Professional Safety - July 2020

LIGHT

& Lighting Basics
for OSH Professionals

Using EMR for
Prequalification

Workplace Violence
in Healthcare

ASSP.ORG JJUUNLYE 2020

The secret to
improved safety
is no secret.

Our signage can create
a culture of safety.

Marlin digital signage is an engaging, state-of-the-
art approach to encouraging safety. You can use
our industry-specific content, your own in-house
messaging, or any combination. Any industry’s needs
can be met, including yours.

The bottom line: An effective safety program with
our digital signage can cost less than you think,
and may even pay for itself.

FREE DEMO AND Get your no-obligation demo and/or free workplace safety guide Making Safety Visual:
VALUABLE GUIDE 10 Proven Strategies. Call 800-344-5901 or visit themarlincompany.com/assp.

Back to Work Safety © 2020 Accuform. All rights reserved.

Promote industrial hygiene to prevent
the spread of germs

Get Your FREE Back To
Work Quick Start Guide at:
Accuform.com/BackToWork

CONTENTS
Features

Peer-Reviewed

22 31 39

LIGHT & EXPERIENCE WHO IS PROTECTING
LIGHTING BASICS MODIFICATION RATE HEALTHCARE
for OSH Professionals as a Pre-Qualification PROFESSIONALS?
Criterion for Safety Workplace Violence &
By William Mills, Kevin Performance the Occupational Risk
Martin and Justin Cathey of Providing Care
By Ahmed Jalil Al-Bayati,
Most OSH professionals’ expe- Kevin O’Barr, SungJoon By Monica Nevels, Wesley
rience with light and artificial Suk, Alex Albert and Jarred Tinker, John N. Zey and
light is limited. LED lighting is Chappell Tricia Smith
being rapidly adopted in all in- Healthcare providers are one of
dustries and homes due to energy Experience modification rate the highest risk groups for work-
and cost reductions and longer (EMR) is commonly used as a place violence. Despite efforts to
product life. Current research prequalification criterion to as- push this issue into the spotlight,
has provided new insight on nu- sess the capabilities of bidders in the tenacity of those passionate
merous impacts of lighting on ensuring workplace safety. This about prevention will be needed
human health and productivity. study investigates factors that for a federally mandated rule to
New metrics and instruments are contribute to firms’ EMR to eval- come to fruition. To make mea-
needed to monitor and manage uate the reliability and validity of surable and meaningful impact,
these issues. This article provides EMR as a safety prequalification employers must also respond to
a review of the emerging issues criterion. The survey results sug- this risk as it impacts not only
regarding lighting that are im- gest that several non-safety-relat- employees, but those they serve.
portant to the OSH professional. ed factors contribute to EMR.

JULY 2020 ABOUT PROFESSIONAL SAFETY
VOL. 65, NO. 7
Professional Safety is a blind peer-reviewed journal published monthly by
COVER the American Society of Safety Professionals, the oldest professional safety
society. Professional Safety keeps the professional OSH specialist informed on
Humans are so developments in the research and technology of incident prevention, industry
accustomed to best practices and safety management techniques.
working and living
in artificial light Judgments made or opinions expressed in Professional Safety feature articles,
that many have news sections, letters to the editor, meeting reports or related journal content
not considered the do not necessarily reflect the views of the editor, nor should they be considered
implications. Photo an expression of official policy by ASSP. They are published for the purpose of
composite Lidiia stimulating independent thought on matters of concern to the OSH profession
Moor/iStock/Getty and its practitioners.
Images Plus and
wacomka/iStock/ Correspondence should be addressed to the editor. Professional Safety
Getty Images Plus reserves the right to edit all journal content to improve clarity and grammar, to
adhere to journal style, and for length as needed. Final editorial decisions are at
the discretion of the ASSP editorial team.

2 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

Portable gas detectors you can count on

MGC Simple & Simple Plus

multi gas detectors that you
never have to charge

Our Family of Products

2 year Multi Gas Clip
multigas
The portable multi gas detector that can run
MGC Simple continuously for two months on one charge
due to advanced infrared sensor technology.
Detects combustible gases (LEL), H2S, CO and O2.

Multi Gas Clip Pump

Compact, light-weight, handheld/wearable multi gas
detector with internal pump draws from 75 ft. & runs
for an average of 52 hours on a single charge. Detects
combustible gases (LEL), H2S, CO and O2.

3 year Single Gas Clip
multigas
Eliminate downtime with our ultra-reliable
MGC Simple portable gas detector. Detects H S, CO or O .
Plus
22
Detects combustible gases (LEL),
hydrogen sulfide (H2S), carbon monoxide (CO) Single Gas Clip Plus

and oxygen (O2) Hibernate mode offers extended life option
when detector is not in use. Detects H S or CO.
‹Two/three year run time with no charging
‹Calibration not necessary 2
‹Detect in oxygen deficient or oxygen
Compatible Docking Stations
enriched environments
‹LEL sensor is immune to sensor poisoning All-in-one, portable, durable four-bay dock
‹Fails to safe stations quickly bump test, calibrate & log
‹Simple, one button operation
‹Logs data at one second intervals whenever data for up to four detectors at once
with the push of a button and one
gas is detected, records bump tests & events stream of gas saving time and money.
‹100% Quality control tested Charge once every six months. Perform 2000+
‹Full two/three year warranty bump tests with one 116L gas cylinder.

Single Gas Clip Dock, Multi Gas Clip Dock,
MGC Pump Clip Dock & MGC Simple Clip Dock

Call or visit our website for simple cost-effective solutions to your gas detection needs

Gas Clip Technologies • gascliptech.com • +1.972.775.7577 • 1.877.525.0808

CONTENTS
Departments

6 President’s Message 46 Checkpoints EDITORIAL STAFF
Embracing our more visible role Playground safety: The difference Tina Angley, Editor
between public and residential (847) 768-3438;
7 ASSP Connection playgrounds [email protected]
The sustainable practice: ASSP’s
Environmental Practice Specialty 47 Vantage Point Sarah Astra, Associate Editor
The impact of decisions (847) 768-3414;
9 Safety Matters [email protected]
Hurricane preparedness, heat 48 Math Toolbox
stress, total worker health, Applying STEM principles to Griffin White, Assistant Editor
firefighting foam research, eye and everyday safety issues (847) 768-3468;
face protection [email protected]
53 Product Pulse
13 Best Practices The latest safety innovations Publication Design Inc.
Controlling COVID-19 transference Design Consultants
through HVAC systems 54 Vantage Point
Transitioning from university to EDITORIAL REVIEW BOARD
16 Worth Reading industry Frank G. D’Orsi, CSP, ARM,
Book reviews of Safe By Accident? CHCM, Chair
and Organization Culture Killers 56 By the Way
All the world’s a stage Salvatore Caccavale, CPEA
18 Best Practices
How to motivate with consquences David A. Dodge, P.E., CSP

44 Best Practices Cari M. Elofson, CHST
Implementing telematics devices for
safer driving E. Andrew Kapp, Ph.D., CSP,
CHMM
Professional Safety copyright Professional Safety is available
©2020 by American Society of free online to ASSP members at Steve Minshall, CSP, CIH
Safety Professionals. All rights www.assp.org/publications/
reserved. No copyright is claimed in professional-safety. Articles are Justin J. Molocznik, CSP, CHST
any works of the U.S. government also available via microform
that may be published herein. and/or electronic databases Matthew D. Reyes, Ph.D.
For information on reprinting or from ProQuest, P.O. Box 1346,
reproducing articles published in Ann Arbor, MI 48106-1346 USA; SOCIETY OFFICERS
Professional Safety, visit www.assp phone +1 (800) 521-0600. For Deborah R. Roy, M.P.H., R.N., CSP,
.org/publications/professional-safety. specific format details, visit www.proquest COHN-S, CIT, FASSP, FAAOHN
.com. President
PSJ (ISSN 0099 0027) is published
monthly by the American Society of Safety POSTMASTER: Send address changes Bradley D. Giles, P.E., CSP, STS,
Professionals, 520 N. Northwest Highway, to Change of Address Dept., ASSP, 520 N. FASSP, GIOSH
Park Ridge, IL 60068-2538 USA; phone (847) Northwest Highway, Park Ridge, IL 60068- President-Elect
699-2929; [email protected]. 2538 USA.
Periodicals postage paid at Park Ridge, IL, Christine M. Sullivan, CSP, ARM
and at additional mailing offices. Senior Vice President

Linda M. Tapp, CSP
Vice President, Finance

Todd William Loushine, Ph.D.,
P.E., CSP, CIH
Vice President,
Professional Development

Jennifer M. McNelly
Chief Executive Officer

ADVERTISING REPRESENTATIVE
Michael Sanders
(847) 232-2038;
[email protected]

4 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

EARN A SAFETY

CERTIFICATE

For more than 100 years, the American Society of
Safety Professionals (ASSP) has delivered top-quality
safety education and training that can immediately
be put into practice. Whether you're just starting
the journey or a seasoned veteran, our certificates
are your guide to greater success. ASSP certificates
include:

Safety Management Leadership in Safety Global Safety
Certificate Management Certificate Management Certificate

Build professional credibility in Secure your leadership position Gain knowledge and skills to
your role with foundational and using contemporary safety implement the most effective
fundamental knowledge to feel methods and the power of techniques in global safety and
confident at your organization. influence. health management.

Required Courses (5.6 CEUs) Required Courses (3.5 CEUs) Required Courses (2.8 CEUs)
▪ Safety Management I ▪ Advanced Safety ▪ Managing Safety and Health
▪ Safety Management II ▪ Implementing a Safety and
▪ Corporate Safety Management Management Methods
Health Management System
▪ Influential Leadership Skills
▪ International Standards

and Legal Requirements for
Safety Management

Why Earn a ▪ Establish credibility as a leader and signify your commitment to the safety profession
Professional ▪ Gain a competitive advantage and maximize your earning potential
Certificate ▪ Become an indispensable asset and valuable resource to your workers and organization
from ASSP? ▪ Grow your professional network by learning alongside other safety professionals
▪ Understand and integrate best practices from leading organizations

Questions? Email [email protected]
or visit assp.org/certificates

PRESIDENT’S MESSAGE

EMBRACING OUR MORE VISIBLE ROLE

Deb Roy As I wrote this first message to parameters, including risk management,
you, I realized that my term as presi- capacity/resilience and sustainability/
Connect With Deb dent will be the first time since early in human capital.”
our more than 100-year history that the
Join Deb on LinkedIn or comment world is facing the same public health Pam’s words really resonated with
on her message at www.assp.org/ crisis at the same time. The SARS CoV-2 me. Our company leaders want answers.
news/presidents-message. virus has challenged each country to As OSH professionals, we are well posi-
find a strategy to protect public health tioned to provide those answers in the
Our unique skill and preserve its economy. Each country form of science-based solutions and best
set, knowledge and has tried various measures to flatten the practices that are grounded in an un-
curve, from containment with testing derstanding of our organization and our
experience place and contact tracing, to mitigation by industry. I have seen a growing number
us in a unique sheltering at home. There simply is no of social posts from OSH professionals
quick solution. saying they have been included in mak-
position to provide ing decisions, often for the first time.
the C-suite with Although the amplitude of the pan-
demic wave varies from one country to Unfortunately, the COVID-19 pan-
credible guidance, another, we all remain vulnerable to a demic continues to cause sickness and
informed risk analy- new coronavirus to which no one is im- death globally. But for OSH profession-
mune and for which there is no preven- als, this crisis presents us with a new
sis and practical tive vaccine. This creates a vital role for opportunity. Our unique skill set, knowl-
solutions that en- us as OSH professionals. We are evalu- edge and experience place us in a unique
able them to make ating this risk, interpreting the research, position to provide the C-suite with
good decisions that developing pandemic plans and helping credible guidance, informed risk analysis
protect employees, our organizations make the right de- and practical solutions that enable them
contractors and cisions to protect their stakeholders. I to make good decisions that protect em-
even had a client tell me recently that I ployees, contractors and customers.
customers. have spent my entire 35-plus year career
in occupational safety, occupational If you have not yet been asked to do
health and public health just to respond so, take some time to develop succinct
to this pandemic. These truly are un- summaries of the latest reputable data
precedented times. that applies to your industry and modify
existing pandemic plans based on what
During the first COVID-19 webinar has been learned so far during reopen-
I taught for ASSP on March 18, 2020, I ing. Then, start to consider the long-term
stated, “COVID-19 will likely be one of solutions that mitigate the risks, such as
the most challenging risks that we as OSH touchless design and new layouts that
professionals experience in our careers allow for distancing.
due to the level of unknowns.” We have
learned much about this virus in the past This pandemic will likely continue
5 months, but many questions remain. in waves for the next couple of years.
We have a tremendous opportunity to
As OSH professionals, we must con- learn and grow by using the valuable
tinue to monitor the latest research, resources readily available from ASSP,
identify the evolving risks, then develop OSHA, CDC and many other credible
innovative solutions that focus on the organizations and agencies. We fulfill a
higher levels of the hierarchy of controls. critical role that will impact the overall
Creative, practical and industry-specific well-being of much of the working pop-
solutions will position us in a more vis- ulation worldwide. Working together,
ible role within our organizations than we will create a safer, stronger future.
ever before. This is our time to shine. Let’s seize the
opportunity. PSJ
During her webinar, “COVID-19: Pro-
active OSH Performance During Chal- Deborah R. Roy, M.P.H., R.N.,
lenging Times,” fellow board member CSP, COHN-S, CIT, FASSP,
Pam Walaski, CSP, said, “OSH profes- FAAOHN
sionals have a unique opportunity to lead
their organizations in the post-pandemic
world.” She added that we are most ef-
fective when we understand how our
organization functions “along several

6 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

ASSP CONNECTION

THE SUSTAINABLE PRACTICE

ASSP’s Environmental Practice Specialty

By Richard Olawoyin

A refreshing surge in technological PEOPLEIMAGES/E+/GETTY IMAGES •hydrogen in the energy transition
innovations is changing our under- with affordable hydrogen-powered fuel
standing of contemporary economic Solutions to local and cell vehicles;
transformations and the associated envi-
ronmental challenges. Global economic global sustainability •electric public transit systems and
growth drives resource scarcity and the electric trucks that reduce emissions;
emergence of environmental issues. Thus, challenges are developed
modern economic growth is inspiring the •Google cars mapping air pollution and
need to investigate potential environmen- to benefit all, when we estimating the health effects in real time;
tal technology impacts on sustainability,
renewable and nonrenewable energy per- connect and share. •use of the Industrial Internet of
formance, and novel innovative technolo- Things to manage energy expenditure
gy on green transformation process. professionals, sustainability analysts, and reduce emissions in smart factories;
policy makers, technology developers and
Nearly 70% of toxic waste and flooding technology adopters play critical roles in: •smart agriculture in which sensors
sites in the U.S. are located near low-income help to modulate the amount of chemicals
housing and communities of color (Berg- •providing the regulatory framework, on the field and the chemical migration;
man, 2019; Dearen, Biesecker & Kastanis, contributing to the reduction of specific
2017). Racial animus and the propensity environmental impacts; •wearable bracelets for tracking daily
for early exposure to vulnerable environ- chemical exposures;
ments degrade human capital and depress •facilitating dialogue surrounding the
lifetime earnings for a disproportionate development and application of novel, •drone technology used to vaccinate
number of black Americans and other mi- enhanced technologies; endangered species;
nority groups, with a projected risk of about
459,000 job losses than white Americans •promoting adequate social conditions •space solar power and carbon, cap-
due to industrial automation (Baboolall, that stimulate and hasten the successful ture, utilization and storage technologies;
Pinder, Stewart et al., 2018; Manduca & adoption and implementation of these
Sampson, 2019). The inhibiting effect of technologies as a top priority in the •cheap long-term energy storage;
the wealth gap will cost the U.S. economy changing world. •3D printing technology for hazardous
about $1.5 trillion of the projected GDP by materials elimination and substitution;
2028 (Baboolall et al., 2018). Financial inclu- Technology provides an amenable solution •blockchain technology for improving
sion is an essential link between economic to tackle these issues helping to make the en- accountability and sustainability across
opportunity and sustainable environment vironment healthier, while ensuring that all the supply chain networks with inten-
outcomes (Furusawa, 2016). communities have equal and adequate access tional focus on minority communities;
to environmental protection programs. •smart policies, contracts documenta-
COVID-19 has delivered unexpected tion and reporting of impact assessments.
environmental gains such as cleaner air There are numerous benefits from Everything around us (in our environ-
and water, lower toxic emissions, and a these innovative and inspiring techno- ment) is in the value chain. Technology is
relief for wildlife. It is crucial to capitalize logical advancements, which include: helping us understand the impact on the
on these gains and continue to dialogue on environment better than ever before, re-
appropriate environmental efficiency and •autonomous and connected vehicles sulting in sustainable ecosystem steward-
effectiveness measures that will facilitate for safer travel and route optimization in ship, which will help maintain a healthy
policy making and balance economic and all communities; environment that accommodates social
social development in the quest of build- change in a robust global economy.
ing a more sustainable society. Proactive Groups around the world are advancing
environmental policies and strategies en- the course of posterity and prosperity in ef-
sure a win-win with improvement in both forts to advance this environmental agenda,
environmental and economic outcomes particularly after the excruciating impact
where the adoption and implementation of of the COVID-19 pandemic. Solutions to
innovative solutions lead to harmonization local and global sustainability challenges are
with other resources in the value chain. developed to benefit all, when we connect
and share. When practitioners, specialists,
Policies and actions designed to pro- scientists, students, engineers, innovators,
mote the conservation of the natural envi- teachers, business owners and all stakehold-
ronment, enhance pollutant disposability ers come together, great things happen.
and optimize output essentiality are For ASSP members, our Environmen-
positive outcomes of sustainable environ- tal Practice Specialty is an important
mental practices. Hence, environmental avenue through which to leverage the
connection between environmental solu-
tions, safety and health knowledge, and
job creation. The practice specialty pro-
vides an avenue for our collective efforts
to yield productive outcomes. The group

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 7

ASSP CONNECTION

is stronger with your support, working pact innovations and solutions, technol- •Dedicate a paragraph in your newslet-
together to contribute to taking actions ogy advancements initiatives, standards ter to conveying your collective discourse
across scales that can help shape the and regulations, and environmental and disseminate the information to your
future rather than focusing on bringing risk management and control. The goal communities.
back the past or on attaining perfection. is to provide competency knowledge in
We can achieve this through empowering a nonintrusive but collaborative way in All student members of the Environ-
knowledge sharing that can affect the all environmental application areas so mental Practice Specialty are invited to
national regulatory framework through that the practice specialty can serve as a attend our open call meetings and, upon
awareness of the value of human-environ- resource for educators, professionals and graduation, are encouraged to join us as
ment interactions. the industry. full members.

As we transition into the post-COVID-19 Engage on technical questions. The Let us invest for impact toward our
era, I encourage all members to think about Environmental Practice Specialty is eager sustainable goals and promote a social
how you can take action to get involved in to work with its membership to explore contract. Our combined efforts to serve
environmental issues. the value of providing a platform to as a valuable resource for knowledge
discuss complex strategic issues and, im- sharing, skills acquisition, continuing
Engage between meetings. Environ- portantly, asking technical questions that education, professional networking, and
mental Practice Specialty members can extend beyond the strategy and agenda to professional development of members are
join our open call meetings; it is even a wide range of issues. The focus is not on essential to ASSP’s objectives of working
more important to stay in touch with whether members have industry experi- together for a safer, stronger future.
fellow members between meetings and to ence, but whether they have access to par-
stay current with emerging environmen- ticipate on all practice specialty platforms We will continue the dialogue on how to
tal trends and topics, which is now possi- to ask important questions and contribute align with the environmental agenda to sup-
ble especially with access to many social to the shared knowledge. port long-term value creation. This call to
media and virtual networking platforms. purpose is a call to your passion for a more
Practice specialty members can help ele- The recognition that everyone is a peer sustainable environment for the species,
vate issues they encounter on the horizon by connecting the dots between issues, ecosystems and the overall society. PSJ
that can be shared with everyone and bridging disparate points, and building
provide feedback that will help our prac- a functional practice group with the References
tice continuously improve. capacity to respond to environmental
challenges as they arise is a quintessen- Baboolall, D., Pinder, D., Stewart, S., et al.
Engage with strategies as they tial vision of the Environmental Practice (2018, Nov. 14). Automation and the future of
form. Strategic alliance with diverse ex- Specialty. the African American workforce. McKinsey &
periences and pattern-recognition skills Co. Retrieved from www.mckinsey.com/fea
of experienced members would empower To future Environmental Practice Spe- tured-insights/future-of-work/automation
all to add significant value to the Soci- cialty members, please join us and let us -and-the-future-of-the-african-american
ety. This is possible when members are connect on this environmental agenda that -workforce
participating early during the strategy is nonprescriptive and all-inclusive. Being a
development, which becomes a shared member presents opportunities for: Bergman, M.M. (2019, Mar. 8). “They chose
and collaborative process in which differ- us because we were rural and poor”: When
ent opinions are valued and respected. In •continued environmental education environmental racism and climate change col-
effect, this contributes to the overall ef- through programs, seminars, webinars lide. The Guardian. Retrieved from www.the
fort of the Society and make us proactive and meetings; guardian.com/environment/2019/mar/08/cli
at addressing contemporary issues and mate-changed-racism-environment-south
providing real-time value to all members. •interactions with professional peers
for knowledge sharing; Dearen, J., Biesecker, M. & Kastanis, A.
Actively cultivate talents. The suc- (2017, Dec. 22). AP finds climate change risk
cess of every organization lies in proper •peer mentoring and skills development; for 327 toxic Superfund sites. AP News. Re-
planning for promotion and succession. •exposure to emerging environmental trieved from https://apnews.com/31765cc6d102
The goal of the Environmental Practice technology solutions; 44588805ee738edcb36b
Specialty is to move from simply engaging •professional recognition and leader-
and monitoring talents to actively cul- ship development. Furusawa, M. (2016, Sept. 20). Financial inclu-
tivating environmental practice talents. A special invitation to future leaders: sion: Bridging economic opportunities and out-
Experienced members can help to mentor I encourage ASSP student members to comes. International Monetary Fund. Retrieved
high-performing members, which allows become engaged with the Environmental from www.imf.org/en/news/articles/2016/09/20/
for a broader talent pool that will fill fu- Practice Specialty. Here is how: sp092016-financial-inclusion-bridging-economic
ture practice specialty leadership roles •Discuss environmental issues within -opportunities-and-outcomes
and positions. Mentees gain experience your ASSP student section.
through the engagement process, which •Carry out projects on environmental Manduca, R. & Sampson, R.J. (2019). Pun-
creates passionate, enthusiastic successors topics and share your work. ishing and toxic neighborhood environments
for the continuity of the practice specialty. independently predict the intergenerational
social mobility of black and white children.
Engage the environmental field. Mem- Proceedings of the National Academy of Sci-
bers are welcome to participate and ences of the United States of America, 116(16),
assume roles in specific Environmental 7772-7777. doi:10.1073/pnas.1820464116
Practice Specialty initiatives, such as
clean technologies, environmental im- Richard Olawoyin, Ph.D., CSP, is an associate professor of industrial and systems engineering
at Oakland University, Rochester, MI, where he also serves as faculty adviser for the National Society
of Black Engineers. He is a book author and chief editor, and has authored many peer-reviewed journal
articles. Olawoyin is a National Science Foundation panel reviewer, a member of the ABET Inclusion, Di-
versity and Equity Advisory Council, ABET Accreditation Council (training committee subgroup) and an
ABET Accreditation Commission member. Olawoyin is a professional member of ASSP’s Greater Detroit
Chapter and serves as Administrator of the ASSP Environmental Practice Specialty. He is the recipient of
the 2019 Charles V. Culbertson Outstanding Volunteer Service Award.

8 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

SAFETY MATTERS

ASSP Update MC1 MARTIN CUARON/U.S. NAVY

ASSP JOINS OSHA

AMBASSADOR PROGRAM
ASSP has elevated its collabo- projects and sharing expertise when
rative relationship with OSHA for needed. Many OSHA employees are OSHA Provides Hurricane
the betterment of workplace safety ASSP members and participate on Preparedness & Response
and health nationwide by joining our technical committees.” Resource Website
OSHA’s Ambassador Program.
Through ongoing engagement, OSHA’s Hurricane Preparedness and Response
The agreement was authorized ASSP has consistently supported page provides information for employers in areas at
by 2019-2020 ASSP President Diana key OSHA initiatives such as its risk of tropical storms and for those who are work-
Stegall, CSP, CFPS, ARM, SMS, Heat Illness Prevention campaign, ing in response and recovery. Employers can find
CPCU, and OSHA’s Loren Sweatt, National Safety Stand-Down to information on hurricane warnings, hazards, and
principal deputy assistant secretary Prevent Falls in Construction, and steps that workers and employers should take after a
of labor for OSH. The new program Safe + Sound campaign. hurricane has occurred.
builds on ASSP’s role in OSHA’s Al-
liance Program that began in 2002. ASSP routinely distributes OSHA A page on preparedness outlines the warnings and
It centers on the sharing and dissem- enforcement and regulatory infor- watches used for hurricanes. It contains information
ination of OSH data and guidance. mation to its members and social on creating evacuation plans and supply kits. A page
media followers, drawing attention on response and recovery features a link to OSHA’s
“Organizations with common to occupational hazards and pro- Hurricane eMatrix with information on hazard expo-
objectives can make better progress moting the rights of workers and sures and risk assessments for hurricane response and
by working together and sharing responsibilities of employers. Both recovery. The site describes employer responsibilities
resources,” says Stegall. “Since the organizations provide the other with to keep workers safe and anticipate hazards associat-
establishment of OSHA nearly 50 opportunities to speak at stakehold- ed with response and recovery operations.
years ago, we have built a strong er meetings and safety education
bond by working closely on several events throughout the year. Learn more at www.osha.gov/dts/weather/hurricane.

CPWR Bulletin Examines COVID-19 & Health

Disparities Among Construction Workers

A data bulletin from CPWR—The Center ticularly Hispanic and black workers, and

for Construction Research and Training those employed in high-risk occupations.

provides updated employment and health In addition to providing protective gear

NIOSH Science Blog information on construction workers and and education and training to workers, the
Discusses Heat Stress
in Construction risk estimates in the COVID-19 pandemic. bulletin says that employers should be aware

A NIOSH Science Blog article discusses According to the bulletin, nearly 60% of of the unique needs of the industry’s po-
the risks of heat stress in construction.
These workers are at risk of death, injuries, the construction labor force has at least one tentially vulnerable groups of workers. The
illness and reduced productivity resulting
from heat exposure on the job. According to factor for potentially higher risk of severe bulletin also provides charts and links to
the article, from 1992 to 2016, 285 construc-
tion workers died from heat-related causes, illness from COVID-19, including underly- the underlying data presented in the report,
which was more than one-third of all U.S.
occupational deaths from heat exposure. ing medical conditions such as heart disease as well as a link to the CPWR COVID-19

The article discusses protective mea- or diabetes, and other risk factors such as Construction Clearinghouse, a resource for
sures such as:
smoking and obesity. Added to job hazards, construction employers and workers to find
•engineering and work practice controls;
•training and acclimatization (allowing essential projects and inadequate health the latest research, guidance documents,
the body to gradually adjust to the heat);
•measuring and assessing heat stress; insurance coverage among construction training and other resources.
•medical monitoring, heat-protective
clothing and PPE. workers, this means that COVID-19 may Access the bulletin at https://bit.ly/
The article also discusses regulation
and exposure limits, the role of clothing have a greater impact on some workers, par- 2YjmYYu.
and recommendations for employers.
Read the article at https://bit.ly/3dfSz1h.
NDOELJINDOEL/ISTOCK/GETTY IMAGES PLUS
KALI9/ISTOCK/GETTY IMAGES PLUS

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 9

SAFETY MATTERS

ADEMPERCEM/ISTOCK/GETTY IMAGES PLUS Article Outlines Core Competencies

for Total Worker Health Professionals

A recent article published in Journal of Oc- Representing eight academic, governmen-

cupational and Environmental Medicine out- tal and private organizations, the authors

lines a proposed set of core competencies for compiled and synthesized information

professionals entering the emerging discipline from TWH symposia, workshops and ac-

of total worker health (TWH). According to ademic offerings over a 5-year period, as

the authors, the goal is to begin a community well as contributions from key stakeholders

dialogue about the education needed for a new regarding education and training needs.

NTSB Calls for brand of OSH professional. The article, “Education and Training to
Renewed Road
Safety as Nation “An integrated, inclusive approach to pre- Build Capacity in Total Worker Health:
Reopens
venting on-the-job illnesses and injuries, while Proposed Competencies for an Emerging
National Transportation
Safety Board (NTSB) is call- simultaneously promoting worker overall health Field,” outlines a proposed set of competen-
ing on Americans to practice
highway safety as the country and well-being, is of increas- cies for those entering
continues to reopen. Accord-
ing to the agency, in a typical ing importance,” says Lee the TWH field under
year, more than 36,000 people
are killed on roadways in the Newman, lead author and six broad domains.
U.S. As businesses begin to
reopen, the number of drivers Director of the Center for The authors note that
on the road will increase, re-
sulting in increased risk, the Health, Work and Envi- the COVID-19 pan-
agency says.
ronment at the Colorado demic illustrates the
“The number of traffic fa-
talities was a crisis before the School of Public Health. fact that many of the
pandemic,” says Robert Sum-
walt, NTSB chair. “It has been “To meet emerging needs, factors that influence
inspiring to see Americans
take dramatic steps to protect TWH professionals must worker safety, health
themselves and others during
the coronavirus pandemic. have knowledge, skills and and well-being tran-
We need the same resolve to
stay safe when Americans experiences covering an scend traditional OSH
increasingly take to the roads
in the coming months.” array of subjects that con- VISUAL GENERATION/ISTOCK/GETTY IMAGES PLUS responsibilities.

View Sumwalt’s public ser- sider the safety and health of “As never before, there
vice announcement at https://
youtu.be/Xo8rbs0Xmvs. the worker, including working conditions, work is a need for professionals trained in a

environment and the nature of work itself.” transdisciplinary approach to promote the

NIOSH defines TWH as a holistic approach safety, health, well-being and productivity

to worker well-being that acknowledges risk of workers,” says Newman. “We will re-

factors related to work that contribute to quire a broader skill set to meet the needs

health problems previously considered unre- of employers and employees as we face

lated to work. TWH policies, programs and global pandemics, climate change, changes

practices integrate protection from work-relat- in demographics, emerging technologies,

ed safety and health hazards with promotion changing work arrangements and profound

of injury and illness prevention efforts to ad- alterations to our work and home environ-

vance worker well-being. ments,” he adds.

According to Center for Health, Work and According to the authors, the guidelines

Environment, several universities have begun will help to standardize education for profes-

implementing TWH certificate programs, sionals being trained in TWH and serve as

graduate degree tracks and professional devel- “a launching point for further discussion and

opment opportunities, heightening the need action by the broader community.”

for standardized competencies. Learn more at https://bit.ly/3fBbbKA.

Researchers Study Health Effects of Firefighting Foams

In a recent webinar focusing them. These foams are wide- cal processes underlying other

on chemical mixtures used in ly used at airports, chemical PFAS-associated health concerns,

firefighting, Kevin Mauge-Lewis, plants and military bases, to put such as fatty liver disease.

a National Institute of Environ- out fuel-based fires, as well as Learn more at https://bit.ly/

mental Health Sciences postdoc- in firefighter training. 2UVxlQ3.

toral fellow, explained the concern Mauge-Lewis and his fellow WELLPHOTO/ISTOCK/GETTY IMAGES PLUS

that use of aqueous film-forming researchers seek to better under-

foams (AFFFs) may lead to adverse stand potential health effects of

human health effects. AFFFs. Their studies indicate that

AFFFs consist of per- and high concentrations of AFFFs

polyfluoroalkyl substanc- result in damage to liver cells and

es (PFAS), detergents, other that the toxicity comes from PFAS.

chemicals and water and create Going forward, the researchers

a sudsy layer over flames to will study how lower doses of

cut off oxygen and extinguish AFFFs may affect key biologi-

10 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

KADMY/ISTOCK/GETTY IMAGES PLUS

Organizations Promote
Safety of Waste & Recycling
Workers During Pandemic

Throughout the COVID-19 pandemic, waste and recy-
cling employees have continued to work, which puts them
at risk for contracting COVID-19. Solid Waste Association
of North America (SWANA) and NIOSH have released
documents for these workers and the public that offer tips
for reducing the risk of COVID-19.

SWANA’s document, “Help Protect Waste and Recy-
cling Workers Now,” details what the public can do to help
protect the health of these workers during the pandemic.
According to the document, the virus can survive on vari-
ous surfaces up to 3 days. The document explains that the
public should be vigilant about closing plastic trash bags,
ensuring that all materials fit inside trash bins or carts,
washing hands before putting out waste containers for col-
lection, sanitizing handles or lids of waste containers, and
avoiding “spring cleaning” at this time.

The document also provides tips for recycling such as
knowing what items can and cannot be recycled, break-
ing down large boxes so they fit in recycling containers,
emptying and rinsing out bottles and cans before recycling
them, and following all safety procedures when visiting a
recycling facility.

In addition, NIOSH has published a fact sheet for waste
collectors and recyclers detailing what these workers should
know about COVID-19. The fact sheet outlines preventive mea-
sures for workers and explains what employers must do to help
reduce transmission among employees and maintain healthy
work environments and business operations such as:

•placing posters around the workplace that encourage stay-
ing at home when sick, proper hygiene and other practices;

•staggering shifts, start times and break times to reduce the
number of people at work;

•cleaning and disinfecting at the beginning and end of each
shift as workers may share tools, workstations or vehicles;

•exploring alternative ways to promote handwashing;
•implementing flexible sick leave and supportive policies
and practices.
Read the SWANA document at https://swana.org/resources/
corona-virus-resources. Read the NIOSH fact sheet at https://
bit.ly/2N9WrpY.

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 11

SAFETY MATTERS

KENTOH/ISTOCK/GETTY IMAGES PLUS OSHA Warns of
Grease Trap Hazards
Study Examines Role of VR in Certification
OSHA’s hazard bulletin provides an
A study from NCCCO cranes and via VR simu- pass/fail score on both overview of the standards for grease
trap hazard prevention. Many busi-
Foundation, an orga- lation. According to the the VR test and the actual nesses such as restaurants, food
processing facilities, hotels, grocery
nization that promotes group, the results show crane is 0.87.” stores and bakeries use grease traps
to capture and separate fats, oils and
construction industry that the VR test is a high- Judd cautions, however, greases from wastewater before the
wastewater flows to the local sewer
safety through education, ly reliable measure for that further studies would system to reduce sewer system block-
ages. Many wastewater treatment
research and workforce predicting a passing score be needed to confirm the agencies and public-owned treatment
facilities require businesses to install
development, examines on an actual crane. encouraging results. grease traps.

the potential value of vir- “The likelihood of a “This study has sig- Workers can be injured if they trip
or fall into a grease trap that is not
tual reality (VR) technol- candidate passing the VR nificant implications for properly covered. According to the
hazard bulletin, grease traps that are
ogy in delivering exams test but failing the sub- the way virtual reality is large enough for bodily entry may
be considered permit-required con-
to crane operators. sequent parallel test on viewed in the profession- fined spaces. The traps can generate
flammable and toxic gases over time,
Conducted over an an actual crane is 5.5%,” al assessment communi- including methane, hydrogen sulfide,
carbon monoxide, carbon dioxide and
8-month period, the says Wallace Judd, who ty and, in that respect, other gases depending on the greases,
oils and fats utilized. Large grease
study tracked the per- designed and authored it is truly groundbreak- traps can be deep enough to present
an engulfment hazard.
formance of a group of the study. “And the ing,” says Judd.
Read the bulletin at www.osha.gov/
candidates taking certi- likelihood that a candi- Download the study at Publications/OSHA3986.pdf.

fication exams on actual date will get the same https://bit.ly/2V0KHL0.

ISEA Publishes Carex Canada Produces Guidance
Updated Eye & Face
Protection Standard Addresses Exposure to Antineoplastic Agents

International Safety Equipment As- Carex Canada, a multidisciplinary •occupational exposure estimates that
sociation (ISEA) has updated its eye and
face protection standard. ANSI/ISEA team of researchers aimed at reducing estimate prevalence and levels of exposure.
Z87.1-2020, American National Standard
for Occupational and Educational Per- exposures to carcinogens and reducing The second set of resources describes
sonal Eye and Face Protection, reinforces
the emphasis on matching the protector the risk of cancer, has developed var- ways to control exposures in healthcare
to the hazard and includes other en-
hancements responsive to the evolving ious resources to help organizations settings. Tools include:
needs for workers, particularly those en-
gaged in specific tasks or applications. address exposures to antineoplastic •a collection of policy levers for the

The standard prescribes the design, agents, which are used to treat various safe handling of these agents in various
performance specifications, and marking
of safety eye and face products, including cancers. Exposure to these agents, healthcare settings;
safety goggles, spectacles, face shields
and welding helmets worn by those who also called chemotherapy or cytotoxic •a prevention framework to help or-
work in manufacturing and processing
facilities, utilities and transportation, drugs, can occur in workplaces such as ganizations assess their safe handling
university and research laboratories, and
other occupational settings. home care, veterinary care, community procedures;

Learn more at https://bit.ly/3hLWTsw. pharmacies and hospitals. Healthcare •a report comparing policies and stan-

workers exposed to these agents have dards that address safe han-

an increased risk of experiencing ad- dling of these agents.

verse health effects. The organization Explore the resourc-

estimates that 75,000 Canadian work- es at https://bit.ly/ FATCAMERA/E+/GETTY IMAGES

ers are exposed to antineoplastic agents 2AIDOXO.

in their workplaces.

One set of resources help organiza-

tions better understand exposures in

workplace. These tools include:

•a carcinogen profile that explains how

exposures take place;

12 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

BEST PRACTICES

CONTROLLING COVID-19 TRANSFERENCE

Through Heating, Ventilation & Air-Conditioning Systems

By Christopher J. Colburn

While information regarding the exact mode of transmission of COVID-19 is limited, some cases demonstrate
that the virus can be transferred as the result of virus-laden aerosolized droplets traveling through heating,
ventilation and air-conditioning (HVAC) systems.

An outbreak of 2019 novel coronavi- unprotected person at a distance more ment, a key element in the preven-
rus disease (COVID-19) from Jan. 26 than 5 meters is 1.08 x 10-1 in the ab- tion of spread of this pathogen in an
through Feb. 10, 2020, affected 10 peo- sence of any protective measures. enclosed populated area is adequate
ple from three families who had eaten ventilation. The document suggests
at the same air-conditioned restaurant In the absence of detailed scientif- that inadequate air changes per hour
in Guangzhou, China. On Jan. 23, 2020, ic data to provide more than cursory (ACH) can lead to the spread of these
a family had traveled from Wuhan and results, one can look to yet another airborne pathogens. ACH is the ratio
arrived in Guangzhou where they ate airborne pathogen that has a transmis- of the volume of air entering the room
lunch in an air-conditioned restaurant sion mobility similar to COVID-19. per hour to the volume of that room. It
on Jan. 24, 2020 (Figure 1, Table A). In a 2006 publication, CDC discusses equals the exhaust airf low (Q) in cubic
Two other families sat at neighboring prevention and control of tuberculo- feet per minute (cfm) divided by the
tables (Figure 1, Tables B and C) at the sis. Tuberculosis is a well-researched volume of the room (V) in cubic feet
same restaurant. Later in the day on and studied airborne pathogen with (ft3) multiplied by 60 minutes per hour,
Jan. 24, one of the family members (A1) a similar mobility of transmission to as expressed thus:
became symptomatic. By Feb. 5, a total COVID-19. It is reasonable to assume
of nine others including members of that the containment and control meth-

the other two families had become ill odologies used for tuberculosis would
with COVID-19. It was determined that likewise be applicable to COVID-19. The most common minimum total
the only known source of exposure was ACH recommended for environments
the first person who became symptom- Engineering Controls similar to an office environment with an
atic. The tables where the respective Based on the information in the HVAC system installed is 6 (CDC, 2006).
families were seated were separated by
a distance of 1 meter (about 3 ft). The aforementioned CDC (2006) docu-
air outlet and the return air inlet of the
central air conditioner were located FIGURE 1
above Table C (Figure 1).
RESTAURANT SEATING SCHEMATIC
On Jan. 24, a total of 91 people (cus-
tomers and staff members) were in the Sketch showing arrangement of restaurant tables and air-conditioning airflow at site of COVID-19
restaurant at the time of exposure. Of outbreak, Guangzhou, China, 2020. Red circles indicate seating of future case-patients; yel-
these people, 83 had eaten lunch at 15 ta- low-filled red circle indicates index case-patient.
bles in the restaurant. Among the 83 cus-
tomers, 10 became ill with COVID-19; Note. Reprinted from “COVID-19 Outbreak Associated With Air Conditioning in Restaurant,
the other 73 were identified as close Guangzhou, China, 2020,” by J. Lu, J. Gu, K. Li et al., 2020, Emerging Infectious Diseases, 26(7).
contacts and quarantined for 14 days.
During that period, no symptoms de-
veloped and COVID-19 test results were
negative (Lu, Gu, Li et al., 2020).

This indicates that, while larger re-
spiratory droplets (> 5 μm) remain in
the air for a short time and travel for
only a short distance, generally less
than 1 meter, the distance between the
infected person and the other infect-
ed person was greater than 1 meter.
This indicates that virus-laden small
(< 5 μm) aerosolized droplets can re-
main in the air and travel long distanc-
es. However, since no other diners or
staff members were infected, it would
indicate that the droplets did not travel
greater than 5 meters from the source.
The risk of becoming infected from an

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 13

BEST PRACTICES

This is further substantiated by World While the acceptable level of risk is quate ACH, air sanitization must also
Health Organization (WHO, 2020): defined by each respective organization, be utilized to control the transference
one would struggle to make an affirma- of COVID-19 through HVAC systems.
Poorly ventilated buildings affect tive argument that ACH values of less The two predominant methods for
air quality and can contribute to than 6 are acceptable in environments sanitizing air in HVAC systems are
the spread of disease. Microor- supported by mechanical ventilation 1) air filtration using high-efficiency
ganisms, such as those causing where there is known to be, or could particulate arrestance (HEPA) or ul-
tuberculosis and legionellosis, can potentially be, an active source of tra-low penetration air (ULPA) filters;
be transmitted by air-conditioning COVID-19 infection. and 2) ultraviolet (UV) germicidal ir-
systems, particularly when they radiation systems.
are poorly maintained or when Air Sanitization
the number of air exchanges per The concept of control layering dic- Air Filtration
hour in a room is insufficient. Fluid droplets from the cough or
tates that to increase the probability
Table 1 illustrates the risk reduction of control success, redundancy is nec- sneeze of an infected person are typically
as it relates to an increase of ACH for essary. Therefore, in addition to ade- 5 microns (5 x 10-6 m) or larger. HEPA
healthcare workers. filters reliably capture 99.97% of particles
that are 0.3 microns in diameter with
TABLE 1 efficiency increasing for both smaller and
larger particles.
INFECTION RISK WITH VARIOUS VENTILATION RATES
The smallest particle one might be
Infection risk with 15 minutes exposure with different ventilation rates and quanta generation for concerned with is a single virion (un-
an infector entering an enclosed space with a dimension 6 x 6.7 x 2.7 meters. attached to any fluid droplet), having a
diameter of approximately 0.12 microns.
Quanta generation Ventilation rate (air changes per hour) (%) While these are conceivably filterable
(quanta/min) 1 6 18 30 by a HEPA filter, ULPA filters are even
0.05 0.01 0.00 0.00 better, catching 99.99% of particles
1 0.30 0.06 0.02 0.01 0.12 microns and larger. In theory, all
7 0.51 0.11 0.04 0.02 COVID-19 virions could be filtered and
14 0.64 0.16 0.06 0.04 captured, assuming that they can be
20 brought into contact with an air filter
(Elias & Bar-Yam, 2020).
Note. Data from “Natural Ventilation for Infection Control in Health-Care Settings,” by WHO,
2009, Table E.2, p. 88. Both HEPA and ULPA type filters
are available for most industrial and
FIGURE 2 residential HVAC systems and are more
than adequate to capture and contain
MERV RATING COVID-19 virus-laden particles. When
selecting, one should note the mini-
Minimum efficiency reporting values, or MERVs, report a filter’s ability to mum efficiency reporting value (MERV)
assigned to the respective filter (EPA,
capture larger particles between 0.3 and 10 microns (μm). This value 2020). The MERV rating indicates, on
a scale of 1 to 16, how effectively a filter
is helpful in comparing the performance of different filters. The traps small particles (Figure 2).

rating is derived from a test method developed by American UV Germicidal Irradiation Systems
Unlike a standard air filter or an elec-
Society of Heating, Refrigerating and Air Conditioning
trostatic air cleaner, a UV air treatment
Engineers (ASHRAE). The higher the MERV rating MERV 16 system uses concentrated UV light to
the better the filter is at trapping specific destroy a wide array of indoor air pollut-
types of particles. Average particle ants. These systems may also be equipped
size, efficiency: 0.3 with an enhanced filter (e.g., HEPA) to
MERV 12 to 1.0 μm, ≥ 75% provide additional protection against
airborne dust, microorganisms and other
Average particle size, •Dust particulates. UV light can harm several
efficiency: 3.0 to 10.0 •Lint types of microorganisms including mold,
μm, ≥ 90%; 1.0 to 3.0 •Pollen mildew, fungi, bacteria and viruses by
μm, 80% to 89.9% breaking down molecular bonds in their
DNA. Exposure to UV light either kills the
MERV 8 •Dust •Dust mites bio-contaminants or renders them unable
to reproduce. The UV air treatment system
MERV 6 Average particle •Lint •Mold works in tandem with the HVAC system
size, efficiency: 3.0 •Pollen •Pet dander and is mounted inside of the system’s
Average particle to 10.0 μm, 84.9% •Dust mites •Smoke ductwork. When the air circulates through
size, efficiency: 3.0 •Mold •Smog
to 10.0 μm, 49.9% •Dust •Pet dander •Cough/sneeze
•Lint •Smoke •Bacteria
•Dust •Pollen •Smog •Virus
•Lint •Dust mites •Cough/sneeze
•Pollen •Mold

Note. Adapted from “What Is a MERV Rating?” by EPA, 2020; and “Filtration/Disinfection Fre-
quently Asked Questions and Glossary of Terms,” by ASHRAE, 2020.

14 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

the ducts, pollutants are destroyed as the from www.ashrae.org/technical-resources/ -unlimited.com/blog/2020/march/how-do-uv
air passes through the UV rays (HVAC & filtration-disinfection -air-treatment-systems-work-
Plumbing Unlimited, 2020).
CDC. (2006, July 7). Prevention and control Lu, J., Gu, J., Li, K., et al. (2020). COVID-19
Conclusion of tuberculosis in correctional and detention outbreak associated with air conditioning in
Given the information discussed and facilities: Recommendations from CDC. Mor- restaurant, Guangzhou, China, 2020. Emerg-
bidity and Mortality Weekly Report, 55(RR-9). ing Infectious Diseases, 26(7). doi:10.3201/
data available, the best course of action Retrieved from www.cdc.gov/mmwr/PDF/rr/ eid2607.200764
to prevent the spread of COVID-19 via rr5509.pdf
an HVAC unit is to 1) ensure that poten- World Health Organization (WHO). (2009).
tially infectious individuals are not with- Elias, B. & Bar-Yam, Y. (2020, March 9). Natural ventilation for infection control in
in 5 meters (about 16.5 ft) of the HVAC Could air filtration reduce COVID-19 severity health-care settings. Retrieved from www.who
inlet duct; 2) measure the ACH of each and spread? New England Complex Systems .int/water_sanitation_health/publications/
affected space and take necessary steps Institute. Retrieved from https://necsi.edu/ natural_ventilation/en
to achieve an ACH value of 6 or greater; could-air-filtration-reduce-covid19-severity
and 3) install air sanitation filters, UV -and-spread WHO. (2020). Ventilation and airborne dis-
light systems (or both) on the inlet side of eases. Retrieved March 9, 2020, from www
HVAC systems that recirculate air from EPA. (2020, May 5). What is a MERV rating? .who.int/sustainable-development/health-sec
inside the building. These tertiary con- Retrieved from www.epa.gov/indoor-air-quali tor/health-risks/airborne-diseases/en
trols should prove effective in preventing ty-iaq/what-merv-rating-1
the transference of COVID-19 through This article was originally published by VPPPA.
HVAC systems. PSJ HVAC & Plumbing Unlimited. (2020, Reprinted with permission.
March 19). How do UV air treatment systems
References work? [Blog post]. Retrieved from www.hvac

American Society of Heating, Refrigerating Christopher J. Colburn, M.Eng., CSP, CHMM, GradIOSH, is North America environmental,
and Air-Conditioning Engineers (ASHRAE). health and safety director for AGCO Corp. He is also an adjunct professor at University of Alabama at
(2020). Filtration/disinfection frequently asked Birmingham teaching in the Master of Engineering, Advanced Safety Engineering and Management pro-
questions and glossary of terms. Retrieved gram. He has guided transformational change initiatives in several companies including Hunter Douglas,
Cooper Tire and Rubber Co. and has mentored numerous work sites into the OSHA VPP Program. Colburn
holds a B.S. in Environmental, Safety and Health Management from University of Findlay, and an M.Eng.
in Advanced Safety Engineering and Management from University of Alabama at Birmingham. He also
serves on the executive board of directors of the Region IV Voluntary Protection Programs Participants’
Association (VPPPA) and is a member of the ANSI/ASSP Z10 Occupational Health and Safety Management
Systems Committee. Colburn is a professional member of ASSP’s Alabama Chapter.

Safely Inspect Dangerous Areas

HIGH-DEF INDUSTRIAL VIDEO INSPECTION

Identify risk in your organization. NEW! ZistosHD CALL OUR
Learn leadership skills from industry experts. SALES TEAM
Safely assess conditions in areas
Elevate your safety training program. dangerous or inaccessible using FOR INFO
highly detailed video images
ASSP books cover a variety of relevant safety topics and are TODAY!
authored by thought leaders in the industry. Our members Share images remotely over
receive a 20% discount off of ASSP published books. network; record for documentation Inspect confined spaces for internal
conditions, contaminants, structural
Learn more at assp.us/safetybooks issues, delamination

Inspect elevated areas without
using ladders or scaffolding

Wireless video is viewed on pole
or wrist mounted, rugged displays

Zistos Corporation • (631) 434-1370
zistos.com/ind1 • [email protected]

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 15

WORTH READING

Book Review

SAFE BY ACCIDENT?
Take the Luck Out of Safety:

Leadership Practices That Build a Sustainable Culture

By Judy L. Agnew, Aubrey C. Daniels and Gail Snyder, 2010, Atlanta, GA: Performance Management Publications

A review by Leslie Hortert

Many accomplishments and improvements in occupational be used, the authors say, organizational leaders should stop us-
safety have taken place over the years, causing a reduction in ing inspirational signs and instead show commitment to safety
incidents. Even with these improvements, safety leadership through their behavior.
still has been a challenge for many organizations. The focus on
safety programs, safety signs, punishing those thought to have The book has several strengths that make it a “must read” for
made a mistake and utilizing safety practices provide low in- any safety leader for improving an organization’s culture. Read-
jury rates. Do these really mean the organization is safe or is it ing through the safety practices, readers place themselves in
safe by accident? the role of the leader and recognize practices that impact safety
behavior in the organization. When you find something relat-
Agnew and Daniels are behavioral safety experts and authors able to your negative action, it helps to want to find solutions to
who provide leaders with information about how behavioral change that behavior. This book does that and then provides a
science can be applied to eliminate practices that are counter- recommendation to help with solutions.
productive to ones that can “forge a path to high-performance
safety culture.” One weakness of the book is that it starts discussing a
concept and then states that the concept is discussed more
The intended audience of this book is organizational leaders: in another chapter. For example, punishment is discussed in
those who should be building a culture that “embraces safe- relation to how to decrease behavior in Chapter 1, then the
ty” with high performance. Improving safety leadership and book states that Chapter 7 will discuss the danger of pun-
facilitating working safely requires that behavioral analysis ishment in greater detail.
be applied, which is the foundation science of “all good behav- However, this encourages
ior-based safety processes.” According to the authors, science continued reading to get to
seeks to gain a complete understanding and with the science of the next concept.
behavior, discovering the “universal laws of behavior.”
Overall, this book pro-
The book is divided into three parts, with chapters focused vides readers with useful
on safety practice addressed in each part. This layout is help- information on how to de-
ful, as it allows readers to focus on the exact chapter needed velop safety leaders to drive
for a specific practice. For example, the book describes seven change in behavior for im-
practices that waste time and money. It explains the problem proving safety without luck.
and why organizations have done things a certain way, and The book emphasizes man-
offers a solution for what should be done instead. Chapter 6 agement not doing their
discusses safety signage: compliance signs required by OSHA, part versus the worker be-
informational signs and inspirational signs. Readers are asked, ing at fault. As the authors
how many signs are actually read and followed? Organizations say, “It is not the human
believe that signs change behavior and use them with good that needs to be fixed, but
intentions. However, the authors explain that most signs have a the system within which
“temporary effect on behavior.” While compliance signs must the human works.” PSJ

Petersen’s Safety ASSP Study Guide
for the ASP Examination:
Supervision, Third Edition ASP10 Blueprint

By Dan Petersen, Kyle Dobson and Dave Johnson, 2020, Park Ridge, IL: ASSP By ASSP, 2020, Park Ridge, IL: Author

As one of the founding fathers of today’s supervisory emphasis on This study guide discusses all nine domains in
modern workplace safety practices, collaboration rather than the old the new BCSP associate safety professional exam,
Dan Petersen’s principles of coach- command-and-control directives. which include advanced sciences and math; safety
ing, motivating, technical incident management systems; ergonomics; fire prevention
investigation and workplace in- This revised edition utilizes new and protection; emergency response management;
spection models for supervisors’ sources, information and research industrial hygiene and occupational health; eviron-
safety responsibilities align with to validate Petersen’s practical mental management, training, education and com-
approach to safety. Kyle Dobson munication; and law and ethics.
Review a Book for PSJ and Dave Johnson updated the
book with effective techniques for The guide includes examples, equations, tables,
What safety or business book are you coaching, hazard identification and charts and illustrations to help readers prepare for
currently reading? Review it for PSJ. Send incident investigation. the 250-question exam.
an e-mail to [email protected].
Learn more at https://assp.us/ Learn more at https://assp.us/2YbAo8L.
2YaND9I.

16 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

Book Review

ORGANIZATION
CULTURE KILLERS

Deadly Expectations 1: How
Leaders Build Cultures of Success

By T.A. Laser, 2019, Katy, TX: TAL Publishing

A review by Christopher Lenda, ASP, OHST

Organization Culture Killers: Deadly Expectations 1 and
corresponding books in the series are billed as a guide to “help
leaders build cultures of success.” The title infers that dire con-
sequences are bound to follow if the reader fails to heed the
advice contained therein. Unfortunately, this volume fell short
on delivery.

It is apparent that Laser expended great effort in crafting
a book that is conversational in tone, easy to read, and free
of obscure and meaningless references that would not add
depth to the text. These traits make this an ideal read for an
individual who has no previous leadership experience and is
looking for a basic primer on the principles of management.
The author states in the opening pages of the book, “In an
effort to keep things simple and avoid slowing down your
read with soon-to-be-outdated information, I’ve opted to
leave it out.”

Regrettably, for those readers who are seeking substance,
new ideas or a novel approach to addressing the most common
pitfalls organizations face when dealing with culture, this book
may leave something to be desired.

The first 23 pages are dedicated to extolling the virtues of
this series while also, perhaps unintentionally, undermining
and underselling the author’s literary ability. Following are a
few examples:

•“Much of what is discussed in this series isn’t new and you
have likely suffered through many of the same painful experi-
ences as I have”;

•“. . . reasons I chose to title this series ‘Deadly Practices.’
First, I’m a huge horror fan!”;

•“Let me draw your attention to the most important section
in this entire book: the blank [emphasis added] ‘Reflections and
Commitments’ pages at the back of the book.”

It is true that the most substantive portions of the book do
little to share new ideas. Most topics covered are recited in nu-
merous leadership texts, many by notable authors, with the dif-
ference being that Laser is more transparent in her admission
that these theories are not new.

As noted, the book’s subtitle, “Deadly Expectations,” leads
one to believe dire circumstances could befall anyone mak-
ing the fatal errors outlined in the book. In reality, this is an
attempt to combine the author’s love of the macabre with a
catchy title intended to draw the reader in. Little within this
text draws a connection between an organization’s culture and
potentially life-altering errors.

Finally, highlighting the blank pages as the most important
section sets the reader up to question the value of the 70-odd
pages between the beginning and end.

On a positive note, the flow of the book seems natural and
smooth. Much effort has been taken to ensure that this is an
easy read and, in that sense, it does not disappoint. Most read-
ers likely can read the entire book in 1 to 2 hours and complete
the series over a weekend.

The book is a good read as a starting point for those with
no previous experience in the way culture drives success, but
readers should peruse the entire series to obtain a clearer un-
derstanding of the writer’s overall message. PSJ

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 17

BEST PRACTICES

PSYCHOLOGICAL SCIENCE
FOR SAFETY SUCCESS, PART 7

How to Motivate With Consequences

By E. Scott Geller and Krista S. Geller

Every reader realizes the significant impact of human behavior on both the occurrence and
the prevention of workplace injuries. And almost every safety professional has heard the
term behavior-based safety (BBS).

However, how many readers under- when it announces the availability of a incentive: “If you perform this behavior,
stand and appreciate the foundation of positive consequence (a reward) follow- then I will give you this reward.”
BBS beyond the systematic observation ing the occurrence of a particular desir-
and documentation of at-risk and safe able behavior. In contrast, an activator A now-that reward is different; there
work behavior, and the delivery of rel- is a disincentive when it announces the is no incentive, just a reward or a sincere
evant behavioral feedback? This article availability of a negative consequence (a statement of appreciation for the desir-
explicates a fundamental principle of penalty) following the occurrence of a able behavior observed. The delivery
applied behavioral science (ABS) and the designated undesirable behavior. of now-that recognition is simple and
research-based foundation of BBS: the straightforward. You simply specify the
consequences of behavior. Behavioral In Figure 1, the sign is an activator positive behavior observed and offer sin-
consequences are extrinsic or intrinsic, and could be an incentive or a disincen- cere praise, recognition or gratitude. The
and they either help or hinder the pre- tive depending on the perception of the result: You might increase occurrences
vention of workplace injuries. driver. In this case, the driver perceives of the recognized behavior, and you will
the sign as a disincentive because she surely enhance the person‘s perception
Motivation by Consequences expects other drivers to report only oc- of personal competence and self-motiva-
B.F. Skinner (1938; 1974), the founder currences of undesirable or unsafe driv- tion (see Part 3, PSJ November 2019). As
ing behaviors. Why doesn’t the driver Carnegie (1936) emphasizes, “Everyone
of the research and scholarship domain expect a phone call for her safe driving? wants to feel important.”
of ABS, is known for the simple but Is this because the driver will not be
profound principle, “selection by con- driving safely and not be eligible for a Extrinsic Criticism
sequences.” Indeed, Skinner and his positive phone call? Of course not, but Figure 2 illustrates a criticism that
followers have demonstrated consistently it is certainly disappointing that people
that behavior occurs to gain positive are more likely to notice and criticize a few pop psychology books have
consequences and to avoid or escape neg- undesirable behavior than to notice and used to discredit the use of positive
ative consequences. Plus, behavior can be recognize desirable behavior (see Part 2, consequences or rewards to increase
modified by changing the consequences PSJ October 2019). the frequency of desirable behavior.
that follow it. Such negativity is reflected by the
Consider how our culture influences title of one of those books: Punished
Three critical aspects of behavioral a focus on undesirable behavior and the by Rewards: The Trouble With Gold
consequences are relevant for motivat- use of negative consequences to elimi- Stars, Incentive Plans, A’s, Praise and
ing human behavior: 1) positive conse- nate such behavior. The news and social Other Bribes (Kohn, 1993). Authored
quences are more effective than negative media report more about unwanted by a journalist, this popular self-help
consequences at improving behavior (see than wanted behavior, and the govern- book caused quite a stir among behav-
Part 2 of this article series, PSJ October ment approach to controlling behavior ioral scientists who have consistently
2019, pp. 28-30); 2) the best consequences is essentially to pass a law and enforce demonstrated the benefits of using
activate or support self-motivation or it. Indeed, we seem to live in a “click it positive consequences to motivate oc-
self-directed behavior (see Part 3, PSJ or ticket” society. However, ABS has currences of behavior since the 1950s.
November 2019, pp. 60-63); and 3) natu- demonstrated various advantages of us-
ral or intrinsic consequences have special ing positive over negative consequences Systematic reviews of research re-
advantages over extra or extrinsic conse- to increase the frequency or improve the lated to the pop psychology critique
quences, as explained in this article with quality of behavior (see Part 2, PSJ Octo- of extrinsic rewards have revealed the
regard to motivating human behavior for ber 2019). following: a) as discussed, consequenc-
injury prevention. es desired by participants increase the
If-Then vs. Now-That Rewards frequency of the targeted behavior; and
The ABC Model Both research and common sense tell b) when behavior-based rewards are
ABS is founded on a basic ABC model: removed, the target behavior decreases
us that it is extremely beneficial to call in frequency of occurrence, as common
A represents an activator or the an- attention to behavior we want to see oc- sense indicates. However, contrary to
tecedent event(s) immediately preceding cur more often and to recognize those the uninformed authors of books that
a target behavior, represented by B. C desirable behaviors. Behavioral scientists demean the use of rewards, the target
stands for the consequence, or the event refer to such positive consequences as behavior rarely occurs less often than its
following the behavior that influences its now-that rewards, in contrast to if-then pre-reward or baseline frequency when
recurrence. An activator is an incentive rewards. An if-then reward reflects an an extrinsic reward is discontinued

18 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

FIGURE 1 FIGURE 2

ACTIVATE BEHAVIOR A DISADVANTAGE OF
WITH A CONSEQUENCE EXTRINSIC CONSEQUENCES

(Cameron & Pierce, 1994; Eisenberger & tem following their safety suggestion or ent reality. Such behavior is not a disease,
Cameron, 1996). the report of a close call. but the outcome of devices that reinforce
the flow of behavior with soon, certain,
Here is the most practical re- The Power of Intrinsic Consequences positive or intrinsic consequences. In ad-
search-based conclusion regarding the Some natural (or intrinsic) conse- dition to texting while driving or walk-
use of extrinsic rewards to improve ing, many other undesirable behaviors
behavior: When using extrinsic rewards quences are immediate while others are are supported by intrinsic positive rein-
to get a desirable behavior started, these delayed. In Figure 3 (p. 20), each person forcers (e.g., excessive alcohol consump-
positive consequences should be faded sees immediate natural consequences, tion, cigarette and marijuana smoking,
(i.e., given intermittently after the target the fruits of their labor. However, Mom overeating). What about at-risk behavior?
behavior), and natural or intrinsic con- and Dad are likely thinking about a de-
sequences should be emphasized, such layed consequence, such as a large shade Are there more positive intrinsic con-
as the meaningfulness or the long-term tree and a vegetable-producing garden. sequences following at-risk than safe
purpose of the target behavior. While their son is experiencing an im- behavior? A “yes” answer to this ques-
mediate intrinsic consequence (a positive tion is reminiscent of the first author’s
The natural consequences of a target reinforcer) for his car-washing behavior, early article, “Managing Safety: Fighting
behavior should be identified at the start he might also be thinking of impressing Human Nature” (Geller, 1990). More
of a motivational process, but it often his date later with a clean car. comfort, convenience and efficiency are
takes an extrinsic consequence to mo- three obvious intrinsic reasons for work-
tivate initial participation and enable Are you thinking that intrinsic or ers choosing at-risk over safe behavior.
recognition of the natural longer-term natural consequences are more powerful With this realization, safety professionals
benefits of the desirable behavior. The than extrinsic or extra consequences? attempt to increase the comfort, conve-
teacher in Figure 2 should certainly focus Yes, your common sense is correct be- nience and efficiency of safe behavior.
on the natural or intrinsic consequences cause you have been there. You have ex-
of the situation by saying, “Billy, how perienced the flow of behavior motivated Unfortunately, it is usually impos-
wonderful, you solved the math problem. by immediate natural consequences sible for safe behavior to match the
You are becoming more and more com- such as entertainment from reading and convenience and efficiency of at-risk
petent at math; your parents will be so watching TV, or the sense of accomplish- behavior. Thus, there is often a need to
proud of you.” ment from playing a musical instrument, implement one or more safety-related
practicing a sport, preparing a meal, or interventions, from education or train-
Regarding occupational safety, an applying artistic skills to drawing, paint- ing programs to extrinsic incentives
extrinsic reward might be needed to mo- ing or woodworking behavior. or disincentives. However, education
tivate the delivery of a thoughtful safety or training provides only an activator,
suggestion or the report of a close call or What about pushing those buttons and even though positive consequences
near-hit. However, consider the intrinsic on your computer, tablet or cell phone? are more effective at changing behav-
motivating consequences of employees Some call this an addiction and the cause ior and attitude, the apparent conve-
seeing an injury-prevention change in of distracted driving and even distracted nience of using negative consequences
the work setting or the management sys- walking. This discussion reveals a differ-

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 19

BEST PRACTICES FIGURE 4

FIGURE 3 THE DIFFICULTY IN DELAYING
POSITIVE CONSEQUENCES
INTRINSIC CONSEQUENCES
HAVE AN ADVANTAGE

often takes precedence over incentive able to wait the 15 to 20 minutes for the 2019); and c) a context that facilitates an
or reward interventions. Fortunately, researcher to return. optimistic and success-seeking mindset
some individuals, particularly safety (see Part 6, PSJ February 2020, pp. 25-27).
professionals, have the emotional in- Most children who delayed their im-
telligence to avoid the enticement of mediate gratification for a delayed but However, activating and motivating
soon, certain and positive consequenc- larger reward did not just sit patiently and EQ for safety-related behavior is espe-
es for at-risk behavior. wait. Instead, they engaged in behaviors cially challenging. The safety professional
that apparently facilitated their self-disci- cannot promise a delayed reward for per-
The Power of Emotional Intelligence pline to resist the impulse for immediate forming safety-related behavior. Safety
Figure 4 illustrates the difficulty of get- pleasure. Some sang or talked to them- professionals ask workers to do the right
selves; others played games with their thing for occupational safety to avoid
ting animals to delay the immediate plea- hands and feet; and others covered their the improbable possibility of an injury.
sure of experiencing an available positive eyes or buried their head in their arms. Indeed, the probability of an injury to an
consequence. Yes, dogs can be trained to employee working at-risk is extremely
wait before devouring a morsel of desir- When these children were evaluated 14 low, supporting the common sense self-
able food. What about humans? years later as adolescents during their last talk, “It won’t happen to me.” And such
year of high school, those who had waited thinking is usually supported by the lack
Have you ever heard a statement such patiently at age 4 were far superior as stu- of an injury from performing relatively
as, “Your success in life depends upon dents compared to those who had failed efficient, comfortable and convenient
your ability to delay immediate pleasures the marshmallow test. They were more at-risk behavior.
for larger rewards from later accomplish- academically competent, they had better
ment”? Research indicates that one’s study habits and appeared more eager to Therefore, consistently choosing safe
ability to keep working on a task in the learn. They were better able to concen- over at-risk behavior requires a relatively
face of temptation to engage in an activ- trate, to express their ideas, and to set high level of EQ. The authors recommend
ity with soon and certain positive con- and achieve goals (Mischel, 2014). In fact, inserting the mission of the actively car-
sequences reflects emotional intelligence those higher achievers scored significant- ing for people movement into discussions
(EQ), which is quite predictive of career ly higher on both the math and verbal about substituting safe behavior for more
success (Goleman, 1995; 1998). portions of the SAT by an average of 210 intrinsically reinforcing at-risk behav-
total points than the students who had ior. Acknowledge that the probability
To verify the direct relationship be- not delayed gratification at age 4 (Shoda, that any one individual will be seriously
tween one’s ability to delay immediate Mischel & Peake, 1990). injured while performing an at-risk
gratification for future success, Mischel behavior (e.g., texting while driving) is
(2014) challenged 4-year-old children While it is tempting to consider EQ to minuscule, supporting the intrapersonal
with a marshmallow test to assess their be determined by nature, research indi- conversation, “It won’t happen to me.”
impulse control. In one-on-one situations, cates that EQ can be learned and nurtured But, ask the individual whether someone
a researcher handed children a marshmal- through appropriate education or training will eventually get hurt if the particular
low and said they could eat it now or wait that includes a) relevant behavior-based at-risk behavior is repeated many times
until later and receive two marshmallows. feedback (see Part 2, PSJ October 2019); by many people in this work setting. Af-
Some children ate the single marshmallow b) techniques to encourage and support ter the individual gives the obvious an-
within a few seconds after the researcher self-motivation and a perception of em- swer of “yes,” then ask, “Do you care?” If
left the room. The other children were powerment (see Part 3, PSJ November

20 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

the worker does not answer “yes, I care” consequences; b) create innovative ways
to this question, you should seriously to implement a behavior-based interven-
consider whether you want this person to tion process for injury prevention; and
continue working at your facility. c) take the extra time and sometimes
the extra financial expense to imple-
When the person answers, “yes, I care,” ment an incentive/reward contingency
suggest that the individual can actively to motivate participation in an inju-
care by always demonstrating safe be- ry-prevention process (e.g., peer-to-peer
havior. You might refer to observational observation and feedback, safety-im-
learning (see Part 1, PSJ September 2019, provement suggestions and follow-up,
pp. 47-49). In addition, you could intro- close-call reporting, analysis, corrective
duce the concept of a social norm. Specif- action). The authors sincerely hope some
ically, when the majority of individuals in suggestions presented here and in parts
a culture perform a certain behavior, that 1 through 6 of this article series activate
behavior becomes the norm. Thus, if an some practical intervention consider-
individual really cares about keeping all ations and applications. PSJ
workers safe, s/he needs to actively care
by always demonstrating the safe exam- References
ple for others to see.
Cameron, J. & Pierce, W.D. (1994). Rein-
Conclusion forcement, reward and intrinsic motivation:
In this article, the authors address the A meta-analysis. Review of Educational Re-
search, 64(3), 363-423.
critical role of behavioral consequences
in motivating occurrences of safe and Carnegie, D. (1981). How to win friends and
at-risk behavior. The challenge of moti- influence people (Revised edition). New York,
vating occurrences of safe over at-risk NY: Simon & Schuster.
behavior can be realized by understand-
ing the power of intrinsic or natural Eisenberger, R. & Cameron, J. (1996). Det-
consequences. While at-risk behavior is rimental effects of reward: Reality or myth?
facilitated by natural or intrinsic conse- American Psychologist, 51(11), 1153-1166.
quences such as relative comfort, conve-
nience or efficiency, the safe alternative Geller, E.S. (1990). Managing safety: Fight-
is often inhibited by relative discomfort, ing human nature. Industrial Safety and Hy-
inconvenience or inefficiency. As a result, giene News, 24(9), 14.
extrinsic incentive/reward or disincen-
tive/penalty contingencies are often im- Goleman, D. (1995). Emotional intelligence.
plemented, with motivation by negative New York, NY: Bantam Books.
consequences (e.g., a penalty for at-risk
behavior) used more often than positive Goleman, D. (1998). Working with emotion-
consequences for safety-related behavior al intelligence. New York, NY: Bantam Dell.
(e.g., if-then or now-that rewards).
Kohn, A. (1993). Punished by rewards: The
Why are disincentive/penalty inter- trouble with gold stars, incentive plans, A’s,
ventions more popular than the more praise and other bribes. Boston, MA: Hough-
effective incentive/reward contingencies? ton Mifflin.
Indeed, the answer is similar to the
rationale for the occurrence of at-risk Mischel, W. (2014). The marshmallow test:
behavior: convenience, efficiency and Mastering self-control. New York, NY: Little,
perhaps a lack of knowledge. It takes EQ Brown and Co.
to a) learn the research-based advantages
of motivating with positive over negative Shoda, Y., Mischel, W. & Peake, P.K. (1990).
Predicting adolescent cognitive and self-reg-
ulatory competition from preschool delay of
gratification. Developmental Psychology, 26(6),
978-986.

Skinner, B.F. (1938). The behavior of organ-
isms: An experimental analysis. Acton, MA: D.
Appleton and Co.

Skinner, B.F. (1974). About behaviorism.
New York, NY: Alfred A. Knopf.

E. Scott Geller, Ph.D., alumni distinguished professor and director of the Center for Applied Be-
havior Systems at Virginia Tech for 50 years, is also senior partner of Safety Performance Solutions and
cofounder of GellerAC4P Inc. (www.gellerac4p.com). He has authored more than 300 research articles,
40 books and 75 book chapters addressing the application of psychological science to improve human
welfare and life satisfaction on a large scale. Geller and his daughter, Krista Geller, coauthored Actively
Caring for People’s Safety: How to Cultivate a Brother’s/Sister’s Keeper Work Culture. Geller is a pro-
fessional member of ASSP’s Star Valley Chapter.

Krista S. Geller, Ph.D., has been involved in applied behavioral science since childhood. She re-
cently coauthored two books: Actively Caring for People’s Safety and The Human Dynamics of Achiev-
ing an Injury-Free Workplace. Her mission is to teach people the psychological science of safety and
inspire actively caring for people (AC4P) applications of these research-based principles to improve
human welfare and life satisfaction on a large scale. Geller is president of GellerAC4P Inc., an educa-
tion/training organization she cofounded with her father.

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 21

OCCUPATIONAL HEALTH
Peer-Reviewed

LIGHT & LIGHTING

for OSH Professionals

By William Mills, Kevin Martin and Justin Cathey

VVISIBLE LIGHT IS ALL AROUND US, from sunlight to street cent, high intensity discharge (metal halide and sodium LIDIIA MOOR/ISTOCK/GETTY IMAGES PLUS; WACOMKA/ISTOCK/GETTY IMAGES PLUS
lighting and automobile headlights to the backlight on a vapor) and solid state lighting (SSL) [e.g., light-emitting
smartphone and in nearly every indoor space. Humans diodes (LED) and organic LED; Table 1, p. 24]. Lighting
are so accustomed to working and living in artificial metrics are used to predict and compare how a lighting
light that many of us have not stopped to consider the system will behave. Luminaires (lighting fixtures) can be
implications. Most OSH professionals’ experience with characterized by many metrics, including the total quan-
light and artificial lighting is likely limited to assessing tity and directional intensity, visual color appearance and
whether sufficient light exists for people to see where brightness, and electrical and fixture efficiency (ANSI/
they are going or carry out a task, or whether a light is IES, 2017; DiLaura et al., 2011; Rea, 2013). An important
too bright. This article aims to provide a current review point is that some metrics can be classified depending on
of lighting for OSH professionals. Such a review is timely them having a radiometric or a photometric basis. Radio-
due to emerging issues including energy efficiency, human metric quantities are associated with measurements of
health impacts (e.g., blue light hazard, circadian rhythm radiant energy and power. Photometric quantities were
disruption, fatigue), human performance (e.g., visual developed to measure light in a manner consistent with
performance, visual comfort) and environmental impacts the human eye’s vision by using, for example, the Interna-
(e.g., light pollution). tional Commission on Illumination (CIE) 1924 photopic
(P) luminosity [V(λ)], or the CIE 1951 scotopic (S) lumi-
Visible Light nosity [V`(λ)] functions (CIE, 2011; Figure 2, p. 24). Table
The visible light spectrum (VLS) is typically considered 2 (p. 26) provides additional key metrics used to charac-
the portion of the electromagnetic spectrum from ap- terize lighting.
proximately 400 to 700 nm wavelength (Figure 1; Elert,
2019; IUPAC, 1997). The colors range from violet (~400 to Although the photopic luminosity function is known
450 nm), blue (~450 to 500 nm), green (~500 to 550 nm), to underestimate the contribution of short wavelength
yellow (~550 to 600 nm), orange (~600 to 650 nm) and red light to perceived illuminance (Rea, Figueiro, Bierman
(~650 to 700 nm). However, there can be some significant et al., 2012), lumens and lux remain widely used lighting
variation in exact wavelength ranges reported for colors metrics. This issue has important implications because
(Elert, 2019; Helmenstine, 2020; Jones, 2020). The radiant the relative proportions of the spectral power distribution
energy of light is characterized by the direct relationship (SPD) for LEDs are different from incandescent or flu-
with frequency (Brune, 2020); that is, the shorter wave- orescent light or sunlight (Figure 3, p. 27). Illuminating
length range of the VLS (e.g., violet/purple) has more Engineering Society (IES, 2013) has published a technical
intrinsic energy than longer wavelengths (e.g., red). The memorandum (TM-24-13) that provides a method to
radiant flux (power) of a light source is a function of the factor in the differences in SPD from various luminaires
frequency of the emitted radiation and time over which while still achieving similar apparent light levels (also
the energy is transmitted (DiLaura, Houser, Mistrick et referred to as visually equivalent lumens) within a space.
al., 2011; Sliney, 2016). The formula used in TM-24-13 factors in these contribu-
tions through the use of the S/P ratio, which is the ratio
Lighting Units & Definitions of the scotopic (S) lumens/photopic (P) lumens. Practi-
Common light sources currently used in commercial cally, LEDs typically have higher S/P ratios than the light
source being replaced, allowing designers to reduce the
and industrial applications include incandescent, fluores- total lumens required in the system.

KEY TAKEAWAYS The OSH professional should also consider that two
light sources can have similar correlated color tempera-
•LED lighting is being rapidly adopted in all industries and homes ture (CCT) and color rendering index (CRI) while having
vastly different SPDs. As a result, a standard (photo-
due to energy and cost reductions and longer product life. metric) light meter alone cannot provide the necessary
expanded metrics required to make an informed decision
•Current research has provided new insight on numerous im- regarding lighting from LEDs (Ferrero, Velázquez, Pons
et al., 2018; Nilsson, 1981). Therefore, a spectroradiometer
pacts of lighting on human health and productivity. (often incorrectly referred to as a spectrometer) is re-

•New metrics and instruments are needed to monitor and manage

these issues. This article provides a review of the emerging issues
regarding lighting that are important to the OSH professional.

22 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

BASICS

quired in lieu of the photometric light meter that the OSH CCOHS, EPA Energy Star Program, American Council of
professional typically utilizes (CIE, 2011). Spectroradiom- Governmental Industrial Hygienists (ACGIH) and Inter-
eters are more complicated instruments and are typically national Commission on Non-Ionizing Radiation.
more expensive than photometers (ScienceDirect, 2019).
Anatomy of the Eye
Lighting Standards & Regulations The two primary vision related photoreceptor cells
In 2019, the U.S. Energy Information Administration
found in the eye include about 40 million cones and 100
(EIA, 2019) estimated that about 6% of total U.S. elec- million rods (DiLaura et al., 2011) with differing sensi-
tricity consumption is used by lighting in the residen- tivities to the VLS. The cones function at higher illumi-
tial and commercial sectors. Although currently being nation levels initiating photopic vision, while the rods
reviewed, the second phase of the U.S. Energy Inde- function at lower light levels initiating scotopic vision.
pendence and Security Act was scheduled to take effect The two receptors work together over a range known as
Jan. 1, 2020 (Energy Independence and Security Act of the mesopic region (Barbur & Stockman, 2010). Three
2007). While the standards are technology neutral, the classes of cones exist: long wavelength (L type), medium
required 25% increase in lighting energy efficiency for wavelength (M type) and short wavelength (S type) with
general service lamps in the 40 to 100 W range would peak photopigment sensitivities of 575, 525 and 450 nm,
serve only to increase the adoption of LEDs. Regardless respectively (DiLaura et al., 2011). The fovea is densely
of the outcome, it is not expected to have an impact on packed with L- and M-type cones, giving the center of
the long-term adoption of LEDs. The Clean Energy for the eye the best visual acuity (i.e., the spatial resolving
All Europeans package of legislative acts directs EU capacity of the visual system) and color differentiation
countries to transpose the set of new energy directives (DiLaura et al., 2011). S-type cones, which are not usually
into national law with the next 2 years (EU, 2019). These found in the fovea, and rod photoreceptors dominate the
include the Energy Performance of Buildings Directive periphery regions (DiLaura et al., 2011). Rods are more
Update of 2018 that sets a target of all new buildings to than 1,000 times as sensitive to light as cones and act as a
be nearly net zero energy by 2020 resulting in adoption much better motion sensor. For the OSH professional, the
of new lighting technologies (EU, 2018). two major implications are 1) tasks requiring higher levels
of target detection, recognition or localization need high-
The U.S. has few national legal requirements for light- er illumination levels (Kalloniatis & Lu, 2007); and 2) at
ing levels beyond OSHA (2011a;b) requiring minimum
illuminance related to avoiding slips, trips and falls, and FIGURE 1
safe egress routes and exit lighting. In response, lighting
systems in the U.S. are typically designed following var- RELATIONSHIP OF VISIBLE SPECTRUM
ious adopted codes, standards and guidelines based on TO ELECTROMAGNETIC SPECTRUM
jurisdiction or organization policy. The acceptable met-
ric values within these codes, standards and guidelines Note. Reprinted from EM spectrumrevised.png (File), by P. Ronan, 2013.
provided by IES and other organizations (e.g., Canadian
Center for Occupational Health and Safety, CCOHS) are
typically categorized based on building type or task. In
contrast, national level legislation, codes, standards and
guidelines such as Energy Policy Act of 2005; Energy In-
dependence and Security Act of 2007; American Society
of Heating, Refrigerating and Air-Conditioning Engi-
neering (ASHRAE) standards 90.1-2016 and 189.1-2017
focus on specifying lighting watts/area or lumens/watt
based on area usage or luminaire type.

Useful lighting concepts and standards can obtained
from a number of organizations including the U.S. De-
partment of Energy, ASHRAE, CIE, IES, U.S. Green
Building Council, International WELL Building Institute,

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 23

TABLE 1

COMMON LIGHTING TYPES

Luminaire type Efficacy CRI rating CCT range Average lifetime
15 lm/W 95 2500 K 1,000 hours
Incandescent 70 to 115 lm/W 65 to 90 3000 to 4200 K 5,500 to 20,000 hours

High- Metal 50 to 125 lm/W 25 1900 to 2100 K 16,000 to 24,000 hours

intensity halide 2700 to 6500 K 8,000 to 10,000 hours
2700 to 6500 K 30,000 hours
discharge High- 2700 to 6500 K 30,000 hours
100,000 hours
pressure 50,000 hours

sodium

Fluorescent Compact 65 to 70 lm/W 77 to 88
92 to 108 lm/W 50 to 95
T5 HO 92 to 95 lm/W 50 to 95
70 lm/W 80 to 90
T8 160 to 170 lm/W (current) 90
255 lm/W (future)
Induction 350 lm/W

LED current (phosphor-

converted)

LED future (color mixed)

Note. Adapted from “LED Lighting Efficacy: Status and Directions,” by Morgan Pattison, Hansen, & Tsao, 2018; “LED efficacy: What America stands
to gain,” by U.S. DOE, 2017.

FIGURE 2 retinal damage and cell death in albino rats (Lougheed,
2014) and lesions in the human eye (Ham, Mueller &
RELATIVE RESPONSE FUNCTION Sliney, 1976). In response, retinal photochemical injury
weighting functions (with maximum responses at 435
Relative response functions for V(λ), V’(λ), melanopic lux, circadian rhythm to 440 nm) were established to protect against blue light
stimulus and blue light hazard. hazard (ACGIH, 2001; Ham, 1983; ICNIRP, 2013; Lund,
Stuck & Edsall, 2006; Sliney, 2016) with corresponding
typical indoor lighting levels the rods are saturated, which exposure limits established (Figure 2). For most OSH
can be a major safety hazard when going from higher to professionals, the blue light hazard exposure guidelines
lower lighting levels (e.g., indoors to outdoors) as it takes have only been of concern in specific limited operations
time for the rods to begin to function. A third class of such as welding or dental curing (Briggs, Parker, Miller et
non-vision-related photoreceptor called an intrinsically al., 1992; Council on Dental Materials, Instruments and
photosensitive retinal ganglion cell (ipRGC) was formally Equipment, 1986; Okuno, Ojima & Saito, 2010). Although
identified in 2002 (Hattar, Liao, Takao et al., 2002). How- LEDs have an increased relative amount of shorter wave-
ever, their existence was alluded to in research on mice length light, CIE (2019) has issued a position statement
dating back to the 1920s (Keeler, 1928). indicating that it does not expect blue light hazard to be a
Physiological & Psychological Impacts major issue with LED replacements. However, reports in
the scientific literature demonstrate that replacement LED
The photochemical risk of short-wavelength radiation fixtures can result in exceedance of the blue light hazard
(~400 to 500 nm) is collectively referred to as blue light exposure guidelines (Leccese, Vandelanotte, Salvadori et
hazard. This consists of three major effects: 1) retinal al., 2015) and other issues (Mou & Peng, 2013; O’Hagan,
burns; 2) cataracts; and 3) macular degeneration (some- Khazova & Price, 2016; Point, 2018; Rebec, Klanjšek-Gun-
times referred to as age-related macular degeneration; de, Bizjak et al., 2015).
Neelam, Au & Zhou, 2014; Sliney, 1994). Light sources
utilizing the blue light portion of the VLS have caused The suprachiasmatic nucleus located in the hypothal-
amus plays a pivotal role in regulating daily oscillations
of organ functions (including melatonin production) and
synchronizing them to day and night body states (Gillette
& Tischkau, 1999). This near 24-hour sleep-wake cycle is
referred to as the body’s circadian rhythm. Several stud-
ies from the 1980s to present have shown that the setting
of the circadian rhythm is impacted by the ipRGCs’ re-
sponse to light (Crowley, Lee, Tseng et al., 2003; Pauley,
2004; Pickard & Sollars, 2010; Sollars & Pickard, 2015;
Wahl, Engelhardt, Schaupp et al., 2019). These ipRGCs
account for less than 1% of all ganglion cells and have
peak sensitivities to light between 459 and 484 nm (Bed-
rosian & Nelson, 2013). Subsequently research has shown
that several types of ipRGC exist with slightly different
responses (Stabio, Sabbah, Quattrochi et al., 2018). These
cells are an area of ongoing research. The absence of a
light/dark cycle or a distinct noncyclical event (e.g., jet lag,
shift work) can cause circadian rhythm disruption leading
to a misalignment between physiology, behavior and the

24 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

environment (Bedrosian & Nelson, 2013). Singular events Fogerson, Lazzerini Ospri et al., 2018). Circadian rhythm
of circadian rhythm disruption can result in short-term disruption has also been shown to have psychological
fatigue. Fatigue has been linked to many OSH incidents connections such as mood fluctuations (Haynes, Gengler
and worker performance issues (Filtness & Naweed, 2017; & Kelly, 2016; Lockley, Dijk, Kosti et al., 2008), fatigue
Lerman, Eskin, Flower et al., 2012; Marcus & Rosekind, (Caldwell, Caldwell, Thompson et al., 2019), insomnia
2017; McCormack, O’Shea, Doran et al., 2018). Over- (Figueiro & White, 2013; Smolensky, Hermida, Reinberg
all, the nonvisual effects of lighting are beginning to be et al., 2016), lack of appetite (Poggiogalle, Jamshed & Pe-
recognized as important factors to be considered as the terson, 2018) and generally impaired performance (Figue-
impacts can be recorded at relatively low light levels, in- iro, Sahin, Wood et al., 2016; Naismith, Hickie, Terpening
cluding from electronic devices (Figueiro & White, 2013; et al., 2014).
Kozaki, Kubokawa, Taketomi et al., 2016; Stevens & Zhu,
2015; Vartanian, Li, Chervenak et al., 2015). Currently, Productivity
two principal metrics are used to characterize the impacts When utilized properly, lighting choices can also pro-
of light on human circadian rhythms (Figure 2): the cir-
cadian rhythm stimulus (Rea, Figueiro, Bierman et al., duce benefits beyond those associated with visual acuity.
2012) and melanopic lux (Enezi, Revell, Brown et al., 2011; Using lights with higher CCTs can improve employees’
Lucas, Peirson, Berson et al., 2014). feelings of well-being and boost overall productivity
(Mills, Tomkins & Schlangen, 2007; Price, Udovicic, Beh-
Although exposure of humans to light can be benefi- rens et al., 2019). In addition, other studies have demon-
cial for photo entrainment, long-term exposure to light strated positive influences on depressive symptoms,
at night can result in long-term circadian rhythm dis- alertness, psychomotor vigilance and task performance
ruption, which has other potential impacts. This disrup- (Askaripoor, Motamedzade, Golmohammadi et al., 2019;
tive method is of unique importance to the roughly 20% Mills et al., 2007). While short wavelengths can promote
of the worldwide population that is involved in night alertness by suppressing melatonin production, it has also
shift work (Bedrosian & Nelson, 2013). Shift work has been shown that a 630 nm light can produce a wakeful-
previously been classified by International Agency for ness response (Sahin & Figueiro, 2013).
Research on Cancer (IARC, 2007) as Group 2A, proba-
bly carcinogenic to humans. Although light at night is Temporal Light Modulation Effects
not definitively connected to night shift work, night shift Temporal light modulation (TLM), known colloquially
work specifically was recently classified in Group 2A
(IARC Monographs Vol. 124 Group, 2019). Of particular as flicker, refers to the temporal pattern of light output.
concern regarding this issue are the potential heightened TLM in light sources is a function of 1) electrical input
circadian rhythm disruption impacts of LED-based light voltage fluctuation; 2) technology type (e.g., LED vs.
at night. OSH professionals must understand that light- incandescent); 3) power source technology (e.g., driver,
ing choices go deeper than cost savings. OSH profes- ballast); 4) light regulation (e.g., dimmers); and 5) visible
sionals must understand the important considerations light communication technologies (e.g., LiFi). Currently,
involving light exposure and how it can have beneficial there is wide variation in TLM among luminaires. TLM
or detrimental impacts on human health and perfor- is known to affect human visual perception, neurobiology
mance. The specific effects depend on many factors in- and performance, sometimes in adverse ways (CIE, 2016b;
cluding prior light exposure history, hours awake, time 2017; Jaen, Sandoval, Colombo et al., 2005). Undesired
of day, SPD, duration and intensity. Workers, especially effects in visual perception of TLM are referred to as tem-
night shift workers, must be educated on this issue and poral light artifacts (CIE, 2016b). CIE (2016b) identifies
proper precautions must be taken to ensure that shift three major types of temporal light artifacts: flicker, stro-
workers have proper sleeping conditions. boscopic effect and phantom array effect, often referred to
as ghosting.
Another lighting impact of increasing concern is light
pollution (Chepesiuk, 2009; Falchi, Cinzano, Duriscoe Without proper ballasts, drivers or capacitors, a light
et al., 2016; Tähkämö, Partonen & Pesonen, 2019). More source will exhibit flicker (Lau, 2014). When light flickers
than 99% of individuals living in the U.S. and Europe, at a frequency greater than 50 Hz, most people cannot dis-
and 80% of the world population experience nighttime tinguish between individual flickers; however, the sensory
light pollution (Falchi et al., 2016). Light pollution can system of some individuals can still detect flicker (ASSIST,
come from many sources, including streetlights, interi- 2012; Lau, 2014). Flicker is associated with eye strain and
or lighting, or the use of computers, televisions or cell fatigue. A common office complaint associated with flick-
phones. As light and dark often signals when to eat, sleep, er is headaches (Karanovic, Thabet, Wilson et al., 2011),
hunt, migrate or reproduce, light pollution can have many however, seizures can be induced in sensitive individuals
negative effects on humans, flora and fauna (Aubé, 2015; (Smedley, Webb & Wilkins, 2010; Wilkins, Veitch & Leh-
Deynego, Elizarov & Kaptsov, 2016; Ouyang, Davies & man, 2010). When the flicker frequency is from 100 to 500
Dominoni, 2018; Tähkämö et al., 2019). Hz, it is possible to encounter a stroboscopic effect when
working with rotating machinery, which causes it to ap-
In addition to the physiological impacts of light, psy- pear stationary or rotating at a slower speed (Poplawski &
chological impacts also must be considered. Not only do Miller, 2013). This could have safety implications in a work-
ipRGCs communicate with the suprachiasmatic nucleus, place. The phantom array effect was recently recognized
their signals also reach the prefrontal cortex, hippocam- and is primarily visible in outdoor nighttime situations
pus and amygdala, all of which are areas involved in where high contrast is present. Currently, the two most
mood regulation (Bedrosian & Nelson, 2013; Fernandez, common metrics for TLM are percent flicker and flicker

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 25

TABLE 2

RADIOMETRIC & PHOTOMETRIC LIGHTING TERMS/METRICS

Term Definition Unit
Radiant intensity W/sr
Radiant flux The radiant flux per unit solid angle W
Radiant efficiency Total radiant energy per unit of time Unitless
Luminous intensity Ratio of radiant flux to power consumed Candela (cd) 1 cd = 1/683
The luminous intensity, in a given direction, of a source that emits W/sr
Luminous flux monochromatic radiation of frequency 540 x 1012 hertz and that has a
radiant intensity in that direction of 1/683 W per steradian (sr) Lumen (lm) = cd·sr
Illuminance The amount of light emitted per second in a unit solid angle of one
steradian from a uniform source of one candela lux (lx) = lm/m2 (foot-
Luminance The area density of the luminous flux from a source divided by the area candle)
over which the flux is received Cd/m2
Lumen maintenance/ The intensity of light emitted from a surface per unit area in a given
lamp lumen depreciation direction LLD = mean lumens/
(LLD) factor A ratio of the mean lumens over the lifetime compared to initial lumen initial lumens
Luminous source efficacy output of a given lamp
CCT
The total luminous flux emitted by the total luminaire versus power input lm/W
Color rendering index (CRI) CCT is the absolute temperature a blackbody has when it has Kelvin (K). Typically
approximately the same color appearance as the source. CCT rating for a between 2000K (warm) and
Spectral power distribution lamp is a general “warmth” or “coolness” measure of its appearance 6500K (cool)
(SPD) A measure of a light source’s ability to show object colors realistically or Scale of 0 to 100, 100 being
naturally compared to a familiar reference source such as daylight perfect rendering
The collective data of radiant power emitted by a light source at each Unitless (relative) or W/cm2
wavelength or band of wavelengths in the visible region of the (absolute)
electromagnetic spectrum

Note. Shaded terms denote radiometric quantities.

index (CIE, 2011). Flicker index (Eastman & Campbell, 2015; Patterson, Bargary & Barbur, 2015). Discomfort
1952) is most commonly used, and indicates the amount glare is a subjective feeling of discomfort due to excessive
of modulation (reduction) in light output over a single on/ contrast in the field of view. One of the most common
off cycle. A value of 100% would indicate that at some point examples of glare is from streetlights, but it is not limited
in the cycle there is no light, while a value of 0 would indi- to outdoor situations. Glare is typically measured with
cate a completely steady source (Bullough & Marcus, 2015; luminance meters or luminance cameras (Aslam, Haider
Eastman & Campbell, 1952). Pacific Northwest National & Murray, 2007). Recent advances in sensor technologies
Laboratory (PNNL, 2016) has published information on have allowed digital cameras to also be used for measure-
characterizing flicker (Poplawski & Miller, 2011; 2013) and ment (Hsu, Chen & Jiaan, 2012). There are several mea-
more recently a performance review of some currently sures of glare, with CIE (1995) recommending the unified
available handheld flicker meters (PNNL, 2018). Other glare rating (UGR) as a quantitative measure of glare
measurement metrics for TLM include modulation depth (Scheir, Hanselaer & Ryckaert, 2017). Other glare calcula-
(CIE, 2016b), short-term-flicker indicator (also called short- tion methods include CIBSE glare index (CLEAR, 2020a),
term flicker severity; CIE, 2016b) or short-term flicker IES glare index (CLEAR, 2020b; Robinson, Bellchambers,
perceptibility (Synergy Systems, 2019), long-term flicker Grundy et al., 1962) and the daylight glare index (Kent,
perceptibility (Synergy Systems, 2019) flicker visibility Fotios & Altomonte, 2019). California’s Building Energy
measure (Perz, Sekulovski, Vogels et al., 2017) and the Efficiency Standards (Title 24, Part 6; CEC, 2019) specifies
time domain flicker visibility measure (Perz, 2019). For the a maximum lumens rating for backlight, uplight and glare
OSH professional, TLM will primarily be of concern due to based on IES (2011) TM-15-11. For the OSH professional,
flicker, especially in an office environment or heavily com- the primary implication is reducing contrast between illu-
puterized environment, and the stroboscopic effect around mination levels in the field of view.
moving machinery.
Dynamic Lighting
Glare In general terms, dynamic lighting refers to changing
The term glare refers to a bright surface or object in the
light source characteristics (e.g., intensity, SPD, CCT,
field of view. There are two common types of glare (CIE, distribution of light) based on the needs of the environ-
2011; Yang, Luo & Huang, 2018a;b; Yang, Luo & Ma, 2017; ment (CIE, 2016a). This emerging field is also referred to
Yang, Luo, Ma et al., 2017). Disability glare results in tem- as tunable-dimmable, smart lighting, intelligent lighting,
porary visual impairment caused by intense light sources spectral tuning, circadian lighting, health and well-being
in the field of view (Epitropoulos, Fram, Masket et al., lighting and human-centric lighting. OSH professionals

26 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

should note that the term adaptive lighting is also some- FIGURE 3
times used, but this term is best reserved for describing
automobile headlights (UNECE, 2019), as the term’s use SPECTRAL POWER DISTRIBUTION
in the U.S. dates back to the 1960 Citroen DS (Perkins,
2015). Dynamic lighting is gaining interest among man- SPD for sunlight, incandescent, HPS, metal halide, florescent, cool LED and
ufacturers, researchers and standards bodies as a method warm LED.
to increase lighting efficacy and manage light exposure
for maximum benefits. Dynamic lighting is often char-
acterized as mimicking the natural rhythm of night and
day lighting conditions that the body naturally responds
to. For example, a dynamic light system could be used in
night shift settings to reduce worker exposure to blue light
as the shift nears the end, while keeping workers awake
and supporting circadian function by utilizing other
VLS regions. Before implementing any dynamic lighting
scheme in the workplace, OSH professionals are cau-
tioned to ensure that the project team includes the proper
expertise and that empirical evidence exists to support
any vendor claims.

Conclusion Note: Adapted from “LSPDD: Lamp Spectral Power Distribution Database,” by
The adoption of LED is ever growing; therefore, OSH J. Roby, 2020.

professionals must update their knowledge on the char- ANSI/Illuminating Engineering Society (IES). (2017). No-
acteristics of this light source and its potential impli- menclature and definitions for illuminating engineering (ANSI/
cations. Understanding lighting in 2020 requires more IES RP-16-17). Retrieved from www.ies.org/standards/defini
than just preventing slips, trips and falls, and providing tions
exit lighting and visibility for safe egress routes. With
greater understanding of the impacts of lighting on Askaripoor, T., Motamedzade, M., Golmohammadi, R., et al.
humans and the environment (e.g., circadian rhythm (2019). Effects of light intervention on alertness and mental per-
disruption, light at night) several new metrics have been formance during the post-lunch dip: A multi-measure study. In-
developed, many of which require the measurement of dustrial Health, 57(4), 511-524. doi:10.2486/indhealth.2018-0030
the luminaire’s SPD. This is achieved using a spectro-
radiometer instead of the basic photometric light meter Aslam, T.M., Haider, D. & Murray, I.J. (2007). Principles of
that has been the standard instrument used by OSH disability glare measurement: An ophthalmological perspective.
professionals in the past. The confluence of lower cost Acta Ophthalmologica Scandinavica, 85(4), 354-360. doi:10.1111/
LEDs, development of Internet of Things technologies j.1600-0420.2006.00860.x
and advances in the understanding of VLS on humans
translates to the potential wide adoption of dynamic Aubé, M. (2015). Physical behavior of anthropogenic light
lighting systems in the near future. For OSH profession- propagation into the nocturnal environment. Philosophical
als, this provides both opportunities and challenges, as Transactions of the Royal Society B, 370(1667). doi:10.1098/
the lighting system characteristics in a workplace can rstb.2014.0117
easily change without undergoing a thorough internal
review, which can result in worker complaints, reduced Barbur, J.L. & Stockman, A. (2010). Photopic, mesopic and
productivity and other unintended consequences. PSJ scotopic vision and changes in visual performance. Encyclopedia
of the Eye, 3, 323-331.
References
Bedrosian, T.A. & Nelson, R.J. (2013). Influence of the mod-
Alliance for Solid-State Illuminations Systems and Tech- ern light environment on mood. Molecular Psychiatry, 18(7),
nologies (ASSIST). (2012). Flicker parameters for reducing 751-757. doi:10.1038/mp.2013.70
stroboscopic effects from solid-state lighting systems. ASSIST
Recommends, 11(1). Retrieved from www.lrc.rpi.edu/programs/ Briggs, T.P., Parker, C., Miller, R.A., et al. (1992). Blue light
solidstate/assist/pdf/AR-Flicker.pdf emission from urological equipment: Can it damage the eyes?
British Journal of Urology, 70(5), 492-495.
American Conference of Governmental Industrial Hygienists
(ACGIH). (2001). Documentation of the threshold limit values for Brune, W. (2020). How is energy related to the wavelength of
physical agents (7th ed.). Cincinnati, OH: Author. radiation? Penn State University. Retrieved from www.e-educa
tion.psu.edu/meteo300/print/book/export/html/682
American Society of Heating, Refrigerating and Air-Con-
ditioning Engineers (ASHRAE). (2017). Standard for the de- Bullough, J.D. & Marcus, D. (2015). Influence of flicker char-
sign of high-performance green buildings (ASHRAE/ICC/ acteristics on stroboscopic effects. Lighting Research and Tech-
USGBC/IES 189.1-2017). Retrieved from www.techstreet nology, 48(7), 857-870. doi:10.1177/1477153515599566
.com/ashrae/standards/ashrae-189-1-2017?product_id
=2027723 Caldwell, J.A., Caldwell, J.L., Thompson, L.A., et al. (2019).
Fatigue and its management in the workplace. Neuroscience and
ASHRAE. (2019). Energy standard for buildings except low- Biobehavioral Reviews, 96, 272-289. doi:10.1016/j.neubiorev.2018
rise residential buildings [ASHRAE 90.1-2019 (I-P)]. Retrieved .10.024
from www.techstreet.com/ashrae/standards/ashrae-90-1-2019-i
-p?product_id=2088527 California Energy Commision (CEC). (2019). 2019 Building
Energy Efficiency Standards (Title 24). Retrieved from www.en
ergy.ca.gov/programs-and-topics/programs/building-energy-effi
ciency-standards/2019-building-energy-efficiency

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 27

Chepesiuk, R. (2009). Missing the dark: Health effects of light Falchi, F., Cinzano, P., Duriscoe, D., et al. (2016). The new
pollution. Environmental Health Perspectives, 117(1), A20-A27. world atlas of artificial night sky brightness. Science Advances,
doi:10.1289/ehp.117-a20 2(6), e1600377. doi:10.1126/sciadv.1600377

CIE. (1995). Discomfort glare in interior lighting. Discomfort Fernandez, D.C., Fogerson, P.M., Lazzerini Ospri, L., et al.
glare in interior lighting (CIE 117-1995). Vienna, Austria: Author. (2018). Light affects mood and learning through distinct reti-
na-brain pathways. Cell, 175(1), 71-84. doi:10.1016/j.cell.2018.08.004
CIE. (2011). ILV: International lighting vocabulary (CIE S
017/E:2011). Vienna, Austria: Author. Ferrero, A., Velázquez, J.L., Pons, A., et al. (2018). Index
for the evaluation of the general photometric performance of
CIE. (2016a). CIE research strategy: Section 5, adaptive, intel- photometers. Optics Express, 26(14), 18633-18643. doi:10.1364/
ligent and dynamic lighting. Retrieved from http://files.cie.co OE.26.018633
.at/872_CIE%20Research%20Strategy%20%28August%20
2016%29%20-%20Topic%205.pdf Figueiro, M.G., Sahin, L., Wood, B., et al. (2016). Light at
night and measures of alertness and performance: Implications
CIE. (2016b). Visual aspects of time-modulated lighting sys- for shift workers. Biological Research for Nursing, 18(1), 90-100.
tems—Definitions and measurement models (CIE TN 006:2016). doi:10.1177/1099800415572873
Retrieved from http://files.cie.co.at/883_CIE_TN_006-2016.pdf
Figueiro, M.G. & White, R.D. (2013). Health consequences
CIE. (2017). Final report: CIE stakeholder workshop for tem- of shift work and implications for structural design. Journal of
poral light modulation standards for lighting systems (CIE TN Perinatology, 33(Suppl 1), S17-S23. doi:10.1038/jp.2013.7
008:2017). Retrieved from http://files.cie.co.at/943_CIE_TN
_008-2017.pdf Filtness, A.J. & Naweed, A. (2017). Causes, consequences and
countermeasures to driver fatigue in the rail industry: The train
CIE. (2019, Apr. 23). Position statement on the blue light haz- driver perspective. Applied Ergonomics, 60, 12-21. doi:10.1016/
ard. Retrieved from www.cie.co.at/publications/position-state j.apergo.2016.10.009
ment-blue-light-hazard-april-23-2019
Gillette, M.U. & Tischkau, S.A. (1999). Suprachiasmatic nu-
CLEAR. (2020a). CIBSE glare index. Retrieved from www cleus: The brain’s circadian clock. Recent Progress in Hormone
.new-learn.info/packages/clear/visual/people/performance/ Research, 54, 33-58.
glare/glare_cib.html
Ham Jr., W.T., Mueller, H. & Sliney, D. (1976). Retinal sensi-
CLEAR. (2020b). IES glare index. Retrieved from www.new tivity to damage from short wavelength light. Nature, 260, 153-
-learn.info/packages/clear/visual/people/performance/glare/ 155. doi:10.1038/260153a0
glare_ies.html
Ham Jr., W.T. (1983). Ocular hazards of light sources: Review
Council on Dental Materials, Instruments and Equipment. of current knowledge. Journal of Occupational Medicine, 25(2),
(1986). The effects of blue light on the retina and the use of pro- 101-103.
tective filtering glasses. Journal of the American Dental Associ-
ation, 112(4), 533-535. doi:10.14219/jada.archive.1986.0038 Hattar, S., Liao, H.-W., Takao, M., et al. (2002). Melanop-
sin-containing retinal ganglion cells: Architecture, projections
Crowley, S.J., Lee, C., Tseng, C.Y., et al. (2003). Com- and intrinsic photosensitivity. Science, 295(5557), 1065-1070.
binations of bright light, scheduled dark, sunglasses and doi:10.1126/science.1069609
melatonin to facilitate circadian entrainment to night
shift work. Journal of Biological Rhythms, 18(6), 513-523. Haynes, P.L., Gengler, D. & Kelly, M. (2016). Social rhythm
doi:10.1177/0748730403258422 therapies for mood disorders: An update. Current Psychiatry
Reports, 18(8), 75. doi:10.1007/s11920-016-0712-3
Deynego, V.N., Elizarov, V.B. & Kaptsov, V.A. (2016). Hygien-
ic and environmental problems of energy-saving illumination Helmenstine, A.M. (2020, April 2). The visible spectrum:
in urbanization of Crimea. Gigiena i Sanitariia, 95(10), 909-913. Wavelengths and colors. Retrieved from www.thoughtco.com/
Retrieved from www.ncbi.nlm.nih.gov/pubmed/29431330 understand-the-visible-spectrum-608329

DiLaura, D.L., Houser, K.W., Mistrick, R.G., et al. (Eds.). Hsu, S.W., Chen, C.H. & Jiaan, Y.D. (2012). Measurements of
(2011). The lighting handbook: Reference and application (10th UGR of LED Light by a DSLR Colorimeter. In M.H. Kane, C.
ed.). New York, NY: Illuminating Engineering Society. Wetzel, J.J. Huang, et al. (Eds.), Proceedings vol. 8484, Twelfth
International Conference on Solid State Lighting and Fourth In-
Eastman, A.A. & Campbell, J.H. (1952). Stroboscopic and ternational Conference on White LEDs and Solid State Lighting,
flicker effects from fluorescent lamps. Illuminating Engineering, San Diego, CA, USA. doi:10.1117/12.928345
47(1), 27-35.
Illuminating Engineering Society (IES). (2011). Luminaire
Elert, G. (2019). Color. The physics hypertextbook. Retrieved classification system for outdoor luminaires (IES TM-15-11).
from https://physics.info/color New York, NY: Author.

Energy Independence and Security Act of 2007, Pub. L. No. IES. (2013). An optional method for adjusting the recom-
110-140, 42 U.S.C. 152 §§ 17001-17386 (2007). mended illuminance for visually demanding tasks within IES
illuminance categories P through Y based on light source spec-
Energy Policy Act of 2005. Pub. L. No. 109-58, 42 U.S.C. 149 trum (IES TM-24-13). New York, NY: Author.
§§ 15801-16538 (2005).
International Agency for Research on Cancer (IARC). (2007,
Enezi, J., Revell, V., Brown, T., et al. (2011). A “melanopic” Dec. 5). IARC monographs program finds cancer hazards asso-
spectral efficency function predicts the sensitivity of melanopsin ciated with shiftwork, painting and firefighting [Press release].
photoreceptors to polychromatic lights. Journal of Biological Lyon, France: Author.
Rhythms, 26(4), 314-323.
IARC Monographs Vol. 124 Group. (2019). Carcinogenici-
Epitropoulos, A.T., Fram, N.R., Masket, S., et al. (2015). ty of night shift work. The Lancet Oncology, 20(8), 1058-1059.
Evaluation of a new controlled point source led glare tester for doi:10.1016/S1470-2045(19)30455-3
disability glare detection in participants with and without cata-
racts. Journal of Refractive Surgery, 31(3), 196-201. doi:10.3928/ International Commission on Non-Ionizing Radiation Pro-
1081597x-20150225-03 tection (ICNIRP). (2013). ICNIRP guidelines on limits of expo-
sure to incoherent visible and infrared radiation. Health Physics,
EU. (2018). Energy performance of buildings directive. Re- 105(1), 74-96. doi:10.1097/HP.0b013e318289a611
trieved from https://ec.europa.eu/energy/en/topics/energy
-efficiency/energy-performance-of-buildings/energy-perfor International Union of Pure and Applied Chemistry (IUPAC).
mance-buildings-directive (1997). Compendium of Chemical Terminology (the “Gold
Book”; 2nd ed.). Compiled by A.D. McNaught and A. Wilkin-
EU. (2019). Clean energy for all Europeans package. Retrieved son. Oxford, U.K.: Blackwell Scientific Publications. Online ver-
from https://ec.europa.eu/energy/en/topics/energy-strategy-and
-energy-union/clean-energy-all-europeans

28 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

sion (2019) created by S.J. Chalk. Retrieved from https://gold Neelam, K., Kah-Guan Au, E. & Zhou, S.W. (2014). The role
book.iupac.org/terms/view/VT07496
of blue light in the pathogenesis of age-related macular de-
Jaen, M., Sandoval, J., Colombo, E., et al. (2005). Office work-
ers visual performance and temporal modulation of fluorescent generation. Points de Vue, International Review of Ophthalmic
lighting. Leukos, 1(4), 27-46. doi:10.1582/leukos.01.04.002
Optics, N71. Retrieved from www.pointsdevue.com/article/
Jones, A.Z. (2020, Feb. 14). What is the visible light spectrum?
Retrieved from www.thoughtco.com/the-visible-light-spectrum role-blue-light-pathogenesis-age-related-macular-degeneration
-2699036
Nilsson, T.H. (1981). Reference light source for luminance
Kalloniatis, M. & Luu, C. (2007). Visual acuity. Webvi-
sion. Retrieved from https://webvision.med.utah.edu/book/ and illuminance photometry. Behavior Research Methods and
part-viii-psychophysics-of-vision/visual-acuity
Instrumentation, 13(1), 18-19. doi:10.3758/bf03201865
Karanovic, O., Thabet, M., Wilson, H.R., et al. (2011). Detec-
tion and discrimination of flicker contrast in migraine. Cepha- O’Hagan, J.B., Khazova, M. & Price, L.L.A. (2016). Low-ener-
lalgia, 31(6), 723-736. doi:10.1177/0333102411398401
gy light bulbs, computers, tablets and the blue light hazard. Eye,
Keeler, C.E. (1928). Blind mice. Journal of Experimental Zool-
ogy, 51(4), 495-508. doi:10.1002/jez.1400510404 30, 230-233. doi:10.1038/eye.2015.261

Kent, M.G., Fotios, S. & Altomonte, S. (2019). An experi- Okuno, T., Ojima, J. & Saito, H. (2010). Blue-light hazard
mental study on the effect of visual tasks on discomfort due to
peripheral glare. Leukos, 15(1), 17-28. doi:10.1080/15502724.201 from CO arc welding of mild steel. Annals of Occupational Hy-
8.1489282 2
giene, 54(3), 293-298. doi:10.1093/annhyg/mep090
Kozaki, T., Kubokawa, A., Taketomi, R., et al. (2016). Light-in-
duced melatonin suppression at night after exposure to different OSHA. (2011a). Illumination (29 CFR 1926.56). Retrieved
wavelength composition of morning light. Neuroscience Letters,
616, 1-4. doi:10.1016/j.neulet.2015.12.063 from www.osha.gov/laws-regs/regulations/standardnumber/

Lau, W. (2014, Apr. 23). LEDs: Fighting flicker. Architectural 1926/1926.56
Lighting. Retrieved from www.archlighting.com/technology/
leds-fighting-flicker_o OSHA. (2011b). Lighting (29 CFR 1915.82). Retrieved from

Leccese, F., Vandelanotte, V., Salvadori, G., et al. (2015). www.osha.gov/laws-regs/regulations/standardnumber/1915/
Blue light hazard and risk group classification of 8 W LED
tubes, replacing fluorescent tubes, through optical radiation 1915.82
measurements. Sustainability, 7(10), 13454-13468. doi:10.3390/
su71013454 Ouyang, J.Q., Davies, S. & Dominoni, D. (2018). Hormonally

Lerman, S.E., Eskin, E., Flower, D.J., et al. (2012). Fatigue risk mediated effects of artificial light at night on behavior and fit-
management in the workplace. Journal of Occupational and En-
vironmental Medicine, 54(2), 231-258. doi:10.1097/JOM.0b013e ness: Linking endocrine mechanisms with function. Journal of
318247a3b0
Experimental Biology, 221. doi:10.1242/jeb.156893
Lockley, S.W., Dijk, D.J., Kosti, O., et al. (2008). Alertness,
mood and performance rhythm disturbances associated with Pacific Northwest National Laboratory (PNNL). (2016). Charac-
circadian sleep disorders in the blind. Journal of Sleep Research,
17(2), 207-216. doi:10.1111/j.1365-2869.2008.00656.x terizing photometric flicker. Retrieved from www.energy.gov/sites/

Lougheed, T. (2014). Hidden blue hazard? LED lighting and prod/files/2016/03/f30/characterizing-photometric-flicker.pdf
retinal damage in rats. Environmental Health Perspectives,
122(3), A81. doi:10.1289/ehp.122-A81 PNNL. (2018). Characterizing photometric flicker-handheld

Lucas, R.J., Peirson, S.N., Berson, D.M., et al. (2014). Measur- meters. Retrieved from www.energy.gov/sites/prod/files/2019/01/
ing and using light in the melanopsin age. Trends in Neurosci-
ences, 37(1), 1-9. doi:10.1016/j.tins.2013.10.004 f58/characterizing-photometric-flicker_nov2018.pdf

Lund, D.J., Stuck, B.E. & Edsall, P. (2006, May). Retinal injury Patterson, E.J., Bargary, G. & Barbur, J.L. (2015). Understand-
thresholds for blue wavelength lasers. Health Physics, 90(5), 477-
484. doi:10.1097/01.HP.0000190115.83416.cb ing disability glare: Light scatter and retinal illuminance as pre-

Marcus, J.H. & Rosekind, M.R. (2017). Fatigue in transporta- dictors of sensitivity to contrast. Journal of the Optical Society of
tion: NTSB investigations and safety recommendations. Injury
Prevention, 23(4), 232-238. doi:10.1136/injuryprev-2015-041791 America A, 32(4), 576-585. doi:10.1364/josaa.32.000576

Mills, P.R., Tomkins, S.C. & Schlangen, L.J. (2007). The effect Pauley, S.M. (2004). Lighting for the human circadian clock:
of high correlated color temperature office lighting on em-
ployee well-being and work performance. Journal of Circadian Recent research indicates that lighting has become a public
Rhythms, 5(2).
health issue. Medical Hypotheses, 63(4), 588-596. doi:10.1016/
Morgan Pattison, P., Hansen, M. & Tsao, J.Y. (2018). LED
lighting efficacy: Status and directions. Comptes Rendus Phy- j.mehy.2004.03.020
sique, 19(3), 134-145. doi:10.1016/j.crhy.2017.10.013
Perkins, C. (2015, July 20). Ford develops smart headlights,
Mou, T., & Peng, Z. (2013, June). Measurement and
standardization of eye safety for optical radiation of LED but an old law will make them illegal in the U.S. Retrieved from
products. In C. Quan, K. Qian & A. Asundi (Eds.), Pro-
ceedings vol. 8769, International Conference on Optics in https://mashable.com/2015/07/20/ford-smart-headlights
Precision Engineering and Nanotechnology, Singapore.
doi:10.1117/12.2019049 Perz, M. (2019). Modelling visibility of temporal light arti-

Naismith, S.L., Hickie, I.B., Terpening, Z., et al. (2014). Cir- facts. Eindhoven, Netherlands: Technische Universiteit Eind-
cadian misalignment and sleep disruption in mild cognitive
impairment. Journal of Alzheimer’s Disease, 38(4), 857-866. hoven. Retrieved from https://pdfs.semanticscholar.org/ff24/
doi:10.3233/jad-131217
cd0f6391d66b08c259416626446270286df5.pdf

Perz, M., Sekulovski, D., Vogels, I., et al. (2017). Quantifying

the visibility of periodic flicker. Leukos, 13(3), 127-142. doi:10.10

80/15502724.2016.1269607

Pickard, G.E. & Sollars, P.J. (2010). Intrinsically photosensi-

tive retinal ganglion cells. Science China Life Sciences, 53(1), 58-

67. doi:10.1007/s11427-010-0024-5

Poggiogalle, E., Jamshed, H. & Peterson, C.M. (2018). Circa-

dian regulation of glucose, lipid and energy metabolism in hu-

mans. Metabolism, 84, 11-27. doi:10.1016/j.metabol.2017.11.017

Point, S. (2018). Blue light hazard: Are exposure limit values

protective enough for newborn infants? Radioprotection, 53(3),

219-224. doi:10.1051/radiopro/2018025

Poplawski, M.E. & Miller, N.J. (2011). Exploring flicker in

solid-state lighting: What you might find, and how to deal with

it. In Illuminating Engineering Society of North America Annual

Conference, Austin, TX, USA, 52-56.

Poplawski, M.E. & Miller, N.M. (2013). Flicker in solid-state

lighting: Measurement techniques and proposed reporting and

application criteria. In Proceedings of the CIE Centenary Confer-

ence: “Towards a New Century of Light,” Paris, France, 188-191.

Price, L.L.A., Udovicic, L., Behrens, T., et al. (2019). Link-

ing the non-visual effects of light exposure with occupational

health. International Journal of Epidemiology, 48(5), 1393-1397.

doi:10.1093/ije/dyz131

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 29

Rea, M.S. (2013). Value metrics for better lighting. Bellingham, Stevens, R.G & Zhu, Y. (2015). Electric light, particularly at
WA: SPIE Press. night, disrupts human circadian rhythmicity: Is that a problem?
Philosophical Transactions of the Royal Society B, 370(1667).
Rea, M.S., Figueiro, M.G., Bierman, A., et al. (2012). Modeling doi:10.1098/rstb.2014.0120
the spectral sensitivity of the human circadian system. Lighting
Research and Technology, 44, 386-396. Synergy Systems. (2019). Flicker in the power master series.
Retrieved from www.rangerpq.com/flicker.html
Rebec, K.M., Klanjšek-Gunde, M., Bizjak, G., et al. (2015).
White LED compared with other light sources: Age-dependent Tähkämö, L. Partonen, T. & Pesonen, A.-K. (2019). Systematic
photobiological effects and parameters for evaluation. Interna- review of light exposure impact on human circadian rhythm.
tional Journal of Occupational Safety and Ergonomics, 21(3), 391- Chronobiology International, 36(2), 151-170. doi:10.1080/074205
398. doi:10.1080/10803548.2015.1085163 28.2018.1527773

Robinson, W., Bellchambers, H.E., Grundy, J.T., et al. (1962). UN Economic Commission for Europe (UNECE). (2019).
The development of the IES glare index system: Contributed Uniform provisions concerning the approval of adaptive
by the Luminance Study Panel of the IES Technical Com- front-lighting systems (AFS) for motor vehicles (Regulation No.
mittee. Transactions of the Illuminating Engineering Society, 123). Retrieved from https://op.europa.eu/en/publication-de
27(1_IEStrans), 9-26. doi:10.1177/147715356202700103 tail/-/publication/980b1279-f899-4119-92a5-fea02d375956/
language-en
Roby, J. (2020). LSPDD: Lamp spectral power distribution da-
tabase. Retrieved from http://galileo.graphycs.cegepsherbrooke U.S. Department of Energy (DOE). (2017). LED efficacy:
.qc.ca/app/en/home What America stands to gain. Retrieved from www.energy.gov/
sites/prod/files/2016/10/f33/efficacy-fs_oct2017.pdf
Ronan, P. (2013, Feb. 19). EM spectrumrevised.png (File). Re-
trieved from https://commons.wikimedia.org/wiki/File:EM U.S. Energy Information Administration (EIA). (2019). An-
_spectrumrevised.png nual energy outlook 2019 with projections to 2050 (AEO2019).
Retrieved from www.eia.gov/outlooks/aeo/pdf/aeo2019.pdf
Sahin, L. & Figueiro, M.G. (2013). Alerting effects of
short-wavelength (blue) and long-wavelength (red) lights in the Vartanian, G.V., Li, B.Y., Chervenak, A.P., et al. (2015). Mela-
afternoon. Physiology and Behavior, 116-117, 1-7. doi:10.1016/ tonin suppression by light in humans is more sensitive than pre-
j.physbeh.2013.03.014 viously reported. Journal of Biological Rhythms, 30(4), 351-354.
doi:10.1177/0748730415585413
Scheir, G.H., Hanselaer, P. & Ryckaert, W.R. (2017). Defining
the actual luminous surface in the unified glare rating. Leukos, Wahl, S., Engelhardt, M., Schaupp, P., et al. (2019). The inner
13(4), 201-210. doi:10.1080/15502724.2017.1283232 clock—Blue light sets the human rhythm. Journal of Biophoton-
ics, 12(12), e201900102. doi:10.1002/jbio.201900102
ScienceDirect. (2019). Spectroradiometers. Retrieved from
www.sciencedirect.com/topics/earth-and-planetary-sciences/ Wilkins, A., Veitch, J. & Lehman, B. (2010). LED lighting
spectroradiometers flicker and potential health concerns: IEEE standard PAR1789
update. Proceedings of the 2010 IEEE Energy Conversion Con-
Sliney, D.H. (1994). Ocular hazards of light. In T.W. Tibbitts gress and Exposition, Atlanta, GA, USA.
(Ed.), International Lighting in Controlled Environments Work-
shop Proceedings (pp. 183-189). Yang, Y., Luo, M.R. & Huang, W.J. (2018a). Assessing glare,
part 3: Glare sources having different colors. Lighting Research
Sliney, D.H. (2016). What is light? The visible spectrum and and Technology, 50(4), 596-615. doi:10.1177/1477153516676640
beyond. Eye, 30(2), 222-229. doi:10.1038/eye.2015.252
Yang, Y., Luo, M.R. & Huang, W.J. (2018b). Assessing
Smedley, A.R., Webb, A.R. & Wilkins, A.J. (2010). Potential glare, part 4: Generic models predicting discomfort glare of
of wind turbines to elicit seizures under various meteorological light-emitting diodes. Lighting Research and Technology, 50(5),
conditions. Epilepsia, 51(7), 1146-1151. doi:10.1111/j.1528-1167 739-756. doi:10.1177/1477153516684375
.2009.02402.x
Yang, Y., Luo, M.R., Ma, S.-N., et al. (2017). Assessing
Smolensky, M.H., Hermida, R.C., Reinberg, A., et al. (2016). glare, part 1: Comparing uniform and non-uniform LED lu-
Circadian disruption: New clinical perspective of disease pa- minaires. Lighting Research and Technology, 49(2), 195-210.
thology and basis for chronotherapeutic intervention. Chrono- doi:10.1177/1477153515607396
biology International, 33(8), 1101-1119. doi:10.1080/07420528.20
16.1184678 Yang, Y., Luo, M.R. & Ma, S.-N. (2017). Assessing glare, part
2: Modifying unified glare rating for uniform and non-uniform
Sollars, P.J. & Pickard, G.E. (2015). The neurobiology of circa- LED luminaires. Lighting Research and Technology, 49(6), 727-
dian rhythms. Psychiatric Clinics of North America, 38(4), 645- 742. doi:10.1177/1477153516642622
665. doi:10.1016/j.psc.2015.07.003

Stabio, M.E., Sabbah, S., Quattrochi, L.E., et al. (2018). The M5
cell: A color-opponent intrinsically photosensitive retinal gangli-
on cell. Neuron, 97(1), 150-163. doi:10.1016/j.neuron.2017.11.030

William Mills, Ph.D., CIH, is co- Kevin Martin, Ph.D., is an associate trical Engineering Technology from NIU.
founder of the Building Energy Efficiency, professor in the Department of Engineer- His master’s thesis involved using lighting
Ergonomics and Management (BEEEAM) ing Technology at NIU where he leads the principles and human factors to create a
laboratory at Northern Illinois University BEEEAM laboratory. His primary research wearable spectrometer to monitor an indi-
(NIU). He has more than 30 years’ experi- interests include human-centric building vidual’s personal exposure to the blue light
ence in environmental, health and safety, control systems with a focus on lighting hazard and circadian rhythm disruption. He
chemical processes and advanced technol- technology. Martin has been involved in is a member of ASSP’s Northeastern Illinois
ogies issues. Mills is a professional member research on renewable energy systems, in- Chapter and a member of the Society’s
of ASSP’s Northeastern Illinois Chapter, a dustrial energy efficiency, hydrogen vehicle Management Practice Specialty. He is also
member of the Society’s Academics, Envi- infrastructure construction and modeling, a member of the Emerging Professionals in
ronmental, Ergonomics, Industrial Hygiene as well as development of fuel cell plug-in OSH Common Interest Group.
and Transportation practice specialties, hybrid electric vehicles.
and a member of the Blacks in Safety Ex- Disclaimer
cellence, Hispanic Safety Professionals and Justin Cathey is a staff scientist at Mills
Emerging Professionals in OSH common Consulting Inc., an environmental health No specific health or technology recommen-
interest groups. and safety consulting firm. He holds an M.S. dations are being made and all examples are
in Industrial Management and a B.S. in Elec- for informational purposes only.

30 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

SAFETY METRICS
Peer-Reviewed

EXPERIENCE
MODIFICATION

RATE

as a Prequalification
Criterion for Safety

Performance

By Ahmed Jalil Al-Bayati, Kevin O’Barr, SungJoon Suk, Alex Albert and Jarred Chappell

ZONECREATIVE/ISTOCK/GETTY IMAGES PLUS TTHE PREQUALIFICATION PROCESS is often used by dayyeh, Fredericks, Butt et al., 2006; Jallon, Imbeau
hiring firms to evaluate the ability of contractors & de Marcellis-Warin, 2011; Ladewski & Al-Bayati,
to execute the work successfully (Truitt, 2012). 2019; Votano & Sunindijo, 2014).
Considering safety performance as one of the pre-
qualification standards is essential to ensure that an As a result, national and international agencies
acceptable level of safety performance is achieved such as American Society of Civil Engineers (ASCE)
(Tappura, Sievänen, Heikkilä et al., 2015; Truitt, and U.K.’s Health and Safety Executive (HSE) have
2012). Generally, firms with satisfactory safety per- suggested the adoption of specific safety best prac-
formance records have a well-defined procedure to tices to ensure superior safety performance (Liang,
identify and eliminate possible hazards in the work- Zhang & Su, 2018). However, the proposed best
place to minimize work-related incidents (Huang & practices have been designed to be used internally
Hinze, 2006). These firms are expected to achieve within organizations, and hiring firms (e.g., general
superior safety performance with a lower likelihood contractors) often do not have access to the infor-
of work-related incidents (Brahmasrene & Smith, mation. Consequently, hiring firms have limited
2008). The likelihood positively impacts budget, capability to evaluate the overall safety performance
completion time, work quality and reputation (Abu- of bidders. Written safety programs and experi-
ence modification rate (EMR) have been suggested
KEY TAKEAWAYS as prequalification criteria (Alzahrani & Emsley,
2013). There is a positive correlation between safety
•Experience modification rate (EMR) is commonly used as a pre- performance and the implementation of the well-es-
tablished safety program (Gilkey, del Puerto, Keefe
qualification criterion to assess the capabilities of bidders in ensur- et al., 2012). However, it is difficult to assess the level
ing workplace safety. and quality with which firms execute and enforce
the safety plan on the basis of a written program;
•This study investigates factors that contribute to firms’ EMR to Wilbanks (2018) suggests that utilizing written safe-
ty programs as a prequalification is questionable,
evaluate the reliability and validity of EMR as a safety prequalifi- which leaves EMR as the most reliable prequalifica-
cation criterion. The survey results strongly suggest that several tion criterion. EMR popularity and acceptance as a
non-safety-related factors contribute to EMR such as firm size in prequalification criterion have increased rapidly in
terms of the number of employees and post-injury management. recent years (Clayton, 2016).

•Accordingly, utilizing EMR as a prequalification criterion without EMR is a numeric representation that indicates the
amount of money a firm has spent on work-related
considering the contributing factors may not be reliable. Thus, the
authors suggest recommendations and best practices to help the assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 31
recruitment of safe firms and to guarantee that EMR is utilized ap-
propriately by safety personnel.

incidents against the average spending by similar firms (i.e., claims, which resulted in days away from work. A med-
dividing actual losses by expected losses). EMR is deter- ical-only claim means that the injured employee will
mined based on the injury claims for previous years that do receive medical attention, but will return to work without
not include the most recent year and essentially provides any indemnity payments (i.e., lost wages). Generally, in-
incentives for firms with good safety performance (Brah- demnity payments do not start until after the 7th day of
masrene & Smith, 2008; Everett & Thompson, 1995; Hinze, missed work. For medical-only claims, only 30% of the
Bren & Piepho, 1995; Hoonakker, Loushine, Carayon et al. claim’s amount counts against the employer, while the
2005; Rouse, 1997; Taggart & Carter, 1999). For example, full dollar amount of temporary or permanent disability
if an employer’s EMR is below 1.0, firms using EMR as a claims counts in the EMR calculation.
prequalification criterion would consider the employer
safer than the average. Similarly, an employer with an EMR For example, identical firms A and B experienced two
greater than 1.0 is considered riskier and must pay a higher incidents that cost $10,000 each. However, firm A brought
premium. For example, a firm with a 1.10 EMR needs to the injured employee back to perform light-duty work the
pay a 10% additional premium, while a firm with a 0.85 next day, while firm B did not. In this case, for firm A, the
EMR receives a 15% premium credit. $10,000 claim would only count on the EMR as a $3,000
claim (i.e., 30%). The EMR would only increase by roughly
EMR has been considered a well-established incentive 0.01 points and costs the employer about $3,000 over 3
mechanism based on firms’ safety performance (Al-Bayati, years in additional premium. On the other hand, for firm
Albert & Ford, 2019; de la Garza, Hancher & Decker, 1998; B, the $10,000 claim would count on the EMR as a $10,000
Hatush & Skitmore, 1997; Imriyas, Low, Teo et al., 2008). claim since it resulted in 1 day’s worth of lost wages. Based
Thus, EMR has been one of the practical indicators that on the North Carolina system, firm B’s EMR goes up by
are often used to measure safety performance (de la Gar- roughly 0.05 points, and the firm will pay $10,000 over the
za, Hancher & Decker, 1998; Hinze, Thurman & Wehle, 3 years. Thus, two identical claims concerning the cost (i.e.,
2013; Jaselskis, Anderson & Russell, 1996; Ng, Cheng & $10,000) have a different impact on EMR values. The dif-
Skitmore, 2005; Votano & Sunindijo, 2014). Abudayyeh et ference in the impact is due to the differences in the claim
al. (2006) found a positive relationship between EMR and severity and management practices.
management commitment to safety. Similarly, Al-Bayati et
al. (2019) found a negative correlation between construc- The second important factor that contributes to the
tion safety culture and EMR. Alzahrani and Emsley (2013) EMR calculation is the actual primary losses (APL). The
concluded that EMR is a critical indicator of successful APL value is the first $16,500 paid out on a claim in the
safety and health performance that promotes the comple- state of North Carolina. The APL is weighted more heav-
tion of a project without major incidents. ily in the EMR calculation than the rest of the claim paid
out after the first $16,500. For example, if firm A had one
However, EMR has never been intended to act as a qualifi- $33,000 claim, it would show on the EMR as $16,500 in
cation criterion. It is designed as a tool for insurance carriers the APL. On the other hand, if firm B had two claims
to adequately recoup costs on future premiums. Therefore, of $16,500 each, it would show on the EMR as $33,000
utilizing EMR as a tool to evaluate the recent safety practices in APL. Thus, even though the total value of the actual
of an employer should be carefully examined. Specifically, claims for the two firms is identical, firm B would be pe-
EMR does not adequately depict what firms have done to nalized more harshly due to the higher primary losses.
correct unsafe conditions after any incident has occurred. Thus, the contributing factor in this scenario is the fre-
In addition, EMR is based on a no-fault instrument whereby quency of cases with values equal to or higher than APL.
the employer is responsible for the injury regardless of the However, if firm B accommodated light-duty work for
injury’s cause and circumstances. For example, if an employ- the two injured employees, then the total APL would be
ee is injured in an auto incident while at work, the employ- $9,900 (i.e., 16,500 x 30% x 2), which is less than the total
er’s workers’ compensation will be the primary payer on that APL of firm A.
injury, even if the other driver may have been at fault. This
would impact EMR without consideration of its nature even Finally, the EMR calculation is more forgiving for
if it is not the fault of the employer, which would cause an larger firms. For example, firm A has $200,000 in payroll
inaccurate depiction of firms’ safety performance. annually (e.g., five workers) with an expected loss rate of
5%. This means that firm A is expected to have $10,000 in
EMR Calculations claims in a year. On the other hand, firm B has $2,000,000
There are a few differences in EMR calculation between in payroll annually (e.g., 50 workers) with a class code
similar to firm A (i.e., an expected loss rate of 5%). This
states due to the fact that states manage workers’ compen- means that firm B is expected to have $100,000 in claims
sation differently. Most states have designated National in a year. Therefore, if both firms had a claim during a
Council on Compensation Insurance (NCCI) as their year that paid out $20,000 (all else being equal), then firm
licensed rating and statistical organization. However, the A has doubled its expected loss rate, while firm B is only
research presented in this article was based entirely in at one-fifth of its expected loss rate. In this scenario, firm
one state, North Carolina, which utilizes an independent A would end up with an EMR higher than firm B.
licensed bureau for rating and statistics. Thus, the calcula-
tion examples presented in this section may differ slightly These examples indicate that several non-safety-related
in a different state or region. factors contribute to EMR. These factors have not been
fully explored in previous studies such as Abudayyeh et
There are two types of claims in the EMR world: 1) al. (2006), Everett and Thompson (1995), and Hinze et al.
medical-only claims, which resulted in job restriction (1995). Thus, there is a need to understand these and other
or transfer; and 2) temporary or permanent disability factors to assess the validity and reliability of using EMR

32 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

as a prequalification criterion. Accordingly, this study TABLE 1
seeks to answer several questions:
STUDY SAMPLE DEMOGRAPHICS
1) What are the safety practices, nature of incidents and
structure of employers that currently have or had an EMR The number of responses per question varies.
higher than 1.5?
Characteristics Number (%)
2) What are the factors that contribute the most toward
the reduction of firms’ EMR? Revenue

Methodology Less than $500,000 12 (9.3 %)
To answer the research questions, a partnership with
$500,000 to $1 million 10 (7.8 %)
the North Carolina Department of Labor’s (NCDOL)
Occupational Safety and Health Division Consultative $1 million to $5 million 99 (76.7%)
Services Bureau was established to reach businesses
whose EMR exceeded 1.5 in the past 3 years. In 1992, More than $5 million 8 (6.2%)
the North Carolina state legislature passed a law (NCGS
§95-250-259) requiring employers with an EMR of 1.5 or Number of employees
higher to develop written safety and health policies and
to establish a safety committee for employers with more Fewer than 10 12 (8.9%)
than 10 employees. The law also requires NCDOL to no-
tify businesses when their EMR exceeds 1.5. Accordingly, 10 to 50 72 (53.3%)
the researchers developed a survey to answer the study
questions. After the research team developed the survey 50 to 100 19 (14.1%)
instrument and its protocol, the survey instrument was
submitted to Western Carolina University’s Human Sub- 100 to 250 23 (17%)
ject Institutional Review Board for review and approval.
Once approved, the research team invited 1,300 employ- More than 250 9 (6.7%)
ers via mail to participate in the survey. The mailings were
sent directly by the NCDOL Consultative Services Bureau Establishment type
to ensure employers’ confidentiality. Invited employers
had workers’ compensation policies with an EMR of 1.5 Construction 39 (28.3 %)
or higher during 2015, 2016 and 2017. Participants had the
option to complete a hard copy of the survey or an online Manufacturing 27 (19.6 %)
survey through a link provided to them in the mail.
Health and education 12 (8.7%)
Survey Results
The survey was administered throughout September Sales 10 (7.2%)

2018 and 138 firms participated in the study (i.e., 10.6% Others 50 (36.2%)
response rate). The design of the survey did not prevent
participants from skipping questions if they so desired. Years of experience
Thus, the number of responses received for each question
is reported in the discussion of the results. Fewer than 10 years 15 (11.4%)

The job title of individuals who completed the survey 10 to 30 years 50 (37.9%)
fell within the following categories: 53 (38.1%) were own-
ers, presidents or executive directors; 24 (17.3%) were 30 to 50 years 34 (25.8%)
accountants or other office roles; 19 (13.6%) were human
resources managers; 11 (7.9%) were safety managers/coor- More than 50 33 (25%)
dinators; 21 (15.1%) were others including vice president,
general manager and operating partner. TABLE 2

In addition, the specialization of participating firms fell CHANGE IN PERCENTAGES
within the following categories: 39 (28.3%) were in con- OF SHWP & SHC
struction businesses, mostly special trades businesses; 27
(19.6%) were in manufacturing; 12 (8.7%) were in health Characteristics Before After (currently)
and education; 10 (7.2%) were in sales businesses; and the
remaining were in a range of businesses such as restau- SHWP 68.9% 89.1%
rants and cleaning services (Table 1).
SHC 46.3% 66.7%
The reported number of workers at the firms were as
follows: 12 (8.9%) had fewer than 10 workers; 72 (53.3%) TABLE 3
had between 10 and 50 workers; 19 (14.1%) had between
50 and 100 workers; 23 (17%) had between 100 and 250 SAFETY MANAGER VS.
workers; and 9 (6.7%) had more than 250 workers. SHWP CROSS-TABULATION

The reported estimated revenue of participants’ firms Safety manager/ SHWP Total
was as follows: 12 (9.3%) were less than $500,000; 10 coordinator Yes No
(7.8%) between $500,000 and $1 million; 99 (76.7%) be- 39 0 39
Yes 84 15 99
No 123 15 138
Total


assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 33

TABLE 4

NUMBER (PERCENTAGE) OF CASES THAT LED TO EMR VALUE GREATER THAN 1.5

Firm size One incident Two incidents Three incidents Four incidents
Fewer than 10 workers 4 (44.5%) 2 (22%) 3 (33.5%) 0
10 to 50 workers 25 (42.4%) 23 (39%) 8 (13.5%) 3 (0.1%)
50 to 100 workers 4 (26.7%) 7 (46.6%) 2 (13.4%) 2 (13.4%)
100 to 250 workers 6 (33.4%) 5 (27.8%) 7 (38.8%) 0
250 to 500 workers 0 0 2 (67%) 1 (33%)
More than 500 workers 0 0 1 (25%) 3 (75%)

tween $1 million and $5 million; and 8 (6.2%) were more SHWP are 6.4 times more likely to have an SHC. Further-
than $5 million. more, the odds ratios between SHWP and SHC, and the
ability to reduce EMR were calculated. Of all participants,
Finally, the reported years of experience was as follows: 133 firms provided information about the status of their
15 (11.4%) had less than 10 years’ experience; 50 (37.9%) SHWP and SHC as well as EMR value (i.e., lower than 1.3).
had between 10 and 30 years; 34 (25.8%) had between The odds ratio of reducing the EMR value among firms that
30 and 50 years; and 33 (25%) had more than 50 years. have an SHC is 0.923 (95% CL, 0.4 to 2.1). This would mean
Accordingly, the study sample represents a wide range of that firms with safety committees were 0.92 times more
firms (Table 1, p. 33). likely to reduce their EMR than firms that do not have a
safety committee. In other words, having a safety commit-
Safety Characteristics of the Study Sample tee within the study sample does not influence EMR values.
This section discusses the safety practices and structure On the other hand, the odds ratio of reducing the EMR val-
ue among firms that have an SHWP is 1.053 (95% CL, 0.33
of employers that participated in the study. It is vital to to 3.29), which means that within the study sample, SHWP
uncover the safety practices and structure of employers helped firms reduce their EMR values by 1.053 times.
before and after the firms reached an EMR value of 1.5 to
help identify the characteristics that led to a higher EMR, The participants were asked to provide information
as well as those that would help reduce it. EMR values of about who manages safety and health in their firms. The
a large percentage of participants (65.2%) have fallen be- findings indicate that 71.7% of participants do not have a
low 1.5, which means the study sample has an acceptable safety manager/coordinator. Additionally, the participants
experience with the factors that contribute to EMR value. were asked about the safety certification carried by the
According to North Carolina law, each firm that reaches individual who manages safety and health in their firms.
1.5 EMR must establish a safety and health written pro- The question provided the following options: certified safe-
gram (SHWP) and safety and health committee (SHC). ty professional (CSP), associate safety professional (ASP),
SHWPs provide adequate systematic policies, procedures construction health and safety technician (CHST), OSHA
and practices to ensure a safe and healthful working en- card, none and other. The results show that the individuals
vironment that allows employees to recognize job-related who manage safety and health of 84 (61.8%) firms have no
safety and health hazards (OSHA, 2019a). safety certification, while only 31 (22.8%) have OSHA cards
and 21 (15.4%) have other certifications. Additionally, the
The SHC is an integral part of the SHWP that helps en- odds ratio was calculated by using the number of firms
sure effective implementation of the program at the estab- that currently have and do not have safety personnel, along
lishment level (OSHA, 2019b). The law in North Carolina with their current EMR values (lower than 1.5 or not). Of
only requires employers with more than 10 employees to all participants, 133 firms provided information about their
establish an SHC. Thus, calculations related to SHC have current EMR values and safety personnel. The odds ratio
excluded firms with 10 or fewer employees. Table 2 (p. of having safety personnel in firms that lowered their EMR
33) shows the change in the percentages of written safety versus firms that do not is 2.29 (95% CI, 1 to 5.556). This
programs and safety committees within the study sample. result means that a firm with safety personnel is 2.29 times
The findings indicate that 20.2% of the study sample has more likely to reduce its EMR value compared to a firm that
initiated a safety and health written program and only does not have a safety manager/coordinator. The overall
20.4% has initiated a safety committee between the time findings regarding safety managers/coordinators and their
their EMR values increased to more than or equal to 1.5 credentials may explain the cause for having an EMR value
and now. Furthermore, the organizations that already had above 1.5. On the other hand, the job titles of individuals
a written program improved it after their EMR increased who manage safety and health included human resources
(i.e., 68.9%). This could mean that the EMR policy encour- manager, workers’ compensation administrator, upper
ages employers to improve their overall safety performance management, operations manager and facility maintenance.
to ensure that the EMR value remains at an acceptable lev-
el. As a result, the data indicates that 90 (65.2%) firms have The odds ratio was calculated to assess the relationship
successfully reduced their EMR below 1.5. between safety managers/coordinators and the presence of
an SHC. The odds ratio of having SHC in firms that have
To better understand the relationship between SHWP safety personnel versus firms that do not is 2.65 (95% CI,
and SHC, the odds ratio was calculated by using the num- 1.04 to 6.745). This result means that a firm with safety per-
ber of firms that currently have written safety programs sonnel is 2.65 times more likely to have an SHC compared
and those that do not, along with their current SHC exis- to a firm that does not have a safety manager/coordinator.
tence. Of all participants, 138 firms provided information Finally, the collected data suggest that 100% of the firms
about the status of their SHWP and SHC. The odds ratio with a safety coordinator have an SHWP (Table 3, p. 33).
of establishing SHC among firms that have an SHWP is
6.4 (95% CI, 1.59 to 25.57), which means that firms with an

34 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

TABLE 5

SAMPLE OF FOCUS GROUPS’ FEEDBACK

Incident type Feedback example
Preventable,
employee • We had an injury involving an employee who was extremely allergic to bee stings and
responsibility was hospitalized for several days.

Preventable, • Employees at fault, not following proper safety procedures.
employer • An employee injured during manual labor. The employee states that the injury could
responsibility
have been prevented if the employee was using proper method of work.
Nonpreventable
• During the time that the EMR was so high, there was no one handling the safety
Auto incidents program. Also, employees’ morale was low. All of this contributed to high EMR.

False claims • One incident is a cut finger, only with safety glass that cuts tendon. He was paid for 2
years to stay at home. Error on our part to allow that which is due to bad/no advice
from previous workers’ compensation company.

• Subcontractor's insurance lapsed and we were not notified by the insurance company.
• A girl fell off one step and twisted her ankle, and she dealt with it for 3 years with

surgery after surgery.
• This incident was not our fault. It was faulty building on the builder’s end. Board was

not nailed down properly in a ceiling.
• Wind blowing debris into eyes. Employee fell off stepladder, subcontractor's insurance

lapsed, and we were not notified by insurance company.

• Employee hit by a car while working.
• We had one large claim that was the result of a traffic incident that was not

preventable as a city bus ran a red light and hit us.
• Our vehicle was struck by another vehicle (i.e., hit and run).
• An employee intentionally fell off ladder because, I later found out, her supervisor had

seen her practicing tipping over the ladder. If I had known she had two other such
occurrences at other jobs, I probably would have not hired her.
• A gentleman who was known to play soccer came in from long Memorial Day
weekend to work. We had inventory that day. He was on hands and knees on floor
picking up trash and said he put his knee on a bolt on the floor and ended up with two
knee replacements.
• Due to one employee’s back injury 3 years ago our EMR increased. After 3 years, they
found he has no back injury.

EMR Calculation & Contributing Factors “I agree if the work environment is large enough
The survey asked participants whether they understand to support the EMR calculation.”

how EMR is calculated and the EMR’s reliability as an “Being a smaller company, if a single incident is
indicator of firms’ overall safety performances. The re- recordable, our EMR is affected significantly.”
sults indicate that 63.8% of participants understand the
EMR calculation method; however, the survey instrument Participants were asked about the number of incidents
cannot validate this belief. It is anticipated that the num- that led to the EMR value higher than 1.5. The responses
ber is much lower when actually pressed to explain the indicate that the EMR value of smaller firms (fewer than
details of how it works. Furthermore, only 30.3% of the 100 workers) is significantly impacted by one or two inci-
participants agreed that EMR is a good indicator of safety dents (Table 4). Three incidents are more likely to impact
performance. Following is a sample of participants’ com- the EMR of midsize firms (100 to 250 workers). Lastly,
ments about why they do not believe EMR is a good safety the EMR value of larger firms (more than 250 workers)
measurement of safety performance: often gets impacted by four incidents or more (Table 4).
A Mann-Whitney U test was conducted to determine
“Our overall safety performance has been satis- whether there were statistical differences in the number
factory. Two incidents that took place in 2013 and of incidents that led to higher EMR between smaller firms
2014 just happened to settle in 2016 at the same and midsize and larger firms. The test results indicated
time. In looking at the facts of each incident, I that number of incidents for smaller firms (mean rank =
think one could determine that these incidents 55.48) and midsize and larger firms (mean rank = 72.43)
do not represent our overall safety performance. are significantly different (U = 898, Z = -2.399, p = .016).
This finding confirms that the EMR of smaller firms is
“I feel that our current rating is largely the result of vulnerable to fewer numbers of work-related incidents
bad luck and poor decisions regarding our insurance than larger firms.
company’s choosing to contest a claim, rather than
being the result of poor safety practices in our plant.” Participants were asked about the factors that contrib-
ute to lower EMR. Safety training, safety meetings, SHC

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 35

and SHWP have been suggested as the most contributing “The number of incidents was very low, only one
factors to lower EMR. Additionally, the participants were or two, but the days away from work were high.”
asked about the actions that would prevent EMR from
increasing in the future. The participants’ recommen- “New management with little institutional
dations include training and education, communicating knowledge.”
safety requirements and practices, involving employees
and subcontractors in the safety program and improving “Physical impairment or limitation not communi-
human resources management. Following is a sample of cated to or perceived by company management.”
participants’ comments:
“The primary driver was our insurance company’s
“Having an open-door policy and discussing safe- decision to deny a knee injury claim. The decision
ty with all employees regularly.” resulted in the employee hiring an attorney. The
claim was eventually settled for $20,000, but sig-
“Having production/field employees on the nificant legal fees were incurred.”
committee.”
Discussion & Recommendations
“The policy itself, education of staff and provid- EMR has been used by many firms as a prequalifier to
ing examples of unsafe behaviors.”
ensure acceptable safety performance. However, few, if
“Safety meetings and on-site safety inspection.” any, studies validate the utilization of EMR. Accordingly,
the survey reveals several factors that would help both
“Sharing the impact of unsafe practices with hiring firms as well as firms seeking to be hired beyond
employees.” the factor suggested by Abudayyeh et al. (2006), Everett
and Thompson (1995), and Hinze et al. (1995). The study
The Nature of Incidents reveals the importance of having a safety manager/coor-
Participants were asked to provide information about the dinator on overall safety performance. A safety manager/
coordinator increases the probability of having SHWP by
nature of incidents that led to a higher EMR in their firms. 100% and SHC by 3.81 times. As a result, the likelihood
Table 5 (p. 35) provides a sample of these incidents. The of improving the overall safety performance increases by
nature of reported incidents could be classified as follows: 2.29 when having full-time safety personnel. The impor-
tance of safety personnel on EMR value as well as safety
•Preventable incidents that could be categorized as follows: culture has been suggested by Al-Bayati et al. (2019).
a) Preventable, employee responsibility: These types of
incidents could be prevented by employees’ safe actions. The study indicates that SHWP increases the likeli-
These incidents include slips, falls, improper use of tools, hood of SHC by 8.3 times and the likelihood of reduced
and not following guidelines and safety protocol. How- EMR by 1.03. Thus, having effective SHWP is crucial. The
ever, further investigation is needed to learn whether findings also suggest that the influence of SHC within
the employers have provided the required training and the study sample is small (Figure 1). The findings suggest
enforcement to encourage employees’ safe actions. These a significant role for the safety manager/coordinator in
incidents would not be the employees’ responsibility if initiating and maintaining a higher than average level
employers did not provide the needed training and en- of safety performance and better incident management.
forcement (Al-Bayati, 2019). These types of incidents were Figure 1 illustrates the significant role of the safety man-
mentioned 76 times in participants’ comments. ager/coordinator revealed in this study. Conversely, the
b) Preventable, employer responsibility: These types of absence of a safety manager/coordinator in 71.7% of the
incidents could be prevented by employers’ commitment study sample could explain the fact that these firms had
to safety. These incidents have been identified when par- or currently have high EMR values. In addition, other
ticipants stated that more safety management or training factors such as safety training, regular safety meetings
should have been implemented to prevent injuries. and employee involvement were suggested to ensure lower
•Nonpreventable: These incidents have been considered EMR value. Accordingly, these factors should be consid-
catastrophic or claimed to be nonpreventable. ered in internal and external efforts that aim to improve
•Non-work-related incidents: Most of these incidents and evaluate the overall safety performance.
happened away from the workplace or while undertaking
non-work-related activities, such as auto incidents during Each firm’s size significantly contributes to the EMR
traveling between the firm’s workplaces. However, they calculations. The EMR values of smaller firms are more
must be reported to the insurance and paid from the sensitive to incidents than larger firms. The findings in-
workers’ compensation fund. dicate that the EMR value of firms with fewer than 100
•False claims: Fake injuries to gain workers’ compen- workers is negatively impacted by one or two incidents,
sation were reported by participants. These cases could while firms with more than 250 workers often are nega-
be eliminated by better hiring processes (e.g., new hire tively impacted by more than three incidents. In addition,
screening). For example, it is essential to hire individuals the EMR value could be a result of poor management of
who have an acceptable career history with no previous the firm’s incidents as well as the hiring process (e.g., lack
suspicious workers’ compensation claims. of pre-hire screening) rather than the overall safety per-
Besides the incidents’ nature, the handling of incidents formance. Effective management of incidents including
appears to be a factor. Poor management could easily lead a return to work policy would reduce the days away from
to a higher number of days away from work, which sig- work cases. For example, firms should communicate the
nificantly impacts the EMR value, as discussed. Following influence of days away from work on the overall EMR to
is a sample of participants’ feedback that illustrates the the healthcare provider to consider job transfer or restric-
influence of poor management:

36 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

FIGURE 1

INFLUENCE OF SAFETY MANAGER/
COORDINATOR IN TERMS OF ODDS RATIOS

tion when possible. On the other hand,

serious hiring screening would reduce

false claims. Finally, non-work-related

incidents such as auto incidents also con-

tribute to the EMR values, and they do

not reflect the overall safety performance.

Figure 2 illustrates the suggested frame-

work of the factors that influence EMR

value based on the study findings.

Based on the suggested framework, Note. *The value is statistically significant

maintaining an acceptable EMR value is

a shared responsibility among involved

parties (e.g., safety personnel, human FIGURE 2

resources personnel, employees, insur- CONCEPTUAL FRAMEWORK OF
ance carriers). The study focus was on FACTORS THAT IMPACT EMR VALUE
safety-related factors since the shared

responsibility concept was not known to

the research team. Therefore, most of the

discussion and findings focus on the char-

acteristics related to overall safety per-

formance. Following are examples of the

responsibilities of involved parties under

the shared responsibility approach:

•Safety personnel:

a) SHWP;

b) safety training and enforcement;

c) safety meetings and inspections;

d) investigate the incident.

•Human resources personnel:

a) employee screening during the con-

ditional employment period;

b) wellness program; •Reviewing the safety personnel’s credentials could be

c) communicate the accommodation available for re- part of the request for qualifications due to the significant

striction and job transfer cases to injured employees and role of safety personnel on overall safety performance.

healthcare provider to reduce the number of days away

from work; Conclusion

d) establish an effective return-to-work policy. Workers’ compensation premiums continue to be a

•Insurance carriers: major concern. Thus, employers strive to fully understand
a) oversee the efforts to improve safety performance; the factors that contribute to EMR. Accordingly, this study
b) claim handling policy; highlights the knowledge needed to regain control of

c) designate a representative to handle workers’ com- workers’ compensation costs. Stakeholders should realize

pensation claims; that workers’ compensation aims to cover the expected

d) program evaluation policy; losses being collected, regardless of whether these losses are

e) educate customers regarding EMR calculations. related to poor safety performance. Thus, the shared re-

Based on overall study findings, EMR should not be used sponsibility among involved parties (e.g., safety personnel,

as a prequalifier without considering the non-safety factors. human resources personnel, insurance carrier) to maintain

Accordingly, following are practical recommendations to a lower EMR should be considered. The study also reveals

effectively and fairly utilize EMR as a prequalifier: a significant role for safety personnel and the importance

•The hiring firms should request the number of employ- of post-incident management. Several factors contribute to

ees along with the EMR value. Accordingly, the bidders the EMR value that are not related to the overall safety per-

should be categorized into smaller and larger firms to rea- formance, such as firm size in terms of the number of em-

sonably utilize EMR as a prequalifier. ployees, non-work-related incidents, return-to-work policy

•Hiring firms should review the nature of work-related and the employer’s knowledge of EMR calculation. Accord-

incidents of firms with higher EMR if other qualifications ingly, this study bridges the gap of knowledge regarding the

satisfy the request for qualifications. The EMR should not factors contributing to EMR value. Firms utilizing EMR as

be used as a prequalifier if the review indicates that inci- a prequalifier should reconsider this practice unless they

dents are not work-related incidents, such as automobile adopt the recommendations provided in this study. PSJ

incidents. On the other hand, the bidders with high EMR

values should submit a detailed explanation as to why References
their EMR value is higher than average and what correc-
Abudayyeh, O., Fredericks, T.K., Butt, S.E., et al. (2006). An in-

tive actions, if any, were taken to ensure an acceptable vestigation of management’s commitment to construction safety.

level of safety performance. International Journal of Project Management, 24(2), 167-174.

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 37

Al-Bayati, A.J. (2019). Satisfying the need for diversity training Imriyas, K., Low, S., Teo, A., et al. (2008). Premium-rating
for Hispanic construction workers and their supervisors at U.S. model for workers’ compensation insurance in construction.
construction workplaces: A case study. Journal of Construc- Journal of Construction Engineering and Management, 134(8),
tion Engineering and Management, 145(6). doi:10.1061/(ASCE) 601-617.
CO.1943-7862.0001663
Jallon, R., Imbeau, D. & de Marcellis-Warin, N. (2011). A pro-
Al-Bayati, A.J., Albert, A. & Ford, G. (2019). Construction safe- cess mapping model for calculating indirect costs of workplace
ty culture and climate: Satisfying necessity for an industry frame- accidents. Journal of Safety Research, 42(5), 333-344. doi:10.1016/
work. Practice Periodical on Structural Design and Construction, j.jsr.2011.06.008
24(4). doi:10.1061/(ASCE)SC.1943-5576.0000452
Jaselskis, E.J., Anderson, S.D. & Russell, J.S. (1996). Strategies
Alzahrani, J.I. & Emsley, M.W. (2013). The impact of contrac- for achieving excellence in construction safety performance.
tors’ attributes on construction project success: A post construc- Journal of Construction Engineering and Management, 122(1),
tion evaluation. International Journal of Project Management, 61-70.
31(2), 313-322.
Ladewski, B. & Al-Bayati, A.J. (2019). Quality and safety
Brahmasrene, T. & Smith, S.S. (2008). Empirical evidence of management practices: The theory of quality management ap-
factors affecting experience modification rate used by the U.S. proach. Journal of Safety Research, 69, 193-200. doi:10.1016/
insurance industry. Journal of Transnational Management, 13(3), j.jsr.2019.03.004
244-258.
Liang, H., Zhang, S. & Su, Y. (2018). Using leading and lagging
Clayton, R.M. (2016, Nov.). Experience modification rating: indicators to select safe contractors at the prequalification stage of
Understanding the value and limitations. Professional Safety, construction projects. International Journal of Occupational and
61(11), 40-43. Environmental Health, 24(1-2), 61-74.

de la Garza, J.M., Hancher, D.E. & Decker, L. (1998). Analysis Ng, S.T., Cheng, K.P. & Skitmore, R.M. (2005). A framework
of safety indicators in construction. Journal of Construction Engi- for evaluating the safety performance of construction contractors.
neering and Management, 124(4), 312-314. Building and Environment, 40(10), 1347-1355.

Everett, J.G. & Thompson, W.S. (1995). Experience modifica- OSHA. (2019a). Safety and health program management guide-
tion rating for workers’ compensation insurance. Journal of Con- lines. Retrieved from www.osha.gov/Publications/Const_Res
struction Engineering and Management, 121(1), 66-79. _Man/1926_C_SH_guide.html

Gilkey, D.P., del Puerto, C.L., Keefe, T., et al. (2012). Compar- OSHA. (2019b). Basic program elements for federal employees
ative analysis of safety culture perceptions among HomeSafe OSHA (29 CFR 1960.40). Retrieved from www.osha.gov/laws
managers and workers in residential construction. Journal of -regs/regulations/standardnumber/1960/1960.40
Construction Engineering and Management, 138(9), 1044-1052.
doi:10.1061/(asce)co.1943-7862.0000519 Rouse, W.L. (1997, Sept.). Factors of the experience modifica-
tion rating and what they mean. Professional Safety, 42(9), 27-29.
Hatush, Z. & Skitmore, M. (1997). Evaluating contractor pre-
qualification data: Selection criteria and project success factors. Taggart, M.D. & Carter Sr., H. (1999, May). Assessment matri-
Construction Management and Economics, 15(2), 129-147. ces for benchmarking. Professional Safety, 44(5), 34-37.

Hinze, J., Bren, D.C. & Piepho, N. (1995). Experience modifica- Tappura, S., Sievänen, M., Heikkilä, J., et al. (2015). A manage-
tion rating as measure of safety performance. Journal of Construc- ment accounting perspective on safety. Safety Science, 71(Part B),
tion Engineering and Management, 121(4), 455-458. 151-159.

Hinze, J., Thurman, S. & Wehle, A. (2013). Leading indicators Truitt, D. (2012, March). Contractor prequalification. Profes-
of construction safety performance. Safety Science, 51(1), 23-28. sional Safety, 57(3), 34-35.

Hoonakker, P., Loushine, T., Carayon, P., et al. (2005). The Votano, S. & Sunindijo, R.Y. (2014). Client safety roles in
effect of safety initiatives on safety performance: A longitudinal small and medium construction projects in Australia. Jour-
study. Applied Ergonomics, 36(4), 461-469. nal of Construction Engineering and Management, 140(9),
04014045.
Huang, X. & Hinze, J. (2006). Owner’s role in construction
safety. Journal of Construction Engineering and Management, Wilbanks, D.W. (2018, July). Contractor safety prequalification:
132(2), 164-173. The reality of demanded written programs. Professional Safety,
63(7), 36-40.

Ahmed Jalil Al-Bayati, Ph.D., P.E., He previously worked in private industry in the sity. He holds a Ph.D. in Civil Engineering
CHST, is an assistant professor in the Civil fields of toxicology, environmental chemistry, from University of Colorado at Boulder and
and Architectural Engineering Department hazardous waste, asbestos, lead and other a master’s degree in Structural Engineering
at Lawrence Technological University. He has environmental projects. He holds a degree in from Lehigh University. Albert received the
more than 15 years’ experience in the con- Environmental Chemistry from Rollins College best paper award from International Council
struction industry working in diverse areas of and an M.S. in Industrial Hygiene from Univer- for Research and Innovation in Building and
the field from safety coordinator to site engi- sity of Washington School of Public Health and Construction in 2012 and from American
neer. He is a certified professional engineer in Community Medicine. O’Barr is a professional Society of Engineering Education in 2013. He
the state of Michigan and an OSHA authorized member of ASSP’s North Carolina Chapter. also received the second-best paper award at
trainer. His research focuses on construction the 2014 Construction Research Congress.
safety and construction management utiliz- SungJoon Suk, Ph.D., is an associate
ing a variety of qualitative and quantitative professor in the Kimmel School of Construc- Jarred Chappell is director of workers’
data collection, data analysis and data tion Management at Western Carolina Uni- compensation operations at North Carolina
mining methods. Al-Bayati is a professional versity. He holds a Ph.D. in Civil Engineering Rate Bureau. Prior to this, he spent 15 years
member of ASSP’s Greater Detroit Chapter. from University of Texas at Austin, and a as the vice president of sales for Business
master’s degree in Construction Manage- Insurers of the Carolinas. Chappell is a
Kevin O’Barr, CSP, CPM, is the on-site ment from Korea University. licensed property, casualty, life and health
consultation program manager for North Car- agent in North Carolina, as well as a certified
olina Department of Labor. During his 24 years Alex Albert, Ph.D., is an assistant pro- insurance counselor. He holds an M.B.A.
with North Carolina state government, he fessor in the construction engineering and from University of North Carolina at Chapel
has worked in several positions including OSH management program in the Department Hill and a B.S. in Business Management from
compliance, standards, education and training. of Civil, Construction and Environmental University of North Carolina at Wilmington.
Engineering at North Carolina State Univer-

38 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

WORKER PROTECTION
Peer-Reviewed

WHO IS
PROTECTING
HEALTHCARE
PROFESSIONALS?

Workplace Violence &
the Occupational Risk
of Providing Care

By Monica Nevels, Wesley Tinker, John N. Zey and Tricia Smith

IIN RESPONSE TO THE INCREASING NUMBER of violent incidents the voluntary guidelines of 1994 and 2004. In January 2017,
resulting in fatalities, injuries and lost workdays in the health- the public comment period opened and OSHA (2017) pub-
care industry (Figure 1, p. 40), several unions and National lished an enforcement directive updating the enforcement
Nurses United (NNU, 2019) petitioned OSHA for a standard procedures and scheduling for enforcement of occupational
to prevent workplace violence. OSHA (2020a) granted the pe- exposure to workplace violence. Although practitioners, labor
tition on Jan. 10, 2017, which unions and governmental agencies have conducted studies on
violence in the workplace, specifically in the healthcare sec-
KEY TAKEAWAYS has since been on the unified tor, the issues are still largely governed by use of the General
agenda in the pre-rule stage Duty Clause of the OSH Act of 1970. Despite General Duty
•Healthcare providers are one Clause citations being issued for workplace violence exposure
of the highest risk groups for with the public comment in healthcare, the industry continues to experience one of the
highest numbers of related injuries compared to all other pri-
workplace violence. period closing April 6, 2017. vate industries (OSHA, 2016a).
Although no federal rule is
•The healthcare industry is Size of the Problem
one of the fastest growing in- currently in place to directly Since understanding vulnerabilities is part of improving em-

dustries in the U.S. and in need address this exposure, nine ployee safety, it is important for employers to be made aware of
the scope of the problem. According to Bureau of Labor Statis-
of the expertise of multidisci- state OSHA plans have de- tics (BLS, 2017; 2019b), in 2018 alone, 16,890 workers in private
industry experienced trauma from nonfatal workplace violence.
plinary teams that include OSH veloped workplace violence
Of those victims who experienced trauma from workplace
professionals. prevention rules (OSHA, violence:
2020a). In the past few years,
•Despite efforts to push this •70% were female;
issue into the spotlight, the OSHA has taken several •67% were aged 25 to 54;
•70% worked in the healthcare and social assistance industry;
AYDINMUTLU/E+/GETTY IMAGES PLUS tenacity of those passionate actions, moving closer to a •21% required 31 or more days away from work to recover,
and 19% involved 3 to 5 days away from work.
about prevention will be needed workplace violence preven-

for a federally mandated rule to tion standard. Early in 2016,

come to fruition. OSHA (2016a) published an
advisory document titled
•To make measurable and
meaningful impact, employers “Guidelines for Preventing

must also respond to this risk as Workplace Violence for

it impacts not only employees, Healthcare and Social Ser-

but those they serve. vice Workers” that updated

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 39

FIGURE 1 Cost, Risk & Employer

VIOLENT INJURIES RESULTING IN DAYS Intervention Strategies
AWAY FROM WORK, BY INDUSTRY, 2002-2013 Aside from regulatory encouragement,

the motivation for risk treatment should

be rooted not only in the moral obliga-

12 tion of the employer, but in the realm of
cost reduction. Workers’ compensation

Cases per 10,000 full-time employees costs alone are a motivator for change,

10 but it is well known that the direct cost

of a claim represents only a fraction of

the overall cost of an injury or fatality.
8 In 2016, a consulting firm researched

and estimated that “hospitals spent $2.7

6 billion on both proactive and reactive
violence response efforts” (Minemyer,
Healthcare and social assistance

Private industry (overall) 2017). When considering the total cost

4 Retail trade of an incident, risk treatment becomes of

Construction paramount concern. Risk treatment can

Manufacturing take many forms, ranging from personal
alarms and access control to an increase
2

0 2004 2006 2008 2010 2012 2014 in security presence. Regardless of the
specific control measures applied, the
2002 authors believe that a layering or multi-

Year pronged, multidisciplinary approach is

most effective. According to case reports

Note. Adapted from “Workplace Violence in Healthcare: Understanding the Challenge,” by (TSS, 2017), strategies of a successful

OSHA, 2015. workplace violence prevention program

include the installation of metal detec-

In that same year, 500 U.S. workers were workplace homicide tors at emergency department entrances,
victims (BLS, 2017; 2019a). When compared to other industries, the establishment of a violent patient database, the hiring of
workplace violence in healthcare ranks as one of the highest, department-based security officers, and placing limitations on
second only to transportation (Ricci, 2017). Healthcare is one visitor access to specific floors or areas via GPS tracking devices
of the fastest growing sectors of U.S. industry, with women (OSHA, 2015a). Personal staff alarm devices have also increased
representing 80% of the workforce (Ricci, 2017). With more security for staff, according to Association of Occupational
than 18 million working in the healthcare industry and many Health Professionals in Healthcare (AOHP, 2017). Employee
at risk daily, it is reasonable to expect employers and legislators training has been of paramount concern when establishing a
to experience an increase in the demand for effective workplace workplace violence prevention program. Communication to the
violence prevention programs by employees, labor unions and employee regarding personal safety and a zero-tolerance pol-
insurance carriers (Ricci, 2017). The annual comprehensive icy is vital to a successful training program (Ferguson, 2016).
cost to businesses, including estimated losses, is now more than A strong message of employee safety as the primary concern
$130 billion and is expected to rise (AlertFind, 2020). has been adopted by many healthcare employers to aid in the
reduction of exposure and an increase in personal safety aware-

Healthcare Professionals Most at Risk ness (Hackethal, 2016). Clear, consistent communication with
Those most at risk for a violent event include emergency staff is an important part of the training strategy as it reinforces
overall employer expectations and solicits critical information
room staff, mental health facility staff and workers in drug de- from those most at risk (OSHA, 2020b).
pendency care units (CDC, 2019). A less recognized, but largely

unprotected group includes those providing in-home patient Recent Cases of Violence & Employer Recognition
care. One of the main concerns with these higher risk jobs in- Although layering of control measures is a widely accepted
cludes the perception of this risk. When asked, employers and
employees alike state that violence is “part of the job” (Phil- approach to risk reduction, healthcare employees are still reg-
lips, 2016). This perception can lead to underreporting, lack of ularly left vulnerable to many forms of violence. During an in-
awareness and limited engagement in risk assessment process- terview with the authors, a first-year medical school resident in
es. According to OSHA (2015), 80% of serious violent incidents Salt Lake City, UT, noted that she received little to no training
reported in healthcare settings were caused by interactions from her employer, and that any useful risk-reduction measures
with patients (Figure 2). With in-home violence toward the were received from attending physicians and were treated as
healthcare provider being a crucial attribute affecting statistics, an afterthought. Another interview was conducted by the au-
a simple control measure could possibly minimize exposure thors with a nursing school student working as a certified nurse
to attacks (Phillips, 2016). One recommendation the authors assistant at one of the largest hospitals in Denver, CO. That
support is administering a buddy system in high-risk visits, not student stated that very limited training was provided during
solely providing care to combative patients, to greatly reduce the new employee orientation, and aside from a staff assist sys-
the probability of incidents. tem button in patient rooms, the only other measure provided
by her employer was a verbal warning about turning her back

40 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

on aggressive patients. Lastly, a pharmacist in St. Louis, MO, cited by critics of the General Duty Clause. Although this is
employed with one of the largest retail pharmacies in the U.S., a significant step toward the development of a proposed rule,
indicated that workplace violence prevention training was not there is much work ahead. There was strong bipartisan support
provided; however, prevention information was communicated in the House of Representatives, which provides hope that this
not from her employer, but from law enforcement after a cus- will stay on OSHA’s regulatory agenda. The tenacity of those
tomer verbally threatened her life. passionate about prevention will be paramount for this attempt,
and any other federally mandated rules that specifically address
It would be desirable to believe that these examples are workplace violence, to come to fruition.
anomalies, and do not represent a true picture of workplace
violence prevention measures in the U.S., but the BLS (2017) Control Measures
case rate points to a different story. Between 2011 and 2013, When reviewing the statistics regarding workplace violence
75% of all workplace assaults occurred in healthcare settings
(Phillips, 2016). Adding to the complexity of the problem, un- within the healthcare industry, it is easy to overlook contrib-
derreporting has been cited as a persistent problem. According uting factors, such as gender, race, ethnicity, whether the in-
to Phillips (2016), only 39% of nurses report verbal assaults and cidents are inside or outside the facility, and even the political
19% report physical assault even though healthcare workers climate that currently exists. Starting with out-of-facility inci-
are “approximately four times as likely” to suffer lost time from dents, we can examine paramedics, emergency medical service
assault than other types of occupationally related injuries. Nu- (EMS) and in-home care. According to CDC (2019), violence
merous reasons for underreporting exist, including a fear of contributes to at least 16% of injuries sustained by EMS work-
losing employment, being perceived as incompetent, and gener- ers; of those injured, 64% were men and 36% were women.
al compassion for confused or disoriented patients (Ferguson, In-facility incidents are similar regarding the statistics between
2016). To address these gaps, employers must view this loss op- female verses male violence.
portunity as worthy of attention and financial investment. The
tolerance level for exposure must be such that employers do not For the safety professional, whose duty is to protect workers,
wait for regulatory enforcement or unionization of employees patients and visitors on and off site, following the hierarchy of
before they take substantive action. controls (i.e., elimination, substitution, engineering controls,
administrative controls and PPE) can be useful when attempt-
NNU was founded in 2009 and has repeatedly cited work- ing to minimize the probability and severity of violence within
place violence as a primary concern for nurses and other the healthcare industry. Completely eliminating the risk of
healthcare providers. This organization is one of the strongest violence would be nearly impossible for any industry and most
voices for nurses, but other sectors of the industry that are also likely is not realistic in healthcare. Substitution methods of
unionizing (e.g., SEIU United Healthcare East, National Union control available in other industries are not generally useful
of Healthcare Workers) cite exposure to workplace violence as in a service-oriented industry. Because the first and preferred
the one of the most compelling reasons for organization (NNU, choices of control are not useful in healthcare, we must start
2019). The collaboration of labor groups, unions, insurance car- analyzing the three control attributes that could hold the most
riers and governmental agencies will be a vital part of address- promise in reducing the probability of incidents.
ing the problem and raising awareness.
Risk reduction using engineering controls is the most wide-
Future Needs & Current Legislative Action ly used method when addressing workplace violence. Part of
U.S. healthcare workers are exposed to the risk of workplace these control measures include addressing parameter security
with fencing, walls, outdoor locking egress doorways and metal
violence with many commenting that it is a daily concern. To detectors, which all have proven to be successful for restrict-
make measurable and meaningful impact, employers must
respond to this risk as it affects not only employees, but those FIGURE 2
they serve. With the U.S. facing one of the biggest crises in his-
tory, opioid addiction, it is reasonable to expect an increase in VIOLENT INJURIES TO
workplace violence as well as the need for prevention measures. HEALTHCARE WORKERS, BY SOURCE
The development of risk-reduction strategies by employers and
regulatory enforcement systems by legislators are significant 3% 3% 1% 1%
primary steps toward improvement. Many attempts have been
made over the past 10 years to push this issue into the spotlight, 12% Patient
but support is presently needed from many disciplines to con- 80% Other client or customer
tinue to move this legislative process forward. As of Nov. 21, Student
2019, H.R. 1309, the Workplace Violence Prevention for Health Coworker
Care and Social Service Workers Act, was passed in the House Other person (not specified)
Committee on Education and Labor. The act requires OSHA Assailant/suspect/inmate
to create a federal workplace violence prevention standard
and mandates that employers develop comprehensive, work- Note. Adapted from “Workplace Violence in Healthcare: Understand-
place-specific plans to prevent violence. It covers a wide variety ing the Challenge,” by OSHA, 2015.
of workplaces and sets a quick timeline on implementation to
ensure timely protection for healthcare workers (Thew, 2019).
The act also sets minimum requirements for the standard and
for employers’ workplace violence prevention plans among
other important provisions (Thew, 2019). It is comprehensive in
nature, and addresses specific concerns, unlike the weaknesses

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 41

AYDINMUTLU/E+/GETTY IMAGES a facility setting, innovative possibilities exist for use in all sec-
tors of the healthcare industry.
The topic of workplace violence
Security parameters, while effective in preventing the prob-
has been and will continue to be ability of violence in the healthcare profession, are not as effec-
tive today as in previous eras. To address the need for a strategy
important for OSH professionals change, the healthcare industry as a whole has been focusing on
preventing hostile individuals from entering critical areas of fa-
for the foreseeable future. cilities by training employees in distinct situational awareness,
teaching them to recognize the radical and extreme behaviors
ing entry. The next layer includes a thorough examination of of individuals before the situation evolves out of control. Such
the healthcare facility’s interior. Many providers are using situational awareness can be one of the best control measures
closed-circuit television in conjunction with security staff, these employees can demonstrate. This prevention-by-observa-
employee panic buttons, and illumination improvements to tion technique is also widely used in law enforcement. Estab-
provide better workplace oversight and emergency communica- lishing a system that helps identify previous patient or visitor
tion. All have been successful in reducing the number of violent violence can support awareness and staff while improving over-
events (TSS, 2017). all facility or scene security.

Although engineering controls are helpful in many set- Safety First
tings, this type of control measure may not be appropriate One weakness of healthcare violence prevention programs
for some healthcare occupations. This includes the groups of
professionals working outside a facility setting. The ability to lies in the balance between patient satisfaction and employee
engineer out the risk is extremely difficult due to the dynamic protection. To receive federal funding, many hospitals are
and unstable environments. EMS personnel are expected to required to have acceptable scores on Hospital Consumer
operate in unknown conditions that pose considerably higher Assessment of Healthcare Providers and Systems (HCAHPS)
levels of risk. To reduce the risk of violence to these types of surveys. Healthcare staff are encouraged to support the effort
personnel, safety professionals should utilize the final two of achieving acceptable scores so the institution will continue
control measures within the hierarchy: administrative con- to receive federal support. Although the system was designed
trols and PPE. to ensure institution accountability and transparency, its im-
pact on reporting has been mentioned by healthcare workers as
One administrative control that can be used for EMS per- being somewhat counterproductive in the prevention of work-
sonnel as well as for in-house personnel is a technique known place violence. In addition to the pressure of providing good
as verbal judo. Appropriate use of this skill has been shown customer service, staff also cite patient empathy as another rea-
to be effective in reducing conflict and calming patients. son to either not report violent events or accept patient violence
This technique was developed by the late George Thompson, as “part of the job” (Phillips, 2016). Since these attitudes and
founder of the Verbal Judo Institute (PoliceOne, 2020). This goals might at times conflict with control measures and reduce
method has been used by law enforcement and healthcare reporting, it is vitally important for management to emphasize
professionals for several years to de-escalate and resolve an employee safety. Employee safety must be recognized by man-
attempted assault. Learning basic situational awareness is a agement as just as valuable as patient safety during training and
skill that is paramount when working in high-risk environ- educational events. Training efforts by the employer and proper
ments. Being aware of one’s surroundings and recognizing goal-setting strategies by management are necessary to keep
when a situation is unraveling is the most critical part of pre- the message consistent, clear and delivered with the support of
venting violence. the caregivers in mind.

Although generally considered the least desirable and last The issue of workplace violence prevention in the healthcare
choice when controlling risk, the use of PPE can provide a sig- industry has recently made it to the regulatory agenda and
nificant advantage in EMS-related violent events. The use of caught the attention of labor groups and other healthcare or-
clothing made from materials such as Kevlar when responding ganizations. Accreditation bodies and labor unions have also
to highly unstable scenes has been useful as it provides an effec- targeted the issue, providing support for the passage of statuto-
tive barrier to attacks and reduced severity of an incident. Even ry requirements that hold employers accountable for protecting
though this approach is normally used in environments outside employees. If passed in its original form, this legislation will
require risk to be identified and effective controls put in place.
Although a workplace violence prevention rule would be a sig-
nificant step toward providing greater protection for healthcare
providers, it will be the actions of OSH professionals and others
that facilitate improvement. Because OSH professionals realize
the sluggish nature of the legislative process and the principles
of risk assessment, the establishment of multiple, independent
layers of control and the increase of overall organizational
awareness will be vital in risk reduction. The authors believe
that the control measures expressed may assist in reducing risk
and prevent injuries for healthcare providers and other services
industries. If the organizational culture is built around safe
work practices and solid management leadership, integration
of an effective workplace violence prevention program should

42 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

garner the support of its stakeholders and protect the safety and OSHA. (2016a). Guidelines for preventing workplace violence
health of the healthcare professional. for healthcare and social service workers (Publication No. OSHA
3148-06R 2016). Retrieved from https://www.osha.gov/Publications/
Conclusion osha3148.pdf
The topic of workplace violence has been and will continue to
OSHA. (2016b). Prevention of workplace violence in healthcare and
be important for OSH professionals for the foreseeable future. social assistance. Retrieved from www.regulations.gov/document
Until there is a standard, companies must implement suggested ?D=OSHA-2016-0014-0001
components of a good program. The actions discussed in this
article can serve as a guide. To date, this issue for healthcare OSHA. (2017). Enforcement procedures and scheduling for occupa-
workers has received less attention than in most workplaces. tional exposure to workplace violence (Directive No. CPL 02-01-058).
Hopefully, this will change in the future; if not, more lawsuits Retrieved from www.osha.gov/sites/default/files/enforcement/direc
will likely result as workers or family members of workers who tives/CPL_02-01-058.pdf
are injured or killed will demand compensation. PSJ
OSHA. (2020a). Unified agenda—Current agenda. Retrieved from
References www.osha.gov/laws-regs/unifiedagenda/currentagenda

AlertFind. (2020). Workplace violence statistics 2018: A growing prob- OSHA. (2020b). Healthcare wide hazards: Workplace violence. Re-
lem. Retrieved from https://alertfind.com/workplace-violence-statistics trieved from www.osha.gov/SLTC/etools/hospital/hazards/workplace
violence/viol.html#violenceprevention
Association of Occupational Health Professionals in Healthcare
(AOHP). (2017). Position statements. Retrieved from www.aohp.org/ OSHA. (2016c). Preventing workplace violence in healthcare. Re-
aohp/Portals/0/Documents/ToolsForYourWork/Position%20State trieved from www.regulations.gov/docket?D=OSHA-2016-0014
ments/PositionStatements%20Jul%202017.pdf
Policeone. (2020). Dr. George Thompson: Verbal judo tactics
Beck, D.L. (2018, Dec. 1). Hazardous to your health: Violence in the and techniques. Retrieved from www.policeone.com/columnists/
health-care workplace. ASH Clinical News. Retrieved from www.ash George-Thompson
clinicalnews.org/spotlight/hazardous-health-violence-health-care
-workplace/ Ricci, M. (2017, May 12). Bill would increase pay for Massachusetts
home healthcare worker. Nexstar Broadcasting. Retrieved from www
Bureau of Labor Statistics (BLS). (2017). Hospital workers: An as- .wwlp.com/news/bill-would-increase-pay-for-massachusetts-home
sessment of occupational injuries and illnesses. Retrieved from www -healthcare-workers
.bls.gov/opub/mlr/2017/article/pdf/hospital-workers-an-assessment-of
-occupational-injuries-and-illnesses.pdf Schillaci, W.C. (2018, Oct. 10). Workplace violence: OSHA enforces
general duty violations in health care. EHS Daily Advisor. Retrieved
BLS. (2019a). Table A-2. Fatal occupational injuries resulting from from https://ehsdailyadvisor.blr.com/2018/10/workplace-violence
transporation incidents and homicides, all United States, 2018. Re- -osha-enforces-general-duty-violations-in-health-care
trieved from www.bls.gov/iif/oshwc/cfoi/cftb0323.htm
Thew, J. (2019, Nov. 21). Workplace violence legislation moves for-
BLS. (2019b). Table R4. Number of nonfatal occupational injuries ward. Health Leaders. Retrieved from www.healthleadersmedia.com/
and illnesses involving days away from work by industry and selected nursing/workplace-violence-legislation-moves-forward
events of exposures leading to injury or illness, private industry, 2018.
Retrieved from www.bls.gov/iif/oshwc/osh/case/cd_r4_2018.htm Total Security Solutions (TSS). (2017, Feb. 6). The ugly truth about
violence in the healthcare industry. Retrieved from www.tssbullet
CDC. (2019). Emergency medical services workers: Injury data. Re- proof.com/blog/ugly-truth-violence-healthcare-industry
trieved from www.cdc.gov/niosh/topics/ems/data.html
World Health Organization (WHO). (2020). Violence against health
Centers for Medicare and Medicaid Services (CMS). (2020). workers. Retrieved from www.who.int/violence_injury_prevention/
HCAHPS: Patients’ perspectives of care survey. Retrieved from www violence/workplace/en
.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instru
ments/HospitalQualityInits/HospitalHCAHPS Monica M. Nevels, M.S., CSP, ASP, is an assistant professor of safe-
ty sciences at the University of Central Missouri (UCM). She has worked in
Ferguson, D. (2016, April 29). Workplace violence in healthcare: healthcare, social services and OSH management. Nevels spent 11 years
Underreported and often ignored. Fierce Healthcare. Retrieved from in manufacturing, and holds an M.S. in Occupational Safety Management
www.fiercehealthcare.com/healthcare/workplace-violence-health and a B.S. in Safety Management from UCM. She is a professional member
care-underreported-and-often-ignored of ASSP’s Heart of America Chapter and a faculty advisor for the ASSP UCM
Student Section.
Hackethal, V. (2016, April 26). Workplace violence rampant in
healthcare. Medscape. Retrieved from www.medscape.com/view Wesley Tinker, M.S., CSP, is an assistant professor of safety at UCM. He
article/862562 holds an M.S. in Occupational Safety and Health Management from Eastern
Kentucky University, and a B.S. in Crisis and Disaster Management from
Jenero, K.A. (2010, Oct. 18). United States: Union organizing trends UCM. He has worked in public safety, EMS, local and state government, and
in the healthcare industry. Retrieved from www.mondaq.com/united in many areas of OSH. Tinker is a member of ASSP’s Heart of America Chapter
states/healthcare/113112/union-organizing-trends-in-the-healthcare and a faculty advisor for the ASSP UCM Student Section.
-industry
John N. Zey, Ed.D., CIH, is a professor emeritus in the safety sciences
Minemyer, P. (2017, Aug. 2). Violence cost hospitals $2.7B in 2016, programs at UCM. From 1976 to 1996, he served as a commissioned officer in
AHA report finds. Fierce Healthcare. Retrieved from www.fiercehealth the U.S. Public Health Service, assigned to NIOSH. He holds a Ed.D. in Educa-
care.com/finance/violence-cost-hospitals-2-7b-2016-aha-report-finds tional Leadership and Policy Analysis from University of Missouri-Columbia,
an M.S. in Industrial Hygiene from UCM, and a B.S. in Biology. Zey is also an
National Nurses United (NNU). (2019, June 11). House committee ABET program evaluator, and an AIHA Fellow. Zey is a professional member
votes to advance bill to protect health care, social service workers from of ASSP’s Heart of America Chapter, which he also serves as Vice President.
epidemic of workplace violence [Press release]. Retrieved from www
.nationalnursesunited.org/press/house-committee-votes-advance Tricia Smith, Pharm.D., has spent the past several years as a staff
-bill-protect-health-care-social-service-workers-epidemic pharmacist and pharmacy manager in retail settings. She holds a Doc-
torate in Pharmacy from St. Louis College of Pharmacy. She has 17 years’
OSHA. (2015a). Preventing workplace violence: A road map for experience in the healthcare industry and has practiced in many specialty
healthcare facilities (Publication No. OSHA 3827). Retrieved from fields including pediatric inpatient pharmacy, long-term care and medi-
www.osha.gov/Publications/OSHA3827.pdf cation therapy management.

OSHA. (2015b). Workplace violence in healthcare: Understanding
the challenge (Publication No. OSHA 3826). Retrieved from www
.osha.gov/Publications/OSHA3826.pdf

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 43

BEST PRACTICES

Best Practices for

IMPLEMENTING TELEMATICS DEVICES

Telematics devices have the power to be a significant asset within a company’s loss
prevention program. The data gleaned from these devices can be used to craft an
effective driver monitoring and coaching program.

The program collects information trate on a larger group. However, make but also to provide fleet data to improve
about driver behavior, specifically the sure the size of the group is manageable. vehicle location and utilization logistics,
frequency and severity of unsafe driving routing and off-route movements, fuel
practices such as speeding, hard stops, Drivers must truly understand that consumption, idle time, and vehicle mal-
hard turning, following too close and you are concerned about their behavior function information. Along with help-
lane departure. The information can be because you want to protect their safety ing drivers, these systems also help fleets
used for operational and equipment utili- and health, and that you will continue to operate more profitably and more safely.
zation as well. monitor their performance and provide The geo-fencing capabilities not only
training to prevent future errors. They help management know the location of
Start by Focusing on Speeding must be sincere about giving you a com- vehicles, but also can be used by an oper-
It is widely believed that speeding is a mitment that they are willing and need ations team to determine whether drivers
to change their unsafe behavior. are stopping at forbidden or unsafe loca-
leading cause of motor vehicle crashes, tions, which can compromise vehicle and
and research indicates that vehicle speed Continue to track those individuals to driver safety.
is directly correlated to increased crash determine whether their status improves.
severity. Speeding increases the risk of If it does not, meet with them again and Additional Uses for Telematics
crashes in the following ways: use a more effective approach. Document There are multiple systems for mon-
the guidance that you provide. Good
1) longer reaction distance; drivers do not need to worry about the itoring numerous aspects of vehicles,
2) longer braking distance; data being collected because it will con- dispatch, driver performance and main-
3) longer steering distance; firm their good performance. tenance. Many will even duplicate data
4) higher impact severity; produced by the other systems, which
5) reduced seat belt/airbag effec- Coaching Guidelines can often result in an overload of more
tiveness, leading to increased injury 1) All drivers must participate in data than you can proficiently work
potential; with. Meet with each of the company’s
6) rollover/loss-of-control potential. the program at all times with no ex- departmental leadership and midlevel
Research shows that drivers who drive ceptions. Driver violations must be management to determine exactly what
fast on highways have more hard stops included and addressed in all driver they need to know to promote better
and hard turns than their counterparts. performance reviews. It is recommend- equipment utilization, efficiency, prof-
Research also shows that drivers who ed that driver performance recognition itability and safety. In addition to the
have these speeding events are not driv- programs be created to identify and data needed by the safety department,
ing longer distances than others. These reward the best performing drivers. determine how you can use the other
high-event-count drivers do not speed The program should be effectively pub- departments’ data to improve your in-
to do their work; they speed because licized and consistently maintained to formation. Most reports from each sys-
they do not really understand the risks reinforce the company’s commitment tem are good as a stand-alone product.
they are taking. to uphold the program standards. However, tie multiple reports together
Once the telematics devices are in- to get an even bigger and more complete
stalled, inform drivers that the company 2) Drivers with the most violations profile of what you need to know. Mul-
is implementing a program to improve should be included in a disciplinary plan. tiple reports can also aid in collision
safe driving. Publish standards of per- The plan should be developed with the reconstruction.
formance so that drivers will understand support of executive management, hu-
what is expected of them and how the man resources and operations so that it Following a other methods to use with
program will be managed. It is critical will be consistently enforced by all func- telematics for driver coaching:
for drivers to realize that not only will tional groups. A “three strikes” or similar
implementing this program benefit the format is recommended in which a driver •Determine the root cause of an event
company, but also, more importantly, is provided corrective remedial guidance (e.g., driver performance, dispatcher
that it will benefit them as well. Regularly and coaching to help the person identify forced or motivated, operational ineffi-
monitor the data. Periodic or infrequent and improve upon weaknesses. Deter- ciencies, distracted driver situations, fa-
monitoring can create a perception mining the driver’s cooperativeness and tigue, illness, injury, personal problem).
among drivers that the company is not attitude toward improvement is a key Perhaps the driver has experienced mul-
taking the program seriously. If just element in how further corrective action tiple hard braking events because the in-
starting a program, begin by identifying or guidance should be applied. dividual is not effectively managing sight
and coaching the bottom 10% of drivers distance or recognizing a stale green
who stand out the most. Once you have 3) Drivers are often concerned that light. The information may not provide
been able to make positive steps, concen- telematics systems are “spying” on them. all the details you need, but it creates a
They must understand that these systems starting point for the investigation.
are designed to not only assist them in
performing their job legally and safely,

44 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

IGPHOTOGRAPHY/ISTOCK/GETTY IMAGES PLUS •Examine current trends and com- if there are several events in a row. Per- Be sure to recognize
pare those trends to previous behaviors, haps the driver is becoming ill, distract-
coaching and desired results. Deter- ed, fatigued or being pushed by dispatch. drivers who are regularly
mine what has been done previously to
make positive adjustments and what •Tailor guidance or corrective action demonstrating safe
modifications need to be completed to the situation. Even though the driver
to attain the desired results. When is ultimately responsible for the vehi- performance. This gives
used properly, an objective scorecard cle, if the individual is being pushed
recording results provides a historical by dispatch to hurry with a run, you them satisfaction in
evaluation process for both driver and will want to have corrective action
operational measurements. with that dispatcher and that person’s knowing that their safe
supervisor as well. Be sure to recognize
•When are poor results being record- drivers who regularly demonstrate safe habits are noticed by
ed? Are poor results due to traffic lanes, performance. This gives them satisfac-
time of day, traffic, fatigue, length of trip, tion in knowing that their safe habits management, and it
customer demands, poor trip planning are noticed by management, and it en-
or aggressive dispatching? Or does driver forces to all drivers that you are moni- enforces to all drivers
training need to be improved with better toring everyone’s performance. Create
orientation, defensive driving or remedi- a performance incentive program, not that you are monitoring
al training programs? just a disciplinary program.
everyone’s performance.
•Does a specific terminal have high- Case Study
er violation frequency or severity? If This case study demonstrates the value captured the event looking out onto
so, determine whether the root cause the roadway from the cab and simulta-
is due to improper driver behavior, of video telematics data in providing evi- neously captured the driver during the
driver management or operational dence during an incident. collision. It was evident based on the
management. video that the at-fault vehicle entered
The Facts the roadway intentionally and the
•Determine whether trends exist with A driver was traveling on a two-lane driver took all necessary precautions
the recruiters, those who complete the to avoid the collision, but simply could
driver paperwork, or whether a specific divided interstate in the middle of the not. The police report later indicated
road examiner or the road examination night. With little warning, another that the at-fault party was indeed in-
process needs improvement. vehicle appeared in front of the driver, toxicated, but the video evidence is key
traveling the wrong way on the inter- in supporting the case for subrogation
•Did violations start immediately or state. The driver took evasive action, and recovery.
have they progressively developed over but could not avoid a collision, as there
time? Either way, it must be determined was another tractor trailer in the lane The Cost
what circumstances may have changed directly to his right. The vehicle and Vehicle: $96,000.
or are developing that are affecting it. In at-fault party struck head-on. Initial Bodily injuries (anticipated): $15,000.
addition to driver behavior, consider all reports indicated the at-fault party Anticipated amount paid after claim
aspects of the company that may have may have been forced across the me-
been a contributing factor. dian into the driver’s lane of travel. closes: $111,000.
Thankfully, our vehicle had an on- Without the video evidence, the
•Follow up as soon as possible with the board video monitoring system that
driver when notified of events, especially at-fault party’s insurance could have
made the case that the driver was not
at fault because he was forced into on-
coming traffic by another unknown
vehicle. This would have made recovery
much more difficult. Luckily, the use
of technology will likely mean a signif-
icant recovery from the at-fault party.
The cost of the video monitoring sys-
tem paid for itself multiple times over
as the result of one collision. PSJ

Protective Insurance specializes in mar-
keting and underwriting insurance for the
transportation industry. The company publishes
a quarterly publication, Shield, that provides
industry-specific information on safety and risk
management for fleet trucking companies.

This article was originally published in Shield. Re-
printed with permission of Protective Insurance.

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 45

CHECKPOINTS

PLAYGROUND SAFETY

Differences Between Public & Residential Playgrounds

By Joann M. Robertson

All types of playgrounds aim to provide children with a safe place to play, challenge themselves and be active
while also serving as the setting for wonderful memories. This article examines some differences between public
and residential playgrounds and helps readers brush up on their knowledge of playground safety overall. 

Typically, public playgrounds are lo- contrast the swing sets in a public setting Public playgrounds are designed according ANAMEJIA18/ISTOCK/GETTY IMAGES PLUS
cated at public schools, parks or apartment may be assembled with metal chains. to U.S. Consumer Product Safety Com-
complexes and are open to large numbers of mission (CPSC) guidelines. “Handbook for
users. In contrast, a residential playground is Residential playgrounds are often made Public Playground Safety” (CPSC, 2010) is
usually found in a backyard for more limited entirely of wood or partially constructed of used as a reference for public playgrounds. It
use by a family and guests.  a mix of wood, metal or plastic. The life span details information about each type of equip-
of these structures is shorter since wood will ment and discusses surfacing requirements.
Supervision eventually rot or splinter. Generally, residen-
tial playgrounds are easier to assemble and Residential playgrounds are addressed
Injuries can occur to users on both public are often not anchored to the ground. by CPSC’s (2005) “Outdoor Home Play-
and residential playgrounds, but proper su- ground Safety Handbook.” CPSC also
pervision is an important way to reduce the Lead paint should always be avoided on provides checklists and tips for residential
chance of injuries or death while on play- both types of playgrounds, as should treated playgrounds.
grounds. Ideally, prompt first aid and medi- wood that is unacceptable for use by children.
cal care is provided at either playground.  ASTM International has standards related
Maintenance to public playgrounds, specifically ASTM
On a public playground, supervision is usu- F1487; the information for residential play-
ally provided by a monitor or teacher during Public playgrounds are maintained by grounds can be found in ASTM F1148.
school hours. A summer program or camp the municipality, school district or orga-
may also provide supervisors. But supervision nization that is responsible. Staff should Accessibility 
varies by time and date. Signs should be post- regularly inspect the equipment using a
ed to provide safety information and warnings checklist, or a certified playground safety Public playgrounds are designed to be
to the public, even if no one is on site.  inspector can provide regular inspections.  shared by users of various abilities. ASTM
F1951 provides extensive information about
Supervision at a residential playground Residential playgrounds may be cared for accessibility in play areas. Next time you
can also vary. An adult can supervise chil- by the homeowner or may be purchased with visit a public playground observe the ramps,
dren playing outside, or watch from afar with a maintenance agreement. Generally, inspec- transfer platforms and activity panels that
line of sight. Therefore, playgrounds are most tions occur less frequently with residential allow children of all abilities to interact. A
often installed on level ground within view.  equipment because it is more lightly used. As residential playground is selected between a
children outgrow the equipment, residential few models to satisfy the consumer’s wishes
For both types of playgrounds, unsuper- playgrounds commonly fall into disrepair.  and is not considered accessible.
vised children are more likely to use equip-
ment unsafely. Effective supervision is the Surfacing & Injuries Conclusion
best way to keep children safe and quickly
notice other problems that can arise (e.g., In addition to proper supervision, resilient Playground safety is an important topic.
insects, bullying, broken playground parts).  surfacing significantly reduces the chance By learning about different types of play-
of injury on playgrounds. Proper surfacing grounds, we can improve our knowledge
Equipment Location  beneath equipment is key, since the major- and allow children to play more safely. PSJ
ity of playground injuries involve falls. The
At a public playground, busy areas such correct depth of such surfacing is critical. References
as swings and slide exits are located away Homeowners, parents, guardians and public
from the center of the playground. This is playground maintainers should understand ASTM International. (2017). Standard con-
not true in a residential playground where the importance of surfacing to greatly reduce sumer safety performance specification for
the different types of equipment are usually the chance of playground injuries overall.  playground equipment for public use (F1487-
all together in one small structure.  17). West Conshohocken, PA: Author.
Vandalism
Material & Lifespan ASTM International. (2020). Standard
Public playgrounds are more prone consumer safety performance specification for
Since public playgrounds are used heavily to vandalism since they are open to the home playground equipment (F1148-20). West
by multiple users, they are often constructed public. Damage to equipment can include Conshohocken, PA: Author.
of durable materials such as metal and stur- graffiti, razors placed on the equipment,
dy plastic. Equipment should be anchored disassembled hardware or melted plastic U.S. Consumer Product Safety Commission
into the ground to prevent tip over.  parts. In a public setting, ongoing inspec- (CPSC). (2005). Outdoor home playground
tions and prompt repairs are important, as safety handbook (CPSC document No. 324).
A specific difference can be found at the are cameras, lights and fencing, which may Bethesda, MD: CPSC.
top of swings, where different hardware be added to combat damage. 
such as bearings or bushings may be used on CPSC. (2010). Public playground safety
public playgrounds. Not commonly seen in handbook (CPSC document No. 325). Bethes-
a residential setting, this hardware helps the da, MD: CPSC.
swings withstand extensive use. Some resi-
dential swings may have rope or lightweight Joann M. Robertson, CSP, CPSI, ARM, CPCU, is employed at Playground Medic in Hawthorne, NY, a
chains supporting the swing sets, while in firm that specializes in playground inspections and repairs. She is a professional member of ASSP’s Long Island
Chapter, and is a member of the Society’s Public Sector and Training and Communications practice specialties,
and the Women in Safety Excellence Common Interest Group. She serves the Public Sector Practice Specialty as
Membership Development Chair, and was named the 2019 Long Island Chapter Safety Professional of the Year.

46 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org

VANTAGE POINT

IMPACT OF DECISIONS

By Dwight J. Grimmer

Many years ago, early in my career, I worked on a farm in southern California. During my first day on the job,
the farmer issued me a new tractor and informed me that my job would be to cultivate all the crops. He taught
me how to set up the blades and shovels on the back of the tractor.

As the blades cut alongside the BULAT SILVIA/ISTOCK/GETTY IMAGES PLUS
plant, they would push the dirt into
the furrow. The shovels would then Let us become the difference in our own safety
come behind and retrench the furrow.
Performing this job safely required and the safety of others around us.
two people: one to drive the tractor,
another to walk behind, observing the I stop and think about how my deci- tions. If you decide to take that short-
action of the implement and commu- sion helped lead to this man’s death. cut, if you decide to ignore the safety
nicating adjustments that needed to rules that are in place or choose not to
be made. I was told during training If only I had been trained and made wear safety glasses, you are giving up
that one person could perform both it a habit to perform this job safely, your agency to remain safe and injury
tasks because the tractor would stay I would have in turn trained my re- free. Keep in mind that it is not only
in the furrow by itself. As I contin- placement to do the same. If only I you who your decision may affect;
ued with this job, I made a habit of had thought about the impact that my what kind of impact might your poor
climbing over the cultivator once the decisions have on myself and others. decision have on those you are train-
tractor was moving to walk behind it. If only a shortcut would not have been ing or others working next to you?
I figured that as long as I took my time made. If only. . . .
and was careful, this was a perfectly There are right and wrong ways to
safe way to perform the job. Now many years later, I work as perform your job; please make the
a safety professional. Having lived right decisions. Be a good example to
I worked for this farmer cultivating through the days when working safely others: don’t take shortcuts; follow the
for more than a year when I realized was an afterthought, I am reminded safety procedures for the task; wear
that there was no money in being a of the importance of making sound your PPE. If you see someone making
farmhand. I decided to move to Alaska decisions regarding our own safety. a wrong decision, don’t be afraid to
and on to bigger and better things. The It is often your decision whether you call them out because you may make
farmer asked me to train my replace- become injured or stay safe. It is your the difference between this person
ment before leaving the farm. I agreed decision whether to perform an un- going home safely or a life-changing
and he hired his brother-in-law to safe act or to do the job the right and event occurring. Your personal actions
take my place. I trained him the same safe way. It is your decision whether matter. Let us become the difference in
way that I had been taught: to climb you follow the safety rules. However, our own safety and the safety of others
over the cultivator and observe what it is not your decision to choose the around us. PSJ
adjustments needed to be made. It was consequences of your choices and ac-
6 months after I had moved to Alaska
that I received word that the man I Dwight J. Grimmer, CHST, is a QSE professional through Mallory Safety Services for Vestas—
had trained was killed. He had slipped American Wind Technology, where he works on a wind farm in Washington and manages safety on
while crossing over the cultivator and the site, performing safety talks, audits, investigations, reports and employee training. He has
had fallen into the blades and shovels. worked on various construction sites including paper mill shutdowns and power plant turnovers
This news was hard for me to take as I before transitioning to the wind industry. Prior to his safety career, Grimmer was a U.S. Postal
had taught him to perform the job this Service postmaster.
way. It still bothers me to this day when

Vantage Point

Vantage Point articles in Professional Safety
provide a forum for authors with distinct view-
points to share their ideas and opinions with
ASSP members and the OSH community. The
goal is to encourage and stimulate critical think-
ing, discussion and debate on matters of concern
to the OSH profession. The views and opinions
expressed are strictly those of the author(s) and
are not necessarily endorsed by Professional
Safety, nor should they be considered an expres-
sion of official policy by ASSP.

assp.org JULY 2020 PROFESSIONAL SAFETY PSJ 47

MATH TOOLBOX

The Case of the

OVERLOADED SLING

By Mitch Ricketts

Math Toolbox is designed to help readers apply STEM principles to everyday safety issues. Many readers may
feel apprehensive about math and science. This series employs various communication strategies to make the
learning process easier and more accessible.

Workers use slings (in conjunc- tially devastating effects for anyone worker; however, one common reason
tion with cranes and other lifting working nearby. for sling failure in general is hitching
machines) to move heavy loads that at angles that create too much tension
would be difficult to handle by other Slings fail for many reasons, in- in the sling legs, causing the sling to
means. Slings may be constructed of cluding overloading, improper rig- pull apart.
chain, wire rope, metal mesh, syn- ging or components that have been
thetic fibers, webbing and other ma- damaged by prior use. No specific One fact that is known about the
terials. As Figure 1 illustrates, loaded cause was reported for the case illus- case in Figure 1 is that the load was
slings can sometimes fail, with poten- trated in Figure 1 in which a falling rigged using a two-leg bridle hitch:
steel beam seriously injured a young Each sling leg was attached separately
to the beam at bottom, and both legs
FIGURE 1 were attached to a single fitting at
top. This arrangement gives the bri-
SLING FAILS TRAGICALLY AT CONSTRUCTION SITE dle-hitch sling its characteristic shape
of an inverted V.
While building a transmission tower, workers used a mobile crane to lift a large steel beam
over a fence. The beam weighed nearly 8,000 lb (about 3,600 kg). Slings with bridle hitches are used
in many workplaces, mainly because
Without warning, The free end of the they are versatile and provide ade-
one leg of the beam swung down, quate stability for an assortment of
sling broke. striking a worker with loads. Unfortunately, bridle hitches
tremendous force. are subject to substantial internal
stresses, especially when the legs are
The worker suffered rigged at improper angles.
severe crushing
injuries. This article focuses on the stresses
created in slings with two-leg bridle
hitches. For comparison, the arti-
cle also examines stresses in slings
with vertical hitches. We can use this
knowledge to help operators under-
stand why manufacturers’ angle-de-
pendent load ratings should never be
exceeded. As will be demonstrated in
a future article, we can also use this
knowledge to calculate acceptable loads
at sling angles that may not be listed in
manufacturers’ labels and charts.

The calculations presented here
assume that slings are used in accor-
dance with guidance published by
manufacturers, American Society of
Mechanical Engineers (ASME, 2018)
and OSHA (2020).

MITCH RICKETTS Sling & Rigging Concepts
This discussion applies to slings that
Note. Adapted from “Young Worker Seriously Injured by Falling Steel Beam (Hazard Alert: Injury
2010-10),” by WorkSafe BC, 2010. have no more than two evenly loaded
legs rigged with vertical or bridle hitches.
48 PSJ PROFESSIONAL SAFETY JULY 2020 assp.org Vertical hitches are rigged perpendicular-
ly to the load. Bridle hitches are rigged at
acute angles, with legs attached to a single
fitting at top. Figure 2 illustrates exam-
ples of slings with bridle and vertical
hitches within the scope of this article.