries and illnesses. Employers must work to reduce or minimize hazards in the workplace and train employees how to work safely on the job.

Workplace hazards include

Hazards

2/21/20, 11:09 AMOSHA | Young Workers - Hazards | Occupational Safety and Health Administration

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UNITED STATES DEPARTMENT OF LABOR

Occupational Safety and Health Administration 200 Constitution Ave NW Washington, DC 20210 ' 800-321-6742 (OSHA) TTY www.OSHA.gov

FEDERAL GOVERNMENT

White House Severe Storm and Flood Recovery Assistance Disaster Recovery Assistance DisasterAssistance.gov USA.gov No Fear Act Data U.S. Office of Special Counsel

OCCUPATIONAL SAFETY AND HEALTH

Frequently Asked Questions A - Z Index Freedom of Information Act Read the OSHA Newsletter Subscribe to the OSHA Newsletter OSHA Publications Office of Inspector General

ABOUT THE SITE

Freedom of Information Act Privacy & Security Statement Disclaimers Important Website Notices Plug-Ins Used by DOL Accessibility Statement

Electricity Heavy lifting Noise

Struck-by Vehicle back-over Noise

Learn More >>

Industry

Moving equipment Hot equipment Hazardous chemicals Electricity Heat Noise

Agriculture

Child labor laws apply to agricultural workers under 16 years of age.

Machinery Struck-by Falls Electricity Confined space Hazardous chemicals Organic dust (e.g., grain) Heat

Learn More >>

OSHA Is Here to Help!

The Occupational Safety and Health Administration (OSHA) is the agency of the Department of Labor (DOL) that protects workers from dangers on the job that can cause injuries or illnesses. OSHA is here to help you. Call us on our toll-free number: 1-800-321-OSHA (6742) or TTY 1-877-889-5627 to get answers to your questions, or to ask OSHA to inspect your workplace if you think there is a serious hazard. You can also submit a question online. To file a confidential complaint about workplace hazards, visit our How to File a Complaint page for instructions.

2/21/20, 11:07 AMTemporary Workers | Occupational Safety and Health Administration

Page 1 of 2https://www.osha.gov/temp_workers/

UNITED STATES DEPARTMENT OF LABOR

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Protecting Temporary Workers

Employer Responsibilities to Protect Temporary Workers

To ensure that there is a clear understanding of each employer's role in protecting employees, OSHA recommends that the temporary staffing agency and the host employer set out their respective responsibilities for compliance with applicable OSHA standards in their contract. Including such terms in a contract will ensure that each employer complies with all relevant regulatory requirements, thereby avoiding confusion as to the employer's obligations.

Joint Responsibility

While the extent of responsibility under the law of staffing agencies and host employers is dependent on the specific facts of each case, staffing agencies and host employers are jointly responsible for maintaining a safe work environment for temporary workers - including, for example, ensuring that OSHA's training, hazard communication, and recordkeeping requirements are fulfilled.

OSHA could hold both the host and temporary employers responsible for the violative condition(s) - and that can include lack of adequate training regarding workplace hazards. Temporary staffing agencies and host employers share control over the worker, and are therefore jointly responsible for temporary workers' safety and health.

OSHA has concerns that some employers may use temporary workers as a way to avoid meeting all their compliance obligations under the OSH Act and other worker protection laws; that temporary workers get placed in a variety of jobs, including the most hazardous jobs; that temporary workers are more vulnerable to workplace safety and health hazards and retaliation than workers in traditional employment relationships; that temporary workers are often not given adequate safety and health training or explanations of their duties by either the temporary staffing agency or the host employer. Therefore, it is essential that both employers comply with all relevant OSHA requirements.

Both Host Employers and Staffing Agencies Have Roles

Both host employers and staffing agencies have roles in complying with workplace health and safety requirements and they share responsibility for ensuring worker safety and health.

A key concept is that each employer should consider the hazards it is in a position to prevent and correct, and in a position to comply with OSHA standards. For example: staffing agencies might provide general safety and health training, and host employers provide specific training tailored to the particular workplace equipment/hazards.

The key is communication between the agency and the host to ensure that the necessary protections are provided. Staffing agencies have a duty to inquire into the conditions of their workers' assigned workplaces. They must ensure that they are sending workers to a safe workplace.

Workers' Rights

Highlights

Recommended Practices: Protecting Temporary Workers Policy Background on the Temporary Worker Initiative Temporary Worker Initiative (TWI) Bulletin No. 1 - Injury and Illness Recordkeeping Requirements Temporary Worker Initiative (TWI) Bulletin No. 2 – Personal Protective Equipment Temporary Worker Initiative (TWI) Bulletin No. 3 – Whistleblower Protection Rights Temporary Worker Initiative (TWI) Bulletin No. 4 - Safety and Health Training Temporary Worker Initiative (TWI) Bulletin No. 5 - Hazard Communication Temporary Worker Initiative Bulletin No. 6 – Bloodborne Pathogens Temporary Worker Initiative Bulletin No. 7 - Powered Industrial Truck Training Temporary Worker Initiative Bulletin No. 8 - Respiratory Protection Temporary Worker Initiative Bulletin No. 9 - Noise Exposure and Hearing Conservation Temporary Worker Initiative Bulletin No. 10 - The Control of Hazardous Energy (Lockout/Tagout) NEW Temporary Worker Initiative Bulletin No. 11 – Safety and Health in Shipyard Employment NEW

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2/21/20, 11:07 AMTemporary Workers | Occupational Safety and Health Administration

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Ignorance of hazards is not an excuse. Staffing agencies need not become experts on specific workplace hazards, but they should determine what conditions exist at their client (host) agencies, what hazards may be encountered, and how best to ensure protection for the temporary workers. The staffing agency has the duty to inquire and verify that the host has fulfilled its responsibilities for a safe workplace. And, just as important: Host employers must treat temporary workers like any other workers in terms of training and safety and health protections.

How Can OSHA Help?

Workers have a right to a safe workplace. If you think your job is unsafe or you have questions, contact OSHA at 1-800-321-OSHA (6742). It's confidential. We can help. For other valuable worker protection information, such as Workers' Rights, Employer Responsibilities and other services OSHA offers, visit OSHA's Workers' page.

OSHA also provides help to employers. OSHA's On-Site Consultation Program offers free and confidential occupational safety and health services to small and medium-sized businesses in all states and several territories, with priority given to high-hazard worksites. To locate the OSHA On- Site Consultation Program nearest you, call 1-800-321- 6742 (OSHA) or visit www.osha.gov/consultation.

Temporary Workers' Rights Pamphlet

News Releases

November 13, 2018 [Region 7 News Release] U.S. Department of Labor Cites Nebraska Staffing Agency Following Heat- Related Fatality

May 11, 2018 [Region 4 News Release] U.S. Department of Labor Cites Contractor and Staffing Agency Following Fatal Trench Collapse at Alabama Work Site

Read More....

UNITED STATES DEPARTMENT OF LABOR

Occupational Safety and Health Administration 200 Constitution Ave NW Washington, DC 20210 ( 800-321-6742 (OSHA) TTY www.OSHA.gov

FEDERAL GOVERNMENT

White House Severe Storm and Flood Recovery Assistance Disaster Recovery Assistance DisasterAssistance.gov USA.gov No Fear Act Data U.S. Office of Special Counsel

OCCUPATIONAL SAFETY AND HEALTH

Frequently Asked Questions A - Z Index Freedom of Information Act Read the OSHA Newsletter Subscribe to the OSHA Newsletter OSHA Publications Office of Inspector General

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2/21/20, 11:06 AMWomen in Construction | Personal Protective Equipment | Occupational Safety and Health Administration

Page 1 of 2https://www.osha.gov/doc/topics/women/ppe.html

UNITED STATES DEPARTMENT OF LABOR

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Women in Construction ' CONSTRUCTION INDUSTRY

Best Practice: In addition to compliance with the OSHA regulations, whenever employers are required to purchase PPE, they should purchase these items in size ranges suitable for women. Employers should maintain a directory of PPE manufacturers and suppliers on hand, identify a wide selection of size ranges for PPE, keep appropriate size ranges in stock, and ensure direct accessibility, as required. Remember: One size does not fit all!

Personal Protective Equipment Many women in nontraditional jobs, such as the construction trades, have encountered improperly fitting personal protective equipment (PPE) and personal protective clothing (PPC) which may compromise their personal safety.

Personal protective equipment used by women workers should be based upon female anthropometric (body measurement) data. Women should make a point to test employer provided PPE, and if the provided PPE is uncomfortable, or not suitable for the worker (e.g., improperly fitting or damaged from wear or defect) they should report this condition to their employer for a suitable replacement.

PPE must fit properly so that it can effectively protect the employee from the hazard for which it was designed. Today there has been tremendous progress in the availability of PPE for women. The International Safety Equipment Association (ISEA) reports that many employers now provide a full range of sizes for PPE. ISEA lists manufacturers who offer safety equipment in various sizes that is appropriate for women in construction.

The Ontario Women’s Directorate and the Industrial Accident Prevention Association (IAPA) co-authored a 35 page publication titled, Personal Protective Equipment For Women – Addressing the Need.

Both, the ISEA list and IAPA publication can be found under PPE for Women.

Other Related Factors Include:

Limited employer knowledge in how to obtain health and safety products specifically, designed for females working in non-traditional jobs, and Limited availability of a full range of stock and sizes of PPE, at the retail/wholesale/distributor levels for health and safety product lines designed for women workers. Providing Safety and health Protection for a Diverse Construction Workforce: Issues and Ideas. NIOSH/CDC, DHHS (NIOSH) Publication 99-140, 5 pages (1999).

UNITED STATES DEPARTMENT OF LABOR

Safety and Health Topics / Women in Construction

Occupational Safety and Health Administration CONTACT US FAQ A TO Z INDEX ENGLISH ESPAÑOL

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2/21/20, 11:06 AMWomen in Construction | Personal Protective Equipment | Occupational Safety and Health Administration

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Occupational Safety and Health Administration 200 Constitution Ave NW Washington, DC 20210 ( 800-321-6742 (OSHA) TTY www.OSHA.gov

FEDERAL GOVERNMENT

White House Severe Storm and Flood Recovery Assistance Disaster Recovery Assistance DisasterAssistance.gov USA.gov No Fear Act Data U.S. Office of Special Counsel

OCCUPATIONAL SAFETY AND HEALTH

Frequently Asked Questions A - Z Index Freedom of Information Act Read the OSHA Newsletter Subscribe to the OSHA Newsletter OSHA Publications Office of Inspector General

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2/21/20, 11:05 AM1910.12 - Construction work. | Occupational Safety and Health Administration

Page 1 of 2https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.12

By Standard Number / 1910.12 - Construction work.

Part Number: 1910 Part Number Title: Occupational Safety and Health Standards Subpart: 1910 Subpart B Subpart Title: Adoption and Extension of Established Federal Standards Standard Number: 1910.12 Title: Construction work. GPO Source: e-CFR

1910.12(a) "Standards." The standards prescribed in part 1926 of this chapter are adopted as occupational safety and health standards under section 6 of the Act and shall apply, according to the provisions thereof, to every employment and place of employment of every employee engaged in construction work. Each employer shall protect the employment and places of employment of each of his employees engaged in construction work by complying with the appropriate standards prescribed in this paragraph.

1910.12(b) "Definition." For purposes of this section, "Construction work" means work for construction, alteration, and/or repair, including painting and decorating. See discussion of these terms in 1926.13 of this title.

1910.12(c) "Construction Safety Act distinguished." This section adopts as occupational safety and health standards under section 6 of the Act the standards which are prescribed in part 1926 of this chapter. Thus, the standards (substantive rules) published in subpart C and the following subparts of part 1926 of this chapter are applied. This section does not incorporate subparts A and B of part 1926 of this chapter. Subparts A and B have pertinence only to the application of section 107 of the Contract Work Hours and Safety Standards Act (the Construction Safety Act). For example, the interpretation of the term "subcontractor" in paragraph (c) of 1926.13 of this chapter is significant in discerning the coverage of the Construction Safety Act and duties thereunder. However, the term "subcontractor" has no significance in the application of the Act, which was enacted under the Commerce Clause and which establishes duties for "employers" which are not dependent for their application upon any contractual relationship with the Federal Government or upon any form of Federal financial assistance.

1910.12(d) For the purposes of this part, to the extent that it may not already be included in paragraph (b) of this section, "construction work" includes the erection of new electric transmission and distribution lines and equipment, and the alteration, conversion, and improvement of the existing transmission and distribution lines and equipment.

UNITED STATES DEPARTMENT OF LABOR

2/21/20, 11:05 AM1910.12 - Construction work. | Occupational Safety and Health Administration

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Occupational Safety & Health Administration 200 Constitution Ave NW Washington, DC 20210 ! 800-321-6742 (OSHA) TTY www.OSHA.gov

FEDERAL GOVERNMENT

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OCCUPATIONAL SAFETY & HEALTH

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2/21/20, 11:04 AM1902.2 - General policies. | Occupational Safety and Health Administration

Page 1 of 2https://www.osha.gov/laws-regs/regulations/standardnumber/1902/1902.2

By Standard Number / 1902.2 - General policies.

Part Number: 1902 Part Number Title: State Plans for the Development and Enforcement of State Standards Subpart: 1902 Subpart A Subpart Title: General Standard Number: 1902.2 Title: General policies. GPO Source: e-CFR

1902.2(a) Policy. The Assistant Secretary will approve a State plan which provides for an occupational safety and health program with respect to covered issues that in his judgment meets or will meet the criteria set forth in 1902.3. Included among these criteria is the requirement that the State plan provide for the development and enforcement of standards relating to issues covered by the plan which are or will be at least as effective in providing safe and healthful employment and places of employment as standards promulgated and enforced under section 6 of the Act on the same issues. In determining whether a State plan satisfies the requirement of effectiveness, the Assistant Secretary will measure the plan against the indices of effectiveness set forth in 1902.4.

1902.2(b) Developmental plan. A State plan for an occupational safety and health program may be approved although, upon submission it does not fully meet the criteria set forth in 1902.3, if it includes satisfactory assurances by the State that it will take the necessary steps to bring the State program into conformity with these criteria within the 3-year period immediately following the commencement of the plan's operation. In such case, the State plan shall include the specific actions it proposes to take and a time schedule for their accomplishment not to exceed 3 years, at the end of which the State plan will meet the criteria in 1902.3. A developmental plan shall include the date or dates within which intermediate and final action will be accomplished. If necessary program changes require legislative action by a State, a copy of a bill or a draft of legislation that will be or has been proposed for enactment shall be submitted, accompanied by (1) a statement of the Governor's support of the legislation and (2) a statement of legal opinion that the proposed legislation will meet the requirements of the Act and this part in a manner consistent with the States constitution and laws. On the basis of the State's submission the Assistant Secretary will approve the plan if he finds that there is a reasonable expectation that the State plan will meet the criteria in 1902.3 within the indicated 3-year period. In such case, the Assistant Secretary shall not make a determination under section 18(e) of the Act that a State is fully applying the criteria in 1902.3 until the State has completed all the developmental steps specified in its plan which are designed to make it at least as effective as the Federal program, and the Assistant Secretary has had at least 1 year to evaluate the plan on the basis of actual operations. If at the end of 3 years from the date of commencement of the plan's development, the State is found by the Assistant Secretary, after affording the State notice and opportunity for a hearing, not to have substantially completed the developmental steps of the plan, the Assistant Secretary shall withdraw the approval of the plan.

1902.2(c) Scope of State plan.

1902.2(c)(1) A State plan may cover any occupational safety and health issue with respect to which a Federal standard has been promulgated under section 6 of the Act. An "issue" is considered to be an industrial, occupational or hazard grouping which is at least as comprehensive as a corresponding grouping contained in

2/21/20, 11:04 AM1902.2 - General policies. | Occupational Safety and Health Administration

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1902.2(c)(1)(i) one or more sections in Subpart B or R of Part 1910 of this chapter, or

1902.2(c)(1)(ii) one or more of the remaining subparts of Part 1910. However, for cause shown the Assistant Secretary may approve a plan relating to other industrial, occupational or hazard groupings if he determines that the plan is administratively practicable and that such groupings would not conflict with the purposes of the Act.

1902.2(c)(2) Each State plan shall describe the occupational safety and health issue or issues and the State standard or standards applicable to each such issue or issues over which it desires to assume enforcement responsibility in terms of the corresponding Federal industrial, occupational or hazard groupings and set forth the reasons, supported with appropriate data, for any variations the State proposes from the coverage of Federal standards.

1902.2(c)(3) The State plan shall apply to all employers and employees within the affected industry, occupational or hazard grouping unless the Assistant Secretary finds that the State has shown good cause why any group or groups of employers or employees should be excluded. Any employers or employees so excluded shall be covered by applicable Federal standards and enforcement provisions in the Act.

UNITED STATES DEPARTMENT OF LABOR

Occupational Safety & Health Administration 200 Constitution Ave NW Washington, DC 20210 ! 800-321-6742 (OSHA) TTY www.OSHA.gov

FEDERAL GOVERNMENT

White House Severe Storm and Flood Recovery Assistance Diaster Recovery Assistance DisasterAssistance.gov USA.gov No Fear Act Data U.S. Office of Special Counsel

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