C S H M - certisafety.com · • OSHA conducted a National Emphasis Program (NEP) for the nursing home industry from July 2002 through September 30, 2003. The agency conducted 1,225

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C S H M PREPARATION GUIDE VOLUME 3

Area III Safety, Health, and Environmental Applications Section C: Ergonomics Study Notes, Questions, and Answer Key

Prepared by

Steven J. Geigle, M.A., CSHM Published by OSHA Training Network

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The information in this preparation guide has been compiled from texts recommended by ISHM for study, and represents the best current information on the various subjects. No guarantee, warranty of other representation is made as to the absolute correctness or sufficiency of any information contained in this preparation guide. OSHA Training Network assumes no responsibility in connection therewith; nor can it be assumed that all acceptable safety measures are contained in the preparation guide or that other or additional measures may not be required under particular or exceptional circumstances. As this preparation guide will continue to be updated and revised on a periodic basis, contributions and comments from readers are invited. Additional volumes to this preparation guide will be produced and made available in the future. Disclaimer: OSHA Training Network (OTN) cannot warrant that the use of this preparation guide will result in certification from the Institute for Safety and Health Management (ISHM). While the content is representative of the knowledge required of a safety and health manager, the successful completion of the CSHM examination is depends on many factors including the applicant's academic background, safety management experience and individual study for the examination. This information is for educational purposes only and does not replace any regulations promulgated by state of federal government agencies.

0© OSHA Training Network

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AREA III C: ERGONOMICS

OSHA's Approach to Ergonomics

A Four-Pronged, Comprehensive Approach In April 2002, Secretary of Labor Elaine L. Chao unveiled a comprehensive approach to ergonomics designed to quickly and effectively address musculoskeletal disorders (MSDs) in the workplace. OSHA developed a four-pronged ergonomics strategy to meet this goal through a combination of industry-specific and task-specific guidelines, outreach, enforcement, and research. Since the ergonomics strategy was announced, OSHA has made significant progress in each of the four areas of emphasis to reduce ergonomic injuries. Some highlights of OSHA's accomplishments are summarized below. Guidelines

• OSHA's first ergonomic guidelines were released on March 13, 2003, and covered the nursing home industry; the guidelines followed public comment and a stakeholder meeting on the draft guidelines.

• OSHA published final Ergonomic Guidelines for Retail Grocery Stores on May 28, 2004 following public comment and a stakeholder meeting on draft guidelines.

• OSHA published final Ergonomic Guidelines for the Poultry Processing Industry on September 2, 2004 following public comment. No Stakeholder meeting was held for this guideline because stakeholders felt that their written comments were sufficient to communicate their concerns.

• OSHA announced in the spring of 2003 that it will develop ergonomic guidelines for shipyards. Work continues on these complex guidelines and anticipates publication of the Draft Guidelines for Shipyards early in 2005.

• OSHA is encouraging other industries to develop ergonomic guidance to meet their specific needs. For example, the State of North Carolina and the American Furniture Manufacturers Association worked together to develop ergonomic guidance for the furniture manufacturing industry.

• As part of their alliances with OSHA, several printing industry associations and the Society of the Plastics Industry, Inc., are developing ergonomic guidance for their respective industries.

Enforcement

• OSHA has issued 16 General Duty Clause violations for ergonomic hazards with more cases under evaluation for citation.

• OSHA conducted a National Emphasis Program (NEP) for the nursing home industry from July 2002 through September 30, 2003. The agency conducted 1,225 inspections under this NEP.

• OSHA has conducted 994 ergonomics inspections in industries other than nursing homes (from January 1, 2002 through January 31, 2005).

• A cross-cutting OSHA ergonomics response team evaluates and screens all inspection cases prior to issuing a citation.

• OSHA sent 361 hazard alert letters to notify employers of ergonomic problems in their facilities. Follow-up inspections at a sample of these facilities will be scheduled to evaluate the progress of response to the hazard alert letters.

• Four Regional Emphasis Programs and six Local Emphasis Programs are underway across the country, focusing on ergonomic hazards in meat processing, health care, hotels, and warehousing industries.

• OSHA named ergonomic coordinators for each of its 10 regional offices to assist staff, employers, employees, and other stakeholders with ergonomic issues.

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• OSHA currently has six ergonomists throughout the country-in regional offices, the national office, an area office, the OSHA Training Institute and the Salt Lake Technical Center.

• The OSHA Training Institute has added a class to teach field personnel policies and procedures for ergonomics enforcement under the Secretary's four-pronged approach.

Outreach and Assistance

• OSHA currently has 24 strategic partnerships with an emphasis on ergonomics. • OSHA has signed 27 national ergonomic Alliances and 17 regional ergonomic Alliances which are

working with OSHA on a number of projects. Several Alliance Program participants, including the American Apparel and Footwear Association, the Airline Industry Alliance and the National Telecommunications Safety Panel are working on industry-developed ergonomics manuals. Another Alliance Program participant, the American Academy of Orthopedic Surgeons is working to develop guidance on worker-related upper extremity musculoskeletal disorders. The Dow Chemical Company helped develop an extensive case study of its successful approach to ergonomics.

• OSHA's Website features eight eTools that address ergonomics for a number of industries and occupations, including baggage handling, beverage delivery, computer workstations, grocery warehousing, health care, poultry processing and sewing. Through the Alliance Program, the Graphic Arts Coalition, which includes representatives from several printing industry trade associations, is working with OSHA to develop an ergonomic eTool for the printing industry.

• OSHA staff serves as adjunct members on the American Industrial Hygiene Association's Ergonomics Committee.

• VPP sites are required to identify and control hazards, including ergonomic hazards, as part of their overall safety and health management system.

• The OSHA Training Institute Education Centers conducted 29 ergonomic classes for 394 students in FY2004 and have scheduled several ergonomics classes in FY2005.

• OSHA provided ergonomic workstation training and evaluation assistance to several government agencies, including the IRS and the Defense Contract Audit Agency.

• OSHA's Ergonomics Safety and Health Topics webpage reflects the Agency's four-pronged strategy to reduce ergonomic injuries. The webpage provides information on ergonomics guidelines, enforcement actions, the National Advisory Committee on Ergonomics, eTools, cooperative programs, a library of 42 success stories from a variety of industries, and case studies.

• OSHA signed a Memorandum of Understanding with the U.S. Small Business Administration, Office of Advocacy, and the U.S. Small Business Administration, Office of the Small Business and Agriculture Regulatory Enforcement Ombudsman, to distribute ergonomics information to small businesses.

• OSHA and the U.S. Chamber of Commerce jointly developed a webcast on the willingness and ability of businesses to adopt and implement ergonomics policies.

• In FY 2004, OSHA awarded more than $480,000 in Susan Harwood Training Program Grants to three organizations to develop and conduct training on ergonomics in the retail grocery, nursing home, and auto supply manufacturing industries. OSHA awarded more than $1.2 million to ten organizations to conduct training in new industry-specific ergonomics guidelines in FY2003.

National Advisory Committee on Ergonomics

• OSHA established a 15-member National Advisory Committee on Ergonomics (NACE), with representatives from industry, academia, labor, and the legal and medical professions. More than 250 people were nominated in response to a Federal Register announcement seeking nominations to NACE.

• The first NACE meeting took place in January 2003. Subsequent meetings were held in May 2003, September 2003, January 2004 and May 2004, and November 2004.

• Discussion at the meetings has centered on task-specific guidelines, research needs and efforts, and outreach and assistance methods to communicate the value of ergonomics.


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• Based upon a recommendation of the NACE research discussion group, OSHA sponsored a symposium entitled Musculoskeletal and Neurovascular Disorders - The State of Research Regarding Workplace Etiology and Prevention for published researchers on work-related musculoskeletal disorders to examine their studies and the methodologies used. This symposium was held in conjunction with the January 2004 NACE meeting.

• The NACE Charter ended in November 2004. A complete list of NACE'S recommendations can be found at: http://www.osha.gov/SLTC/ergonomics/recommendations.html

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ERGONOMICS: AN INTRODUCTION

In 1996, more than 647,000 American workers experienced serious injuries due to overexertion or repetitive motion on the job. These work-related musculoskeletal disorders (MSDs) account for 34 percent of lost workday injuries. MSDs cost employers an estimated $15 to $20 billion in workers' compensation costs in 1995 and $45 to $60 billion more in indirect costs.

A compelling customer satisfaction story

Sysco Food Services of Houston, Texas had serious ergonomic problems when OSHA inspected the company. In 1996, Sysco had 210 injuries with 3,638 lost workdays. Back injuries accounted for 40 percent of the injuries and more than half the cost. An OSHA inspector issued Sysco a citation and $7,000 fine for failing to protect its employees from ergonomic hazards and set out an abatement plan for the company to follow.

Today, after implementing a formal ergonomics program under the direction of Sandra Carson, an occupational health nurse, Sysco's injury compensation costs have fallen by almost 75 percent, and major back injuries have dropped from 76 a year to 21.

Ms. Carson says the $7,000 penalty "was one of the best investments the company has made." Along with the citation, Ms. Carson says Sysco "received an analysis of our problem jobs as well as alternative controls to consider." The health and safety improvements have made Ms. Carson's branch one of Sysco's most profitable.

What are work-related musculoskeletal disorders (MSDs)?

Musculoskeletal disorders include a group of conditions that involve the nerves, tendons, muscles, and supporting structures such as intervertebral discs. They represent a wide range of disorders, which can differ in severity from mild periodic symptoms to severe chronic and debilitating conditions. Examples include carpal tunnel syndrome, tenosynovitis, tension neck syndrome, and low back pain.

Work-related Musculoskeletal Disorders are caused or made worse by the work environment. MSDs can cause severe and debilitating symptoms such as:

• pain, numbness, and tingling • reduced worker productivity • lost time from work • temporary or permanent disability • inability to perform job tasks, and • an increase in workers compensation costs


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MSDs are often confused with ergonomics. Ergonomics is the science of fitting workplace conditions and job demands to the capabilities of workers.

In other words, MSDs are the problem and ergonomics is a solution.

What are the risk factors for MSDs?

Risk factors for MSDs include;

• repetitive, forceful, or prolonged exertions of the hands • frequent or heavy lifting, pushing, pulling, or carrying of heavy objects • prolonged awkward postures, and • vibration contribute to MSDs

Jobs or working conditions that combine risk factors will increase the risk for musculoskeletal problems. The level of risk depends on how long a worker is exposed to these conditions, how often they are exposed, and the level of exposure.

How common are MSDs?

MSDs of any cause are among the most prevalent medical problems, affecting 7% of the population and accounting for 14% of physician visits and 19% of hospital stays.

When looking specifically at work-related MSDs, the Bureau of Labor Statistics (BLS) reports that in 1995, 62% (308,000) of all illness cases were due to disorders associated with repeated trauma. This figure does not include back injuries. BLS also reports that the number of cases of repeated trauma has increased significantly, rising from 23,800 cases in 1972 to 332,000 cases in 1994—a fourteen-fold increase. In 1995, the number of cases decreased by 7% to 308,000 reported cases, but this number still exceeds the number of cases in any year prior to 1994.

When looking specifically at cases involving days away from work, for which more detailed information is available, BLS reports that in 1994, approximately 32% or 705,800 cases were the result of overexertion or repetitive motion. This figure includes back injuries.

NIOSH research and prevention

The National Institute for Occupational Safety and Health (NIOSH) is the only federal agency mandated to conduct research and train professionals to identify and prevent workplace hazards. The Institute is part of the Centers for Disease Control and Prevention. NIOSH conducts and funds a substantial amount of research on musculoskeletal disorders, currently a total of 80 projects on work-related MSD-related topics. A directory of all these projects has been published by NIOSH (DHHS [NIOSH] Publication No. 97-109). For more information on work-related MSDs or on other workplace safety and health issues call: 1-800-35-NIOSH (1-800-356-4674).

What this course is about

This internet course has been developed to help you

• Evaluate the potential for workplace musculoskeletal disorders, and • Develop an effective ongoing ergonomics program

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Ergonomics: Part of a company safety and health program

Fred A. Manuele, author of On the Practice of Safety, considers occupational ergonomics to be "the art and science of designing the work to fit the worker to achieve optimum productivity and cost efficiency, and minimum risk of injury." To best fulfill the goal to achieve these benefits through ergonomics, a sound program should be developed: A program that includes a written plan, education and training, and effective procedures to identify, analyze and evaluate work for ergonomic risk factors.

Ergonomics programs should not be regarded as separate from those intended to address other workplace hazards. Aspects of hazard identification, case documentation, assessment of control options, and health care management techniques that are used to address ergonomic problems use the same approaches directed toward other workplace risks of injury or disease. Although many of the technical approaches described in this course are specific to ergonomic risk factors and MSDs, the core principles are the same as efforts to control other workplace hazards.

Reactive vs. Proactive approaches

Proactive ergonomics activities emphasize efforts at the design stage of work processes to recognize needs for avoiding risk factors that can lead to musculoskeletal problems. The goal is to design operations that ensure proper selection and use of tools, job methods, workstation layouts, and materials that impose no undue stress and strain on the worker.

Essential considerations

Ergonomics issues are identified and resolved in the planning process. In addition, general ergonomic knowledge, learned from an ongoing ergonomics program, can be used to build a more prevention-oriented approach.

Management commitment and employee involvement in the planning activity are essential. For example, management can set policy to require ergonomic considerations for any equipment to be purchased, and production employees can offer ideas on the basis of their past experiences for alleviating potential problems.

Planners of new work processes involved in the design of job tasks, equipment, and workplace layout, must become more aware of ergonomic factors and principles. Designers must have appropriate information and guidelines about risk factors for MSDs and ways to control them. Studying past designs of jobs in terms of risk factors can offer useful input into their design strategies.

Expressions of management commitment

Management commitment is a key and perhaps the most important controlling factor in determining whether any worksite hazard control effort will be successful. Management commitment can be expressed in a variety of ways. Lessons learned from NIOSH case studies of ergonomic hazard control efforts in the meatpacking industry emphasize the following points regarding evidence of effective management commitment:

Policy statements are issued that:

• treat ergonomic efforts as furthering the company's strategic goals, • expect full cooperation of the total workforce in working together toward realizing ergonomic

improvements, • assign lead roles to designated persons who are known to "make things happen," • give ergonomic efforts priority with other cost reduction, productivity, and quality assurance activities,

and • have the support of the local union or other worker representatives.


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• allow full discussion of the policy and the plans for implementation. • set concrete goals that address specific operations and give priority to the jobs posing the greatest risk.

Resources are committed to:

• train the workforce to be more aware of ergonomic risk factors for MSDs, • Provide detailed instruction to those expected to assume lead roles or serve on special groups to handle

various tasks, • bring in outside experts for consultations about start-up activities and difficult issues at least until in-

house expertise can be developed, and • implement ergonomic improvements as may be indicated. • provide release time or other compensatory arrangements during the workday for employees expected

to handle assigned tasks dealing with ergonomic concerns.

It's important to furnish information to all those involved in or affected by the ergonomic activities. Misinformation or misperceptions about such efforts can be damaging: If management is seen as using the program to gain ideas for cutting costs or improving productivity without equal regard for employee benefits, the program may not be supported by employees. For example, management should be up-front regarding possible impacts of the program on job security and job changes. All injury data, production information, and cost considerations need to be made available to those expected to make feasible recommendations for solving problems.

Employee involvement Promoting employee involvement in efforts to improve workplace ergonomic conditions has several benefits. They include

• enhanced worker motivation and job satisfaction, • added problem-solving capabilities, • greater acceptance of change, and • greater knowledge of the work and organization.

Worker involvement in safety and health issues means obtaining worker input on several issues.

• The first input is defining real or suspected job hazards. • Another is suggesting ways to control suspected hazards. • A third involves working with management in deciding how best to put controls into place.

Employee participation in an organization's efforts to reduce work-related injury or disease and ergonomic problems may take the form of direct or individual input. A common involvement process is participation through a joint labor-management safety and health committee, which may be company-wide or department-wide in nature. Membership on company-wide committees includes union leaders or elected worker representatives, department heads, and key figures from various areas of the organization.

Two factors are critical to the different forms of worker involvement. One is the need for training both in hazard recognition and control and in group problem solving. The second is that management must share information and knowledge of results with those involved.

No single form or level of worker involvement fits all situations or meets all needs. Much depends on the nature of the problems to be addressed, the skills and abilities of those involved, and the company's prevailing practices for participative approaches in resolving workplace issues.


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Who should participate?

Ergonomic problems typically require a response that cuts across a number of organizational units. Hazard identification through job task analyses and review of injury records or symptom surveys, as well as the development and implementation of control measures, can require input from

• safety and hygiene personnel, • health care providers, • human resource personnel, • engineering personnel, • maintenance personnel, and • ergonomics specialists.

In addition, worker and management representatives are considered essential players in any ergonomics program effort.

In small businesses, two or more of the functions noted on this list may be merged into one unit, or one person may handle several of the listed duties. Regardless of the size of the organization, persons identified with these responsibilities are crucial to an ergonomics program. Purchasing personnel in particular should be included, since the issues raised can dictate new or revised specifications on new equipment orders.

Gathering and examining evidence of MSDs

Once a decision has been made to initiate an ergonomics program, a necessary step is to gather information to determine the scope and characteristics of the problem or potential problem. A variety of techniques and tools have been used; many provide the basis for developing solutions to identified problems.

• Following up of worker reports • Reviewing OSHA 200 logs • Conducting symptom surveys • Using periodic medical examinations • Identifying Risk Factors in Jobs

o Screening jobs for risk factors o Performing job analyses o Setting priorities

Conditions and Symptoms

What are some of the clues that MSDs are a real or possible workplace problem? Some signs are obvious while others are more subtle.

• OSHA Form 300 logs or workers compensation claims show cases of MSDs such as carpal tunnel syndrome, tendonitis, tenosynovitis, epicondylitis, and low back pain. Sometimes these records contain nonspecific entries like "hand pain," which may be an indicator of a significant health problem if severe or persistent.

• Certain jobs or work conditions cause worker complaints of undue strain, localized fatigue, discomfort, or pain that does not go away after overnight rest.

• Workers visiting the clinic make frequent references to physical aches and pains related to certain types of work Exercises.


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• Job tasks involve at risk activities such as repetitive and forceful exertions; frequent, heavy, or overhead lifts; awkward work positions; or use of vibrating equipment.

If you uncover signs like these in your workplace, it might be a good idea to request a confidential evaluation by OSHA or insurer ergonomics consultant. Ergonomic evaluations may uncover significant problems and be very helpful in correcting them.

Other sources that could alert employers to potential problems include the following:

• Trade publications, insurer newsletters, or references in popular literature indicating risks of MSDs

• Cases of MSDs found among competitors or in similar businesses

• Proposals for increasing line speed, retooling, or modifying jobs to increase individual worker output and overall productivity

Following up on Worker Reports

Assuring that employees feel free to report, as early as possible, symptoms of physical stress is a key component of any ergonomics program. Early reporting makes it possible to begin corrective measures before the effects of a job problem worsen. When employees feel comfortable reporting their symptoms or other concerns, it indicates a high level of trust between labor and management.

As mentioned earlier, individual worker concerns that certain jobs cause undue physical fatigue, stress, or discomfort may be signs of ergonomic problems. Following up on these reports, particularly reports of MSDs, is essential. Such reports indicate a need to evaluate the jobs to identify ergonomic risk factors.

Reviewing OSHA Logs and other existing records

Inspecting OSHA 300 logs and plant medical records, as well as workers compensation claims, insurance claims, absentee records, and job transfer applications can yield information about the nature of MSDs. Finding workers in certain departments or operations experiencing more of these problems than others would suggest some immediate areas for study with regard to possible risk factors.

Jobs with elevated rates of low back musculoskeletal disorders often also have higher risks for acute injuries due to slips and trips or other safety hazards. In these cases, acute musculoskeletal injuries may also be an important problem.

Conducting symptoms surveys

Interviews or symptom surveys can be used to identify possible MSDs that might otherwise go unnoticed. In addition to questions about the type, onset, and duration of symptoms, symptom survey forms may include a body map. The employee is asked to locate and rate the level of discomfort experienced in different areas of his or her body. The assumption is that any discomfort or symptoms may be associated with some increased risk for MSDs.

Using periodic medical examinations

A disadvantage of using OSHA logs or company medical information to identify possible cases of MSDs is the lack of specific or uniform medical information. This limitation may make identifying MSDs difficult. One optional approach to overcome this limitation is to have each worker undergo a periodic standard examination


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that includes a history and physical examination. Such an examination program should be designed and administered by a health care provider.

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Screening for Risk Factors

Screening jobs for physical and psychological risk factors is very proactive, and should involve one or more of the following:

• Walk-through observational surveys of the work facilities to detect obvious risk factors • Interviews with workers and supervisors to obtain the above information and other data not apparent in

walk-through observations, such as time and workload pressures, length of rest breaks, etc. • Checklists for scoring job features against a list of risk factors

A great deal of research has been conducted to identify workplace factors that contribute to the development of musculoskeletal disorders. NIOSH has recently summarized the epidemiological studies that show a relationship between specific work activities and the development of musculoskeletal disorders.

According to the scientific literature, the following are recognized as important risk factors for musculoskeletal disorders, especially when occurring at high levels and in combination.

Physical risk factors include:

• Awkward postures • Forceful exertions • Repetitive motions • Duration of exposure • Frequency of exposure • Contact stresses • Vibration • Other conditions

Let's take a closer look at each of these risk factors.

Awkward postures

Body postures determine which joints and muscles are used in an activity and the amount of force or stresses that are generated or tolerated. For example, more stress is placed on the spinal discs when lifting, lowering, or handling objects with the back bent or twisted, compared with when the back is straight. Manipulative or other tasks requiring repeated or sustained bending or twisting of the wrists, knees, hips, or shoulders also impose increased stresses on these joints. Activities requiring frequent or prolonged work over shoulder height can be particularly stressful.

Forceful exertions (including lifting, pushing, and pulling)

Tasks that require forceful exertions place higher loads on the muscles, tendons, ligaments, and joints. Increasing force means increasing body demands such as greater muscle exertion along with other physiological changes necessary to sustain an increased effort. Prolonged or recurrent experiences of this type can give rise to not only feelings of fatigue but may also lead to musculoskeletal problems when there is inadequate time for rest or recovery. Force requirements may increase with:


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• increased weight of a load handled or lifted, • increased bulkiness of the load handled or lifted, • use of an awkward posture, • the speeding up of movements, increased slipperiness of the objects handled (requiring increased grip

force), • the presence of vibration (e.g., localized vibration from power handtools leads to use of an increased

grip force), • use of the index finger and thumb to forcefully grip an object (i.e., a pinch grip compared with

gripping the object with your whole hand), and use of small or narrow tool handles that lessen grip capacity.

Repetitive motions

If motions are repeated frequently (e.g., every few seconds) and for prolonged periods such as an 8-hour shift, fatigue and muscle-tendon strain can accumulate. Tendons and muscles can often recover from the effects of stretching or forceful exertions if sufficient time is allotted between exertions. Effects of repetitive motions from performing the same work activities are increased when awkward postures and forceful exertions are involved. Repetitive actions as a risk factor can also depend on the body area and specific act being performed.

Duration

Duration refers to the amount of time a person is continually exposed to a risk factor. Job tasks that require use of the same muscles or motions for long durations increase the likelihood of both localized and general fatigue. In general, the longer the period of continuous work (e.g., tasks requiring sustained muscle contraction), the longer the recovery or rest time required.

Frequency

Frequency refers to how many times a person repeats a given exertion within a given period of time. Of course, the more often the exertion is repeated, the greater the speed of movement of the body part being exerted. Also, recovery time decreases the more frequently an exertion is completed. And, as with duration, this increases the likelihood of both localized and general fatigue.

Contact stresses

Repeated or continuous Contact with hard or sharp objects such as non-rounded desk edges or unpadded, narrow tool handles may create pressure over one area of the body (e.g., the forearm or sides of the fingers) that can inhibit nerve function and blood flow.

Vibration

Exposure to local vibration occurs when a specific part of the body comes in Contact with a vibrating object, such as a power handtool. Exposure to whole-body vibration can occur while standing or sitting in vibrating environments or objects, such as when operating heavy-duty vehicles or large machinery.

Other conditions Workplace conditions that can influence the presence and magnitude of the risk factors for MSDs can include

o cold temperatures, o insufficient pauses and rest breaks for recovery, o machine paced work, and unfamiliar or unaccustomed work.

Psychological Risk Factors


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In addition to the above conditions, other aspects of work may not only contribute to physical stress but psychological stress as well. As long as we believe we have adequate control over all aspects of our job, we may experience normal stress. However, if we believe we have little control over job demands, we may suffer from distress with accompanying ill health and possible irrational behaviors. Under distress, the probability of an accident increases greatly.

Research is examining work factors such as performance monitoring, incentive pay systems, and unreasonable management production demands to determine whether these factors have a negative effect on the musculoskeletal system. Another related area of research is to determine which personal, work, or societal factors contribute to acute musculoskeletal disorders developing into chronic or disabling problems.

Using a checklist

The checklist is a formal and orderly procedure for screening jobs. Numerous versions of checklists exist in ergonomics manuals. When checklist data are gathered by persons familiar with the job, task, or processes involved, the quality of the data is generally better. This checklist illustrates three processes:

• Assessment - identify to determine if something is present. • Analysis - take it apart to determine what it looks like, how it works. • Evaluation - judge it against the best.

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Ergonomics Job Hazard Analysis

Efforts to identify jobs or tasks having known risk factors for musculoskeletal problems can provide the groundwork for changes aimed at risk reduction. Even without clear medical evidence, screening jobs for musculoskeletal risk factors can offer a basis for early interventions.

An effective identification method is the Ergonomics Job Hazard Analysis which breaks a job into its various elements or actions, describes them, measures and quantifies the ergonomics risk factors inherent in the elements, identifies conditions contributing to the risk factors, and determines corrective measures.

Job analyses are usually done by persons with considerable experience and training in these areas. While most job analyses have common approaches, such as a focus on the same set of risk factors described above, no "standard" protocol exists for conducting a job analysis to assess ergonomic hazards.

Most job analyses have several common steps:

• A complete description of the job is obtained. • Employees are often interviewed in order to determine if the way the job is done changes over time. • During the job analysis, the job is divided into a number of discrete tasks. • Each task is then studied to determine the specific risk factors that occur during the task. • Sometimes each risk factor is evaluated in terms of its magnitude, the number of times it occurs during

the task, and how long the risk factor lasts each time it occurs.

The tasks of most jobs can be described in terms of:

• The tools, equipment, machinery and materials used to perform the job. Their design can have enormous impact on the risk of injury.

• The workstation layout and physical environment. Establishes parameters and constraints on our posture, movement, etc.


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• The task demands and organizational climate in which the work is performed. Works schedules, production quotas, psychosocial support can create fatigue, anxiety, and low morale that may increase the probability of injury or illness.

More definitive procedures for collecting information on these components can include the following:

• Observing the workers performing the tasks in order to furnish time-activity analysis and job or task cycle data; videotaping the workers is typically done for this purpose

• Still photos of work postures, workstation layouts, tools, etc., to illustrate the job • Workstation measurements (e.g., work surface heights, reach distances) • Measuring tool handle sizes, weighing tools and parts, and measuring tool vibration and part

dimensions • Determining characteristics of work surfaces such as slip resistance, hardness, and surface edges • Measuring exposures to heat, cold, and whole body vibration • Biomechanical calculations (e.g., muscle force required to accomplish a task or the pressure put on a

spinal disc based on the weight of a load lifted, pulled, or pushed) • Physiological measures (e.g., oxygen consumption, heart rate) • Special questionnaires, interviews, and subjective rating procedures to determine the amount of

perceived exertion and the psychological factors influencing work performance

Setting Priorities

Jobs associated with cases of musculoskeletal problems deserve the highest consideration in follow-up efforts to identify ergonomics risk factors and implement control actions. Jobs in which current cases have been identified should receive immediate attention, followed by those in which past records have noted a high incidence or severity of MSDs despite the lack of current cases.

Priority for job analysis and intervention should be given to those jobs:

• In which most people are affected or in which work method changes are going to be taking place anyway.

• Associated with employee reports of fatigue and discomfort. • Where screening efforts suggest the presence of significant risk factors for musculoskeletal disorders.

Ratings of high or extreme levels of risk factors, especially occurring in combination, may indicate a need for control actions. While appearing last in the priority order, taking steps to reduce apparent risk factors for musculoskeletal disorders is an important proactive approach.

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Controlling Ergonomic Hazards

Controlling MSDs through engineering controls

The preferred approach to prevent and control MSDs is to design the job including:

• the workstation layout • selection and use of tools • work methods to take account of the capabilities and limitations of the work force

A good match, meaning that the job demands pose no undue stress and strain to the person doing the job, helps ensure a safe work situation.


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Engineering control strategies to reduce ergonomic risk factors include the following:

• Changing the way materials, parts, and products can be transported . For example, using mechanical assist devices to relieve heavy load lifting and carrying tasks or using handles or slotted hand holes in packages requiring manual handling

• Changing the process or product to reduce worker exposures to risk factors. Examples include

maintaining the fit of plastic molds to reduce the need for manual removal of flashing, or using easy-connect electrical terminals to reduce manual forces Modifying containers and parts presentation, such as height-adjustable material bins.

• Changing workstation layout. Examples might include using height-adjustable workbenches or

locating tools and materials within short reaching distances. • Changing the way parts, tools, machinery and materials are to be manipulated. Examples include

using fixtures (clamps, vise-grips, etc.) to hold work pieces to relieve the need for awkward hand and arm positions or suspending tools to reduce weight and allow easier access.

• Changing tool designs. For example, pistol handle grips for knives to reduce wrist bending postures

required by straight-handle knives or squeeze-grip-actuated screwdrivers to replace finger-trigger-actuated screwdrivers.

• Changes in materials and fasteners. For example, lighter-weight packaging materials to reduce

lifting loads. • Changing assembly access and sequence. For example, removing physical and visual obstructions

when assembling components to reduce awkward postures or static exertions.

Controlling MSDs through work-practice and administrative controls

Work practice and administrative controls are closely related attempts to change behaviors. They are management-dictated work practices and policies to reduce or prevent exposures to ergonomic risk factors. Work practice and administrative control strategies include:

• changes in job rules and procedures such as scheduling more rest breaks • rotating workers through jobs that are physically tiring • training workers to recognize ergonomic risk factors and to learn techniques for reducing the stress and

strain while performing their work tasks

Although engineering controls are preferred, work practice and administrative controls can be helpful as temporary measures until engineering controls can be implemented or when engineering controls are not technically feasible. Since work practice and administrative controls do not eliminate hazards, management must assure that the practices and policies are followed.

Common examples of administrative control strategies for reducing the risk of MSDs are as follows:

• Reducing shift length or curtailing the amount of overtime • Rotating workers through several jobs with different physical demands to reduce the stress on limbs

and body regions • Scheduling more breaks to allow for rest and recovery • Broadening or varying the job content to offset certain risk factors (e.g., repetitive motions, static

and awkward postures)


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• Adjusting the work pace to relieve repetitive motion risks and give the worker more control of the work process

• Training in the recognition of risk factors for MSDs and instruction in work practices that can ease the task demands or burden

Personal protective equipment

One of the most controversial questions in the prevention of MSDs is whether the use of personal equipment worn or used by the employee (such as wrist supports, back belts, or vibration attenuation gloves) is effective. Some consider these devices to be personal protective equipment (PPE).

In the field of occupational safety and health, PPE generally provides a barrier between the worker and the hazard source. Respirators, ear plugs, safety goggles, chemical aprons, safety shoes, and hard hats are all examples of PPE. Whether braces, wrist splints, back belts, and similar devices can be regarded as offering personal protection against ergonomic hazards remains open to question.

Although these devices may, in some situations, reduce the duration, frequency, or intensity of exposure, evidence of their effectiveness in injury reduction is inconclusive. In some instances they may decrease one exposure but increase another because the worker has to "fight" the device to perform his or her work. An example is the use of wrist splints while engaged in work that requires wrist bending.

On the basis of a review of the scientific literature completed in 1994, NIOSH concluded that insufficient evidence existed to prove the effectiveness of back belts in preventing back injuries related to manual handling job tasks [NIOSH 1994]. A recent epidemiological study credits mandatory use of back belts in a chain of large retail hardware stores in substantially reducing the rate of low back injuries [Kraus 1996]. Although NIOSH believes this study provides evidence that back belts may be effective in some settings for preventing back injuries, NIOSH still believes that evidence for the effectiveness of back belts is inconclusive..

Less controversial types of personal equipment are vibration attenuation gloves [NIOSH 1989] and knee pads for carpet layers [Bhattacharya et al. 1985]. But even here, there can be concerns. For example, do the design and fit of the gloves make it harder to grip tools?

There you have it? Almost everything you need to know about ergonomic control strategies, right? Well, not quite, but you do have a good introduction to them. Remember, ergonomics control strategies may not be immediately obvious. If you can't figure out an effective solution, don't forget to take advantage of an outside expert. Participating in the consultation process with an ergonomist is a real win-win for your company and an excellent education for you.

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Medical Management

Company health care management strategies and policies, and coordination with health care providers are important parts of the overall ergonomics program.

In general, medical management emphasizes the prevention of impairment and disability through early detection, prompt treatment, and timely recovery. Medical management responsibilities fall on employers, employees, and health care providers.

Employer responsibilities

The employer can create an environment that encourages early evaluation by a health care provider by:


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• Providing education and training to employees regarding the recognition of the symptoms and signs of MSDs and the employers procedures for reporting MSDs

• Encouraging employees to report symptoms early so prompt evaluation by an appropriate health care provider can be provided

• Giving health care providers the opportunity to become familiar with jobs and job tasks • Modifying jobs or accommodating employees who have functional limitations secondary to MSDs as

determined by a health care provider • Ensuring, to the extent permitted by law, employee privacy and confidentiality regarding medical

conditions identified during an assessment

Employee responsibilities

Employees should participate in the health care management process by:

• following applicable workplace safety and health rules, • following work practice procedures related to their jobs, and • reporting early signs and symptoms of MSDs.

Employees may be faced with conflicting job demands or requirements. Safe work practices or rules may conflict with pressures or incentives to be more productive.

Health Care Provider Responsibilities

The health care provider can support the employer's ergonomics program by:

• Acquiring experience and training in the evaluation and treatment of MSDs • Seeking information and review materials regarding employee job activities • Ensuring employee privacy and confidentiality to the fullest extent permitted by law • Evaluating symptomatic employees including:

o medical histories with a complete description of symptoms o descriptions of work activities as reported by the employees o physical examinations appropriate to the presenting symptoms and histories o initial assessments or diagnoses o opinions as to whether occupational risk factors caused, contributed to, or exacerbated the

conditions o examinations to follow up symptomatic employees and document symptom improvements or

resolutions

Job Familiarity and Job Placement Evaluations

Health care providers who evaluate employees, determine their functional capabilities, and prepare opinions regarding work relatedness should be familiar with employee jobs and job tasks. With specific knowledge of the physical demands involved in various jobs and the physical capabilities or limitations of employees, the health care provider can match the employee's capabilities with appropriate jobs. Being familiar with employee jobs not only assists the health care provider in making informed case management decisions but also assists with the identification of ergonomic hazards and alternative job tasks.

One of the best ways for a health care provider to become familiar with jobs and job tasks is by periodic plant walk-throughs. Once familiar with plant operations and job tasks, the health care provider should periodically revisit the facility to remain knowledgeable about changing working conditions. Other approaches that may help the health care provider to become familiar with jobs and job tasks include reviewing job analysis reports, detailed job descriptions, job safety analyses, and photographs or videotapes that are accompanied by narrative or written descriptions of the jobs.


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Early Reporting and Access to Health Care Providers

Employees reporting symptoms or signs of potential MSDs should have the opportunity for prompt evaluation by a health care provider. In general, the earlier symptoms are identified and treatment is initiated, the less likely a more serious disorder will develop. Employers should not establish policies that discourage employees from reporting symptoms. For example, programs that link a manager's earnings to the number of employees reporting symptoms may discourage supervisors from allowing symptomatic employees to be evaluated by the health care provider. Employees should not fear discipline or discrimination on the basis of such reporting.

Treatment

• Health care providers are responsible for determining the physical capabilities and work restrictions of the affected workers.

• The employer is responsible for giving an employee a task consistent with these restrictions. • Until effective controls are installed, employee exposure to ergonomic stressors can be reduced

through restricted duty and/or temporary job transfer. • Complete removal from the work environment should be avoided unless the employer is unable to

accommodate the prescribed work restrictions. • Immobilization devices, such as splints or supports, can provide relief to the symptomatic area in some

cases. These devices are especially effective off-the-job, particularly during sleep. They should not be used as prophylactic PPE to prevent the development of MSDs. Therefore, these devices should be dispensed to individuals with MSDs only by health care providers who have knowledge of the benefits and possible negatives of these devices.

_________________________________________________________________________________________

Ergonomics Training

Identifying and solving workplace MSD problems require some level of ergonomic knowledge and skills. Recognizing and filling different training needs is an important step in building an effective program.

For ergonomics, the overall goal of training is to enable managers, supervisors, and employees to identify aspects of job tasks that may increase a worker's risk of developing MSDs, recognize the signs and symptoms of the disorders, and participate in the development of strategies to control or prevent them.

The educational component of ergonomics training ensures employees are well informed about ergonomic hazards so they can actively participate in identifying and controlling exposures. To be "well informed," includes knowing why using ergonomically safe procedures is important.

Employers may opt to have outside experts conduct ergonomics education and training. If so, the outside instructors should first become familiar with company operations and relevant policies and practices before starting to present the training. Tailoring the instruction to address specific concerns and interests of the worker groups can enhance learning.

Ergonomics awareness training

The objectives for ergonomics awareness training are as follows:

• Recognize workplace risk factors for musculoskeletal disorders and understand general methods for controlling them.

• Identify the signs and symptoms of musculoskeletal disorders that may result from exposure to such risk factors, and be familiar with the company's health care procedures.


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• Know the process the employer is using to address and control risk factors, the employee's role in the process, and ways employees can actively participate.

• Know the procedures for reporting risk factors and musculoskeletal disorders, including the names of designated persons who should receive the reports.

Training in job analyses and control measures

The objectives for training in job analyses and control measures are as follows:

• Demonstrate the way to do a job analysis for identifying risk factors for musculoskeletal disorders • Select ways to implement and evaluate control measures

Training in problem solving

The objectives for training in problem solving are as follows:

• Identify the departments, areas, and jobs with risk factors through a review of company reports, records, walk-through observations, and special surveys.

• Identify tools and techniques that can be used to conduct job analyses and serve as a basis for recommendations.

• Develop skills in team building, consensus development, and problem solving. • Recommend ways to control ergonomic hazards based on job analyses and pooling ideas from

employees, management, and other affected and interested parties.

Special considerations and precautions

Training objectives are not intended to have workers, supervisors, or managers diagnose or treat MSDs. Rather, the purpose is to instill an understanding of what type of health problems may be work related and when to refer employees for medical evaluation. The training should include what is known about work and nonwork causes of musculoskeletal disorders and the current limitations of scientific knowledge.

Training should be understandable to the target audience. Training materials used should consider the participants educational levels, literacy abilities, and language skills. This may mean, for example, providing materials, instruction, or assistance in Spanish rather than English.

Open and frank interactions between trainers and trainees, especially those in affected jobs, are especially important. Employees know their own jobs better than anyone else and often are the source of good ideas for ways to improve them. At a minimum, employees must be given an opportunity to discuss ergonomic problems in their jobs as they see them and engage in relevant problem-solving exercises during the training.

THE SEVEN STEP SAFE OJT TRAINING MODEL Source: Steven Geigle, CSHM

Step 1. Introduction. State and discuss the learning objectives and answer any questions the employee may have. Discuss the acceptable standards of knowledge and performance. Tell the trainee what you’re going to train. Emphasize the importance of the procedure to the success of the production/service goals. Invite questions. Emphasize the natural and system consequences of their performance. The natural consequences describe the hurt or health that automatically results. The system consequences are those consequences the organization applies as a result of an employee's performance; discipline or positive recognition.

Step 2. Trainer shows and tells. In this step the trainee becomes familiar with each work practice and why it is important. Review the initial conditions for the procedure. Demonstrate the process, carefully explaining each


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step as you go. Answer questions and continue to demonstrate and explain until the employee understands what to do, when and why to do it, and how to do it.

Trainer: EXPLAINS and PERFORMS each step.

Learner: OBSERVES each step and QUESTIONS the trainer.

Step 3. Leaner tells - Trainer shows. This step is necessary when exposure to hazards inherent in the procedure could cause serious harm. It protects the trainee because the trainer performs the procedure. The trainee explains the procedure to the trainer, while the trainer does it. This gives the trainer an opportunity to discover whether there were any misunderstandings in the previous step. The trainee also responds to trainer questions.

Learner: EXPLAINS each step and RESPONDS to questions.

Trainer: PERFORMS each step and QUESTIONS the trainee.

Step 4. Leaner shows and tells. The trainer has the trainee do it. The trainee explains the step, gets permission to perform the stem and then carries out the step. This step is very important when training tasks that might result in serious physical injury or death if not performed correctly. The learner may try to perform the task too quickly, increasing the probability of an injury. Requiring permission helps prevent this from happening.

Learner: EXPLAINS the step, gets PERMISSION and then PERFORMS each step.

Trainer: Gives PERMISSION and OBSERVES each step, ask QUESTIONS as the trainee

performs.

Step 5. Conclusion. Recognize accomplishment - “Good job!” Reemphasize the importance of the procedure and how it fits into the overall process. Tie the training again to accountability by discussing the natural and system consequences of performance.

Step 6. Document. Training documentation should be more than an attendance sheet. See the sample training certification document on the next page. It represents one possible way to document training. Strong documentation includes:

• Trainee’s and trainer’s name. • Date of training. • Subject(s) being trained - procedures, practices, related policies, rules, etc. • Certification - trainee and trainer signatures. • Trainee statement of understanding and intent to comply. • Trainee statement that he/she was provided opportunity to practice.


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• Trainer statement that testing of knowledge and skills was conducted. • Trainer statement that student demonstrated adequate knowledge and skill.

Step 7. Validate. At some point in time after the conclusion of the OJT session, observe and question the employee to validate that the training has been successful and that the employee has developed a proper attitude related to the work.

__________________________________________________________________________________________

Model Ergonomics Plan

I. Purpose of the program

A. The Ergonomics Protection Program is established to prevent the occurrence of work-related musculoskeletal disorders, primarily those in the back, upper and lower extremities. To do this the program employs various strategies:

1. Informs employees about musculoskeletal disorders and the risk factors that can cause or aggravate them.

2. Promotes continuous improvement in workplace ergonomic protection.

3. Encourages new technology and innovation in ergonomic protection.

4. Identifies design principles that prevent exposure to risk factors.

5. Ensures ongoing and consistent management leadership and employee involvement.

B. _________________________ (person and position) is responsible for managing the Ergonomic Protection Plan. The ergonomic program health care provider, supervisors and the safety committee will assist in monitoring the effectiveness of the program.

II. Worksite analysis

A. Supervisor, with assistance from the program manager or a consultant, will conduct an ergonomic hazard analysis for each task in his or her area of responsibility. The purpose of worksite analysis is to recognize and identify existing ergonomic risk factors in the workplace. The analysis will include the use of an ergonomic checklist and employee questionnaire. Periodic surveys of the workplace will be conducted at appropriate intervals to evaluate changes in risk factors and effectiveness of work practices and engineering controls.

B. The OSHA 200 log will be reviewed to determine whether any musculoskeletal disorders have occurred during the last two years. If musculoskeletal disorders have occurred in the past two years, the supervisor will further analyze and evaluate the associated "at risk" work areas for ergonomic hazards

C. Each "at risk" task will be videotaped for the purpose of documenting work procedures, tools and materials used, and hazardous conditions encountered. The supervisor will analyze the task for ergonomic related hazard that could result in injury or illness. (See program description for instructions on videotaping) The following risk factors should be considered in your analysis:

1. Performance of the same motions or motion pattern every few seconds for more than two hours at a time. Questions to ask:


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• What is the task or cycle frequency per shift? • Is the task continuous or sporadic? • Does the worker perform the task for the entire shift or rotate with other workers?

2. Fixed or awkward work postures for more than a total of two hours: for example, overhead work, twisted or bent back, bent wrist, kneeling, stooping, or squatting. Questions to ask:

• What is the height of the workbench? • What is the maximum reach to parts bins, etc.? • What is the chair height? • Is movement restricted due to confined workspace?

3. Use of hand tools. Questions to ask:

• What is the weight of tool being used? • Are vibrating or impact tools and/or equipment used for more than a total of two hours? • Is there air exhaust onto the worker’s hand?

4. Manual handling of objects more than 25 pounds more than once each work shift.

5. The type of handwear being used. Questions to ask:

• Is handwear slippery? • Do the gloves fit properly?

6. No worker control over work pace (e.g., work is mechanically or electronically paced) for more than four hours at a time (exclusive of regular breaks.)

7. Work performed in cold environment.

D. The use of outside ergonomics consultants to evaluate areas identified is encouraged. Their assistance may be extremely valuable in conducting the initial analysis. Coordinate with the program manager to request assistance.

III. Correct Actions

A. The supervisor with assistance from the program manager will determine the surface and root causes for all hazards (ergonomic and general) related to a task being analyzed. The following control strategies will be used to reduce or eliminate those hazards:

1. Engineering controls should be designed by a qualified ergonomist and may include workstation redesign, tool and handle redesign, and change of work methods. The goal is to make the job fit the person.

2. Work practice controls to include proper work techniques, new employee conditioning, and monitoring and modifications as necessary to reduce ergonomic stressors.

3. Administrative controls to reduce the duration, frequency, and severity of exposure to ergonomic stress. These controls may include job rotation, reduction of repetitions, and preventive maintenance of related equipment.


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4. Personal protective equipment (PPE) may be used if appropriate. However, in all cases, if employees are not properly trained, or are reluctant to accept change, reducing ergonomic injuries and illnesses may be difficult at best.

IV. Employee involvement and training

A. Management will be involved in all stages of identifying, assessing, and controlling ergonomics hazards. Managers and supervisors will work closely with employees to determine hazards. Training in ergonomic awareness and safe work practices will be essential in ultimately reducing injuries and illnesses, and involving employees in this training will improve the interest and quality of the training

B. All supervisors and employees will be educated on the early signs and symptoms of ergonomic injury and illness..

C. Further ergonomics training will be conducted for all "at risk" employees and supervisors, and will include specific information on the hazards associated with their jobs, reporting procedures, the risks of developing cumulative trauma disorders, symptoms of exposure, and how to prevent the occurrence of cumulative trauma disorders. The supervisor’s training program will also be implemented to allow recognition of the signs of cumulative trauma disorders and to reinforce the ergonomics program. After training is completed, supervisors will provide regular feedback on work practices to their employees.

D. The training program will be conducted by a qualified health care provider.

V. Medical management

A. A medical management program will be established under the guidance of an appropriately qualified health professional. Appropriately trained health care providers will be available at all times, and on an ongoing basis as required. They will be knowledgeable in the prevention, early recognition, evaluation, treatment and rehabilitation of CTDs, and in the principles of ergonomics, physical assessment of employees, and OSHA recordkeeping requirements.

B. Program health care providers will conduct monthly, systematic workplace walk-through to remain knowledgeable about operations and work practices, identify risk factors for CTDs in the workplace, identify potential light duty jobs, and maintain close contact with employees. Findings and recommendations will be documented and reported to the safety committee as soon as possible after the walk-through is completed.

C. Program managers will develop a symptoms survey to measure the extent of symptoms of work-related disorders for each area of the plant, to determine which jobs are exhibiting problems and to measure progress of the ergonomic program. Body diagrams should be used to facilitate the gathering of this information. Employee identities and medical records, including surveys will remain confidential.

D. All employees who report pain or other symptoms possibly related to musculoskeletal disorders will be promptly evaluated by a health care provider, and appropriate treatment and follow-up will be provided.

E. Where an employee states that the injury or illness is work-related, and the case otherwise meets the criteria for recording, the case will be entered on the OSHA log pending final determination of the cause.

E. The employee will be monitored until he or she is able to perform work without restrictions. The idea is to detect any problem as early as possible to reduce the severity of the injury and associated costs.

F. The program health care provider will compile a list of light duty jobs with the lowest ergonomic risk. For such jobs, ergonomic risk(s) will be described.


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G. New and current employees who are assigned to at risk jobs or tasks will be given a baseline survey by the health care provider to establish a base against which changes in health status can be evaluated. The baseline survey is not for the purpose of precluding people from performing particular jobs.

VI. Program Evaluation

A. The Ergonomics Protection Program will be evaluated by the program manager and safety committee annually for its ability to identify, assess, and eliminate ergonomic hazards in the workplace. Reductions in ergonomics related injuries and illness should ideally be experienced soon after the program is implemented.

B. Findings of the evaluation will be reported directly to the CEO.

Certification _____________________________ ______________________ Reviewed by (Signature) Date

_______________________________ ______________________ Approved by (Signature) Date

_________________________________________________________________________________________

Sample Ergonomic Hazard Analysis

The following is an example of a checklist to aid in an ergonomic hazard analysis of a specific job or workstation. It is designed to be used as a supplement to close visual observation or videotaping of the job/workstation.

Person performing analysis _________ Date ________ Job location ______ Bldg ____ Floor _______

Job name __________________ Department _________________Job description____________________

Number of employees on job _________ line speed ____________ (pieces/minute)

Jobs rotated with ____________ Rotation schedule _____________ Break schedule ________________

Workstation:

____ 1. Are there any sharp edges?

____ 2. What is the height of the work table? __________________

____ 3. Adjustability:

____ Can tools be moved around in the workplace?

____ Can the work surface height be adjusted vertically?

____ Can fixtures be tilted or rotated?

____ 4. What is the worker standing on? ______________________________

(e.g., grate, mat, concrete floor)


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____ 5. Is the floor or platform slippery? _______________

Postural

____ 1. Can worker change postures (sit-to-stand or stand-to-sit)?

____ 2. What are the maximum reach distances in inches? Vertical ___ Horizontal ___

Tools

____ 1. Name of tool ______________________

____ 2. Type: Torque ______ reciprocating or vibrating _________ Other ___________

____ 3. What is the weight of the tool? ____________ lbs.

____ 4. Size of the handle: Span ____ inches, length ____ inches material _________

____ 5. What is the source of power? _____________ (e.g., air, electric)?

____ 6. If air, is the exhaust away from the hand? _____________

____ 7. Is the tool counterbalanced? ____________

Manual or hand tools

____ 1. Name of tool _____________________

____ 2. Weight ____________ lbs.

____ 3. Size of the handle: Span ____ inches, length ____ inches material _________

____ 4. Is there a place for tools in the workplace? ___________ (e.g., holster, fixture)

Miscellaneous

____ 1. Are other objects or materials handled? _________

____ 2. What are they and what do they weigh? Name _____ Weight ________lbs.

____ 3. What is the temperature of the work environment? _______ degrees (C./F.)

____ 4. What personal protective equipment is used ?______ (e.g., gloves, hard hats, aprons)

____ 5. Can the worker stop or control line speed?

____ 6. Are there opportunities for micro rest pauses? If so, how many seconds? ______


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____ 7. Estimate exertion or effort required to do the job (1 to 5) ____ 1=low, 5=high

Ergonomic Protection Program Audit

Written Program

____ 1. Has a written ergonomics program been established?

____ 2. Is there a person assigned to manage the program?

Survey

____ 1. Are ergonomic surveys being conducted according to a regular schedule?

____ 2. Do surveys determine the presence of ergonomic related injuries and illnesses: for example, musculoskeletal injuries to the neck, back, shoulders, arms, hands, fingers?

____ 3. Are copies of survey being maintained?

Company procedures

____ 1. Are managers, supervisors, and all employees who may be exposed to hazardous ergonomic conditions knowledgeable of signs and symptoms of CTD?

____ 2. Does your employer have procedures for employees who report pain or other signs and symptoms related to ergonomic injury or illness?

____ 3. Are supervisors instructed on procedures when employees report pain or other symptoms of ergonomic injury or illness?

____ 4. Are employee reports of pain or other symptoms of ergonomic injury or illness being recorded?

____ 5. Are incentive programs in place that deter employees from reporting problems?

Evaluation

____ 1. Are the company’s injury and illness logs evaluated on a regular basis for evidence of ergonomic related injuries and illnesses?

____ 2. Is the information gathered from evaluating logs used to identify, assess and control ergonomic hazards?

____ 3. Is there an effective medical protocol for evaluating and treating employees for complaints of upper extremity discomfort or back pain?

____ 4. Are trained health care providers available to diagnose and treat early stages of CTD?

____ 5. Following early detection of CTD symptoms or treatment, is the amount of time prescribed or allowed off work, and/or allotted for restricted activity, appropriate?


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Treatment procedures

____ 1. Are medical restrictions being followed?

____ 2. Have ergonomic hazard analyses been conducted for all alternative work assignments (e.g., light or restricted duty jobs) for CTD potential?

____ 3. Are health care providers familiar with the jobs being used for alternative work assignments.

____ 4. Is job reassignment appropriate so as not to further exacerbate the condition or create another condition?

____ 5. Does your employer document all instances where a reassignment did not help or actually worsen the CTD with explanation for the reason.

____ 6. Do health care providers track and follow up the symptom process of all reassigned and/or treated employees?

____ 7. Are appointments made for follow-up required and kept?

____ 8. Has any decrease in employee pay or loss of overtime been an impediment to timely medical care resulting in CTD surgery.

Application of controls

____ 1. Is your employer installing engineering controls: such as, equipment replacement or redesign.

____ 2. Is your employer implementing administrative controls: such as, job rotation, rest periods, etc.

____ 3. Are control strategies effective in reducing the incidence of ergonomic related injuries and illnesses?

__________________________________________________________________________________________

Ergonomics Case Study Source: OSHA

The Dow Chemical Company's Use of the "Six Sigma" Methodology May 15, 2004 The Problem Reducing Musculoskeletal Disorders: Ergonomics-related injuries, including musculoskeletal disorders (MSDs) caused by repetitive strains, continue to be a serious problem for employers. In 2002, ergonomics-related injuries accounted for a third of all workplace injuries involving missed work time, with an average absence of nine days per injury. The resulting worker injury claims and loss of productivity are estimated to cost $13 to $20 million per year for U.S. employers. As computer workstation users spend more and more time at desktops, the risk of MSDs occurring


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has increased. Yet, as illustrated below, in many companies there are inherent difficulties and concerns associated with addressing this increased ergonomics risk. For example, Tricia, the Environmental, Health and Safety (EH&S) Leader for the Specialty Chemicals Business of The Dow Chemical Company, wants to reduce MSDs among computer workstation users throughout her business’ various divisions and operations. Before she can understand what changes to make in either the workstations or the work practices in those divisions, she must identify the root causes of MSDs among the operators. Although she has some theories, Tricia does not know for sure what factors are causing or contributing to the employees’ MSD complaints. Only by knowing the root causes can she implement with confidence controls that would achieve positive results. Tricia also suspects, but is not sure, that many of the root causes of MSDs are the same across the different operations and divisions in her business. Because of constraints on both her budget and time, Tricia would like to design one basic program that is flexible enough to implement company-wide. She also knows that any reductions achieved under the new program must be sustained over the long term, and she is concerned that over time employees and managers will "backslide" on their commitment to the program and return to their ergonomically risky behaviors. Fortunately for Tricia, she could refer to a similar project successfully undertaken by the Design and Construction function of The Dow Chemical Company, which is discussed in the case study below. This project, which utilized a problem-solving methodology called "Six Sigma," offered an innovative way to address Tricia’s concerns for the development and implementation of a sustainable program to reduce MSDs throughout her business. The Solution The Dow Chemical Company’s Innovative Use of "Six Sigma": Avoiding ergonomics-related injuries is an important component of The Dow Chemical Company’s ("Dow" or "the Company") overall emphasis on safety and health. Dow is a science and technology company that develops, manufactures and provides various chemical, plastic and agricultural products and services for customers in over 180 countries. In 1994, Dow adopted a set of voluntary 10-year EH&S goals to dramatically improve the Company’s performance by 2005. These goals call for a reduction in the Company’s reportable injury and illness rate by 90 percent to 0.24. In 2000, the company identified an opportunity to improve its injury rate within the Dow Design and Construction business unit. Dow Design and Construction ("DDC") is responsible for managing the design and construction of Dow’s facilities worldwide. Because DDC’s approximately 1,250 workers (including employees and contractors) work primarily at desktop workstations, where they spend the majority of their time working at computer keyboards, they were increasingly susceptible to ergonomics injuries. While the rate of ergonomics-related injuries among the DDC workers was low (only three were reported in 1999), the Company chose to make proactive improvements before ergonomic injuries increased in number or severity. Dow’s EH&S function decided to address ergonomic injuries at DDC using the "Six Sigma" problem solving methodology. Six Sigma is a disciplined, process-oriented approach to problem solving, adopted by Dow and many other companies, which emphasizes the reduction of defects in processes, products and services by applying a four-step improvement methodology. Because Six Sigma emphasizes sustainable results over short-term fixes, Dow has found it particularly useful for EH&S projects. Following the steps prescribed under Six Sigma, Dow developed a Six Sigma project team, which first defined the primary contributing factors to MSDs in the DDC function, and then sought to reduce the those factors by 70 percent. While each of the four steps of the Six Sigma project are outlined below, a more detailed discussion of the Six Sigma methodology appears at the end of this case study. Step 1: Measure Once the Six Sigma project team developed its charter and defined its task, it then began by defining the current


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process. First, the team outlined the sequence of events from workstation assignment to task performance and potential injury. They next identified a series of key variables affecting the process outcome that included:

• user attributes (such as daily time at workstations); • user behaviors (including posture, force, and duration of use); and • environmental factors.

In this phase of the Six Sigma method, the "defect" – a measurable outcome of the process for which improvement is desired – is defined. While the true "defect" for this process would be the occurrence of an ergonomic injury, there were so few at the start of the project that measuring a statistically significant improvement was going to be difficult. Therefore, the key process variables identified were taken as the "defect," and a goal of 70% improvement (reduction) in the baseline level was set for the project. Scored surveys of DDC workstation users were developed and conducted on the variables identified and used to measure the baseline defect level. Step 2: Analyze Accurately identifying the root causes of a problem, which in turn leads to more effective improvements, is an essential function of the Six Sigma methodology. Therefore, the project team next analyzed the collected survey data to determine differences in the workstations, work environments, user training, and behavior at the different DDC sites. The team then identified possible root causes underlying these variables using several of the Six Sigma tools and methodologies, including brainstorming, ‘fishbone’ diagramming, a work performance matrix, and Antecedent-Behavior-Consequence and Balance of Consequences analyses. After developing a list of possible root causes, the team used additional Six Sigma tools and methodologies to identify probable root causes and validate them. For example, one possible root cause identified was a failure of the employee to recognize the importance of ergonomics compliance to his or her personal well-being. This root cause was validated by the employee survey, in which many of the employees expressed an attitude of "it won't happen to me." Other key root causes validated through this process were the lack of adjustable furniture at some worksites and a lack of "ownership" in personal safety on the part of the employee. The team also determined that ergonomics was not emphasized by DDC to the same extent as other, more immediate, safety issues such as the use of personal protective equipment in hazardous environments. Step 3: Improve After determining the most significant root causes through analysis and validation, the project team developed a series of improvements to correct the identified root causes, including both work-related and personal risk factors. Workstation deficiencies were easily addressed by implementing a workstation upgrade plan. Elevating workstation ergonomics to the same level of importance as other personal safety and health issues was a more challenging improvement. However, the team elevated the focus on workstation ergonomics by improving awareness on the part of management and employees and by altering employee behavior and work habits through increased accountability. The project team developed a novel approach to raising employee awareness by collecting a series of personal testimonials from other employees and posting them on the Company’s intranet site. These testimonials were supplemented by more traditional communications, including regular work group safety meetings, training, and increased ergonomics resources. At each facility, the company also designated Ergonomic Focal Points and Ergonomic Contacts, DDC workers who volunteered to receive specialized training and be available as a first point of contact for ergonomic concerns and questions. The team addressed employee behavior by providing feedback to individuals, creating a specific channel for early reporting of discomfort, and developing a health assessment program to address the early warning signs of potential MSDs. Employee personal accountability was addressed by implementing a "Safety First" mentality that stressed ergonomics as a key issue in personal safety and not a separate stand-alone topic.


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These improvements are not static, but are a part of an ongoing ergonomics safety and health process. For example, while furniture improvements have been implemented, it is understood that the workstations will continually evolve to meet the employees’ changing needs. Step 4: Control After the immediate improvements were implemented, the project team developed a long-term control plan designed to sustain the achievements. The control plan took the sequence of events which might contribute to an injury, as outlined in the Measure step, and added a series of performance standards, measures, responsibilities, and contingency plans. For example, in the original sequence, an employee was instructed to attend ergonomics training when starting a job, but there was no control measure to ensure this took place. Under the control plan, the employee is now required to attend the training within 30 days of job assignment, and the designated Ergo Contact at the job site is alerted and follows up with the employee if the employee fails to attend within that timeframe. Each step in the sequence has a similar control, ensuring that the improved process is followed long after the conclusion of the project. Results of the Project: DDC made immediate improvements in the identified risk factors, which have been reduced 64% since the baseline measurement and by more than 45% overall. These improvements have been well received by the DDC’s management and workers, and employees are proactive in addressing discomfort and have a better understanding of the personal benefits of ergonomics. As improvements like these have been repeated throughout the Company, the severity of ergonomics injuries has declined. In 2001, 53% of the Company's ergonomic injuries resulted in lost work time or advanced medical treatment. However, in 2003, only 30% of ergonomic injuries were this severe; the remaining 70% of cases required only first aid or precautionary measures. This result, in turn, has contributed to Dow’s 2005 goal of reducing the Company’s reportable injury and illness rate by 90 percent to 0.24. Moreover, by virtue of the Six Sigma Methodology’s emphasis on long-term control, the project has developed an ongoing process that will help the DDC sustain its immediate results and continue to improve. The positive results of this project have been shared with Tricia and other EH&S managers at other business units, leading to similar projects throughout the company. Dow believes that using Six Sigma for EH&S projects such as these enables employers to develop program improvements based on measurement and analysis, rather than speculation, resulting in a more cost-efficient and sustainable fix that will yield benefits indefinitely. Rather than undertaking costly trial and error attempts at solutions, the Company was able to identify the root causes of ergonomic injuries with confidence and make improvements to the ergonomics program in a systematic and sustainable way.

Sidebar: Six Sigma Methodology The Greek letter sigma (s) is used in mathematics to represent standard deviation, or how much a process varies from its average value. Under the Six Sigma methodology, deficiencies are described in terms of "defects" per million opportunities, with the score of 6s equal to 3.4 defects per million opportunities. Six Sigma uses the following four-step process known as MAIC (Measure, Analyze, Improve, Control) to significantly reduce defects in processes, products, and/or services:

Step 1: Measure - clearly define the process to be improved and the "defect" for the project, and identify a clear and appropriate measure for the "defect" Step 2: Analyze - determine the root causes of the defect Step 3: Improve - develop solutions to address the root causes and validate process improvement Step 4: Control - implement a long-term strategy to ensure that the improvements are sustained.

The methodology can be applied to any process that allows the measurement of benefits and improvements in defect reduction, whether in the manufacture of a product, the delivery of a service, the control of costs, or the


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management of injuries and illnesses. Dow has adopted the Six Sigma methodology to accelerate the company’s improvement in quality and productivity. Dow has expanded the use of the Six Sigma approach to help manage aspects of the Company’s operations beyond production and quality, including the safety and health of its workforce. Some of the projects to which Dow has applied the Six Sigma methodology include:

• reduction of repetitive stress injuries; • reduction of motor vehicle accidents; • improved safety for visitors (especially contractors); • site logistics risk reduction; and • off-the-job safety process improvement.

These projects have been key components of Dow’s 2005 Environmental, Health and Safety Goals, which include reducing Dow's reportable injury and illness rate by 90% to 0.24. As the example in our case study illustrates, Dow’s Environmental Health and Safety (EHS) function has found the Six Sigma methodology particularly useful in identifying and validating root causes that are hard to discern because of their subjectivity, and in focusing improvements to an ergonomics program in ways that caused measurable improvements. Moreover, since the Six Sigma process includes implementation of controls to ensure that achievements are sustained over a long-term period, the Company expects to realize the benefits of its efforts for years to come. References 1 March 2004 U.S. Department of Labor News Release regarding Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses. 2 "A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back," The National Institute for Occupational Safety and Health. 3 This case study was developed from information provided by Karen Kearns, Industrial Hygiene Specialist, and Mark Spence, Manager, North American Health and Safety Regulatory Affairs, The Dow Chemical Company. This product was funded under GS 35F 5544H for the U.S. Department of Labor, Occupational Safety and Health Administration. The views expressed herein do not necessarily represent the official position or policy of the U.S. Department of Labor.

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Ergonomics Questions and Answers

What is an "ergonomic injury? Input from the recent ergonomics forums demonstrated to OSHA that there are a wide variety of opinions on how the Agency should define an ergonomic injury and that the definition adopted by OSHA depends on the context. Ergonomic injuries are often described by the term "musculoskeletal disorders" or "MSDs." This is the term of art in scientific literature that refers collectively to a group of injuries and illnesses that affect the musculoskeletal system; there is no single diagnosis for MSDs. As OSHA develops guidance material for specific industries, the agency may narrow the definition as appropriate to address the specific workplace hazards covered. OSHA will work closely with stakeholders to develop definitions for MSDs as part of its overall effort to develop guidance materials. Are all MSDs work-related? No. MSDs can and do develop outside the workplace.


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How do you determine whether MSDs are work-related? The determination of whether any particular MSD is work-related may require the use of different approaches tailored to specific workplace conditions and exposures. Broadly speaking, establishing the work-relatedness of a specific case may include: -- taking a careful history of the patient and the illness; -- conducting a thorough medical examination; and -- characterizing factors on and off the job that may have caused or contributed to the MSD.

Why aren't you doing another rule? Congress passed, and the President signed, Senate Joint Resolution 6, which rescinded the original ergonomics rule, and under the Congressional Review Act, prohibits the agency from issuing a rule that is substantially the same as the former one. There are a number of reasons why guidelines are preferable to doing a rule. OSHA must follow certain criteria in doing a rule - any rule. In terms of ergonomics, there are factors that make doing a rule very difficult:

• There are a variety of different hazards and combinations of different hazards to be addressed; • Exposure to the hazards is not readily measured in some cases; • The exposure-response relationship is not well understood; • Cost and feasibility of abatement measures may be uncertain and may be very high in some cases; and • It is very difficult, except in the most general terms, to prescribe remedies for abating such hazards in a

single rule.

These considerations make it very difficult to develop simple criteria for compliance that can apply to a broad range of industries. On the other hand, industry and task specific guidelines can be developed more quickly and are more flexible, and can provide specific and helpful guidance for abatement to assist employees and employers in minimizing injuries. Guidelines are the most effective method available for reducing injuries quickly. How do you expect OSHA's guidelines to reduce injuries and illnesses related to MSDs? Injuries and illnesses related to MSDs have consistently declined over the last 10 years, even though there has not been a standard addressing them. Guidelines, such as OSHA's Meatpacking Guidelines, and voluntary industry efforts have been successful in reducing the injury and illness rates for these disorders. For example, on a national basis, rates for carpal tunnel injuries with days away from work have gone down by 39 percent from 1992 to 1999. For the same time period, rates for strains and sprains with days away from work have also gone down by 39 percent, and rates for back injuries with days away from work have gone down by 45 percent. In the meatpacking industry, with industry-specific guidelines and focused OSHA enforcement, rates of carpal tunnel injuries with days away from work have gone down 47 percent from 1992 to 1999. Over the same time period, rates of strains and sprains with days away from work have gone down by 61 percent, and rates for back injuries with days away from work have gone down by 64 percent. OSHA expects that industry-or-task-specific guidelines will further reduce injuries and illnesses as they are completed and implemented. OSHA's VPP (Voluntary Protection Program) participants, who have implemented safety and health programs, have injury and illness rates 53 percent below the average for their respective SIC codes. What is a guideline and how does it differ from a standard? A guideline is a tool to assist employers in recognizing and controlling hazards. It is voluntary. Failure to implement a guideline is not itself a violation of the General Duty Clause of the OSH Act. Guidelines that


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OSHA develops will provide information to help employers identify ergonomic hazards in their workplaces and implement feasible measures to control those hazards. Guidelines are more flexible than standards. They can be developed quickly and can be changed easily as new information becomes available with scientific advances. Guidelines make it easier for employers to adopt innovative programs to suit their workplaces, rather than inflexible, one-size-fits-all solutions to issues that may be unique to the industry or facility. Does having guidelines mean that OSHA is excluding a regulatory approach in the future? OSHA will regularly review the injury and illness rates for MSDs and make decisions based on the best-available information about what approach to take to protect workers from MSDs. OSHA believes that guidelines currently offer the best method of continuing to bring down injury and illness rates for MSDs. What industries will these guidelines cover? OSHA will develop industry-or-task-specific guidelines for a select number of industries, taking into account injury and illness incidence rates as well as available information on what is known to work. These guidelines will be developed with input from others. As industry-or-task-specific guidelines are drafted, we will make public announcements and share the information as broadly as possible. Will the guidelines cover agriculture, construction and maritime? Guidelines offer the flexibility to go beyond general industry. The previous administration's ergonomics standard was limited in scope to general industry. In addition to the industry-specific guidelines that OSHA plans to develop, the agency will encourage other industries to develop their own guidelines to reduce MSDs.

Will OSHA use the new guidelines as a basis for enforcement? No. An employer's failure to implement the new guidelines will not be a violation of the General Duty Clause of the OSH Act. Rather, OSHA intends that the guidelines will provide information to help employers identify ergonomic hazards in their workplaces and implement feasible measures to control such hazards. For this reason, OSHA anticipates that there would likely be no basis for a Section 5(a)(1) citation for employers with ergonomic hazards who effectively implement the ergonomics guidelines or other appropriate measures. OSHA will not be focusing its enforcement efforts on employers who have implemented effective ergonomic programs or who are making good-faith efforts to reduce ergonomic hazards. What if I am an employer in an industry for which OSHA does not develop industry-specific guidelines? Even if there are no guidelines specific to your industry, as an employer you still have an obligation under the General Duty Clause, Section 5(a)(1) to keep your workplace free from recognized serious hazards, including ergonomic hazards. OSHA will cite for ergonomic hazards under the General Duty Clause or issue ergonomic hazard letters where appropriate as part of its overall enforcement program. OSHA encourages employers where necessary to implement effective programs or other measures to reduce ergonomic hazards and associated MSDs. A great deal of information is currently available from OSHA, NIOSH, and various industry and labor organizations on how to establish an effective ergonomics program, and OSHA urges employers to avail themselves of these resources. Does this mean OSHA will not use the General Duty Clause to cite for ergonomic hazards? OSHA will use the General Duty Clause to cite employers for ergonomic hazards. Under the OSH Act's General Duty Clause, employers must keep their workplaces free from recognized serious hazards, including ergonomic hazards. This requirement exists whether or not there are voluntary guidelines.


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What will the OSHA enforcement program entail? OSHA has been assessing MSD-related issues in complaints, referrals, and targeted inspections. OSHA will continue to evaluate the findings of its inspections and issue General Duty Clause citations or hazard alert letters for ergonomics hazards where appropriate. OSHA will do the same when responding to worker complaints. OSHA will conduct inspections for ergonomic hazards and issue citations under the General Duty Clause and issue ergonomic hazard alert letters where appropriate. OSHA will conduct follow-up inspections or investigations within 12 months of certain employers who receive ergonomic hazard alert letters. OSHA will initiate a National Emphasis Program in the nursing home industry to guide inspections of nursing homes, and to focus significant effort on addressing ergonomic hazards related to patient lifting. OSHA will conduct specialized training of appropriate staff on ergonomic hazards and abatement methods and designate 10 regional ergonomic coordinators and involve them in enforcement and outreach. What about construction? Where appropriate in the construction industry, OSHA will continue to evaluate MSD-related issues through targeted inspections and response to worker complaints. Will OSHA notify employers who have high rates of MSDs? Yes. As an adjunct to the Site Specific Targeting (SST), OSHA annually notifies employers in the OSHA Data Initiative who report high Lost Workday Injury and Illness rates at their establishment(s), and recommends that they seek assistance in addressing these workplace hazards. If employers report high rates of injuries which in some cases may be related to ergonomic issues, they will also be urged to seek assistance to address those hazards.

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Questions and Answer Key

1. Which of the following best describes carpal tunnel syndrome?

a. Elbow and shoulder swelling and inflammation b. Inflammation of the channel in the wrist c. Raynaud's syndrome of the hand and wrist d. White finger

2. Carpal tunnel syndrome include all of the following symptoms, except:

a. Numbness in the little finger b. Pain in the wrist upon exertion c. Pain in the second and third finger d. Inflammation and swelling of the wrist

3. Lateral epicondylitis is also called:

a. Trigger finder b. Roffer's wrist c. Carpenter's elbow d. Rotator cuff

4. This agency publishes the Work Practices Guide for Manual Lifting:

a. OSHA b. ANSI c. NIOSH d. ASSE

5. An injury of the median nerve inside the wrist is known as:

a. Carpal Tunnel Syndrome b. Osteoarthritis c. DeQuarvain's Disease d. Reynold's Syndrome

6. This field of study is interested in the physical and behavioral interaction between humans and their environment on and off the job: (Brauer, p. 483)

a. Ergonomics b. Anthropometrics c. Biomechanics d. Biobehavioral Systems

7. The most common of the work related musculoskeletal disorders, and in economic terms, the most costly is:

a. Back pain b. Carpal Tunnel Syndrome c. Trigger finger d. Tennis elbow


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8. Grasping a pencil or pen between the thumb and distal joints of the fingers is referred to as:

a. Power grip b. Hook grip c. Precision grip d. Relaxed grip

9. Which grip produces the maximum force that can be developed by the hand?

a. Power grip b. Hook grip c. Precision grip d. Relaxed grip

10. What is the normal line of sight at rest?

a. 10 degrees upward b. 10 degrees downward c. 15 degrees upward d. 15 degrees downward

11. The application of mechanical principles to biological problems is known as:

a. Kinesiology b. Physiology c. Biomechanics d. Ergonomics

12. Ergonomics, as a field of study, is best described as: (Brauer, p. 483)

a. The science that deals with causal factors b. The measure of negative entropy in a system c. The study of mechanics of biological systems d. The man-machine relationship

13. An MSD is an ergonomics acronym for:

a. Material Safety Data b. Musculoskeletal Disorders c. Machine System Design d. Muskulo-Safe Determination

14. Which of the following is most likely produced by a cumulative trauma disorder?

a. Hearing loss b. Vision loss c. Tennis elbow d. Loss of memory

15. This category of vibration is a commonly experienced by truck drivers:

a. back vibration b. segmental vibration c. whole-body vibration d. neck vibration


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16. Ergonomics is derived from two Greek words meaning: (Brauer, p. 483) a. Work and Law b. Cumulative and Trauma c. Work and Disease d. Trauma and Law

17. The science of measuring the body is called:

a. physiometry b. anthropometry c. ergonomics d. socionoics

18. Force can be defined by all of the following, except:

a. an external load b. expressed in newtons or pounds c. capacity to do work or cause physical change d. a vector quantity that tends to produce a deceleration

19. All of the following are considered ergonomics risk factors associated with a task, except: (NSC, APM-BIET, p.107)

a. Fitness b. Repetitive motion c. Weight d. Point of operation

20. Which of the following is not considered in study of ergonomics?

a. Physiological demands b. Psychological demands c. Physical demands d. Emotional demands

21. Work-related MSDs of the neck, shoulder, and upper limb are referred to as:

a. Cumulative trauma injuries (CTI) b. Carpal Tunnel Syndrome c. Repetitive Strain Injuries (RSI) d. Upper limb syndrome

22. Which of the following is not an important ergonomics consideration?

a. Safe lift techniques b. Repetitive motion risk factors c. Exposure to blood-borne pathogens d. Exposure to excessive vibration or extreme temperatures

23. Which of the following is the least strategy to increase employee involvement in ergonomics?

a. Effective reporting b. Prompt responses to concerns c. Using employee ideas on program development d. Ignore employee concerns and ideas


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24. Which of the following is not an effective manual material handling principle?

a. Lift loads between knees and shoulders b. Keep the travel distance less than 10 feet c. Twist as you lift from the floor d. Keep the load close to the body

25. A proactive approach to ergonomics would emphasize:

a. reduction in injury costs b. early return to work programs c. workstation design d. aggressive accident investigation

26. Which of the following is not an effective ergonomics program policy?

a. give ergonomics efforts high priority b. further strategic goals c. allow full discussion and cooperation d. discourage union involvement

27. Each of the following is a way management can demonstrate commitment to an ergonomics program, except:

a. conduct awareness training b. encourage compliance c. bring in outside experts d. carry out ergonomic improvements

28. Which of the strategies below are counter-productive to effective ergonomics?

a. Ignoring employees registering complaints b. Training in ergonomic risk factor awareness c. Sharing information and results d. Incentives for involvement

29. Which of the following is the least effective technique in developing concrete ergonomics solutions?

a. reviewing OSHA logs b. brainstorming c. periodic medical exams d. screening jobs for risk factors

30. If you uncover signs and symptoms of possible MSDs in your workplace, the most effective strategy would be to:

a. implement a training program b. assess for signs and symptoms c. request a confidential evaluation d. Purchase safety belts


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31. Once a decision has been made to initiate an ergonomics program, what is your next step?

a. identify players b. determine risk factors c. determine scope of the problem d. identify costs

32. The purpose of the walk-through ergonomics observational survey is to:

a. interview safety committee members b. detect obvious risk factors c. score unsafe behaviors d. conduct in-depth analysis

33. The quality of checklist data collected during an ergonomics inspection is generally better when:

a. interviews cover supervisors as well as workers b. data is expressed as percentages c. employees providing data do not feel intimidated d. persons are familiar with the job, task, or process

34. Activities requiring frequent or prolonged work can be particularly stressful in all of the following situations, except:

a. work requiring sustained bending or twisting b. work requiring sustained or repeated work above the shoulders c. work requiring sustained or repeated work at chest level d. work requiring sustained or repeated work below the knees

35. Force requirements may increase with:

a. increasing speed of movements b. pinch grip c. decreased slipperiness d. vibration

36. To determine possible negative effects on the musculoskeletal system, research is conducted all of the following areas, except:

a. group dynamics b. performance monitoring c. production demands d. incentive pay systems

37. An effective ergonomics job hazard analysis would never do which of the following?

a. identify conditions contributing to risk factors b. measure and quantify ergonomic risk factors c. break down task into individual steps d. exclude employee involvement in the analysis


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38. Which of the following procedures is least likely to be used for collecting information on the ergonomic components of a job?

a. videotaping b. observation c. investigation d. measurements

39. Which of the following procedures is least effective proactive strategy for collecting information on the ergonomic components of a job?

a. biomechanical calculations b. physiological measures c. investigation d. interviews

40. Jobs in which current cases have been identified should receive ____________ attention, followed by those in which past records have noted a high incidence or ________ of MSDs despite the lack of current cases.

a. planned, probability b. some, number c. immediate, severity d. primary, type

41. Priority for ergonomics job analysis and intervention should be given to those jobs:

a. employees complain of discomfort b. in which most people are affected c. significant risk factors exist d. all of the above

42. Which of the three ergonomics control strategies is most effective in eliminating risk factors?

a. Technical Controls b. Engineering Controls c. Work Practice Controls d. Interim Measures

43. Which ergonomics control strategy below has as its primary purpose to limit exposure to the hazard?

a. Technical Controls b. Engineering Controls c. Work Practice Controls d. Interim Measures

44. Which of the following is not considered a component of proper computer workstation design to maintain proper posture?

a. the printer b. the work surface c. the keyboard d. the chair


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45. Effective procedures should incorporate each of the following ergonomics goals, except:

a. decrease recovery time b. maintain neutral postures c. reduce duration of exposure d. reduce frequency of exposure

46. What is the purpose of the testing and evaluation phase of an ergonomics program implementation?

a. verifies duties and responsibilities b. verifies proposed solutions c. identifies additional enhancements d. identifies additional modifications

47. What of the following is not considered a purpose of the follow-up ergonomics evaluation?

a. new risk factors do not exist b. controls reduce risk factors c. controls eliminate risk factors d. controls are identified

48. Long-term indicators of the effectiveness of an ergonomics program can include:

a. reduced severity rates b. reduced incidence rates c. increased product quality d. reduced productivity

49. In general, the medical management process in an ergonomics program emphasizes the prevention of impairment and disability through all of the following, except:

a. Early return to work b. Prompt treatment c. Early detection d. Timely recovery

50. It is not appropriate for employers to provide ergonomics training to employees regarding which of the following?

a. signs and symptoms of MSDs b. methods of self-treating MSDs c. procedures for reporting MSDs d. importance of reporting MSDs

51. It is not appropriate for employees or supervisors to:

a. be aware of signs and symptoms of MSDs b. diagnose signs and symptoms c. report signs and symptoms of MSDs d. thank employees for reporting possible MSDs


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52. One of the best ways for a health care provider to become familiar with jobs and job tasks is by:

a. formal communication b. periodic plant tours c. medical exams d. accident record reviews

53. The least effective goal of ergonomics training is to enable managers, supervisors, and employees to do all of the following except:

a. Comply with mandatory OSHA rules b. Identify job tasks that may increase risk of MSDs c. Recognize signs and symptoms of MSDs d. Develop control and prevention strategies

54. One of the primary objectives for ergonomics awareness training is to recognize workplace risk factors for _________ and understand general methods for controlling them:

a. environmental injuries b. musculoskeletal disorders c. psychosocial factors d. ergonomic awareness

55. Musculoskeletal disorders can result when there is a mismatch between the physical _______ of the job and the physical ________ of the worker:

a. demands, requirements b. requirements, capacity c. requirements, requirements d. demands, demands

56. Workers are likely to develop MSDs when they:

a. work in an awkward position b. use a great deal of force c. repeatedly lift heavy objects d. Any of the above

57. Which of the following is not considered one the three areas within which ergonomics risk factors exist?

a. the worker b. the procedure c. the task d. the environment

58. Musculoskeletal disorders are among the most prevalent medical problems in the U.S., affecting _____ of the entire population:

a. 3 percent b. 7 percent c. 40 percent d. 72 percent


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59. MSDs include a group of conditions that involve all of the following, except:

a. nerves b. tendons c. muscles d. skin

60. All of these factors may contribute to MSDs, except:

a. vibration b. unique motions c. awkward postures d. forceful exertions

61. Which of the following is not considered a critical risk factor leading to cumulative trauma disorders (CTDs) as well as other musculoskeletal disorders?

a. force b. duration c. capacity d. frequency

62. By the age _____, most people have had their first episode of back pain:

a. 25 b. 35 c. 45 d. 55

63. The amount of effort in performing a task depends on a number of factors. Which of the factors below is not one of those factors?

a. Type of grip b. Object weight c. Object dimensions d. Fatigue

64. The amount of effort in performing a task depends on a number of factors. Which of the factors below is not one of those factors?

a. repetition b. duration c. environment d. slipperiness

65. All of the following are common locations of injury due to exerting excessive force, except:

a. neck/shoulder b. foot/ankle c. upper back d. wrist/hand


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66. What condition exists when any part of your body presses against an external object and the resulting sustained force has caused too much mechanical stress on tissues?

a. Mechanical trauma b. Recovery trauma c. Force trauma d. Contact trauma

67. This grip strategy to manipulate objects requires much greater muscle strength so it is more likely going to cause an injury:

a. pinch grip b. power grip c. sustained grip d. intermittent grip

68. This form of exertion combines force, posture, and duration to create a condition that quickly fatigues our muscles which increases the chances of acquiring a cumulative trauma disorder (CTD):

a. intermittent exertion b. repetitive exertion c. static exertion d. forceful exertion

69. This term describes a measure of the rest (or low stress activity) period available to the muscle group between similar exertions:

a. rest period b. recovery time c. degree of recovery d. muscle group rest time

70. Awkward postures typically include all of the following, except:

a. squatting b. working overhead c. bending d. standing

71. ____ is the speed at which the body part moves and ____ is the rate of change of the speed at which the body part moves:

a. angular velocity, acceleration b. acceleration, angular velocity c. angular acceleration, velocity d. velocity, angular acceleration

72. Heat stress can result in:

a. Heat exhaustion b. Heat cramps c. Dehydration d. All of the above


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73. Heat stress is made even more dangerous in the presence of ______ due to the reduced ability of the body to cool itself:

a. low humidity b. high humidity c. greater exertion d. higher force

74. This condition may result if the worker is exposed to an environment so cold that the body cannot maintain adequate deep core temperature:

a. hyperthermia b. hypothermia c. hyperthermitis d. hypothermitis

75. Which of the following is not one of the symptoms brought on by cold stress?

a. pulmonary pain b. dilated pupils c. ventricular fibrillation d. shivering

76. The body's response to vertical vibration will be greatest between ____ Hz:

a. 2 and 4 b. 4 and 8 c. 8 and 10 d. 10 and 12

77. Factors influencing the adequacy and effectiveness of illumination include the following, except:

a. freedom from diffusion b. freedom from glare c. freedom from concentration d. freedom from glare

78. To create a healthy work environment that reduces the risk of ergonomics injuries, management should do all of the following, except:

a. understand roles b. allow participation c. threaten for noncompliance d. conduct adequate training

79. Which of the following are least likely to result in work-related MSDs?

a. intensified workload b. limited job control c. monotonous work d. poor labor-management relations


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80. For proper work surface design, all of these factors should be considered, except:

a. deep enough b. wide enough c. high enough d. flat enough


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Answer Key

1. a. Elbow and shoulder swelling and inflammation

2. b. Pain in the wrist upon exertion 3. c. Carpenter's elbow 4. c. NIOSH 5. a. Carpal Tunnel Syndrome 6. a. Ergonomics 7. a. Back pain 8. c. Precision grip 9. a. Power grip 10. b. 10 degrees downward 11. c. Biomechanics 12. d. The man-machine relationship 13. b. Musculoskeletal Disorders 14. c. Tennis elbow 15. c. whole-body vibration 16. a. Work and Law 17. b. anthropometry 18. d. a vector quantity that tends to produce a

deceleration 19. a. Fitness 20. d. Emotional demands 21. c. Repetitive Strain Injuries (RSI) 22. c. Exposure to blood-borne pathogens 23. d. Ignore employee concerns and ideas 24. c. Twist as you lift from the floor 25. c. workstation design 26. d. discourage union involvement 27. b. encourage compliance 28. a. Ignoring employees registering complaints 29. b. brainstorming 30. c. request a confidential evaluation 31. c. determine scope of the problem 32. b. detect obvious risk factors 33. d. persons are familiar with the job, task, or

process 34. c. work requiring sustained or repeated work

at chest level 35. c. decreased slipperiness 36. a. group dynamics 37. d. exclude employee involvement in the

analysis 38. c. investigation

39. c. investigation 40. c. immediate, severity 41. d. all of the above 42. b. Engineering Controls 43. c. Work Practice Controls 44. a. the printer 45. a. decrease recovery time 46. b. verifies proposed solutions 47. d. controls are identified 48. d. reduced productivity 49. a. Early return to work 50. b. methods of self-treating MSDs 51. b. diagnose signs and symptoms 52. b. periodic plant tours 53. a. Comply with mandatory OSHA rules 54. b. musculoskeletal disorders 55. c. requirements, requirements 56. d. Any of the above 57. b. the procedure 58. b. 7 percent 59. d. skin 60. b. unique motions 61. c. capacity 62. b. 35 63. d. Fatigue 64. c. environment 65. c. upper back 66. d. Contact trauma 67. a. pinch grip 68. c. static exertion 69. b. recovery time 70. d. standing 71. a. angular velocity, acceleration 72. d. All of the above 73. b. high humidity 74. b. hypothermia 75. a. pulmonary pain 76. b. 4 and 8 77. c. freedom from concentration 78. c. threaten for noncompliance 79. d. poor labor-management relations 80. d. flat enough


C S H M - certisafety.com · • OSHA conducted a National Emphasis Program (NEP) for the nursing home industry from July 2002 through September 30, 2003. The agency conducted 1,225

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