Case Study

Ergonomics
Incidence rate = (Number of new cases/yr) × (200,000 work hrs) per facility*
Number of hours worked/facility/yr
Minimizing the amount of physical stress in the workplace requires continuous study of the ways in
which people and technology interact. The insight learned from this study must then be used to improve
the interaction. This is a description of the science of ergonomics. For the purpose of this book,
ergonomics is defined as follows:
Ergonomics is a multidisciplinary science that seeks to conform the workplace and all of its physiological
aspects to the worker. Ergonomics involves the following:
Using special design and evaluation techniques to make tasks, objects, and environments more
compatible with human abilities and limitations.
Seeking to improve productivity and quality by reducing workplace stressors, reducing the risk of injuries
and illnesses, and increasing efficiency.
The word ergonomics is derived from the Greek language. Ergon is Greek for work; nomos means laws.
Therefore, in a literal sense, ergonomics means work laws. In practice, it consists of the scientific
principles (laws) applied in minimizing the physical stress associated with the workplace (work). Some of
the widely accepted benefits of ergonomics include:
Improved health and safety for workers
Higher morale in the workplace
Improved quality
Improved productivity
Improved competitiveness
Decreased absenteeism and turnover
Fewer workplace injuries and health problems
There are benefits to be derived from ergonomics. There are also problems, both financial and health
related, that can result from giving too little attention to ergonomics. The matter is complicated further
because health problems tend to multiply a company’s financial problems. Consequently, modern safety
and health professionals need to be well versed in ergonomics, Figure 10–1.
Figure 10–1 Ergonomic factors are now an important part of product and work station design.

Human Factors and Ergonomic Hazards
When the topic of ergonomics is discussed, the term human factors will usually find its way into the
conversation. But what is meant by the term? It can be defined as follows: Consumers are demanding
safe and effective products. However, not all people have control over products they use. Therefore, all
products must be carefully designed. For example, if a child car seat fails because it does not fit the child
or is difficult to install, everyone will lose: the child, the parent, the designer, and the manufacturer.
Human factors is a profession to help ensure that equipment and systems are safe and easy to operate
by human beings.1 A human factors researcher gathers and analyzes data on human beings (how they
work, their size, their capabilities, and their limitations). A human factors engineer works with designers
as a team to incorporate data into designs to make sure people can operate and maintain the product or
system. Human factors professionals then determine the skills needed to operate or maintain a finished
product. Human factors is difficult to define because it is a compilation of many sciences dealing with
both humans and machines. Some of the disciplines human factors experts are trained in include the
following: psychology, anthropology, engineering, biology, medicine, education, and physiology.2
Human Factors Defined
Human factors is a science that combines research with the application of human data.3 The concept
can also be viewed as a science that bridges research about human beings and the application of that
research in designing products and systems for human beings. Human factors are human characteristics
as well as environmental, organizational, and job factors that influence the behavior of workers in ways
that can affect workplace safety and health.
Human Factors in Action
Perhaps the best way to get a feel for the concept of human factors is to consider several of these
examples:
Predesign analysis. In this stage of the design process, human factors professionals conduct research to
answer such questions as: What is the best way for humans to interact with computers? What factors
contribute to fatigue and stress in an office environment? How can designers overcome these factors?
Preliminary design. In this stage, human factors professionals study machine and human capabilities to
determine which tasks should be undertaken manually and which should be automated.
Detail design and development. In design and development, human factors professionals define the
environment required for operator safety, enhanced operator performance, and the reduction or
prevention of operator stress and fatigue.
Test and evaluation. In this stage of the process, human factors professionals test actual humans in
using the prototype equipment or system.4
Workplace culture. Organizational culture can affect worker behavior. Does the organization have a
safety-first culture or a culture that ignores safety and health practices? To change worker behavior, it
may be necessary to first change the culture of the workplace. An organization’s top executives set the
tone for an organization’s culture. If they insist on safety first and make it an organizational priority,
workers will adopt a safety-first attitude.
Communication. If executives, managers, supervisors, and team leaders want safety, they must convey
that expectation to employees in every way possible (e.g., verbally, in written policies and procedures,
in evaluation criteria, in recognition and reward criteria, and by their examples). Worker behavior is
affected by the expectations of those in positions of authority, particularly when authority figures
exemplify their expectations in their examples.
Resources. If executives, managers, supervisors, and team leaders want safety, they must provide
workers with the resources necessary to do their jobs in a safe manner. From an ergonomic perspective,
this means providing ergonomically correct workstations, tools, and processes.
Employee attitudes and personalities. Safety and health professionals and other decision makers in an
organization must be aware of the effect worker attitudes and personalities can have on safety.
Attitudes and personalities are human factors that can help ensure that safe work practices are adhered
to or that they are undermined. When attempts to ensuring that a worker follows safe work practices
fail because that worker has a negative attitude toward safety or risk-taking personality, decision makers
should remove the individual in question or transfer him or her to another position that involves less
risk.
Human Factors and Safety
Human factors can play an important role in both product safety and workplace safety (where many
products are used). What follows is how the science of human factors can help reduce both product and
workplace hazards:
Factors Associated with Physical Stress
Eight variables that can influence the amount of physical stress experienced on the job are as follows:
Sitting versus standing
Stationary versus moveable/mobile
Large demand for strength/power versus small demand for strength/power
Good horizontal work area versus bad horizontal work area
Good vertical work area versus bad vertical work area
Nonrepetitive motion versus repetitive motion
Low surface versus high surface contact
No negative environmental factors versus negative environmental factors
The following paragraphs summarize the extent of this influence and the forms that it can take.6
Sitting versus Standing
Generally speaking, sitting is less stressful than standing. Standing for extended periods, particularly in
one place, can produce unsafe levels of stress on the back, legs, and feet. Although less strenuous than
standing, sitting can be stressful unless the appropriate precautions are taken. These precautions
include proper posture, a supportive back rest, and frequent standing/stretching movement.
Stationary versus Moveable/Mobile
Stationary jobs are those done primarily at one workstation. Of course, even these jobs involve
movement at the primary workstation and occasional movement to other areas. Mobile jobs, on the
other hand, require continual movement from one station to another. The potential for physical stress
increases with stationary jobs when workers fail to take such precautions as periodically
standing/stretching/moving. The potential for physical stress increases with mobile jobs when workers
carry materials as they move from station to station.
Large versus Small Demand for Strength/Power
In classifying jobs by these two criteria, it is important to understand that repeatedly moving small
amounts of weight over a period of time can have a cumulative effect equal to the amount of stress
generated by moving a few heavy weights. Regardless of whether the stress results from lifting a few
heavy objects or repeated lifting of lighter objects, jobs that demand larger amounts of strength/power
are generally more stressful than those requiring less strength/power.
Good versus Bad Horizontal Work Area
A good horizontal work area is one that is designed and positioned so that it does not require the
worker to bend forward or to twist the body from side to side. Horizontal work areas that do require
these movements are bad. Bad horizontal work surfaces increase the likelihood of physical stress.
Good versus Bad Vertical Work Area
Good vertical work areas are designed and positioned so that workers are not required to lift their
hands above their shoulders or bend down in order to perform any task. Vertical work areas that do
require these movements are bad. Bad vertical work areas increase the likelihood of physical stress.
Nonrepetitive versus Repetitive Motion
Repetitive motion jobs involve short-cycle motion that is repeated continually. Nonrepetitive jobs
involve a variety of tasks that are not, or only infrequently, repeated. Repetition can lead to monotony
and boredom. When this happens, the potential for physical stress increases.
Safety Fact
High Cost of Pain
When employees are in pain, they respond by taking sick leave from work. Sick leave due to unspecified
pain costs employers more than $3 billion in lost workdays. Approximately 17 million employees in the
United States take an average of three days of sick leave per year to deal with unspecified pain (for
example, headaches, neck pain, back pain, and menstrual pain). Often the pain is not work related.
Low versus High Surface Contact
Surface stress can result from contact with hard surfaces such as tools, machines, and equipment. Highsurface-contact jobs tend to be more stressful in a physical sense than are low-surface-contact jobs.
Absence versus Presence of Negative Environmental Factors
Generally, the more environmental factors with which a worker has to contend on the job, the more
stressful is the job. For example, personal protective equipment, although conducive to reducing
environmental hazards, can increase the amount of physical stress associated with the job.
gonomics: A Political Football
The Occupational Safety and Health Administration’s (OSHA’s) attempts to develop an ergonomics
standard have been the subject of bitter disputes between labor and management in the private sector.
These disputes, in turn, have found their way into the political arenas of both the U.S. Congress and the
executive branch. OSHA established its voluntary ergonomics guidelines in 1989. Soon thereafter,
organized labor began its campaign to have the guidelines made mandatory through passage of an
ergonomics standard. During the Clinton administration (1993–2000), Congress steadfastly refused to
approve OSHA’s proposed ergonomics standard.
Finally, on November 14, 2000, OSHA issued a final Ergonomic Program Standard (29 CFR 1901 Subpart
W). The final rule became effective on January 16, 2001. However, on March 6, 2001, the United States
Senate passed a resolution of disapproval (S.J. Res. 6) of the Ergonomic Program Standard under the
Congressional Review Act. The House of Representatives then passed S.J. Res. 6 on March 7, 2001.
President George W. Bush signed the resolution into law as Public Law 107-5 on March 20, 2001. At this
point, OSHA removed the Ergonomic Program Standard from the Code of Federal Regulations.
The disagreement between business and labor concerning the need for an ergonomic standard
continues. There is also opposition from various states, which claim that it encroaches on existing
workers’ compensation programs and statutes. This criticism grows out of the fact that OSHA’s
Ergonomic Program Standard threatened the exclusive remedy provision of state statutes by requiring a
new and entirely separate benefit system for musculoskeletal disorders (MSDs). What further concerned
the states was that the eligibility requirements in OSHA’s Ergonomic Program Standard were different
from those already established in the various state programs for workers’ compensation. The standard
did contain a provision that allowed an offset of workers’ compensation benefits when a worker was
entitled to both types of benefits, but state officials complained that this provision would create a
bureaucratic nightmare in paperwork and red tape. OSHA has responded to the ongoing controversy in
two ways. First, OSHA continues to offer voluntary guidelines beyond those that apply to industry in
general for businesses in specific industrial classifications. Second, OSHA has begun to claim that it will
use its general duty clause to enforce ergonomic safety. However, there is little evidence that this is
actually happening. After vowing to make enforcement through the general duty clause part of its fourpronged attack on musculoskeletal hazards, OSHA is, in reality, focusing most of its efforts on the other
three prongs: voluntary guidelines, outreach and assistance, and continuing research.
Osha’s Voluntary Ergonomics Guidelines
OSHA first published guidelines for general safety and health program management in 1989. OSHA’s
ergonomics guidelines are voluntary and are designed to provide employers with the information and
guidance needed to meet their obligations under the Occupational Safety and Health Act (OSH Act)
regarding ergonomics.
OSHA has since followed these guidelines with others designed specifically for meatpacking, shipyards,
poultry processing, nursing homes, and retail grocery stores. Other guidelines are in the process of being
developed. These specific guidelines represent a model for guidelines that are likely to be developed for
other specific industries. Meatpacking and poultry processing were singled out because of the high
incidence of cumulative trauma disorders (CTDs) associated with these industries. CTDs are injuries that
result from an accumulation of repetitive motion stress. For example, using scissors continually over
time can cause a CTD in the hand and wrist.
OSHA’s Ergonomics Standard (Voluntary Guidelines)
OSHA’s voluntary guidelines were well received by employees and labor organizations with one major
caveat: the “voluntary” nature of the guidelines. Many people interested in occupational safety and
health advocated a mandatory standard for ergonomics. This led to discussions concerning the
development by OSHA of a new ergonomics standard. The standard has not yet been developed.
However, OSHA’s proposed ergonomics standard failed to win approval from Congress. Consequently,
after much political wrangling, OSHA officials decided to convert the proposed ergonomics standard into
voluntary ergonomics guidelines. OSHA’s current plan for reducing ergonomic hazards in the workplace
has four elements:
Voluntary guidelines for specific industries.
Enforcement of the guidelines under the general duty clause of the OSH Act 5(a)(1). This is a
controversial element of the four-part plan because some employers think that OSHA is using the
general duty clause to make the “voluntary” guidelines mandatory against the stated will of Congress.
Compliance assistance to help employers reduce ergonomic hazards.
Research into ergonomic issues to help identify gaps in the body of knowledge surrounding this topic.
Enforcement by OSHA
Although the ergonomics guidelines developed by OSHA are voluntary, at least for the foreseeable
future, the agency does claim that it will use the general duty clause of the OSH Act to enforce the
guidelines in certain situations. OSHA’s criteria for applying the general duty clause are as follows:
Is there currently an ergonomic hazard that is causing injuries?
Does the employer in question know about the hazard (or should the employer know)?
Are the injuries caused by the ergonomic hazard resulting in serious physical harm?
Are there feasible alternatives available to the employer for reducing, abating, or minimizing the
hazard?
Although the use of the general duty clause to enforce voluntary ergonomics guidelines is controversial
and has been questioned by many employers in theory, in practice this is an approach that is rarely used
by OSHA.
Rationale for the Voluntary Guidelines
In a typical year, more than 85 percent of the workers’ compensation payments made to workers for
both lost wages and medical treatment due to disabling injuries can be traced to 10 causes. MSDs and
CTDs are typically sixth on the list of the top 10 causes accounting for 6.7 percent of disabling injuries.
This relatively low figure differs radically from the perceptions of business and labor leaders as well as
the general public. Popular perception places MSDs and CTDs at the top of the list. This is probably
because these types of injuries have received so much attention in the press and professional journals
for more than past 30 plus years owing to the ongoing controversy over passage and repeal of OSHA’s
Ergonomic Program Standard.
Application of the Voluntary Guidelines
OSHA’s ergonomics guidelines are geared toward manufacturing and materials handling in the general
industry sector. They do not apply to construction, maritime operations, agriculture, or employers that
operate a railroad, although they can be applied to other jobs in which the type of work that is
fundamental and necessary to perform the job results in MSDs. The ergonomics guidelines apply to
more than 1.5 million employees nationwide. Examples of jobs to which the guidelines apply are as
follows:
Patient-handling jobs (nurse assistants and orderlies)
Shipping, receiving, and delivery (package sorting, handling, delivery, etc.)
Baggage handlers
Warehouse work (manual tasks)
Beverage and water handling and delivery
Grocery/retail store stocking and bagging
Garbage and trash collecting
Assembly-line work
Piecework assembly
Product inspection (involving manual tasks such as weighing objectives)
Meat, poultry, and fish processing
Machine loading, unloading, and operation
Textile manufacturing
Food preparation assembly-line work
Commercial banking
Cabinet making
Tire making
Proposed Requirements of the Voluntary Guidelines
Organizations that fall into the general industry classifications of manufacturing and manual material
handling are asked by the guidelines to implement a “basic ergonomics program.” This amounts to
assigning responsibility for ergonomics to one individual and informing employees about the risks of
MSD-related injuries, symptoms of such injuries, and why early reporting of symptoms is important. In
addition, the basic program requires employers to establish a system that employees can use to report
symptoms of MSD injuries.
The so-called full ergonomics program set forth in the guidelines is not required unless and until an
employee’s job is determined, by use of a basic screening tool (such as the one shown in Figure 10–2) to
have met the “action trigger.” The full program consists of the following components:
Figure 10–2 Basic screening tool for VDT workstations.
Source: Adapted from Appendix D-2 of OSHA Standard 1910.900.
Figure 10–2 Full Alternative Text
Management leadership and employee participation
Training
Record keeping
Job hazard analysis and control
Work restriction protection
MSD management
Program evaluation
Worksite Analysis Program for Ergonomics
Although complex analyses are best performed by a professional ergonomist, the “ergonomics team”—
or any qualified person—can use this program to conduct a worksite analysis and identify stressors in
the workplace. The purpose of the following information is to give a starting point for finding and
eliminating those tools, techniques, and conditions that may be the source of ergonomic problems.7
Safety Fact
Keys to a Successful Ergonomics Program
Regardless of the type of organization, the keys to having a successful ergonomics program are as
follows:
Commitment on the part of top management
Written program
Employee involvement
Continuous monitoring of the program
Adjusting as necessary based on the results of monitoring
In addition to analyzing current workplace conditions, planned changes to existing and new facilities,
processes, materials, and equipment should be analyzed to ensure that changes made to enhance
production will also reduce or eliminate ergonomic risk factors. As emphasized before, this program
should be adapted to each individual workplace.
The discussion of the recommended program for worksite analysis is divided into four main parts: (1)
gathering information from available sources; (2) conducting baseline screening surveys to determine
which jobs need closer analysis; (3) performing ergonomic job hazard analyses of those workstations
with identified risk factors; and (4) after implementing control measures, conducting periodic surveys
and follow-up studies to evaluate changes.
Information Sources
Records Analysis and Tracking
The essential first step in worksite analysis is records analysis and tracking to develop the information
necessary to identify ergonomic hazards in the workplace. Existing medical, safety, and insurance
records, including OSHA 300 logs, should be analyzed for evidence of injuries or disorders associated
with CTDs. Healthcare providers should participate in this process to ensure confidentiality of patient
records.
Incidence Rates
Incidence rates for upper extremity disorders and/or back injuries should be calculated by counting the
incidence of CTDs and reporting the number for each 100 full-time workers per year by facility*:
*Adapted from OSHA 3123.
Incidence rate=(Number of new cases/yr)×(200,000 work hrs) per facilityNumber of hours worked/facili ty/yr Screening Surveys The second step in worksite analysis is to conduct baseline screening surveys. Detailed baseline screening surveys identify jobs that put employees at risk of developing CTDs. If the job places employees at risk, an effective program will then require the ergonomic job hazard analysis.*
*The same method should be applied to departments, production lines, or job types within the facility. . . Checklist The survey is performed with an ergonomic checklist. This checklist should include components such as posture, materials handling, and upper extremity factors. (The checklist should be tailored to the specific needs and conditions of the workplace.) Ergonomic Risk Factors Identification of ergonomic hazards is based on ergonomic risk factors: conditions of a job process, workstation, or work method that contribute to the risk of developing CTDs. Not all these risk factors will be present in every CTD-producing job, nor is the existence of one of these factors necessarily sufficient to cause a CTD. CTD Risk Factors Some of the risk factors for CTDs of the upper extremities include the following: Repetitive and/or prolonged activities Forceful exertions, usually with the hands (including pinch grips) Prolonged static postures Awkward postures of the upper body, including reaching above the shoulders or behind the back, and twisting the wrists and other joints to perform tasks Continued physical contact with work surfaces (soft tissue compression) Excessive vibration from power tools Cold temperatures Inappropriate or inadequate tool design High wrist acceleration Fatigue (inadequate recovery time) Use of gloves Back Disorder Risk Factors Risk factors for back disorders include the following: Bad body mechanics such as continued bending over at the waist, continued lifting from below the knees or above the shoulders, and twisting at the waist, especially while lifting Lifting or moving objects of excessive weight or asymmetric size Prolonged sitting, especially with poor posture Lack of adjustable chairs, footrests, body supports, and work surfaces at workstations Poor grips on handles Slippery footing Multiple Risk Factors Jobs, operations, or workstations that have multiple risk factors have a higher probability of causing CTDs. The combined effect of several risk factors in the development of CTDs is sometimes referred to as multiple causation. Ergonomic Job Hazard Analyses At this point, the employer has identified—through the information sources and screening surveys discussed above—jobs that place employees at risk of developing CTDs. As an essential third step in the worksite analysis, an effective ergonomics program requires a job hazard analysis for each job so identified. The job hazard analysis should be routinely performed by a qualified safety and health professional, preferably an ergonomist, for jobs that put workers at risk of developing CTDs. This type of analysis helps verify lower risk factors at light-duty or restricted activity work positions and to determine if risk factors for a work position have been reduced or eliminated to the extent feasible. Workstation Analysis An adequate workstation analysis would be expected to identify all risk factors present in each studied job or workstation. A workstation consists of the equipment, furniture, tools, and accessories required to do the job in question. When selecting a workstation for analysis, consider at least the following factors: Are repetitive movements required of the worker? (yes) Are awkward postures required of the worker? (yes) Are long periods of sitting or standing required of the worker?(yes) Is the noise level appropriate? (no) Is the lighting at the proper level for the tasks in question? (no) Has glare been eliminated as a potential hazard? (no) Is the temperature appropriate for the tasks in question? (no) Is the humidity appropriate for the tasks in question? (no) Has static electricity been eliminated as a potential hazard? (no) The answer in parentheses after each question is a trigger answer. If the answer in parentheses applies to the station in question, the station should be subjected to a thorough assessment. The more trigger responses that apply to a given workstation, the more critical it is to conduct a thorough assessment of that workstation. For upper extremities, three measures of repetitiveness are the total hand manipulations per cycle, the cycle time, and the total manipulations or cycles per work shift. Force measurements may be noted as an estimated average effort and a peak force. They may be recorded as light, moderate, or heavy. Tools should be checked for excessive vibration. The tools, personal protective equipment, and dimensions and adjustability Incidence rate = (Number of new cases/yr) × (200,000 work hrs) per facility
Number of hours worked/facility/yr
Hazard Prevention and Control
Engineering solutions, where feasible, are the preferred method for ergonomic hazard prevention and
control. The focus of an ergonomics program is to make the job fit the person—not to make the person
fit the job. This is accomplished by redesigning the workstation, work methods, or tools to reduce the
demands of the job, including high force, repetitive motion, and awkward postures. A program with this
goal requires research into currently available controls and technology. It should also include provisions
for utilizing new technologies as they become available and for in-house research and testing. Following
are some examples of engineering controls that have proven to be effective and achievable.
Workstation Design
Workstations should be designed to accommodate the persons who actually use them; it is not
sufficient to design for the average or typical worker. Workstations should be easily adjustable and
should be either designed or selected to fit a specific task, so that they are comfortable for the workers
who use them. The work space should be large enough to allow for the full range of required
movements, especially where knives, saws, hooks, and similar tools are used.
Design of Work Methods
Traditional work method analysis considers static postures and repetition rates. This should be
supplemented by addressing the force levels and the hand and arm postures involved. The tasks should
be altered to reduce these and the other stresses associated with CTDs. The results of such analyses
should be shared with the healthcare providers to assist in compiling lists of light-duty and high-risk
jobs.
Tool Design and Handles
Tools should be selected and designed to minimize the risks of upper extremity CTDs and back injuries.
In any tool design, a variety of sizes should be available. Examples of criteria for selecting tools include
the following:
Designing tools to be used by either hand or providing tools for both left- and right-handed workers.
Using tools with triggers that depress easily and are activated by two or more fingers.
Using handles and grips that distribute the pressure over the fleshy part of the palm, so that the tool
does not dig into the palm.
Designing and selecting tools for minimum weight; counterbalancing tools heavier than one or two
pounds.
Selecting pneumatic and power tools that exhibit minimal vibration and maintaining them in accordance
with the manufacturer’s specifications or with an adequate vibration-monitoring program. Wrapping
handles and grips with insulation material (other than wraps provided by the manufacturer for this
purpose) is normally not recommended, as it may interfere with a proper grip and increase stress.
Medical Management Program
An effective medical management program for CTDs is essential to the success of an employer’s
ergonomic program in industries with a high incidence of CTDs.8 It is not the purpose of these guidelines
to dictate medical practice for an employer’s healthcare providers. Rather, they describe the elements
of a medical management program for CTDs to ensure early identification, evaluation, and treatment of
signs and symptoms; to prevent their recurrence; and to aid in their prevention. Medical management
of CTDs is a developing field, and healthcare providers should monitor developments on the subject.
These guidelines represent the best information currently available.
A physician or occupational health nurse (OHN) with training in the prevention and treatment of CTDs
should supervise the program. Each work shift should have access to healthcare providers in order to
facilitate treatment, surveillance activities, and recording of information. Where such personnel are not
employed full time, the part-time employment of appropriately trained healthcare providers is
recommended.
In an effective ergonomics program, healthcare providers should be part of the ergonomics team
interacting and exchanging information routinely to prevent and treat CTDs properly. The major
components of a medical management program for the prevention and treatment of CTDs are trained
first-level healthcare providers, health surveillance, employee training and education, early reporting of
symptoms, appropriate medical care, accurate record keeping, and quantitative evaluation of CTD
trends throughout the plant.
Trained and Available HealthCare Providers
Appropriately trained healthcare providers should be available at all times and on an ongoing basis as
part of the ergonomics program. In an effective medical management program, first-level healthcare
providers should be knowledgeable in the prevention, early recognition, evaluation, treatment, and
rehabilitation of CTDs, as well as in the principles of ergonomics, physical assessment of employees, and
OSHA record-keeping requirements.
Periodic Workplace Walk-Through
In an effective program, healthcare providers should conduct periodic, systematic workplace walkthroughs to remain knowledgeable of operations and work practices, to identify potential light-duty
jobs, and to maintain close contact with employees. Healthcare providers should also be involved in
identifying risk factors for CTDs in the workplace as part of the ergonomics team.
These walk-through surveys should be conducted every month or whenever a particular job task
changes. A record should be kept documenting the date of the walk-through, areas visited, risk factors
recognized, and action initiated to correct identified problems. Follow-up should be initiated to correct
problems identified and should be documented to ensure that corrective action is taken when indicated.
Symptoms Survey
Those responsible for the medical management program should develop a standardized measurement
to determine the extent of work-related disorder symptoms in each area of the plant. This
measurement will help determine which jobs are exhibiting problems and to measure progress of the
ergonomics program.
Institute a Survey
A symptoms survey of employees should be conducted to measure employee awareness of workrelated disorders and to report the location, frequency, and duration of discomfort. Body diagrams
should be used to facilitate gathering this information. Surveys normally should not include employee’s
personal identifiers to encourage employee participation.
The survey is one method for identifying areas or jobs where potential CTD problems exist. The major
strength of the survey approach is in collecting data on the number of workers who may be experiencing
some form of CTD. Reported pain symptoms by several workers on a specific job would indicate the
need for further investigation of that job.
Conduct the Survey Annually
Conducting the survey annually should help detect any major change in the prevalence, incidence,
and/or location of reported symptoms.
Keep a List of Light-Duty Jobs
The ergonomist or other qualified person should analyze the physical procedures used in the
performance of each job, including lifting requirements, postures, hand grips, and frequency of
repetitive motion.
The ergonomist and healthcare providers should develop a list of jobs with the lowest ergonomic risk.
For such jobs, the ergonomic risk should be described. This information will assist healthcare providers
in recommending assignments to light- or restricted- duty jobs. The light-duty job should, therefore, not
increase ergonomic stress on the same muscle-tendon groups. Healthcare providers should likewise
develop a list of known high-risk jobs. Supervisors should periodically review and update the lists.
Health Surveillance
Baseline
The purpose of baseline health surveillance is to establish a base against which changes in healthcare
status can be evaluated, not to prevent people from performing work. Prior to assignment, all new and
transferred workers who are to be assigned to positions involving exposure of a particular body part to
ergonomic stress should receive a baseline health surveillance.
Conditioning Period Follow-Up
New and transferred employees should be given the opportunity during a four- to six-week break-in
period to condition their muscle-tendon groups prior to working at full capacity. Unfortunately, this is
not always possible; however, when it is possible, conditioning should be done. Healthcare providers
should perform a follow-up assessment of these workers after the break-in period (or after one month,
if the break-in period is longer than a month) to determine if conditioning of the muscle-tendon groups
has been successful; whether any reported soreness or stiffness is transient and consistent with normal
adaptation to the job or whether it indicates the onset of a CTD; and if problems are identified, what
appropriate action and further follow-up are required.
Periodic Health Surveillance
Periodic health surveillance—every two to three years—should be conducted on all workers who are
assigned to positions involving exposure of a particular body part to ergonomic stress. The content of
this assessment should be similar to that outlined for the baseline. The worker’s medical and
occupational history should be updated.
Employee Training and Education
Healthcare providers should participate in the training and education of all employees, including
supervisors and other plant management personnel, on the different types of CTDs and means of
prevention, causes, early symptoms, and treatment of CTDs. This information should be reinforced
during workplace walk-throughs and the individual health surveillance appointments. All new employees
should be given such education during orientation. This demonstration of concern and the distribution
of information should facilitate the early recognition of CTDs prior to the development of more severe
and disabling conditions and increase the likelihood of compliance with prevention and treatment.
Encourage Early Report of Symptoms
Employees should be encouraged by healthcare providers and supervisors to report early signs and
symptoms of CTDs to the in-plant health facility. This allows for timely and appropriate evaluation and
treatment without fear of discrimination or reprisal by employers. It is important to avoid any potential
disincentives for employee reporting, such as limits on the number of times that an employee may visit
the health unit.
Protocols for Healthcare Providers
Healthcare providers should use written protocols for health surveillance and the evaluation, treatment,
and follow-up of workers with signs or symptoms of CTDs. A qualified healthcare provider should
prepare the protocols. These protocols should be available in the plant health facility. Additionally, the
protocols should be reviewed and updated annually or as state-of-the-art evaluation and treatment of
these conditions changes.
Evaluation, Treatment, and Follow-Up of CTDs
If CTDs are recognized and treated appropriately early in their development, a more serious condition
can likely be prevented. Therefore, a good medical management program that seeks to identify and
treat these disorders early is important.
OSHA Record-Keeping Forms
The OSH Act and record-keeping regulations in Title 29, Code of Federal Regulations (CFR) 1904, provide
specific recording requirements that comprise the framework of the occupational safety and health
recording system. The Bureau of Labor Statistics (BLS) has issued guidelines that provide official agency
interpretations concerning the record keeping and reporting of occupational injuries and illnesses. These
guidelines—U.S. Department of Labor, BLS: Record-Keeping Guidelines for Occupational Injuries and
Illnesses, September 1986 (or later editions as published)—provide supplemental instructions for the
OSHA record-keeping forms and should be available in every plant healthcare facility. Because
healthcare providers often provide information for OSHA logs, they should be aware of record-keeping
requirements and participate in fulfilling them.
Monitor Trends
Healthcare providers should periodically (for example, quarterly) review healthcare facility sign-in logs,
OSHA Form 300, and individual employee medical records to monitor trends for CTDs in the plant. This
ongoing analysis should be made in addition to the symptoms survey to monitor trends continuously
and to substantiate the information obtained in the annual symptoms survey. The analysis should be
done by department, job title, work area, and so on.
The information gathered from the annual symptoms survey will help identify areas or jobs where
potential CTD problems exist. This information may be shared with anyone in the plant because
employees’ personal identifiers are not solicited. The analysis of medical records (for example, sign-in
logs and individual employee medical records) may reveal areas or jobs of concern, but it may also
identify individual workers who require further follow-up. The information gathered while analyzing
medical records is confidential; thus, care must be exercised to protect the individual employee’s
privacy. The information gained from the CTD trend analysis and symptoms survey will help determine
the effectiveness of the various programs initiated to decrease CTDs in the plant.
Training and Education
The fourth major program element for an effective ergonomics program is training and education.9 The
purpose of training and education is to ensure that employees are sufficiently informed about the
ergonomic hazards to which they may be exposed and thus able to participate actively in their own
protection, Figure 10–3.
Figure 10–3 Training a worker in proper lifting techniques.
Source: wavebreakmedia/Shutterstock
Training and education allow managers, supervisors, and employees to understand the hazards
associated with a job or process, their prevention and control, and their medical consequences. A
training program should include all affected employees, engineers and maintenance personnel,
supervisors, and healthcare providers.
The program should be designed and implemented by qualified persons. Appropriate special training
should be provided for personnel responsible for administering the program. The program should be
presented in language and at a level of understanding appropriate for the individuals being trained. It
should provide an overview of the potential risk of illnesses and injuries, their causes and early
symptoms, the means of prevention, and treatment.
The program should also include a means for adequately evaluating its effectiveness. This may be
achieved by using employee interviews, testing, and observing work practices to determine whether
those who received the training understand the material and the work practices to be followed. For
more comprehensive coverage of safety and health training, refer to Chapter 12 of this book. Also,
students and safety professionals are encouraged to take advantage of the training relating to
ergonomics as well as other topics from the OSHA Training Institute (OTI). For a complete listing of the
courses available from the OTI, go to the following Web site: www.osha.gov/dte/oti/
In addition to the in-class and online courses provided by the OTI, OSHA maintains a network of
Education Centers nationwide. OTI Education Centers are nonprofit organizations such as colleges and
universities that are authorized by OSHA to deliver safety and health training. To see a list of all OTI
Education Centers as well as the courses they provide and accompanying fees, go to the following Web
site: www.osha.gov/otiec

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