[Federal Register Volume 86, Number 205 (Wednesday, October 27, 2021)]
[Proposed Rules]
[Pages 59309-59326]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-23250]
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DEPARTMENT OF LABOR
Occupational Safety and Health Administration
29 CFR Parts 1910, 1915, 1917, 1918, 1926, and 1928
[Docket No. OSHA-2021-0009]
RIN 1218-AD39
Heat Injury and Illness Prevention in Outdoor and Indoor Work
Settings
AGENCY: Occupational Safety and Health Administration (OSHA), Labor.
ACTION: Advance notice of proposed rulemaking (ANPRM).
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SUMMARY: OSHA is initiating rulemaking to protect indoor and outdoor
workers from hazardous heat and is interested in obtaining additional
information about the extent and nature of hazardous heat in the
workplace and the nature and effectiveness of interventions and
controls used to prevent heat-related injury and illness. This ANPRM
provides an overview of the problem of heat stress in the workplace and
of measures that have been taken to prevent it. This ANPRM also seeks
information on issues that OSHA can consider in developing the
standard, including the scope of the standard and the types of controls
that might be required.
DATES: Submit comments on or before December 27, 2021.
ADDRESSES: You may submit comments and attachments, identified by
Docket No. OSHA-2021-0009, electronically at www.regulations.gov, which
is the Federal e-Rulemaking Portal. Follow the instructions online for
making electronic submissions.
Instructions: All submissions must include the agency's name and
the docket number for this ANPRM (Docket No. OSHA-2021-0009). When
submitting comments or recommendations on the issues that are raised in
this ANPRM, commenters should explain their rationale and, if possible,
provide data and information to support their comments or
recommendations. Wherever possible, please indicate the title of the
person providing the information and the type and number of employees
at your worksite.
All comments, including any personal information you provide, will
be placed in the public docket without change and will be publicly
available online at www.regulations.gov. Therefore, OSHA cautions
commenters about submitting information they do not want to be made
available to the public or submitting materials that contain personal
information (either about themselves or others) such as Social Security
Numbers and birthdates.
Docket: To read or download comments or other material in the
docket, go to Docket No. OSHA-2021-0009 at www.regulations.gov. All
comments and submissions are listed in the www.regulations.gov index;
however, some information (e.g., copyrighted material) is not publicly
available to read or download through that website. All submissions,
including copyrighted material, are available for inspection at the
OSHA Docket Office. Documents submitted to the docket by OSHA or
stakeholders are assigned document identification numbers (Document ID)
for easy identification and retrieval. The full Document ID is the
docket number plus a unique four-digit code. OSHA is identifying
supporting information in this ANPRM by author name and publication
year, when appropriate. This information can be used to search for a
supporting document in the docket at www.regulations.gov. Contact the
OSHA Docket Office at 202-693-2350 (TTY number: 877-889-5627) for
assistance in locating docket submissions.
FOR FURTHER INFORMATION CONTACT:
Press Inquiries: Contact Frank Meilinger, Director, Office of
Communications, U.S. Department of Labor; telephone (202) 693-1999;
email meilinger.francis2@dol.gov.
General and technical information: Contact Andrew Levinson, Acting
Director, Directorate of Standards and Guidance, U.S. Department of
Labor; telephone (202) 693-1950.
SUPPLEMENTARY INFORMATION: This ANPRM on Heat Injury and Illness
Prevention in Outdoor and Indoor Work Settings follows this outline:
Table of Contents
I. Background
A. Occupational Illnesses, Injuries, and Fatalities Due to
Hazardous Heat
B. Under Reporting of Occupational Illnesses, Injuries, and
Fatalities Due to Hazardous Heat
C. Scope
1. Industries, Occupations, and Job Tasks
2. Structure of Work and Work Arrangements
3. Business Size
D. Geographic Region
E. Inequality in Exposures and Outcomes
F. Climate Change
II. Existing Heat Illness Prevention Efforts
A. OSHA Efforts
1. OSHA's Heat Illness Prevention Campaign and Other Guidance
Efforts
2. Stakeholder Engagement--NACOSH Work Group
3. General Duty Clause
4. Other Enforcement Efforts
5. Applicable OSHA Standards
B. Petitions for Rulemaking
C. NIOSH Criteria Documents
D. History and Requirements of State Standards
E. Other Standards
F. Employer Efforts
III. Key Issues in Occupational Heat-Related Illness
A. Determinants of Occupational Heat Exposure
1. Heat Exposure
2. Contributions to Heat Stress in the Workplace
B. Strategies To Reduce Occupational Heat-Related Injury and
Illness
1. Heat Injury and Illness Prevention Programs
2. Engineering Controls, Administrative Controls, and Personal
Protective Equipment
3. Acclimatization
4. Monitoring
5. Planning and Responding to Heat-Related Illness Emergencies
6. Worker Training and Engagement
IV. Costs, Economic Impacts, and Benefits
A. Overview
B. Impacts on Small Entities
V. References
I. Background
Heat is the leading cause of death among all weather-related
phenomena (NWS, September 8, 2021a; NWS,
September 8, 2021b). Excessive heat exacerbates existing health
problems like asthma, kidney failure, and heart disease, and can cause
heat stroke and even death if not treated properly and promptly.
Workers in both outdoor and indoor work settings without adequate
climate-controlled environments are at risk of hazardous heat exposure.
In an evaluation of 66 heat-related illness enforcement investigations
from 2011-2016, 80% of heat-related fatalities occurred in outdoor work
environments. However, 61% of non-fatal heat-related illness cases
occurred during or after work in an indoor work environment (Tustin et
al., August 2018). Pregnant workers (NIOSH, April 20, 2017) and workers
of color are disproportionately exposed to hazardous levels of heat in
essential jobs across these work settings (Gubernot et al., February
2015). In addition, climate change is increasing the frequency and
intensity of extreme heat events, as well as increasing daily average
daytime and nighttime temperatures. OSHA is initiating a rulemaking to
protect both indoor and outdoor workers from hazardous heat, and as a
first step is seeking additional information about the extent and
nature of hazardous heat in the workplace and the nature and
effectiveness of interventions and controls used to prevent heat-
related illness. This ANPRM provides an overview of the problem of heat
stress in the workplace and the measures that have been taken to
prevent it. This ANPRM also seeks information on issues that may be
considered in developing a standard, including the scope of the
standard and the types of controls that might be required.
OSHA uses several terms related to excessive heat exposure
throughout this document. Heat stress means the load of heat that a
person experiences due to sources of heat or heat retention, or the
presence of heat in a work setting. Heat strain means the physiological
response to heat exposure (ACGIH, 2017). Heat-related illness means
adverse clinical health outcomes that occur due to exposure to
hazardous heat. Heat-related injury means an injury linked to heat
exposure that is not considered one of the typical symptoms of heat-
related illness, such as a fall or cut. The document also uses the
combined terms of heat injury and illness when talking about prevention
or programming to demonstrate that both injury and illness should be
considered, with the exception of the names of existing programs.
A. Occupational Illness, Injuries, and Fatalities Due to Hazardous Heat
According to the Bureau of Labor Statistics (BLS) Census of Fatal
Occupational Injuries, exposure to excessive environmental heat stress
has killed 907 U.S. workers from 1992-2019, with an average of 32
fatalities per year during that time period (BLS, September 10, 2021a).
In 2019, there were 43 work-related deaths due to environmental heat
exposure (BLS, September 1, 2021). A recent analysis of BLS data by
National Public Radio and Columbia Journalism Investigations found that
the three-year average of heat-related fatalities among U.S. workers
has doubled since the early 1990s (Shipley et al., August 17, 2021).
The BLS Annual Survey of Occupational Injuries and Illnesses estimates
that 31,560 work-related heat injuries and illnesses involving days
away from work have occurred from 2011-2019, with an average of 3,507
injuries and illnesses of this severity occurring per year during this
period (BLS, September 10, 2021b). However, the estimates provided here
on occupational heat-related illnesses, injuries, and fatalities are
likely vast underestimates, as discussed further in Underreporting of
occupational illnesses, injuries, and fatalities due to hazardous heat
(Section I.B. of this ANPRM).
In a warm environment, the human body maintains a healthy internal
body temperature by getting rid of excess heat through mechanisms like
sweating and increasing blood flow to the skin. This is especially true
during physical activity or exertion. Briefly, if the body is not able
to dissipate heat, the body temperature may rise, and symptoms of heat-
related injury and illness can result. These can include heat rashes,
heat syncope (fainting), heat cramps, heat exhaustion, rhabdomyolysis
(a complex medical condition involving muscle breakdown), kidney
injury, and even heat stroke (the inability of the body to cool which
can lead to death) if the thermoregulatory capacity of the body is
exceeded (Ebi et al., August 21, 2021; NIOSH, February 2016). A multi-
country meta-analysis of dozens of studies involving thousands of
workers globally found that of those exposed to hazardous heat during a
single work shift, 35% experienced heat strain while 15% of those who
frequently worked in hazardous heat experienced kidney disease or acute
kidney injury (Flouris et al., December 2018).
Exposure to hazardous heat can also result in the exacerbation of
pre-existing medical conditions, such as diabetes or cardiovascular
disease. A study of U.S. Army personnel demonstrated that those who
have been hospitalized in U.S. hospitals for heat-related illness may
experience organ damage that can persist for years afterward, even
resulting in an increased risk of death from cardiovascular disease and
ischemic heart disease compared to those previously hospitalized for
other reasons (Wallace et al., 2007). Recurrent exposure to hazardous
heat, and resulting dehydration, has also been found to be associated
with acute and chronic kidney disease and injury in agricultural
workers and others performing manual labor in outdoor work settings,
particularly in South America, central America and certain South Asian
countries. These illnesses appear to be unrelated to traditional causes
of the disease (Glaser et al., August 8, 2016; Johnson et al., May 9,
2019; Sorensen and Garcia-Trabanino, August 22, 2019). Although much of
this research has focused on international populations, there is
emerging evidence of this health hazard in occupational populations
within the U.S. (Mix et al., 2019; Glaser et al., August 8, 2016).
The following questions are intended to solicit information on the
topics related to assessing the nature and magnitude of occupational
illness, injuries, and fatalities occurring due to hazardous heat.
(1) What are the occupational health or safety impacts of hazardous
heat exposure?
(2) What sources of data are important to consider when evaluating
occupational heat-related illnesses, injuries, and fatalities?
(3) Beyond the studies discussed in this ANPRM, are there other
data that provide more information about the scope and magnitude of
injuries, illnesses, and fatalities related to occupational heat
exposure?
B. Underreporting of Occupational Illnesses, Injuries, and Fatalities
Due to Hazardous Heat
Heat-related illnesses, injuries, and fatalites are underreported
(EPA, April 2021; Popovich and Choi-Schagrin, August 11, 2021).
Occupational heat-related illnesses, injuries, and fatalities may be
underestimated for several reasons. First, the full extent of heat-
related health outcomes is underreported generally because heat is not
always recognized as a contributing factor and the criteria for
defining a heat-related death or illness may vary by state, and among
physicians, medical examiners, and coroners. (Gubernot et al., October
2014). Due to the varying
nature of heat-related illness symptoms, some of which (e.g., headache,
fatigue) may have other causes, not all cases of illness or injury are
reported. Further, if the illness or injury does not require medical
treatment beyond first aid, or result in restrictions or days away from
work, loss of consciousness, diagnosis by a healthcare professional as
a significant injury, or death, an employer is not required to report
the incident under OSHA's existing injury reporting requirements (see
29 CFR 1904.7(a)). There may also be situations where an illness,
injury, or fatality is deemed to be unrelated to work, but heat
exposure at work may have contributed to that incident (Gubernot et
al., October 2014; Shipley et al., August 17, 2021).
Second, hazardous heat can impair job tasks related to complex
cognitive function (Ebi et al., August 21, 2021), and also reduce
decision-making abilities and productivity. A recent global meta-
analysis showed that 30% of workers who experienced hazardous heat
during a single shift reported productivity losses (Flouris et al.,
December 2018). Additionally, a growing body of evidence has
demonstrated that these heat-induced impairments may result in
significant occupational injuries that are not currently factored into
assessments of the health hazards resulting from occupational heat
exposure (Park et al., July 2021). In California, the likelihood of
same-day workplace injury risk significantly increased by approximately
5-7% when comparing a day that was 60-65 degrees Fahrenheit to a day
that was 85-90 degrees Fahrenheit. Same-day workplace injury risk
increased 10-15% when comparing a day that was 60-65 degrees Fahrenheit
to a day that was above 100-degrees Fahrenheit. These increased risks
were demonstrated in certain indoor and outdoor work environments,
contributing to approximately 360,000 additional workplace injuries in
California alone from 2001-2018 (Park et al., July 2021).
Third, self-reporting of health outcomes can result in bias which
can lead to over- or under-estimates of health outcomes (Althubaiti,
May 4, 2016). In 2009, the Government Accountability Office (GAO)
reported that the BLS Survey of Occupational Injuries and Illnesses,
which relies heavily on employer self-report of non-fatal injuries and
illnesses, may underreport employer-reported injury and illness data
(GAO, October 2009). This underreporting of non-fatal illnesses and
injuries may be particularly present in some industries, like
agriculture, where some employers (e.g., employers with 10 or fewer
employees) are excluded from reporting requirements (Leigh et al.,
April 2014). While there may be multiple factors influencing
underreporting, BLS investigations of this issue have found that
employers and employees may face disincentives for reporting injuries
and illnesses (BLS, December 8, 2020). By reporting injuries and
illness, employers may increase their workers' compensation costs and
jeopardize their reputation. Employees may also face disincentives for
reporting if they are reluctant to report for fear of retaliation or
may not realize an illness or injury is heat-related. Employees may
decide to continue working for economic incentives and to avoid losing
wages. Employee fear of retaliation, including the potential loss of
employment, may be of particular concern with heat-related illness and
injuries given the disproportionate number of undocumented, migrant,
low-wage, or other vulnerable workers that make up sectors that are at
high risk of hazardous heat exposure such as agriculture and
construction. These workers may lack the awareness of their right to,
and perceived ability to, speak out about workplace conditions.
Additional concerns related to the inequalities in hazardous heat
exposure and resulting health outcomes are discussed below in more
detail. Despite potential underreporting, these datasets are important
indicators of occupational safety and health, and through the questions
below, OSHA seeks additional information and data to better assess the
fullest extent of occupational illnesses, injuries, and fatalities due
to hazardous heat exposure in the workplace.
Finally, there are some health conditions associated with
occupational heat exposure that may take many years to manifest in
workers previously exposed to hazardous heat due to the latency period
between exposure and symptom onset (Gubernot et al., October 2014). For
these illnesses that develop over time, it is unlikely that the current
national datasets of occupational illnesses and injuries associate
those outcomes with hazardous heat exposure.
The following questions are intended to solicit information on the
topics related to assessing and addressing underreporting of
occupational illness, injuries, and fatalities occurring due to
hazardous heat.
(4) Are there quantitative estimates of the magnitude of
occupational illnesses, injuries, and fatalities related to hazardous
heat, beyond what is described in this ANPRM?
(5) Are there quantitative estimates or other quantitative or non-
quantitative examinations of the magnitude of underreporting of
occupational illnesses, injuries, and fatalities related to hazardous
heat?
(6) What factors lead to the underreporting of occupational heat-
related illness, injuries, and fatalities of which OSHA should be
aware?
(7) What datasets are available to address some of the limitations
associated with the underreporting of occupational heat-related
illnesses, injuries, and fatalities?
C. Scope
1. Industries, Occupations, and Job Tasks
Workers across hundreds of industries are at risk for hazardous
heat exposure and resulting health impacts. Since 2018, 789 heat-
related hospitalizations and 54 heat-related fatalities across nearly
275 unique industries have been documented by OSHA through workplace
inspections and violations . During this time, hospitalizations
occurred most frequently in postal and delivery service, landscaping,
and commercial building, as well as highway, street, and bridge
construction workers. Fatalities were reported in landscaping, masonry,
and highway, street, and bridge construction workers (OSHA, August 20,
2021).
Also since 2018, over 230 unique industries (as identified by 6-
digit NAICS codes) across indoor and outdoor work settings have had at
least one heat-related inspection by OSHA. During 2019, for example,
OSHA heat-related inspections occurred most often in industries and
workplaces such as roofing, postal and delivery service, construction
and contracting, masonry, landscaping, restaurants, and warehousing and
storage (OSHA, August 20, 2021).
Further, multiple analyses of OSHA enforcement investigations and
the Census of Fatal Occupational Injuries have found that Agriculture
(NAICS code 11), Construction (NAICS code 23), Transportation and
Warehousing (NAICS codes 48-49), and Administrative and Support and
Waste Management and Remediation Services (NAICS code 56) experience
the highest rates of heat-related mortality (Gubernot et al., February
2015; Tustin et al., August 2018). Compared to the average annual heat-
related workplace fatality rate in all other industries of 0.09 deaths
per 1 million workers, Agriculture, Forestry, Fishing, and Hunting was
found to have 35 (95% confidence interval, 26.3-47.0) times the risk of
heat-related deaths with 3.06 deaths per 1 million workers from 2000-
2010. Construction had 13 (95% confidence interval, 10.1-16.7) times
the risk of heat-related deaths with 1.13 deaths per 1 million workers
during that time period (Gubernot et al., February 2015).
Many job tasks, regardless of the industry in which they are
performed, may also result in the risk of exertional heat stress in
workers. The American Conference of Governmental Industrial Hygienists
(ACGIH) has developed categories of work intensity based on their
estimated metabolic rate, with the metabolic rate increasing across
categories: rest (e.g., sitting), light (e.g., sitting, standing, light
arm/handwork, occasional walking), moderate (e.g., normal walking,
moderate lifting), heavy (e.g., heavy material handling, walking at a
fast pace), very heavy (e.g., pick and shovel work) (ACGIH, 2017; OSHA,
September 15, 2017). In an evaluation of 14 heat-related workplace
fatalities that occurred from 2011-2016, the workload was moderate,
heavy, or very heavy in 13 of the incidents (Tustin et al., July 6,
2018). Of 20 enforcement cases from 2012-2013 that resulted in heat-
related citations under the Occupational Safety and Health Act's
General Duty Clause, all fatalities and non-fatal heat-related
illnesses occurred under moderate or heavy workloads (Arbury et al.,
April 2016).
The following questions are intended to solicit information about
how hazardous heat exposure and risk varies across industries,
occupations, and job tasks.
(8) Are there industries, occupations, or job tasks that should be
considered when evaluating the health and safety impacts of hazardous
heat exposure in indoor and outdoor work environments? Please provide
examples and data.
(9) Are there any industries, occupations, or job tasks that are
facing changes in the rate or frequency of occupational heat-related
illness? Please provide examples and data.
2. Structure of Work and Work Arrangements
The structure of work and various work arrangements, such as the
use of temporary, gig, or contingent workers, has been found in some
studies, including of non-US workers, to be associated with increased
health and safety risks to workers (Caban-Martinez et al., April 2018;
Virtanen et al., 2005). This may be due to a variety of reasons,
including workers in these work arrangements being assigned more
hazardous work tasks, being less aware of their ability to report
unsafe work conditions, being less acclimatized to the heat conditions
of the work environment, or not receiving adequate personal protective
equipment (PPE) or training for the job duties they are conducting.
These work arrangements are present in a variety of industries where
workers face hazardous heat exposure, such as construction,
agriculture, and landscaping, in part due to outdoor work settings and
seasonality of work.
Additionally, multi-employer contexts may impact the health and
safety of workers due to the need for and challenges associated with
close coordination across employers on health and safety issues such as
training and monitoring safe work practices (OSHA, October 6, 2021a;
OSHA and NIOSH, October 6, 2021). OSHA recognizes that any rulemaking
will need to consider the challenges for employers and employees
related to protecting those in non-traditional, variable, and multi-
employer work arrangements.
The following questions are intended to solicit information about
how unique and non-traditional work arrangements contribute to workers'
risk of heat-related injuries and illnesses, as well as the best
practices and challenges for reducing those risks in these work
settings.
(10) In addition to traditional work arrangements, are there
specific types of work arrangements or multi-employer work arrangements
that should be considered when evaluating the health and safety impacts
of hazardous heat exposure in indoor and outdoor work environments?
(11) What are current and best practices for protecting workers in
various types of work arrangements, including temporary and multi-
employer work arrangements, from hazardous heat exposure?
(12) What are current challenges in and limitations of protecting
workers in various types of work arrangements, including temporary and
multi-employer work arrangements, from hazardous heat exposure?
3. Business Size
Heat-related illnesses can occur in businesses of all sizes. An
evaluation of 38 enforcement investigations involving 66 incidents of
fatal and non-fatal heat-related illness from 2011-2016 found that 92%
of workplaces investigated had less than 250 employees (Tustin et al.,
August 2018). In a different assessment of workplace heat-related
fatalities from 2000-2010, almost half of all fatalities where
establishment size was known (244 cases out of 359 fatalities) occurred
in what the authors termed ``very small establishments,'' or those with
fewer than 10 employees (Gubernot et al., February 2015). However,
approximately a quarter of fatalities during that time period occurred
in ``very large establishments'' with more than 100 employees (Gubernot
et al., February 2015).
The following questions are intended to solicit information about
how business size may influence the practices and interventions
implemented to prevent heat-related injuries and illnesses and the
challenges experienced by businesses of varying sizes when implementing
these prevention strategies. There are additional questions on the
economic considerations for small entities included in Impacts on Small
Entities (Section IV.B. of this ANPRM).
(13) How are employers in businesses of various sizes currently
preventing heat-related injury and illness in workers?
(14) Are there limitations or concerns in preventing heat-related
injury and illness in workers that vary among businesses of various
sizes?
D. Geographic Region
Heat-related injury and illness among workers can occur anywhere in
the United States. In 2015, Texas and California had the highest number
of nonfatal injuries and illnesses with days away from work (BLS,
August 30, 2017). Texas and California also accounted for a quarter of
all heat-related workplace fatalities from 2000-2010 (Gubernot et al.,
February 2015).
However, when the size of the worker populations are taken into
account, states across the southern United States, including
Mississippi, Arkansas, Nevada, West Virginia, and South Carolina, have
been found to have the highest rates of heat-related workplace
fatalities from 2000-2010 (Gubernot et al., February 2015). In 2015,
Kansas and South Carolina had the highest rates of heat-related
nonfatal injuries and illnesses with days away from work, at 1.3 and
1.0 per 10,000 workers, respectively (BLS, August 30, 2017). Recent
evidence also shows that the Southeast United States accounts for the
most cases officially reported to OSHA.
As discussed in Under-reporting of Occupational Illnesses,
Injuries, and Fatalities due to Hazardous Heat (Section I.B. of this
ANPRM), significant underreporting of workplace heat-related injury and
illness limits the understanding of the full geographic scope of
outcomes. Additionally, populations that are less accustomed to
hazardous heat, such as those in the Northeast or Midwest U.S., may be
at increased risk of health impacts from
extreme heat, particularly during early season high heat events
(Anderson and Bell, February 2011).
The following questions are intended to solicit information,
relevant data sources, and considerations related to occupational heat
exposure and outcomes based on geographic region.
(15) How does geographic region contribute to occupational heat
hazards and the outcomes experienced by workers? Please provide
examples and data.
(16) Are there regions with improving or worsening occupational
heat hazards and associated outcomes? Please provide examples and data.
(17) Do regions with traditional and pervasive heat hazards address
the hazard differently than regions with more episodic exposures (e.g.,
heat waves in a normally temperate region)?
(18) What regional differences should be considered or accounted
for when determining the appropriate interventions and practices to
prevent heat-related injuries and illnesses among workers?
E. Inequality in Exposures and Outcomes
Disproportionate exposure to hazardous working conditions and their
resulting health and safety impacts on workers exacerbates
socioeconomic and racial inequalities in the U.S. In assessments of
national work-related injuries, illnesses, and fatalities, employment
in high-risk occupations has been disproportionately held by those who
are Black, foreign-born, or low wage-earners, after adjusting for other
demographic characteristics like sex and education (Steege et al.,
2014). Non-Hispanic Black workers and foreign-born Hispanic workers
tend to work in jobs with the highest injury risks even after adjusting
for sex and education (Seabury et al., February 2017). Sociodemographic
disparities in hazardous occupational exposures to dust and chemicals,
noise, musculoskeletal hazards, and strain have been found to persist
even after accounting for industry and job (Quinn et al., 2007).
These disparities are also present when focusing on health and
safety outcomes that result from hazardous heat exposure. Black and
Hispanic workers had higher relative risks of heat-related fatalities
compared to white workers from 2000-2010 (Gubernot et al., February
2015), and one-third of workplace heat-related fatalities since 2010
have occurred in Hispanic workers (Shipley et al., August 17, 2021).
From 1992-2006, agricultural crop workers were estimated to be 20 times
more likely to suffer a heat-related fatality at work when compared to
all other civilian occupations, with the majority of fatalities
occurring among immigrant workers (CDC, June 20, 2008), and from 2000-
2010, agricultural workers had 35 (95% confidence interval, 26.3-47.0)
times the risk of dying from heat-related causes compared to all other
industries (Gubernot et al., February 2015). Lower-wage workers are
more likely to live and work in areas facing greater exposure to
hazardous heat, to work in dangerous occupations, and to have limited
access to air conditioning at home or other housing which may limit the
ability to recover from occupational and non-occupational heat
exposures. In California, lower-wage workers experienced five times as
many heat-related injuries compared to the highest-wage workers between
2001 and 2018 (Park et al., July 2021). As climate change increases
extreme heat events, Hispanic and Latino individuals, as well as
American Indian and Alaska Native individuals, individuals with low
income, and individuals lacking a high school diploma are more likely
to live in areas with the highest projected labor hour losses (EPA,
September 2, 2021).
The following questions are intended to solicit information,
relevant data sources, and considerations related to inequalities in
occupational heat exposure and disproportionate outcomes experienced by
vulnerable occupational populations.
(19) Are there specific populations facing disproportionate
exposure to or outcomes from hazardous heat in indoor or outdoor work
settings? Please provide examples and data.
(20) Are there data sources available to assess inequalities in
exposure to or outcomes from hazardous heat in indoor or outdoor work
settings?
(21) Are there industries or employers who are addressing
occupational heat-related illness with an environmental justice
approach (i.e., with a focus on fair treatment and meaningful
involvement of all people regardless of race, color, national origin,
or income) to appropriately address the disproportionate exposures and
outcomes faced by workers of color, low-wage workers, immigrant
workers, or pregnant workers (NIOSH, April 20, 2017)? Please provide
examples and data.
F. Climate Change
Climate change is increasing the frequency and intensity of extreme
heat events, as well as increasing daily average daytime and nighttime
temperatures. The National Climate Assessment, the United States'
quadrennial report assessing climate change science and impacts and
published by the U.S. Global Change Research Program, states that high
summer temperatures are linked to increased illness and death, that hot
days are associated with increased heat-related illnesses, that health
risks may be higher earlier in warmer seasons before people have had
time to acclimatize, and that workers will face an increased risk of
heat-related illness due to heat exposure. This will be especially true
in rural areas, particular sectors and occupations such as agriculture,
forestry, construction, utilities, warehousing, manufacturing, and
indoor workplaces producing additional heat or lacking adequate
cooling, such as steel mills, dry cleaning, and others, and for workers
of color, those who are older, and of lower socioeconomic status
(USGCRP, 2016; USGCRP, 2018). It is estimated that under a high
emissions scenario, climate change will result in the annual loss of
almost 2 billion labor hours with an annual cost of an estimated $160
billion in lost wages (in 2015 dollars) due to extreme temperatures
alone, the vast majority of which is due to heat (EPA, May 2017;
USGCRP, 2018). As the number of days above 90 degrees Fahrenheit
increases due to climate change, so do lost hours of work. Nationally,
the average losses are projected to be 14 to 34 hours annually per
``weather-exposed'' worker due to high temperature days. Weather-
exposed workers in parts of the Southwest and Southern Great Plains
could lose up to 84 hours per worker annually, depending on the level
of temperature increases (EPA, September 1, 2021).
The following questions are intended to solicit information,
relevant data sources, and considerations to further assess the impact
of climate change on occupational heat exposure and outcomes.
(22) Are there data sources available to assess how climate change
is altering hazardous heat exposure in outdoor and indoor work
environments?
(23) How will climate change affect existing inequities in
occupational heat exposure and related health outcomes? Please provide
relevant data.
(24) How will climate change affect the risk of occupational heat-
related illness and mortality in the different regions of the United
States?
(25) How should climate change be factored into an OSHA heat
illness and injury prevention standard?
(26) What efforts are employers currently taking to prepare for and
respond to the ways that climate change
is altering hazardous heat exposure in their workplaces?
II. Existing Heat Injury and Illness Prevention Efforts
A. OSHA Efforts
OSHA has taken a multi-pronged approach to address hazardous heat
among both indoor and outdoor workers. This includes efforts ranging
from education and awareness building, guidance, compliance assistance,
stakeholder engagement, and enforcement.
1. OSHA's Heat Illness Prevention Campaign and Other Guidance Efforts
OSHA has a long-running Heat Illness Prevention Campaign (https://www.osha.gov/heat), which was initiated in 2011 to build awareness of
prevention strategies and tools for employers and workers to reduce
occupational heat-related illness. Historically, the Campaign has
utilized the slogan ``Water. Rest. Shade.'' The agency updated Campaign
materials in 2021 to recognize both indoor and outdoor heat hazards, as
well as the importance of protecting new and returning workers from
hazardous heat. These efforts, which are ongoing, incorporate
stakeholder feedback and feature materials available in an increasing
number of languages. Despite the strengths and reach of the Campaign,
these guidance and communication materials are not legally enforceable
requirements.
In addition to the Heat Illness Prevention Campaign materials, OSHA
publishes a heat specific Safety and Health Topics page (https://www.osha.gov/heat-exposure), which provides additional information and
resources on heat topics. The page provides information on planning and
supervision in hot environments, identification of heat-related illness
and first aid, information on prevention such as training, calculating
heat stress and controls, personal risk factors, descriptions of other
heat standards and case study examples of situations where workers
developed heat-related illness. OSHA and the National Institute for
Occupational Safety and Health (NIOSH) also co-developed a Heat Safety
Tool Smartphone App for both Android and iPhone devices. The app
provides outdoor location sensitive temperature, humidity, and heat
index readings, as well as provides a corresponding risk level for
ranges of heat index. The app is not for indoor use if using
automatically downloaded data for the heat index calculation. Each risk
level provides relevant information on identifying signs and symptoms
of heat-related illness and steps that should be taken at that risk
level to prevent heat-related illness.
2. Stakeholder Engagement--NACOSH Work Group
On June 22, 2021, at a meeting of the National Advisory Committee
for Occupational Safety and Health (NACOSH), the agency announced its
intention to form a NACOSH work group to engage stakeholders and better
understand current best practices and challenges in occupational heat-
related illness prevention across a variety of industries to inform
OSHA's response to this important hazard. This NACOSH Heat Illness
Prevention Work Group (WG) will consist of experts who have extensive
knowledge and experience in causes of, identification of, and factors
that affect heat-related illness hazards in the workplace, as well as
best practices and interventions for mitigating occupational heat-
related illness. OSHA intends to initially convene the work group in
late fall 2021.
3. General Duty Clause
Although OSHA does not have a specific standard governing hazardous
heat conditions at workplaces, the agency currently enforces Section
5(a)(1) (General Duty Clause) of the OSH Act against employers that
expose their workers to this recognized hazard. Section 5(a)(1) states
that employers have a general duty to furnish to each of their
employees employment and a place of employment free from recognized
hazards that cause or are likely to cause death or serious physical
harm to employees (29 U.S.C. 654(a)(1)). To prove a violation of the
General Duty Clause, OSHA needs to establish--in each individual case--
that: (1) The employer failed to keep the workplace free of a hazard to
which its employees were exposed; (2) the hazard was recognized; (3)
the hazard was causing or likely to cause death or serious injury; and
(4) a feasible means to eliminate or materially reduce the hazard
existed. (See, e.g., A.H. Sturgill Roofing, Inc., 2019 O.S.H. Dec.
(CCH) ] 33712, 2019 WL 1099857, (No. 13-0224, 2019)).
OSHA has relied on the General Duty Clause to cite employers for
heat-related hazards for decades. Additionally, OSHA has issued various
forms of guidance for employers and employees whose work occurs in
indoor and outdoor heat environments and has addressed heat-related
illness in Regional Emphasis Programs in an attempt to protect workers
from heat-related injury. (Please see OSHA Heat Illness Prevention
Campaign and Guidance Efforts and Other Enforcement Efforts, Sections
II.A.1 and II.A.4 of this ANPRM, respectively.) However, the General
Duty Clause does not specifically prescribe hazardous heat exposure
thresholds or provide specifics on how employers are to eliminate or
reduce their employees' exposure to hazardous heat. A standard specific
to heat-related injury and illness prevention would more clearly set
forth employer obligations and help employers to identify the measures
necessary to more effectively protect employees from hazardous heat.
OSHA's enforcement efforts to protect employees from hazardous heat
conditions using the General Duty Clause, although important, have been
met with significant legal challenges, leaving many workers vulnerable
to heat-related hazards. Because there are no specific, authoritative
exposure thresholds for OSHA to rely on, it has been challenging for
the agency to prove the existence of a recognized hazard, even in cases
in which a heat-related fatality has occurred. (See, e.g., A.H.
Sturgill Roofing, Inc., 2019 O.S.H. Dec. (CCH) ] 33712, 2019 WL
1099857, (No. 13-0224, 2019); Aldridge Elec., Inc., 26 BNA OSHC 1449,
2016 WL 8581709, (No. 13-2119, 2016)).
Moreover, in litigated cases OSHA has been largely unsuccessful in
relying on third-party scientific documents--such as ACGIH exposure
thresholds and NIOSH criteria--to prove the existence of a recognized
hazard. (See Aldridge Elec., Inc., 2016 WL 8581709 at *14 (noting that
``none of these documents is a mandatory document that [employers] must
follow akin to an OSHA regulation.''); Industrial Glass, 15 BNA OSHC
1594, 1992 WL 88787, at *12 n. 10, (No. 88-348, 1992) (noting that the
NIOSH criteria ``[do] not have the force or effect of law.'')).
Additionally, because the available scientific information is not
currently defined in terms of a workplace hazard standard, adjudicators
have found that crucial terms and methods for determining the severity
of risk for heat-related illness are too vague or insufficiently
defined to effectively determine the existence of a recognized hazard
in the context of a particular case. (See, e.g., A.H. Sturgill Roofing,
Inc., 2019 WL 1099857 at *4 (noting that the National Oceanic and
Atmospheric Administration's (NOAA) National Weather Service Heat Index
chart does not define ``prolonged exposure'' or explain what factors
must be considered to increase heat index values; only stating that
``exposure to full sunshine
can increase heat index values by up to 15 [deg]F.'')).
Under the General Duty Clause, OSHA cannot require abatement before
proving in an enforcement proceeding that specific workplace conditions
are hazardous; whereas a standard would establish the existence of the
hazard at the rulemaking stage, thus allowing OSHA to identify and
require specific abatement measures without having to prove the
existence of a hazard in each case. Given OSHA's burden under the
General Duty Clause, it is currently difficult for OSHA to ensure
necessary abatement before employee lives and health are unnecessarily
endangered. Moreover, under the General Duty Clause OSHA must largely
rely on expert witness testimony to prove both the existence of a
hazard and the availability of feasible abatement measures that will
materially reduce or eliminate the hazard in each individual case.
(See, e.g., Industrial Glass, 1992 WL 88787 at *4-7).
4. Other Enforcement Efforts
In 2019, OSHA conducted 289 heat-related inspections (OSHA, August
20, 2021). More than 110 of these were initiated by complaints and 20
were due to the occurrence of a fatality or catastrophe. As a result of
these inspections, OSHA issued 155 Hazard Alert Letters (HALs), which
provide employers with information to mitigate hazards and resources to
assist in this process when OSHA determines a formal citation cannot be
issued. OSHA issued only 31 General Duty Clause citations during the
same period (OSHA, August 20, 2021). Thus, HALs were issued at five
times the rate of 5(a)(1) citations in 2019.
On September 1, 2021, OSHA's Directorate of Enforcement Programs
issued an Inspection Guidance for Heat-Related Hazards, which
establishes a new enforcement initiative to prevent heat-related
illnesses and fatalities while working in hazardous hot indoor and
outdoor environments (OSHA, September 1, 2021). The guidance provides
that days when the heat index exceeds 80 degrees Fahrenheit will be
considered heat priority days. Enforcement efforts will be increased on
heat priority days for a variety of indoor and outdoor industries, with
the aim of identifying and mitigating potential hazards and preventing
heat-illnesses before they occur.
OSHA's Region VI regional office, located in Dallas, TX, has a
heat-related special Regional Emphasis Program (REP) (OSHA, October 1,
2019). This region covers Texas, New Mexico, Oklahoma, Arkansas, and
Louisiana, which have a high number of heat-related injuries,
illnesses, and fatalities. This REP allows field staff to conduct heat
illness inspections of outdoor work activities on days when the high
temperature is forecast to be above 80 degrees Fahrenheit. This REP
includes employers with fewer than 11 employees. Under the authority of
this REP, Region VI conducted 78 inspections on heat-related illness,
which identified 89 violations, in 2019 alone.
Heat-related inspections are also initiated by heat-related
complaints, hospitalizations or fatalities, and during an unrelated
programmed or unprogrammed inspection where a heat hazard is
identified. In addition, OSHA Area Offices can initiate heat
interventions or inspections based on local knowledge of
establishments, referrals from the local health department, or from
other Federal agencies with joint jurisdictions, such as U.S.
Department of Agriculture (USDA), Environmental Protection Agency
(EPA), media referrals or previous OSHA inspection history.
5. Applicable OSHA Standards
OSHA currently has other existing standards that, while applicable
to some issues related to hazardous heat, have not proven to be
adequate in fully protecting workers. OSHA's Recordkeeping standard (29
CFR 1904.7) requires employers to record and report injuries and
illnesses that meet recording criteria. If an injury or illness does
not require medical treatment beyond the provision of first aid, it
does not need to be reported. Some actions that a worker may be
recommended to take when experiencing heat-related illness, such as
hydration, are considered to be first aid, and therefore are not
recordable.
The agency's Sanitation standards (29 CFR 1910.141, 29 CFR 1915.88,
29 CFR 1917.127, 29 CFR 1926.51, and 29 CFR 1928.110) require employers
to provide potable water readily accessible to workers. While these
standards require that drinking water be made available in ``sufficient
amounts,'' it does not specify what those amounts are, and employers
are only mandated to encourage workers to frequently hydrate on hot
days.
OSHA's Safety Training and Education standard (29 CFR 1926.21)
requires employers in the construction industry to train employees in
the recognition, avoidance, and prevention of unsafe conditions in
their workplaces. OSHA's PPE standards (29 CFR 1910.132, 29 CFR
1915.152, 29 CFR 1917.95, and 29 CFR 1926.28) require employers to
conduct a hazard assessment to determine the appropriate PPE to be used
to protect employees from the hazards identified in the assessment.
However, hazardous heat is not specifically identified as a hazard for
which workers need training or PPE, complicating the application of
these requirements to hazardous heat.
The following questions are intended to solicit information related
to the existing efforts OSHA has undertaken to prevent occupational
heat-related illness, injuries, and fatalities.
(27) Are OSHA's existing efforts and authorities adequate or
effective in protecting workers from hazardous heat in indoor and
outdoor work settings?
(28) What additional efforts or improvements should be undertaken
by OSHA to protect workers from hazardous heat in indoor and outdoor
work settings?
(29) What are the gaps and limitations of existing applicable OSHA
standards, as well as existing campaign, guidance, enforcement, and
other efforts for preventing occupational heat-related illness in
indoor and outdoor work settings?
B. Petitions for Rulemaking
OSHA has received three petitions from Public Citizen and
supporting organizations, in 2011, 2018, and 2021, to implement a heat
standard. The petitions presented data on the impacts of heat on
workers' morbidity and mortality. The 2011 petition was for an
Emergency Temporary Standard under section 6(c) of the OSH Act and was
denied for failing to meet the grave danger requirement of the Act. The
2018 petition asked for an OSHA heat standard under section 6(b) of the
OSH Act and was co-signed by over 130 organizations and nearly 100
individuals. The 2021 petition again requested that OSHA issue an
Emergency Temporary Standard. The agency has not yet responded to the
2018 and 2021 petitions.
Over the last several years, many members of Congress have also
urged OSHA to initiate rulemaking for a Federal heat standard. In 2019,
OSHA received a request for rulemaking from members of the Senate
(Brown et al., November 18, 2019). In August 2021, OSHA received a
request for rulemaking from members of both the Senate and the House of
Representatives (Padilla et al., August 3, 2021; Chu et al., August 6,
2021). Both chambers of Congress also have pending legislation in the
2021-2022 legislative session that would order OSHA to develop and
implement a Federal heat standard (U.S. Senate, 117th Congress, April
12, 2021; U.S. House of Representatives, 117th
Congress, March 26, 2021). This legislation has also been considered in
past legislative sessions.
C. NIOSH Criteria Documents
NIOSH first proposed details of a potential Federal heat standard
in 1972 in its Criteria for a Recommended Standard (NIOSH, 1972).
Criteria documents, issued under the authority of section 20(a) of the
Occupational Safety and Health Act of 1970, recommend occupational
safety and health standards based on exposure limits and work intensity
that are safe for various periods of employment as established by a
critical review of scientific and technical information. NIOSH's
criteria for a recommended standard have since been updated in 1986
(NIOSH, April 1986) and again in 2016 (NIOSH, February 2016). The 2016
criteria recommend that a Federal heat standard include provisions for
medical screening and physiological monitoring, heat stress thresholds,
rest breaks, hydration, shade, acclimatization plans, engineering
controls (e.g., air conditioners, fans, tents), administrative controls
(e.g., rest breaks and altered work schedules), PPE and auxiliary body
cooling (e.g., cooled or iced vests, jackets, or other wearable
garments), exposure and medical monitoring, hazard notification alerts,
worker training and education, medical surveillance, and recordkeeping
(NIOSH, February 2016).
The 2016 criteria document recommends occupational exposure limits
for heat stress, such that no worker be ``exposed to combinations of
metabolic and environmental heat greater than'' the recommended alert
limit (RAL, for unacclimatized workers) or the recommended exposure
limit (REL, for acclimatized workers). The NIOSH criteria recommend
that environmental heat should be assessed with hourly measurements of
Wet Bulb Globe Temperature (WBGT) (NIOSH, February 2016), and metabolic
heat should be assessed using the metabolic-work-rates set by ACGIH
(ACGIH, 2017). There are lower recommended exposure limits for
unacclimatized workers, workers who are wearing work clothing that
minimizes heat dissipation from the body, and those who have underlying
personal risk factors. These exposure limits were highly sensitive,
meaning the exposure limits were met or exceeded, in an investigation
of a subset of 14 cases of fatal (100% sensitivity) and 11 nonfatal
(72% sensitivity) heat-related illness in workers that occurred during
outdoor work (Tustin et al., July 6, 2018).
D. History and Requirements of State Standards
As of October 2021, four states have promulgated hazardous heat
standards requiring employers in various industries and workplace
settings to provide protections and abatement measures to reduce the
risk of heat-related illness for their employees: California,
Minnesota, Oregon, and Washington. Oregon issued a temporary rule in
July of 2021 after experiencing temperatures well above 100 [deg]F for
an extended period. Washington State also issued emergency heat rules
during the summer of 2021 that provide additional worker protections to
its previously promulgated heat rule. Additionally, since 2020, three
more states, Colorado, Maryland, and Nevada, have passed laws requiring
state health and safety administrators to promulgate rules related to
hazardous heat in the workplace. Virginia's Safety and Health Codes
Board is also considering a standard on this topic.
State standards differ in the scope of coverage. For example,
Minnesota's standard covers only indoor workplaces. California and
Washington standards cover only outdoor workplaces, although California
is engaged in rulemaking for a potential indoor heat standard. Oregon's
emergency rule covers both indoor and outdoor workplaces. California,
Washington, and Oregon all have additional protections that are
triggered by high heat, however, they differ as to the trigger for
these additional protections: In California it is at a temperature
reading of 95 [deg]F (and only includes certain industries), in
Washington it is at a temperature reading of 100 [deg]F, and in Oregon
it is at a heat index of 90 [deg]F. State rules also differ in the
methods used for triggering the heightened protections against
hazardous heat. Minnesota's standard considers the type of work being
performed (light, moderate, or heavy) and has calculated a threshold
WBGT for each work activity. California's heat-illness prevention
protections go into effect at 80 [deg]F, ambient temperature.
Washington's rule also relies on ambient temperature readings combined
with considerations for the weight and breathability of workers'
clothing. Oregon's emergency rule relies on the heat index as
calculated by NOAA's National Weather Service.
All of the state standards require training for employees and
supervisors. All of the state standards except for Minnesota require
employers to provide at least 1 quart of water per hour for each
employee, require some form of emergency response plan, mention the
importance of acclimatization for workers, and require access to shaded
break areas. Washington and Oregon require that employers provide
training in a language that the workers understand. Similarly,
California's standard requires that employers create a written heat-
illness prevention plan in English as well as in whatever other
language is understood by the majority of workers at a given workplace.
California has the most robust acclimatization program, which requires
close monitoring of new employees for up to fourteen days and
monitoring of all employees during a heat wave. Table II.D.1, below,
highlights these and additional similarities and differences between
the existing state standards on hazardous heat.
Table II.D.1--State Rules on Hazardous Heat as of August 2021
----------------------------------------------------------------------------------------------------------------
WA **** (emergency
Standard requirements CA * MN ** OR *** rule additions in
italics)
----------------------------------------------------------------------------------------------------------------
Worksite coverage............... Outdoor, year- Indoor, year-round Indoor and Outdoor, May 1-
round. outdoor, Sept. 30.
emergency rule.
Thresholds triggering protection 80 [deg]F (ambient Between 77 [deg]F- 80 [deg]F (NOAA 89 [deg]F (ambient
requirements. temp.). 86 [deg]F (WBGT) NWS Heat Index). temp.); lower if
based on workload. wearing heavy
clothing/PPE.
Add'l high heat protections..... At 95 [deg]F No................ At 90 [deg]F...... At 100 [deg]F.
(certain
industries only).
Water/Hydration................. 1 qt./hr./worker.. No................ 1 qt./hr./worker, 1 qt./hr./worker
cool or cold. Suitably cool.
Shade........................... Yes............... N/A............... Yes............... Yes.
Training........................ Yes (new hire).... Yes (new hire and Yes............... Yes (new hire and
annual). annual).
Breaks.......................... Yes (Encouraged Yes (After two Yes (Mandatory if Yes. (Encouraged
generally, hours exposure at symptoms at any preventative and
mandatory if threshold). temp. every 2 must be paid;
symptoms). hours for all at Mandatory if
90 [deg]F). symptoms;
Mandatory at 100
[deg]F).
Acclimatization Plan............ Yes............... No................ Yes (in practice No (only included
at 90 [deg]F). in training).
Heat Illness Prevention Plan.... Yes............... No................ No................ Yes (as part of
accident
prevention plan).
Emergency Medical Response Plan. Yes............... No................ Yes............... Yes.
Medical Monitoring.............. Reactive, Reactive.......... Reactive.......... Reactive.
Proactive when
above 95 [deg]F.
Record-keeping requirements..... Yes............... Yes............... No................ Yes.
----------------------------------------------------------------------------------------------------------------
* CAL/OSHA, Title 8, section 3395. Heat Illness Prevention. https://www.dir.ca.gov/Title8/3395.html.
** Minnesota Administrative Rules. Section 5205.0110 Indoor ventilation and temperature in places of employment.
https://www.revisor.mn.gov/rules/5205.0110/.
*** Oregon Administrative Rules. 437-002-0155 Temporary Rule Heat Illness Prevention. https://osha.oregon.gov/OSHARules/div2/437-002-0155-temp.pdf.
**** Washington Administrative Code (WAC) Title 296, General Occupational Health Standards. Sections 296-62-095
through 296-62-09560. Outdoor Heat Exposure. https://app.leg.wa.gov/WAC/default.aspx?cite=296-62&full=true#296-62-095; Emergency Rule 2125 CR103E. https://lni.wa.gov/rulemaking-activity/AO21-25/2125CR103EAdoption.pdf.
The following questions are intended to solicit information related
to the existing efforts at the state level to prevent occupational
heat-related illness, injuries, and fatalities.
(30) What are the most effective aspects of existing state
standards aimed at preventing occupational heat-related illness?
(31) What are the challenges with the implementation of existing
state standards aimed at preventing occupational heat-related illness?
(32) Of the existing state standards, have any been more effective
or challenging in their implementation than others? Why?
(33) What components of a state standard or program should be
included in Federal guidance or regulatory efforts on heat-related
illness prevention?
(34) Would any of the elements of the state standards not be
feasible to include at the Federal level?
E. Other Standards
Various other organizations have also either identified the need
for standards to prevent heat-related injury and illness or published
their own standards. In 2019, the American National Standards
Institute/American Society of Safety Professionals A10 Committee (ANSI/
ASSP) announced a proposed consensus standard on heat stress
management. The International Organization for Standardization has a
standard estimating heat stress: ISO 7243: Hot Environments--Estimation
of Heat Stress on Working Man, Based on the WBGT-Index (ISO, 2017).
Additional standards address predicting sweat rate and core temperature
(ISO 7933), methods for determining metabolic rate (ISO 8996),
physiological strain (ISO 9886), and thermal characteristics for
clothing (ISO 9920) (NIOSH, February 2016). The ISO heat stress
standard uses WBGT values to assess hot environments and assumes
workforces to which thresholds are applied are healthy, physically fit,
and are wearing standard clothing.
ACGIH has identified Threshold Limit Values or TLVs for heat stress
and heat strain (ACGIH, 2017). The TLVs utilize WBGT and take into
consideration metabolic rate or work load categories: Light (sitting,
standing, light arm/handwork, occasional walking), moderate (normal
walking, moderate lifting), heavy (heavy material handling, walking at
a fast pace), very heavy (pick and shovel work). Additionally, ACGIH
provides clothing adjustment factors in degrees Celsius that should be
added to the assessed WBGT for certain types of work clothing. The TLVs
range from WBGTs of approximately 24.5 degrees Celsius at the highest
level of work to just under 34 degrees Celsius at light work and low
metabolic rates (ACGIH, 2017). ACGIH emphasizes that the TLVs are
appropriate for healthy, acclimatized workers and they encourage
screening of workers for potential sensitivities to heat and provide
guidelines for physiological monitoring for heat strain. An action
limit that is below the level of the TLV is identified for
unacclimatized workers.
The U.S. Armed Forces has developed extensive heat-related illness
prevention and management strategies. The Warrior Heat and Exertion
Related Events Collaborative is a tri-service group of military leaders
focused on clinical, educational, and research efforts related to
exercise and exertional heat-related illnesses and medical emergencies
(HPRC, October 6, 2021). The U.S. Army has a Heat Center at Fort
Benning which focuses on management, research, and prevention of heat-
related illness and death (Galer, April 8, 2019). In 2016, the U.S.
Army updated its Training and Doctrine Command (TRADOC) Regulation 350-
29 addressessing heat and cold casualties. The regulation includes
requirements for rest and water consumption according to specific WBGT
levels and work intensity (Department of the Army, July 18, 2016). The
U.S. Navy has developed Physiological Heat Exposure Limit curves based
on metabolic and environmental heat load and represent the maximum
allowable heat exposure limits, which were most recently updated in
2009. The Navy monitors WBGT, with physical training diminishing as
WBGTs increase and all nonessential outdoor activity stopped when WBGTs
exceed 90 degrees Fahrenheit (Department of the Navy, February 12,
2009). The U.S. Marine Corps follows the Navy's guidelines for
implementation of the Marine Corps Heat Injury Prevention Program
(Commandant of the Marine Corps, June 6, 2002). The U.S. Army and U.S.
Air
Force issued a technical heat stress bulletin in 2003 with measures to
prevent indoor and outdoor heat-related illness in soldiers, with
recommended limitations of continuous work at ``moderate'' or ``hard''
intensities, acclimatization planning, work-rest cycles, and fluid and
electrolyte replacement (Department of the Army and Air Force, March 7,
2003).
The following questions are intended to solicit information related
to the existing efforts undertaken to prevent occupational heat-related
illness, injuries, and fatalities by other entities.
(35) Do any of these existing standards contain elements that
should be considered for a Federal standard?
(36) Are there other industry standards that contain elements that
should be considered for a Federal standard?
(37) Are there elements of these standards that would not be
appropriate or feasible for a Federal heat standard?
F. Employer Efforts
While this section has primarily detailed efforts undertaken by
OSHA, other Federal agencies, states, and industry trade associations,
OSHA also recognizes that some employers may be engaged on this topic
and implementing their own heat-related illness prevention efforts.
The following questions are intended to solicit information,
relevant data sources, and considerations to further assess the current
employer efforts to prevent heat-related illness and their efficacy in
preventing heat-related illnesses.
(38) What efforts are employers currently taking to prevent
occupational heat-related illness in their workplace? Please provide
examples and data.
(39) How effective have employers been in preventing occupational
heat-related illness in their workplaces, and how are employer-driven
heat injury and illness prevention programs being evaluated?
III. Key Issues in Occupational Heat-Related Illness
A. Determinants of Occupational Heat Exposure
1. Heat Exposure
Workers in both indoor and outdoor occupations in a variety of
sectors are exposed to heat at work through process, exertional, and/or
environmental heat. Hazardous heat exposure can reduce the body's
ability to regulate physiological processes and can result in heat-
related injury or illness, heat stroke, or death. Determining when heat
becomes hazardous is complex. Heat exposure and its resultant health
effects depend on multiple factors, such as heat-generating practices
within a workplace, level of exertion during work, air temperature,
humidity, whether work is occurring in direct sunlight or shade, wind,
and cloud cover (OSHA, September 2, 2021). Individual-level factors
such as age, pharmaceutical use, underlying health conditions (such as
cardiovascular diseases), and the ability to cool at night (during heat
waves or access to night time air conditioning, for example) also play
a role (Kilbourne, 1997; Quandt et al., 2013; OSHA, October 6, 2021b).
Multiple metrics and thresholds exist for measuring heat and
identifying when it may become hazardous to a population. Ambient
temperature, heat index, and WBGT are available metrics for measuring
environmental heat and identifying conditions that may lead to heat-
related injury or illness. Ambient temperature, which can be calculated
using a common thermometer, is the most accessible and understandable
metric that most people are familiar with. However, ambient temperature
measurements alone do not take into consideration humidity, which is an
important factor that influences the body's ability to cool. Heat index
combines air temperature and humidity and is a widely reported weather
statistic that many people are familiar with and is often referred to
as the ``feels like'' or ``apparent'' temperature. Heat index is used
for setting heat advisories (NWS, September 2, 2021) but does not take
into consideration radiant heat or wind speed, which the more health-
relevant WBGT does. WBGT is a health-relevant measurement that
incorporates air temperature, wind, radiant heat, and humidity (Budd,
2008; OSHA, September 15, 2017; Oliveira et al., 2019). Measuring WBGT
requires specialized thermometers or equipment, and may not always be
available as a forecast through the National Weather Service.
Additionally, WBGT may require guidance and training to avoid confusion
with more well-known scales like temperature or heat index.
Another challenge with each of these metrics is identifying
appropriate thresholds for each metric that will prevent adverse health
impacts due to hazardous heat exposure. There is no universally
accepted threshold for ambient temperature, heat index, or WBGT at
which heat is considered hazardous. Determining thresholds is
complicated by differences in regional climatology, where one region's
population may become vulnerable to heat-related illness at lower heat
levels (Grundstein et al., January 2015; NWS, August 25, 2021). NOAA,
NIOSH, OSHA, the U.S. Military, and other organizations currently offer
differing thresholds and metrics for the identification of hazardous
heat (Department of the Army and Air Force, March 2007; NIOSH, 2016;
NWS, August 25, 2021; OSHA, September 2021; NWS, September 1, 2021).
Existing state standards also apply different thresholds and metrics.
Further, existing thresholds for various metrics may not be protective
in the occupational setting because injuries and illnesses have been
reported below these existing thresholds (Morris et al., January 28,
2019; Park et al. July 2021), and many of the thresholds indicating the
potential for heat-related injury or illness are based on older data or
studies that included populations that may not be most appropriate for
evaluating heat stress or strain in the occupational setting, such as
military populations (Steadman, April 11, 1979; Rothfusz, July 1, 1990;
Budd, 2008).
The following questions are intended to solicit information,
relevant data sources, and considerations to further assess the
application of various heat metrics and the identification and
definition of hazardous heat using metric thresholds.
(40) What metrics are currently being used to monitor and assess
hazardous heat exposure in the workplace (e.g., heat index, ambient
temperature, WBGT)?
(41) What are the advantages and disadvantages of using each of
these metrics (e.g., heat index, ambient temperature, WBGT) in indoor
and outdoor work settings? Are there any challenges associated with
training employers and employees on these different metrics?
(42) Are there other metrics used to assess hazardous heat exposure
in the workplace that are not discussed here?
(43) What are current and best practices in defining hazardous heat
exposure in outdoor and indoor workplaces, and what are the limitations
or challenges associated with those practices?
(44) Are there industries implementing exposure monitoring for
heat? Please provide examples and data.
(45) What thresholds are utilized for various metrics implemented
in existing occupational heat prevention plans or activities? Are these
thresholds effective for preventing heat-related illness and
fatalities?
(46) Which metrics and accompanying thresholds are both feasible
and health-protective in both
indoor and outdoor occupational settings?
(47) Does application of certain heat metrics require more training
than the use of other heat metrics?
2. Contributions to Heat Stress in the Workplace
Air temperature, humidity, wind, and whether work occurs in direct
sunlight all contribute to the potential for heat stress for outdoor
workers. Additionally, physical exertion contributes to heat stress by
increasing metabolic heat production. Exertion is an important
consideration for the development of heat stress especially since
physical activities may take place over prolonged periods of time in a
work setting and in environmental conditions that limit the body's
ability to cool, such as working in direct sunlight or under warm and
humid conditions. These factors that contribute to heat stress can lead
to heat strain and heat-related illness when the body fails to lose
heat. Some surfaces, such as asphalt, absorb heat and can add to heat
exposure. The urban heat island effect is a well-studied phenomenon
that can elevate temperatures in areas concentrated with heat absorbent
surfaces. For example, dense urban areas may experience afternoon
temperatures 15-20 degrees higher than surrounding areas with more
natural land cover and vegetation (NIHHIS, August 25, 2021). PPE can
also contribute to heat stress by interfering with the body's ability
to cool. PPE intended to protect workers from chemical, physical, or
biological hazards can reduce sweat evaporation and subsequent cooling
(i.e., limit the body's ability to sweat), can trap heat and moisture
next to the skin, and can increase the level of exertion required to
complete a task (NIOSH, February 2016).
The factors that contribute to heat stress in outdoor settings
contribute to heat stress in indoor settings as well, especially in
buildings that lack adequate climate control. Additionally, heat-
producing processes and equipment such as those that generate steam,
generate heat, or use certain tools and combustion, can increase
ambient temperature and contribute to heat stress in indoor work
settings. Lack of adequate climate control in indoor work settings can
also contribute to occupational heat stress since indoor settings can
increase in temperature and humidity as outdoor temperatures increase,
and there is no relief for process or task-related heat production.
Additionally, buildings with windows may be further heated by sunlight
that enters windows and warms the workspace.
The vulnerability of the energy grid is another variable that may
place many workers at risk of experiencing heat-related illness. In
many areas of the country, energy grids are vulnerable to brownouts and
blackouts in conditions of high heat due to the increased demand and
stress placed on the energy infrastructure (Stone, Jr., et al., 2021).
Because of this vulnerability of a key cooling mechanism, more workers
in more industries may be at risk for experiencing heat stress, strain,
and heat-related illness than is currently realized, especially during
heat waves or during other natural disasters that impact the
functionality of energy grids.
In both indoor and outdoor settings, individual risk factors
contribute to the risk of heat-related illness as some individuals are
more susceptible to the detrimental effects of heat. Occupational heat-
related fatalities have been found to occur more frequently in men than
in women, in those with preexisting conditions (e.g., obesity,
diabetes, hypertension, cardiac disease), and in those with a
preexisting use of certain medications or illicit drugs that predispose
individuals to heat-related illness (Gubernot et al., February 2015;
Tustin et al., July 6, 2018; Tustin et al., August 2018). Other
factors, such as age, fitness level, alcohol consumption, prior heat-
related illness, and lack of access to air conditioning in housing,
also reduce the body's ability to regulate heat and can increase
individual risk of heat-related illness. Workplace controls should
focus on making indoor and outdoor work safe for all employees, while
also complying with the Americans with Disabilities Act and the Age
Discrimination in Employment Act.
The following questions are intended to solicit information,
relevant data sources, and considerations to further assess
contributions to heat stress in indoor and outdoor work settings as
well as individual risk factors that may contribute to heat-related
illness in occupational settings.
(48) What factors, beyond those discussed above, contribute to heat
stress in outdoor and/or indoor occupational settings?
(49) Is air conditioning provided in employer-provided or sponsored
housing?
(50) Are there existing employer efforts or programs to ensure that
employees have the ability to adequately cool at night in order to
recover from occupational heat exposure?
(51) What factors are the most important contributors to heat-
related illness risk?
(52) Are there other individual risk factors that contribute to the
risk of heat-related illness?
(53) What individual risk factors are the most important
contributors to heat-related illness risk?
(54) Are there existing employer-led heat prevention programs that
consider individual-level risk factors in their prevention guidance? If
so, how are they implemented? What are the challenges associated with
this?
B. Strategies To Reduce Occupational Heat-Related Injury and Illness
Workplace heat-related injury and illness is preventable, and many
effective controls can be implemented. The following sections provide a
brief overview and targeted questions about controls that would be
important to consider as part of an effective heat injury and illness
prevention program.
1. Heat Injury and Illness Prevention Programs
Safety and health programs aim to prevent workplace injuries,
illnesses, and fatalities by using a proactive approach to managing
workplace safety and health. An effective heat injury and illness
prevention program would include elements on: Assessing heat hazards
that may occur at the workplace, acclimatizing new and returning
workers, evaluating how and when heat will be measured, and determining
what controls will be put into place and what training will be provided
to workers and supervisors. Evaluations of heat-related enforcement
cases have shown that in investigations of heat-related fatalities or
heat-related illness that resulted in 5(a)(1) violations from 2012-
2013, no employer had a complete heat illness prevention program that
addressed all of the recommended components, and 12 of the 20 cases
evaluated had no heat illness prevention program at all (Arbury et al.,
April 2016). In one study, the implementation of a heat illness
prevention program was found to decrease workers' compensation costs
associated with heat-related illness incidents and reduce the total
number of heat-related illnesses experienced by outdoor municipal
workers in Texas (McCarthy et al., September 2019).
The following questions are intended to solicit information and
relevant data sources that OSHA should consider when evaluating the
need for and elements of a heat injury and illness prevention program
for indoor and outdoor work environments.
(55) What are the elements of a successful employer-led heat injury
and illness prevention program? How are these programs implemented?
What are the challenges associated with them? Please provide examples
and data.
(56) Are there other elements of a heat injury and illness
prevention program that are important to consider?
(57) Are there limitations associated with implementing a heat
injury and illness prevention program across indoor or outdoor work
settings, or across businesses of various sizes? If so, what are they?
(58) Are there demonstrated evaluations on the successes or
limitations of various components of any existing state or employer
heat injury and illness prevention program, including quantitative or
qualitative evaluations?
2. Engineering Controls, Administrative Controls, and Personal
Protective Equipment
Engineering controls, such as air conditioning or increased
ventilation, increase evaporative cooling and can keep body
temperatures at safe levels. Other examples of engineering controls
that may reduce the amount of hazardous heat present could include the
use of local exhaust ventilation at points of high heat production,
insulating hot surfaces or equipment (e.g., furnaces), and providing
shade tents, or other building modifications where appropriate.
Administrative controls, such as making changes to workloads or
work schedules, can be useful in keeping workers cool during hazardous
heat exposure. For example, work schedules may shift from the hottest
parts of the day to cooler times of the day, like overnight or early in
the morning. Employers may implement work-rest cycles by adding
additional rest breaks in the shade or air conditioning away from heat
sources as environmental and exertional heat increases. Some employers
have implemented self-pacing for workers as an alternative to work-rest
cycles, allowing employers to pace themselves throughout the work shift
when heat is hazardous. Other examples of administrative controls could
include reducing physical demands during the hottest times of the day
or implementing buddy systems to ensure workers are watching out for
signs and symptoms of heat-related illness in each other.
OSHA's Heat Illness Prevention Campaign has historically
recommended the implementation of ``Water. Rest. Shade.,'' which is a
combination of engineering and administrative controls to provide
workers with adequate amounts of water, rest, and shade. As discussed
above in more detail, because the Campaign is not mandatory, these
controls are not always implemented in workplaces. An evaluation of 38
enforcement investigations from 2011-2016 found that while nearly 85%
of the inspected employers provided accessible water, none of them
enforced or required rest breaks during periods of hazardous heat
(Tustin et al., August 2018). In some work settings, such as in
agricultural workplaces, workers may be paid piecemeal or receive wages
based on their productivity or output. These payment schemes can result
in workers making tradeoffs between reduced productivity and lost wages
versus taking breaks to rest or drink water (Wadsworth et al., 2019).
However, without breaks, overall productivity can decline during
hazardous heat due to workers being less able to work efficiently, as
well as from higher rates of accidents and heat-related illnesses (Ebi
et al., August 21, 2021).
In some situations, PPE and auxiliary body cooling methods (e.g.,
cooled or iced vests, jackets, or other wearable garments) may further
reduce the risk of heat strain in those working in hazardous heat
conditions. For example, reflective and breathable clothing, cooling
neck wraps, and cooling vests or jackets may provide enhanced
protection to some workers.
The following questions seek to solicit additional information,
data sources, and considerations for engineering and administrative
controls, as well as PPE, and their use in preventing heat-related
illness in indoor and outdoor work settings.
(59) What engineering controls, administrative controls, or PPE can
be used to prevent heat-related illness in indoor and outdoor work
settings? Have the qualitative or quantitative effectiveness of these
controls been evaluated?
(60) Are there data that demonstrate the role of facility energy
efficiency in maintaining optimal thermal conditions, optimizing worker
performance, and cost-effectiveness of cooling strategies?
(61) Are certain controls that are more effective or more feasible
than others? If so, which ones? Do effectiveness and feasibility of
controls differ due to setting (indoor/outdoor, business size,
arrangement of work, etc.)?
(62) What are the limitations associated with implementing water,
rest, and shade effectively in indoor and outdoor work settings?
(63) How are work-rest cycles currently implemented in indoor and
outdoor work settings? What are the limitations for implementation?
(64) Are there additional sources of data or evidence that describe
the quantitative or qualitative impacts of work-rest cycles on
productivity?
(65) How do productivity or output based payment schemes affect the
ability of workers to follow heat illness and injury prevention
training, guidance or requirements?
(66) How do productivity or output based payment schemes affect
employer implementation of heat illness and injury prevention training,
guidance or requirements?
(67) Are there additional sources of data or evidence that describe
the quantitative or qualitative impacts of self-pacing as an
alternative to work-rest cycles to prevent occupational heat-related
illness?
3. Acclimatization
Acclimatization refers to the process of the human body becoming
accustomed to new environmental conditions by gradually adapting to the
conditions over time. Gradual exposure to the condition of concern
(e.g., heat) allows the body to develop more robust physiological
responses, such as a greater sweat response, to adapt to heat more
efficiently. Workers who are new to working in warm environments may
not be acclimatized to heat, and their bodies need time to gradually
adapt to working in hot environments. Evaluations of workplace
fatalities have shown that approximately 70% of deaths occur within the
first few days of work, and upwards of 50% occur on the first day of
work (Arbury et al., August 8, 2014; Tustin et al., August 2018),
highlighting the consequences of workers not becoming acclimatized to
the environmental conditions of the workplace. Acclimatization is also
important for those who may have been previously acclimatized but were
out of the workforce or hot environment of the workplace for more than
2 weeks (e.g., due to vacation or sick leave). All outdoor workers may
need time to acclimatize to heat during early season hazardous heat, or
during particularly severe or long-lasting heat events, which are
associated with higher mortality in the general population (Anderson
and Bell, February 2011). During a heat wave, environmental conditions
may become extremely hazardous, even to workers who may have been
previously acclimatized.
OSHA and NIOSH have historically recommended the ``Rule of 20
Percent'' for acclimatizing workers. Under this regimen, workers would
only work 20 percent of the normal duration of work
on their first day in hazardous heat conditions performing job tasks
similar in intensity to their expected work, increasing the work
duration by 20 percent on each subsequent day until performing a normal
work schedule. For example, if the normal workday lasts 8 hours, then
new workers should work no more than 1 hour and approximately 40
minutes (20 percent of 8 hours) on their first day in the heat, and
spend the remainder of the workday doing work tasks without heat stress
(OSHA, October 7, 2021). They should be given at least one rest break
during the period when they are working. Workers with underlying
medical conditions may need more time to fully adapt to the heat.
The following questions aim to solicit additional information,
relevant data sources, and considerations on the design and
implementation of acclimatization plans for workers in indoor and
outdoor work settings.
(68) What are current and best practices for implementing
acclimatization in various industries and across businesses of various
sizes?
(69) What are the challenges with acclimatizing workers, including
workers in non-traditional/multi-employer work arrangements (e.g.,
temporary workers)?
(70) Are there different challenges and best practices for
acclimatization in indoor work settings versus outdoor work settings?
(71) Are there unique concerns or approaches for implementing
acclimatization for a small versus large business?
(72) Are there additional sources of data or evidence that describe
the quantitative or qualitative impacts of acclimatization schedules on
productivity?
4. Monitoring
Physiological, medical, and exposure monitoring of workers exposed
to heat hazards can prevent heat strain from progressing to heat-
related illness or death. Monitoring can alert both employees and
employers when workers have been exposed to hazardous heat and are
experiencing heat strain and should seek water, rest, shade, cooling,
or medical attention. Monitoring activities may include monitoring
environmental conditions regularly, self-monitoring of urine color, and
monitoring of heart rate and core body temperature. Individual-level
biomonitoring with wearable technologies may be an option in some
occupational settings. Monitoring activities may also include buddy
systems where workers are educated in signs and symptoms of heat-
related illness and proactively look for signs and symptoms in fellow
workers and encourage them to rest, hydrate, and find shade or seek
emergency medical attention if the worker is experiencing signs of
heat-related illness.
The following questions are intended to solicit information,
relevant data sources, and considerations to further assess heat
monitoring activities or programs in occupational settings.
(73) Are there industries or individual employers implementing
exposure, medical, and/or physiological monitoring to assess workers'
health and safety during hazardous heat events?
(74) What are the best practices for implementing a monitoring
program? How effective are the monitoring activities in preventing
heat-related illness in workers?
(75) If physiological and medical monitoring programs are used, who
implements these programs? Does that individual(s) have specialized
training or experience?
(76) If physiological and medical monitoring programs are used, are
data protected by confidentiality or privacy requirements? Please
describe how data are maintained to ensure employee privacy and to meet
any confidentiality or privacy requirements.
(77) How is exposure, medical, or physiological monitoring
currently implemented or tracked across various time scales (e.g.,
hourly, daily) in an occupational setting?
(78) What are the risks or challenges with this type of medical or
physiological monitoring in a workplace?
(79) Do you use physiological or medical monitoring to assist in
identifying high risk employees?
(80) How do you use physiological monitoring data (e.g., as a short
term response to heat stress conditions, to address long term
examination in protecting employees, to identify high risk categories
of workers)?
(81) Do you require that notification of monitoring results be
provided to employees?
(82) Do you use physiological monitoring to validate the
effectiveness of recommended controls?
(83) Are there unique concerns or approaches in developing a
monitoring program for small versus large businesses?
5. Planning and Responding to Heat-Illness Emergencies
A heat-illness emergency occurs when a worker is experiencing a
health crisis due to over-exposure to hazardous heat. Workers and
employers need to be able to identify a heat-illness emergency, know
how to respond to an emergency to protect the health of the affected
worker, to have materials on-site to respond to an emergency, and know
how to contact emergency medical care when needed. Emergency response
plans can ensure that workers understand how to respond in an emergency
and can help prevent heat-related illness from progressing to heat
stroke or death.
The following questions are intended to solicit information,
relevant data sources, and considerations to further assess the role of
heat-illness emergency planning and response in indoor and outdoor work
settings in responding to heat stress in the workplace and preventing
heat-related injury and illness from progressing to heat stroke or
death.
(84) How do organizations in both indoor and outdoor work
environments currently deal with heat-illness emergencies if they
arise?
(85) What are current best practices in workplace response to
occupational heat-illness emergencies?
(86) What are the challenges with responding to a heat-illness
emergency in various work environments (e.g., indoor settings, outdoor
settings, remote locations)?
(87) What should be included in an employer's heat emergency
response plan?
(88) What materials or supplies should employers have on-site to
respond to a heat emergency?
(89) When should employers refer employees for medical treatment or
seek medical treatment for an employee who is experiencing a heat-
illness emergency?
(90) When and how do employers refer employees for medical
treatment or seek medical treatment for them when experiencing a heat-
illness emergency?
6. Worker Training and Engagement
Employers informing employees of the hazards to which employees may
be exposed while working is a cornerstone of occupational health and
safety (OSHA, 2017). Training is an effective tool to reduce injury and
illness (Burke et al., February 2006). Employees must know what
protective measures are being utilized and be trained in their use so
that those measures can be effectively implemented. Training and
education provide employees and managers an increased understanding of
existing safety and health programs. Training provides managers,
supervisors, and employees with the knowledge and skills needed to do
their
work safely, as well as awareness and understanding of workplace
hazards and how to identify, report, and control them.
Because OSHA has long recognized the importance of training in
ensuring employee safety and health, many OSHA standards require
employers to train employees (e.g., the Bloodborne Pathogen standard at
29 CFR 1910.1030(g)(2)). When required as a part of OSHA standards,
training helps to ensure that employees can conduct work safely and
healthfully (OSHA, April 28, 2010). Training is essential to ensure
that both employers and employees understand the sources of potential
exposure to hazardous heat, control measures to reduce exposure to the
hazard, signs and symptoms of heat-related illness, and how to respond
in the event of an emergency. A 2018 analysis of OSHA enforcement
investigations of 66 heat-related illnesses showed that nearly two-
thirds of the employers did not provide employees with training on
occupational heat-related illness (Tustin et al., August 2018).
The following questions are intended to solicit information,
relevant data sources, and considerations to further assess existing
worker training and engagement programs and their effectiveness for
preventing occupational heat injury and illness.
(91) How do employers currently involve workers in heat injury and
illness prevention?
(92) What types of occupational heat injury and illness prevention
training programs have been implemented and how effective are they?
What is the scope and format of these training programs? Are workers in
non-traditional/multi-employer work arrangements included in these
training programs?
(93) What are best practices in worker training and engagement in
heat injury and illness prevention?
(94) How do employers involve workers in the design and
implementation of heat injury and illness prevention activities?
(95) What challenges are there with worker training and engagement
for heat injury and illness prevention?
IV. Costs, Economic Impacts, and Benefits
A. Overview
OSHA also seeks information on the costs, economic impacts, and
benefits of heat injury and illness prevention practices. In addition
to information regarding the costs and economic impacts of heat injury
and illness prevention practices, OSHA is interested in the benefits of
such practices in terms of reduced injuries, illnesses, deaths, and
compromised operations (i.e., emotional distress, staffing turnover,
and unexpected reallocation of resources), as well as any other
productivity effects. As discussed above in Part I of this ANPRM,
millions of workers across hundreds of occupations are likely to be
exposed to conditions that could lead to heat-related injury, illness,
and death.
The effects of heat-related injury and illness can be significant
to employers and workers alike. They harm workers financially,
physically, and mentally, and employers also bear several costs and
reduced revenue. A single serious injury or illness can lead to
workers' compensation losses of thousands of dollars, along with
thousands of dollars in additional costs for overtime, temporary
staffing, or recruiting and training a replacement. Even if a worker
does not have to miss work, heat stress can still lead to higher
turnover and deterioration of productivity and morale.Globally, the
International Labour Organization (ILO) has estimated that increased
heat stress could result in a productivity decline by the equivalent of
80 million full-time jobs by the year 2030 (ILO, 2019).
According to BLS, as shown below in Table IV.A.1, exposure to
environmental heat results in thousands of injury and illness cases and
dozens of deaths per year (BLS, December 22, 2020 and BLS, January 28,
2021). Note that these data do not provide a comprehensive account of
the number of heat-related injuries and fatalities, for a variety of
reasons, such as employee reluctance to report and lack of awareness of
the contributing effects of heat to symptoms.
Table IV.A.1--Reported Occupational Injuries (Involving Days Away From
Work) and Fatalities as a Result of Exposure to Environmental Heat
------------------------------------------------------------------------
Annual Annual
Year injuries fatalities
------------------------------------------------------------------------
2011.................................... 4,420 61
2012.................................... 4,170 31
2013.................................... 3,160 34
2014.................................... 2,660 18
2015.................................... 2,830 37
2016.................................... 4,110 39
2017.................................... 3,180 32
2018.................................... 3,950 49
2019.................................... 3,080 43
------------------------------------------------------------------------
Source: U.S. Bureau of Labor Statistics: Injuries, Illnesses, and
Fatalities, (BLS, December 22, 2020 and BLS, January 28, 2021)
(Accessed August 30, 2021).
The following questions are intended to solicit information on the
topics covered in this section.
(96) OSHA requests any workers' compensation data related to heat-
related injury and illness. Any other information on your workplace's
experience would also be appreciated.
(97) Are there additional data (other than workers' compensation
data) from published or unpublished sources that describe or inform
about the incidence or prevalence of heat-related injuries, illness, or
fatalities in particular occupations and industries?
(98) What are the potential economic impacts associated with the
promulgation of a standard specific to the risk of heat-related injury
and illness? Describe these impacts in terms of benefits, including
reduction of incidents; effects on costs, revenue, and profit; and any
other relevant impact measurements.
(99) If you utilize the WBGT method when making your work
determinations, what were the costs of any associated equipment and/or
training to implement this measurement method?
(100) If you utilize a temperature metric other than WBGT when
making work determinations, what were the costs associated with
measurement and/or training to implement this measurement method?
(101) Have you instituted programs or policies directed at
mitigating heat-related injury and illness at your worksite? If so,
what were the resulting benefits?
(102) If you have implemented a heat injury and illness program or
policy, what was the cost of implementing the program or policy, in
terms of both time and expenditures for supplies and equipment? Please
describe in detail the resource requirements and associated costs
expended to initiate the program(s) and to conduct the program(s)
annually. If you have any other estimates of the costs of preventing or
mitigating heat-related injury and illness, please provide them. It
would be helpful to OSHA to learn both overall totals and specific
components of the program (e.g., cost of equipment, equipment
installation, equipment maintenance, training programs, staff time,
facility redesign).
a. What are the ongoing operating and maintenance costs for the
program?
b. Has your program reduced incidents of heat-related injury and
illness and by how much? Can you identify which elements of your
program most reduced incidents? Which elements did not seem effective?
c. Has your program reduced direct costs for your facility (e.g.,
workers' compensation costs, fewer lost workdays)? Please quantify
these reductions, if applicable.
d. Has your program reduced indirect costs for your facility (e.g.,
reductions in absenteeism and worker turnover; increases in reported
productivity, satisfaction, and level of safety in the workplace)?
(103) Do you provide wearable devices (specific to heat) to
workers? Does each worker get a device or only specific members of the
crew?
a. If wearables are provided, what were the associated upfront
costs of the equipment and how often do they need to be replaced?
b. Which specific wearable did you choose? What were your deciding
factors (i.e., price, ease of use)?
(104) If you are in a state with standards requiring programs and/
or policies to reduce heat stress, how did implementing the program
and/or policy affect the facility's budget and finances?
(105) What changes, if any, in market conditions would reasonably
be expected to result from issuing a standard on heat stress
prevention? Describe any changes in market structure or concentration,
and any effects on the prices of products and services to consumers,
that would reasonably be expected from issuing such a standard.
(106) If you have implemented acclimatization practices in your
workplace, were there any associated costs?
(107) How does your workplace address the costs of any rest breaks
necessary to prevent heat-related injury and illness?
B. Impacts on Small Entities
As part of the agency's consideration of a heat stress standard,
OSHA is concerned about whether its actions will have a significant
economic impact on a substantial number of small entities. Small
entities included small businesses, small non-profit organizations, and
small governmental jurisdictions with a population of less than 50,000.
These other small employer organizations may experience heat stress
issues in much the same manner as small businesses. Injury and illness
incidence rates are known to vary by establishment size. In the
construction industry, for example, across all nonfatal occupational
injuries and illnesses, establishments between 11 and 49 employees had
an average incidence rate of 3.3 per 100 Full Time Equivalent (FTE)
workers, whereas establishments with 1,000 or more employees had an
average incidence rate of 0.9 per 100 FTE workers. (BLS, August 31,
2021). If the agency pursues the development of a standard that would
have such impacts on small businesses, OSHA is required to develop a
regulatory flexibility analysis and convene a Small Business Advocacy
Review panel under the Small Business Regulatory Enforcement Fairness
Act (before publishing a proposed rule (see Regulatory Flexibility Act,
5 U.S.C. 601 et seq.)). Regardless of the significance of the impacts,
OSHA seeks ways of minimizing the burdens on small businesses
consistent with OSHA's statutory and regulatory requirements and
objectives.
The following questions are intended to solicit information on the
topics covered in this section.
(108) How many, and what type of small firms, or other small
entities, have heat-related injury and illness training, or a heat
injury and illness program, and what percentage of their industry
(NAICS code) do these entities comprise? Please specify the types of
heat stress risks employees in these firms face.
(109) How, and to what extent, would small entities in your
industry be affected by a potential OSHA standard to prevent heat
stress? Do special circumstances exist that make preventing heat stress
more difficult or more costly for small entities than for large
entities? Please describe these circumstances.
(110) How many, and in what type of small entities, is heat-related
injury and illness a threat, and what percentage of their industry (by
NAICS codes) do these entities comprise?
(111) Are there alternative regulatory or non-regulatory approaches
OSHA could use to mitigate possible impacts on small entities?
(112) For very small entities (historically defined by OSHA as
those with fewer than 20 employees), what types of heat-related injury
and illness threats are faced by workers? Does your experience with
heat-related injury and illness reflect the lower rates reported by
BLS?
(113) For very small entities, what are the unique challenges
establishments face in addressing heat-related injury and illness?
(114) If you are in a jurisdiction with standards requiring
programs and/or policies to reduce heat stress, how did implementing
the program and/or policy affect your small entity or other small
entities in your jurisdiction?
V. References
Althubaiti A. (2016, May 4). Information bias in health research:
definition, pitfalls, and adjustment methods. Journal of
Multidisciplinary Healthcare, 9, 211-217. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862344/pdf/jmdh-9-211.pdf.
(Althubaiti, May 4, 2016)
American Conference of Governmental Industrial Hygienists (ACGIH).
(2017). Heat Stress and Strain: TLV[supreg] Physical Agents 7th
Edition Documentation. http://mhssn.igc.org/2017%20ACGIH%20-%20Heat%20Stress%20TLV.pdf. (ACGIH, 2017)
Anderson GB and ML Bell. (2011, February). Heat waves in the United
States: mortality risk during heat waves and effect modification by
heat wave characteristics in 43 U.S. communities. Environmental
Health Perspectives, 119, 210-218. doi:10.1289/ehp.1002313.
(Anderson and Bell, February 2011)
Arbury S et al. (2014, August 8). Heat illness and death among
workers--United States, 2012-2013. Centers for Disease Control and
Prevention, Morbidity and Mortality Weekly Report, 63(31). (Arbury
et al., August 8, 2014)
Arbury S et al. (2016, April). A critical review of OSHA heat
enforcement cases: lessons learned. Journal of Occupational and
Environmental Medicine, 58(4). doi:10.1097/JOM.0000000000000640.
(Arbury et al., April 2016)
Brown S, Baldwin T, Murray P, Whitehouse S, Warren E, Schatz B, Wood
Hassan M, Blumenthal R, Casey, Jr. RP, Rosen J, Hirono MK, Reed J.
(2019, November 18). Correspondence from members of the U.S. Senate
to the Honorable Eugene Scalia, Secretary, United States Department
of Labor. (Brown et al., November 18, 2019)
Budd G. (2008). Wet-bulb globe temperature (WBGT)--its history and
limitations. Journal of Science and Medicine and Sport, 11, 20-32.
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(Washington Administrative Code)
Authority and Signature
James S. Frederick, Acting Assistant Secretary of Labor for
Occupational Safety and Health, U.S. Department of Labor, 200
Constitution Avenue NW, Washington, DC 20210, authorized the
preparation of this document pursuant to the following authorities: 29
U.S.C. 653, 655, and 657, Secretary's Order 8-2020 (85 FR 58393; Sept.
18, 2020), and 29 CFR part 1911.
James S. Frederick,
Acting Assistant Secretary of Labor for Occupational Safety and Health.
[FR Doc. 2021-23250 Filed 10-26-21; 8:45 am]
BILLING CODE 4510-26-P
