Under the statute, federal agencies are to develop safety standards consistent with those issued by OSHA, maintain occupational safety and health records, and report to the Secretary of Labor regarding their programs. As set forth in a 1980 executive order, federal agencies must (1) follow OSHA standards unless the Secretary of Labor approves an alternative safety plan, (2) comply with the act’s general-duty clause by eliminating recognized hazards that cause or are likely to cause death, (3) permit unannounced inspections under certain conditions, and (4) allow employees to report safety problems without fear of discrimination or retaliation. OSHA may inspect and cite federal agencies, but it cannot fine them.

State and local employees are not covered by OSHA rules unless their states have adopted state occupational safety and health plans approved by OSHA. If states adopt plans that are “at least as effective as” the federal plan, the federal government pays up to 50 percent of the cost of enforcing the plans.

Almost half the states and territories have approved plans, and two of these states (New York and Connecticut) cover only public employees.6 If OSHA adopts a final rule on tuberculosis, states with state plans would have to adopt a comparable standard within 6 months. States with approved plans must still require employers to submit reports to OSHA as though no plan were in place, and OSHA may also inspect workplaces in these states to monitor state performance. In states without approved plans, public hospitals, medical examiners’ offices, most prisons and jails, and other facilities would not be subject to an OSHA tuberculosis standard. They might, however, be affected by general or tuberculosis-specific infection control provisions in state licensure laws, Medicare or Medicaid requirements, or private accreditation standards. Further, if a public facility such as a prison contracted with a private agency to operate the health unit in the facility, then that agency would have to comply with OSHA requirements even if the rest of the facility was exempt.

Multiple-Employer Workplaces

For hospitals and other employers covered by OSHA rules, outsourcing arrangements have become an increasingly popular way to cut costs and increase flexibility. Thus, some nurses may work for the hospital directly, whereas others may be supplied by one or more outside agencies. Food-service employees may be supplied by one contract and janitors by another. As a result, professional and nonprofessional workers at


The other jurisdictions are Arizona, California, Hawaii, Iowa, Kentucky, Maryland, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Oregon, Puerto Rico, South Carolina, Tennessee, Utah, Vermont, Virginia, Virgin Islands, Washington, and Wyoming.

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