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  • ACOEM Comments on Proposed Revisions to OSHA Safety and Health Program Management Guidelines

    February 18, 2016

    The Honorable David Michaels
    Assistant Secretary
    Occupational Safety and Health Administration
    U.S. Department of Labor
    200 Constitution Avenue, N.W.
    Washington, DC 20210

    Re: Docket No. OSHA-2015-0018; OSHA Safety and Health Program Management Guidelines

    Dear Dr. Michaels:

    The American College of Occupational and Environmental Medicine (ACOEM) is pleased to respond to OSHA’s request for comments on the revisions to the Safety and Health Program Management Guidelines.

    ACOEM, an international society of more than 4,000 occupational and environmental physicians, provides leadership to promote optimal health and safety of workers, workplaces, and environments. Our medical specialty, occupational and environmental medicine (OEM) is devoted to prevention and management of occupational and environmental injury, illness and disability, and promotion of health and productivity of workers, their families, and communities.

    Overall, ACOEM applauds OSHA’s efforts to strengthen workplace preventive efforts, and recognizes the importance of systematic planning and high-level management support for key elements of successful preventive programs, including employer affirmation of the importance of safety and health, a clear system of accountability, ongoing surveillance for potential workplace hazards, skilled investigation of workplace injuries and “near misses,” engagement of workers in setting workplace health and safety policies, effective training, and careful attention to the control or elimination of identified risks.

    To that end, ACOEM has long supported promulgation of a new OSHA standard related to requiring employers to implement Injury and Illness Prevention Programs (IIPPs). As an intermediate step, ACOEM supports the promulgation of clear guidelines that may help achieve the same objectives for effective preventive activities in workplaces through voluntary cooperation.

    A guidance document such as this one will be most effective, in ACOEM’s view, if its recommendations are both feasible and clear, with easily understood “triggers” for specific preventive steps in the workplace. This idea is discussed in more detail below under Answer #4.

    OSHA has posed 13 questions regarding its Guidelines. We respond to several of these questions below.

    1. Should OSHA consider changing the title of the document?
    ACOEM would favor a title that includes, or closely reflects, the terms “Injury and Illness Prevention Plans/Programs,” since there is already an appreciable literature on this subject. ACOEM notes that this document’s goal appears to be to encourage employers to implement a systematic approach to injury and illness prevention, which would be the equivalent of I2P2s.

    2. Does the section on Program Evaluation and Improvement make it clear that employers are to improve their programs over time as their evaluation suggests ways to enhance program performance on an ongoing basis?
    Yes, we believe that the message about a continuous improvement process comes through clearly in the document. However, ACOEM also believes that certain proven preventive techniques are already so well established that they should be part of an effective safety management and prevention program right from the start. That is, we would not want to sanction weak or partial Prevention Plans, or encourage employers to delay effective planning for workplace safety. The prevention strategies discussed in these draft Guidelines have been known, accepted and readily available for decades, and many are already required by regulation, in whole or in part, in at least 22 states as part of “state plan” standards.

    3. Has OSHA achieved its objective to write the guidelines in language that is appropriate for, and easily understood by small and medium-sized businesses and their workers without relying on consultants or outside assistance?
    The document appears quite clear overall. However, ACOEM believes that the document would benefit from the inclusion of additional clear “triggers” for employer action, as we discuss in the next answer.

    4. Have the guidelines overlooked any concepts or actions that are critical to establishing and maintaining an effective safety and health program?
    a) The Prevention Plan should always be in writing, and should be updated periodically, at least every one to two years.
    b) The Prevention Plan should establish clear accountability as to which individual(s) will be responsible for implementing which parts of the plan. Furthermore, it is often very helpful, although not always essential, to spell out how a “Health and Safety Leader” will report to upper management.
    c) In the section on employee participation, we suggest stronger language and additional detail about how worker participation will be incorporated into the setting of health and safety policies. Under Action Item 1 (page 8) ACOEM recommends that OSHA additionally call on employers to establish an anonymous system for employees to report safety concerns to employers. (On page 8 we find the statement “Reporting processes may have an anonymous component.”) However, ACOEM believes that it is very important for employers to document that they have implemented a system for anonymous reporting of possible safety risks, and further to document that employees have been trained in how to access that anonymous reporting system. Furthermore, we have learned from other OSHA standards that have explicit requirements for worker involvement (such as the bloodborne pathogen standard and the respirator standard) that it is very helpful for the employer to document and track how employee involvement is sought. That is, we believe employee participation in risk reporting and in the setting of health and safety policies is itself a variable which management should track. We suggest that Action Item #3 be strengthened accordingly.
    d) Under the section on Hazard Identification and Assessment (pages 11-15), ACOEM has found that the use of written checklists (as mentioned on page 12) is nearly essential, and we applaud OSHA for including this recommendation. The section on “incident investigations” (page 13) mentions that accident investigation teams should be trained. ACOEM believes that the training of incident investigation teams is a step too often overlooked by employers, and would encourage OSHA to provide additional detail here, in order to assure that such investigations are conducted thoroughly and consistently. To assure that investigation of accidents and near misses will be effective, we recommend additional steps: investigators should generally work from an organized checklist, with input from both management and workers on the details of the checklist.
    e) The section on Hazard Prevention and Control (pages 16-18) has little detail on how a written prevention plan will specify who should review the completed checklists (completed during hazard assessments and incident investigation), or other information about identified hazards. ACOEM believes that this is an area where careful attention to process details is helpful; to prevent surveillance activities from becoming hollow or meaningless exercises. For example, the written prevention plan might specify how minutes of safety meetings will be kept, so that identified problems are not disregarded, or patterns of problems overlooked, and should specify accountability for review of such data, including details of the reporting line up to a “Health and Safety Chief.”
    f) In the section on Education and Training (pages 19-20), we suggest additional discussion, with illustrative examples, of how the employer can assess the “effectiveness” of worker training. An illustrative example would be OSHA’s Occupational Noise Exposure Standards (29 CFR 1910.95). The employer should not only assess whether workers are wearing hearing protectors (29 CFR 1910.95(i)) but whether workers are losing hearing. For certain kinds of workplace risks (for example, in the deployment of PPE for hospital workers caring for certain infectious diseases) trained workers should be able to demonstrate both knowledge and motor skills required to keep them safe from hazards. That is, in dealing with many kinds of workplace risks, it is often not enough for a worker merely to understand the risks and the appropriate mitigation measures. The worker may also need to practice and demonstrate the needed skills to carry out those mitigation measures precisely and reliably. An important corollary is that Prevention Plans should include some features related to retraining and even corrective action, up to and including disciplinary action when necessary.
    g) Overall ACOEM believes that this document would be more useful if it more often contained bright lines and triggers for particular preventive steps to be taken employers. For example, are there specific risks or situation that should prompt an employer to implement specific portions within these guidelines? For example, should an employer ALWAYS prepare a written Prevention Plan? What if the employer identifies, say, 2 or more of the risks mentioned in Appendix B? In those cases, because the employer will now be faced with more complex and potentially overlapping hazards, employers might be advised would be well advised to write at a minimum a written Prevention Plan with subsections on worker training and use of PPE, with the inclusion of written checklists as discussed under paragraph d above. Other actionable “triggers” might include the reporting of two or more work injuries or “near misses” with similar mechanisms of injury. Workplace hazards for which OSHA has previously issued other guidance documents (for example, violence prevention in health care settings) might automatically trigger the preparation of a written prevention plan.

    5. Can you submit to OSHA any case studies or other documentation that illustrates the effects (benefits, organizational impacts) of fully implementing a safety and health program similar to the program described in OSHA’s guidelines?
    No response.

    6. Are these Guidelines consistent with comparable guidelines by ASSE or OHSAS?
    No response.

    7. Do these guidelines contain any action items that cannot be fully implemented or are too difficult to be implemented by small and medium-sized businesses?
    We have not identified any action items that would in general be unfeasible for small and medium-sized businesses. However, ACOEM would support a recommendation that small businesses (for example, with 10 or fewer employees) could be exempted from any provision that communication of workplace hazards must be in writing, to permit verbal communication of workplace hazards. This approach has worked fairly well in California under its IIPP standard (8 CCR 3203).

    8. Are there industries or types of workplaces in which these guidelines are not appropriate or would be difficult to implement?
    We have not identified any specific industries of types of workplaces for which these guidelines would not be appropriate. In general, ACOEM favors the principle that in general all employers will benefit from preparing a written Prevention Plan, dealing with potential workplace hazards, and setting out procedures for soliciting input from employees on workplace health and safety.

    9. Has the section on Coordination and Communication on Multiemployer Worksites effectively conveyed actions needed to protect all workers?
    Yes, we applaud the inclusion of this section, although we also would suggest strengthening the recommendation that contractors assure that their own prevention plans are consistent with those of subcontractors. That is, work at a multi-employer worksite should not proceed until the general contractor has assured that each subcontractor, where appropriate, has a written prevention plan with all required elements (hazard assessment, incident investigation, risk mitigation, worker training, and program evaluation) prepared in a way that is consistent with the contractor’s own written prevention plan.

    10. Should OSHA develop additional tools and resources beyond those specified in Appendix A?
    We recommend including in the Appendix a link to the NIOSH Total Worker Health® resources — http://www.cdc.gov/NIOSH/twh/. The Total Worker Health (TWH) approach advocates for a holistic understanding of the factors that contribute to worker wellbeing. Scientific evidence now supports what many safety and health professionals, as well as workers themselves, have long suspected — that risk factors in the workplace can contribute to health problems previously considered unrelated to work.

    We also recommend providing a link to the National Standard of Canada — Psychological health and safety in the workplace — Prevention, promotion, and guidance to staged implementation. This is a voluntary standard that specifies requirements for a documented and systematic approach to develop and sustain a psychologically healthy and safe workplace. “Psychological health and safety is embedded in the way people interact with one another on a daily basis and is part of the way working conditions and management practices are structured and the way decisions are made and communicated. While there are many factors external to the workplace that can impact psychological health and safety, this Standard addresses those psychological health and safety aspects within the control, responsibility, or influence of the workplace that can have an impact within, or on, the workforce.”

    Further, employers should be made aware of the Standard for Integrating Health and Safety in the Workplace, UL 904Z, which was developed in collaboration with key industry stakeholders. It offers organizations a set of components that should be considered as part of integrated health and safety programming. Although a growing body of research conceives that establishing a culture of health, safety and wellbeing for workers is dependent on the integration of health and safety efforts, the number of employers actively implementing this concept remains small.

    The standard provides guidance for organizations to operationalize integrated health and safety programming, and using IHSI’s Integrated Health and Safety Index, organizations will be able to measure the effectiveness of their integrated health and safety strategies. Developed by UL and ACOEM and based on the Dow Jones Sustainability Index, the IH&S Index allows companies to translate the impact of employer health and safety programs in three core dimensions: economic, environmental and social.

    11. Some of the actions recommended in these guidelines are also required in certain circumstances by OSHA standards. Appendix B lists OSHA standards that contain requirements that are the same or similar to the actions recommended in the Guidelines. Is Appendix B needed and helpful? Is there a more effective way to convey the information contained in Appendix B?
    We find Appendix B to be a very helpful compilation of the requirements of various OSHA standards. Of interest, the “gaps” in the table of the Appendix may be their most illustrative feature, since those gaps represent additional opportunities for preventive activities such as those envisioned by these guidelines.

    12. What type of information is most persuasive to small and medium-sized businesses about the benefits of implementing a safety and health program in their workplace? Who can speak most persuasively about the topic (e.g., other business owners/managers, OSHA staff, consultants, etc.)? What stops small and medium-sized businesses from adopting a safety and health program?
    We direct OSHA’s attention to the work being done by Health Links™, a non-profit initiative that is housed within the Center for Health, Work & Environment in the Colorado School of Public Health,

    To assess small business adoption and need for health promotion programs — and understand how health promotion affects health protection — they are conducting the Health Risk Management Study, which is the first field-based study to examine a broad-scale implementation of health promotion in a large number of small businesses. The state-based workers’ compensation insurer for Colorado, Pinnacol Assurance, agreed to provide their policyholders with free access to online health risk assessments, telephonic coaching, and advising on health promotion program design. This intervention aims to assess the impact worker health, workers’ compensation claims and costs, and productivity. Initially, they examined the health risk assessment data for 6,507 employees in the first 260 participating companies, and identified a number of important modifiable health risks in the population. They are now analyzing results for 14,406 workers who have completed up to three health risk assessments between 2009-2013, examining the relationship between the self-reported health and health risk factors of employees and their risk of work-related injuries (frequency, severity, and cost), in a prospective, longitudinal study design, clustering within employer. They are also completing the analysis of a nested case-referent study, using non-participating businesses as the reference group for examining workers’ compensation outcomes. Several manuscripts based on these data are in preparation or have been submitted for publication.

    As of 2015, in 2.5 years of operation, 145 small businesses have engaged in Health Links, representing over 80,000 employees across the state of Colorado. The majority of the businesses are small and represent a range of industries, including food service, utilities, real estate, energy, and health care, among others. Preliminary data indicate that the majority of certified businesses are starting health and safety programs because they are interested in improving the health of their employees and their families (89%), improving employee morale (83%), enhancing productivity (83%), and increasing employee retention (68%).

    13. Should OSHA plan to hold stakeholder meeting(s) to allow the public to discuss the guidelines with Agency officials face-to-face? Would holding such a meeting(s) be productive and result in significant improvements in the guidelines? Would you participate in such a meeting?
    ACOEM is aware that OSHA held a series of nationwide workshops on a possible new standard for Injury and Illness Prevention Programs (I2P2), and gathered considerable input, which should be relevant for these guidelines. We are not aware of a large body of additional information that has been developed since that time. Accordingly, we are not persuaded that additional stakeholder meetings should be a high priority. However, ACOEM would stand ready to participate in such workshops if OSHA should convene them.

    The guidelines are silent on issues related to the growing recognition that the work environment and employer programs and practices influences personal as well as occupational health. ACOEM believes that workplace prevention programs are best implemented in the context of other health and safety interventions, including workplace wellness programs and coordination of employee benefits. ACOEM recognizes that mixing personal health issues with investigation of health and safety hazards can sometimes run the risk of appearing to “blame the worker” for workplace injuries and illnesses. Accordingly, joint evaluation of safety issues with health and wellness issues is probably best done by assessing aggregate data behind a medical firewall — an idea that underscores the importance of an occupational medicine presence in these programs. As well, ACOEM emphasizes that the most effective interventions to improve overall workforce health rely on creating a work environment that protects employees from harm and lowers barriers to and supports self-care and healthy lifestyles.

    Thank you for your consideration of our comments. Please do not hesitate to contact me should you have any questions.

    Sincerely,

    Mark A. Roberts, MD, PhD, MPH, FACOEM
    President