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A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century (2018)

Chapter: Appendix D Updates on Recommendations from the1987 National Research Council Report Counting Injuriesand Illnesses in the Workplace: Proposals for a Better System

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Suggested Citation:"Appendix D Updates on Recommendations from the1987 National Research Council Report Counting Injuriesand Illnesses in the Workplace: Proposals for a Better System." National Academies of Sciences, Engineering, and Medicine. 2018. A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/24835.
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Page 187
Suggested Citation:"Appendix D Updates on Recommendations from the1987 National Research Council Report Counting Injuriesand Illnesses in the Workplace: Proposals for a Better System." National Academies of Sciences, Engineering, and Medicine. 2018. A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/24835.
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Page 188
Suggested Citation:"Appendix D Updates on Recommendations from the1987 National Research Council Report Counting Injuriesand Illnesses in the Workplace: Proposals for a Better System." National Academies of Sciences, Engineering, and Medicine. 2018. A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/24835.
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Page 189

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Appendix D Updates on Recommendations from the 1987 National Research Council Report Counting Injuries and Illnesses in the Workplace: Proposals for a Better System 1987 RECOMMENDATIONS ACTIONS Annual Survey 1. The BLS annual survey should be modified to permit the OSHA’s revised recordkeeping requirements, collection of detailed data on severe occupational injuries including modifications to the forms, became categorized as injuries resulting in death, hospitalization, or effective on January 1, 2002. The OSHA form 301 outpatient surgery. This will require: (previously Form 101) includes fields asking Modification of the OSHA 200 and 200S to provide whether the injured worker was treated in the categories for admission to a hospital or for out-patient emergency room or as in-patient within the surgery, regardless of whether at a hospital, clinic, hospital. physician’s office, or the establishment itself. BLS should convene a working group to develop an appropriate The BLS Census of Fatal Occupational Injuries classification and corresponding definitions. (CFOI), created after the 1987 set of Collection and coding of data from the OSHA 101 (or recommendations, collects data on all occupational equivalent) for all fatalities, hospitalizations, and outpatient fatalities using a multisource approach (see also the surgery. response to Recommendation 4, below). 2. The OSHA 200 and 200S should be modified to include The Survey of Occupational Injuries and Illnesses specific categories of injuries, such as amputations, burns, now collects, codes, and publishes data on many cuts, fractures, contusion or bruises, categories of injuries and illnesses including those sprains/strains/unspecified pain, and other. listed in Recommendation #2. 3. The annual survey should continue to collect OSHA’s revised recordkeeping requirements occupational illness data from the OSHA 200 log with the became effective on January 1, 2002. The separate following revision in the distinction between “acute” and recording criteria that distinguished between “chronic” and in the categories of illness. injuries and illnesses were removed. OSHA Form Acute occupational illnesses should be divided into such 300 has six general categories for each injury and categories as skin, respiratory, gastrointestinal, nervous illness recorded: injuries, skin disorders, system, musculoskeletal, and other. Illnesses would be respiratory conditions, poisoning, hearing loss, and recorded in this section if the onset of an illness is less than all other illnesses. 14 days after the last exposure identified as the probable cause. The BLS SOII Case and Demographic product Chronic occupational diseases should be divided into such allows for additional detailed illness data to be categories as hearing loss, repetitive trauma disorders, made available (such as the nature of the illness). illnesses diagnosed as a result of a medical examination Specific distinctions between acute and chronic are required under the OSHA health standard, and other not made but estimates are published for the chronic illness. categories listed in this recommendation, based on the Occupational Injury and Illness Coding System. (Continued) Prepublication Copy 187

A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century Continued 1987 RECOMMENDATIONS ACTIONS Annual Survey 4. The annual survey should be modified to permit the As a result of the 1987 report, BLS collects collection of detailed data on occupational illnesses detailed case data for Days Away From Work resulting in hospitalization or death, as recommended (DAFW). Recently, BLS began collecting above for occupational injuries. This will require: information on whether DAFW cases include a Modification of the OSHA 200 and 200S to provide a visit to the emergency room or result in a hospital category for hospitalization. stay. Pilot efforts are under way to collect data for Collection by BLS of the OSHA 101 (or equivalent) for Days of Job Transfer or Restriction for select all hospitalization and fatalities. industries. Fatal occupational illnesses are not included in the CFOI. 5. BLS should undertake studies to assess how well BLS has explored this issue in a variety of ways, employers understand the guidelines for maintaining the including the initial undercount qualitative OSHA 200 logs and how uniformly they record entries on interviews in the mid-2000s, the four state studies, the logs. These studies might include, but are not limited the Washington state follow-back interviews, and to, telephone surveys and small test groups. the Westat follow-back study. 6. BLS should select a probability sample of establishments BLS conducted a quality assurance (QA) study in and obtain a copy of the OSHA 200 log from each the mid-2000s and has an ongoing QA study to establishment in the sample. BLS should compare these review logs from subsampled establishments logs against the summary forms submitted by the against the submissions to SOII. In general, if an establishments in the annual survey sample. injury or illness is on the log, it is included in the establishment's response to the SOII. 7. If the validation study now being carried out by BLS and Subsequent research found that gaining regular OSHA in Massachusetts and Missouri proves to be feasible access to medical records from across the nation is and useful, in terms of being able to gain access to medical not feasible. This research included using the records in the sufficient proportion of the establishments, methodology from the Massachusetts/Missouri they should be encouraged to consider extending this study to evaluate the records of a representative approach to a broader sample. sample of employers that reported data to OSHA through the OSHA Data Initiative. 8. BLS should conduct studies to obtain independent BLS conducted relevant studies in response to this medical information on occupational injuries, such as for recommendation and noted that the results outpatient surgery and admissions to hospitals other than indicated that obtaining medical data from multiple for observation, to determine the extent to which these sources from across the nation would not be injuries have been recorded on the OSHA 200 logs in the feasible. establishments in which the injured workers were employed. 9. In order to obtain estimates of coverage, BLS should Efforts regarding the 1987 National Health conduct sample surveys of employees to obtain information Interview Survey are not known. The household as to possible injuries sustained in the workplace. These SOII pilot now being planned is a survey of events should be followed back to determine whether they employees, but the sample is specifically not linked were, in fact, work-related and whether they had been to sampled SOII establishments. Differences in recorded on the OSHA 200 log. Given the unique research results between the household and establishment opportunity afforded by the 1987 National Health surveys will be available by various characteristics, Interview Survey, we urge BLS to apply this kind of case- such as occupation and industry. by-case follow-back. 188 Prepublication Copy

Appendix D 10. BLS should work with state agencies to carry out CFOI collects data on all occupational fatalities studies in which complete rosters of occupational using a multi-source approach. Ongoing CFOI fatalities are compiled from death certificates, medical efforts at BLS are exploring the identification of examiner records, workers’ compensation claims, and occupational fatalities referenced in public reports to OSHA and matched against the OSHA 200 documents, such as print media, and providing logs in the establishments in which these workers were rapid turnaround in disseminating this employed. information. 11. Data from the BLS annual survey should be fed back BLS includes a section in survey materials on to companies by industry and size classification and “how your injury and illness data are used.” BLS posted so that employers and employees can see how provides data to employers, employees, and their company compares with the appropriate referent other data users in many web-based formats, group. including the incidence rate calculator, flat data files, tables, charts, publications, and other products. 12. Special studies focusing on specific research topics Since 1987 BLS has introduced the SOII Case should be conducted by BLS in conjunction with the and Demographic expansion and implemented annual survey, in which OSHA 101s are collected for CFOI, which provide extensive data on specific specific injuries or from specific industries, as injuries and industries. Additionally, determined by BLS. partnerships with NIOSH have focused on respirator use and workplace violence prevention. BLS Supplementary Data System 13. The Supplementary Data System should be refocused The Supplementary Data System was replaced and modified to gather data in greater detail on all with the SOII Case and Demographics and injuries rather than collecting a minimal data set from a CFOI. large number of states. This would permit detailed analyses for a wide range of specific injuries. Grants should be made on a competitive basis to states that can meet the criteria for data detail and quality specified by BLS. Competition for grants for data analyses should also be open to other organizations or individuals (e.g., university researchers) and should encourage proposals for new areas of analyses. Use of Other Data Systems 14. NIOSH should be designated as the lead agency Additional funding has not been provided for a having the responsibility for the development of a comprehensive system, however NIOSH has comprehensive occupational disease surveillance system been able to work with federal and state partners that would include the compilation, analysis, and to collect and explore data on national trends in dissemination to occupational illness data. These data some areas (NIOSH, 2017). NIOSH has would come from national data bases and state health developed standardized case definitions for departments, beginning with data that are already elevated blood levels, pesticide poisonings, available. As part of this system, NIOSH should support work-related asthma, and silicosis. the development of follow-back interventions; should develop standardized methods for the detection of recognized occupational illnesses; and should publish periodic reports summarizing the data on occupational disease from the various sources. To accomplish this, NIOSH should request, and Congress approve, appropriation of additional funds. NOTE: The examples of actions were provided by staff from NIOSH, OSHA, and BLS in response to a request from the committee. The agency responses were edited to provide some examples of the extensive efforts. Prepublication Copy 189

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The workplace is where 156 million working adults in the United States spend many waking hours, and it has a profound influence on health and well-being. Although some occupations and work-related activities are more hazardous than others and face higher rates of injuries, illness, disease, and fatalities, workers in all occupations face some form of work-related safety and health concerns. Understanding those risks to prevent injury, illness, or even fatal incidents is an important function of society.

Occupational safety and health (OSH) surveillance provides the data and analyses needed to understand the relationships between work and injuries and illnesses in order to improve worker safety and health and prevent work-related injuries and illnesses. Information about the circumstances in which workers are injured or made ill on the job and how these patterns change over time is essential to develop effective prevention programs and target future research. The nation needs a robust OSH surveillance system to provide this critical information for informing policy development, guiding educational and regulatory activities, developing safer technologies, and enabling research and prevention strategies that serves and protects all workers.

A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century provides a comprehensive assessment of the state of OSH surveillance. This report is intended to be useful to federal and state agencies that have an interest in occupational safety and health, but may also be of interest broadly to employers, labor unions and other worker advocacy organizations, the workers’ compensation insurance industry, as well as state epidemiologists, academic researchers, and the broader public health community. The recommendations address the strengths and weaknesses of the envisioned system relative to the status quo and both short- and long-term actions and strategies needed to bring about a progressive evolution of the current system.

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