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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 the 1987 National Research Council Report "Counting Injuries and Illnesses in the Workplace: Proposals for a Better System"

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Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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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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 collection of detailed data on severe occupational injuries categorized as injuries resulting in death, hospitalization, or outpatient surgery. This will require:
    • Modification of the OSHA 200 and 200S to provide categories for admission to a hospital or for out-patient surgery, regardless of whether at a hospital, clinic, physician’s office, or the establishment itself. BLS should convene a working group to develop an appropriate classification and corresponding definitions.
    • Collection and coding of data from the OSHA 101 (or equivalent) for all fatalities, hospitalizations, and outpatient surgery.
OSHA’s revised recordkeeping requirements, including modifications to the forms, became effective on January 1, 2002. The OSHA Form 301 (previously Form 101) includes fields asking whether the injured worker was treated in the emergency room or as inpatient within the hospital.
The BLS Census of Fatal Occupational Injuries (CFOI), created after the 1987 set of recommendations, collects data on all occupational fatalities using a multisource approach (see also the response to Recommendation 4, below).
Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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.
×
1987 RECOMMENDATIONS ACTIONS
  1. The OSHA 200 and 200S should be modified to include specific categories of injuries, such as amputations, burns, cuts, fractures, contusion or bruises, sprains/strains/unspecified pain, and other.
The Survey of Occupational Injuries and Illnesses now collects, codes, and publishes data on many categories of injuries and illnesses including those listed in Recommendation #2.
  1. The annual survey should continue to collect occupational illness data from the OSHA 200 log with the following revision in the distinction between “acute” and “chronic” and in the categories of illness.
    • Acute occupational illnesses should be divided into such categories as skin, respiratory, gastrointestinal, nervous system, musculoskeletal, and other. Illnesses would be recorded in this section if the onset of an illness is less than 14 days after the last exposure identified as the probable cause.
    • Chronic occupational diseases should be divided into such categories as hearing loss, repetitive trauma disorders, illnesses diagnosed as a result of a medical examination required under the OSHA health standard, and other chronic illness.
OSHA’s revised recordkeeping requirements became effective on January 1, 2002. The separate recording criteria that distinguished between injuries and illnesses were removed. OSHA Form 300 has six general categories for each injury and illness recorded: injuries, skin disorders, respiratory conditions, poisoning, hearing loss, and all other illnesses.
The BLS SOII Case and Demographic product allows for additional detailed illness data to be made available (such as the nature of the illness). Specific distinctions between acute and chronic are not made but estimates are published for the categories listed in this recommendation, based on the Occupational Injury and Illness Coding System.
  1. The annual survey should be modified to permit the collection of detailed data on occupational illnesses resulting in hospitalization or death, as recommended above for occupational injuries. This will require:
    • Modification of the OSHA 200 and 200S to provide a category for hospitalization.
    • Collection by BLS of the OSHA 101 (or equivalent) for all hospitalization and fatalities.
As a result of the 1987 report, BLS collects detailed case data for Days Away From Work (DAFW). Recently, BLS began collecting information on whether DAFW cases include a visit to the emergency room or result in a hospital stay. Pilot efforts are under way to collect data for Days of Job Transfer or Restriction for select industries. Fatal occupational illnesses are not included in the CFOI.
Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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.
×
1987 RECOMMENDATIONS ACTIONS
  1. BLS should undertake studies to assess how well employers understand the guidelines for maintaining the OSHA 200 logs and how uniformly they record entries on the logs. These studies might include, but are not limited to, telephone surveys and small test groups.
BLS has explored this issue in a variety of ways, including the initial undercount qualitative interviews in the mid-2000s, the four state studies, the Washington state follow-back interviews, and the Westat follow-back study.
  1. BLS should select a probability sample of establishments and obtain a copy of the OSHA 200 log from each establishment in the sample. BLS should compare these logs against the summary forms submitted by the establishments in the annual survey sample.
BLS conducted a quality assurance (QA) study in the mid-2000s and has an ongoing QA study to review logs from subsampled establishments against the submissions to SOII. In general, if an injury or illness is on the log, it is included in the establishment’s response to the SOII.
  1. If the validation study now being carried out by BLS and OSHA in Massachusetts and Missouri proves to be feasible and useful, in terms of being able to gain access to medical records in the sufficient proportion of the establishments, they should be encouraged to consider extending this approach to a broader sample.
Subsequent research found that gaining regular access to medical records from across the nation is not feasible. This research included using the methodology from the Massachusetts/Missouri study to evaluate the records of a representative sample of employers that reported data to OSHA through the OSHA Data Initiative.
  1. BLS should conduct studies to obtain independent medical information on occupational injuries, such as for outpatient surgery and admissions to hospitals other than for observation, to determine the extent to which these injuries have been recorded on the OSHA 200 logs in the establishments in which the injured workers were employed.
BLS conducted relevant studies in response to this recommendation and noted that the results indicated that obtaining medical data from multiple sources from across the nation would not be feasible.
Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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.
×
1987 RECOMMENDATIONS ACTIONS
  1. In order to obtain estimates of coverage, BLS should conduct sample surveys of employees to obtain information as to possible injuries sustained in the workplace. These events should be followed back to determine whether they were, in fact, work-related and whether they had been recorded on the OSHA 200 log. Given the unique research opportunity afforded by the 1987 National Health Interview Survey, we urge BLS to apply this kind of case-by-case follow-back.
Efforts regarding the 1987 National Health Interview Survey are not known. The household SOII pilot now being planned is a survey of employees, but the sample is specifically not linked to sampled SOII establishments. Differences in results between the household and establishment surveys will be available by various characteristics, such as occupation and industry.
  1. BLS should work with state agencies to carry out studies in which complete rosters of occupational fatalities are compiled from death certificates, medical examiner records, workers’ compensation claims, and reports to OSHA and matched against the OSHA 200 logs in the establishments in which these workers were employed.
CFOI collects data on all occupational fatalities using a multisource approach. Ongoing CFOI efforts at BLS are exploring the identification of occupational fatalities referenced in public documents, such as print media, and providing rapid turnaround in disseminating this information.
  1. Data from the BLS annual survey should be fed back to companies by industry and size classification and posted so that employers and employees can see how their company compares with the appropriate referent group.
BLS includes a section in survey materials on “how your injury and illness data are used.” BLS provides data to employers, employees, and other data users in many web-based formats, including the incidence rate calculator, flat data files, tables, charts, publications, and other products.
  1. Special studies focusing on specific research topics should be conducted by BLS in conjunction with the annual survey, in which OSHA 101s are collected for specific injuries or from specific industries, as determined by BLS.
Since 1987 BLS has introduced the SOII Case and Demographic expansion and implemented CFOI, which provide extensive data on specific injuries and industries. Additionally, partnerships with NIOSH have focused on respirator use and workplace violence prevention.
Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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.
×
1987 RECOMMENDATIONS ACTIONS
BLS Supplementary Data System
  1. The Supplementary Data System should be refocused and modified to gather data in greater detail on all injuries rather than collecting a minimal data set from a 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.
The Supplementary Data System was replaced with the SOII Case and Demographics and CFOI.
Use of Other Data Systems
  1. NIOSH should be designated as the lead agency having the responsibility for the development of a comprehensive occupational disease surveillance system that would include the compilation, analysis, and dissemination to occupational illness data. These data would come from national data bases and state health departments, beginning with data that are already available. As part of this system, NIOSH should support 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.
Additional funding has not been provided for a comprehensive system, however NIOSH has been able to work with federal and state partners to collect and explore data on national trends in some areas. NIOSH has developed standardized case definitions for elevated blood levels, pesticide poisonings, work-related asthma, and silicosis.

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.

Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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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Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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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Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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.
×
Page 286
Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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.
×
Page 287
Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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.
×
Page 288
Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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.
×
Page 289
Suggested Citation:"Appendix D: Updates on Recommendations from the 1987 National Research Council Report "Counting Injuries and 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.
×
Page 290
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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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