February 9, 1993

Patrick J. Beecher, M.D.
Associate Medical Director
Ford Motor Company
900 Parklane Towers West
Three Parklane Boulevard
Dearborn, Michigan 48126

Dear Dr. Beecher:

Thank you for your letter dated January 8, requesting interpretations on several OSHA injury and illness recordkeeping issues. I will respond by first repeating each question then addressing it. Wherever possible, I will refer to the Recordkeeping Guidelines for Occupational Injuries and Illnesses.

Q1 The BLS Guidelines (p. 49, B-9) indicates that "if long term restrictions result in permanent assignments to modified jobs, the count of days of restricted work activity ceases once the transfer or modification is made permanent". Does the count of days away cease as well given the same situation?

A1 In order to stop the count of days away from work, the employee must be doing some work. If a decision is made to permanently modify a persons job, and that employee has not yet begun to work at the "new" job, the day count should continue. When the employee begins to work his or her new job, the day count may stop.

Q2 The BLS Guidelines (p. 4, A-12) indicates that "records need not be kept for employees when they are outside the geographic scope of coverage prescribed by section 4(a) of the Act - the United States and its territories." Must records be maintained for Company employees who are employed at Company locations outside of the United States and its territories when they are on Company business and within the geographic scope of coverage?

A2 Yes. Section 4(a) of the Act states "This Act shall apply with respect to employment performed in a workplace in a State, the District of Columbia, ..." Therefore, records must be kept for any employees who are performing work for their employers within the geographic scope of the Act.

Q3 Recent clarification (Stephen Newell, Office of Statistics, 3-11-92) stated that self-administered, self-directed treatments at home are not considered a visit to medical personnel and, therefore, do not constitute medical treatment. Are medically-directed treatments which are self-administered on the employer's premises considered medical treatment when they are not supervised by medical personnel?

A3 As found in the Ergonomic Program Management Guidelines for Meatpacking Plants, medical treatment is defined to include self-administered treatment when made available to employees by their employer. To be considered medical treatment, the treatment must be self-administered at the medical facility or on the employer's premises when provided by the employer. An example would be heat or cold treatments located near the employee's work station to be applied when they are feeling discomfort. The treatment does not have to be supervised by medical personnel to be considered medical treatment.

Q4 Regarding work related injuries which result in chipped or broken teeth, the BLS Guidelines (p. 44, F-8) states that "these injuries would normally be recordable because they ordinarily require medical treatment." Does this mean that all injuries involving chipped or broken teeth are recordable? One could argue that a chipped tooth is a fracture and not a minor injury since it involves damage to the physical structure of a nonsuperficial nature.

A4 The distinction between medical treatment and first aid depends not only on the treatment provided, but also on the severity of the injury being treated. First aid involves treatment of only minor injuries. Injuries are not minor if they result in damage to the physical structure of a non- superficial nature. Our interpretation is that all fractures are non-minor injuries. Therefore, all work related cases involving chipped or broken teeth are recordable.

Q5 The BLS Guidelines (p. 47, B) states that "when counting the number of days away from work or days of restricted work activity, do not include: (1) The initial day of injury or onset of illness, or (2) any days on which the employee would not have worked even though able to work (holidays, vacations, etc.)." How would the lost workdays be counted in the examples below given the specific circumstances?

a. an employee suffers a work related back injury on 2-1-92 and is placed on medical leave. While on medical leave, the employee fractures his leg in a personal fall on 2-15-92 for which his personal physician recommends a medical leave.

1. The Company physician indicates that the employee is unable to work due to his back condition 2-2-92 thru 3-31-92 and may return to his regular job on 4-1-92. The employee's personal physician indicates that the employee is unable to work due to his fractured leg 2-15-92 thru 4-30-92.

Answer: Count the days away from 2-2-92 through 2-15-92.

2. The Company physician indicates that the employee is unable to work due to his back condition 2-2-92 thru 3-31-92 and may return to restricted work 4-1-92 thru 4-30-92. The employee's personal physician indicates that the employee is unable to work due to his fractured leg 2-15-92 thru 4-30-92.

Answer: Count the days away from 2-2-92 through 2-15-92.

3. The Company physician indicates that the employee is unable to work due to his back condition 2-2-92 thru 3-31-92 and may return to restricted work on 4-1-92. However, it is determined that there will be no restricted work available until 4-30-92. The employee's personal physician indicates that the employee is unable to work due to his fractured leg 2-15-92 thru 4-30-92.

Answer: Count the days away from 2-2-92 through 2-15-92.

b. An employee suffers a work related back injury on 2-1-92 and is placed on restricted work activity 2-2-92 thru 3-31-92. On 2-15-92 the employee goes on a personal medical leave for stress.

1. The Company physician evaluates the employee on 2-15-92 and determines that the employee still requires restricted work activity thru 3-31-92 due to the back injury.

Answer: If the stress is not work related, stop counting the days of restricted work activity on 2-15-92. If the stress is work related, stop the count of restricted days on the back case and enter the stress as a new illness case with days away.

2. The Company physician evaluates the employee on 2-15-92 and determines that the employee can return to unrestricted work that day based on his back condition.

Answer: If the stress is not work related, stop counting the days of restricted work activity on 2-15-92. If the stress is work related, stop the count of restricted days on the back case and enter the stress as a new illness case with days away.

Q6 How should a case be recorded when an injured/ill employee does not report back to work even though the Company doctor and/or his doctor has given him permission to do so? The BLS Guidelines (p. 50, B-15) indicates that "employers need not record lost workdays when an injured employee is able to resume work, but simply refuses to do so." If an employee does not report back to work when advised to return to restricted work, is the employer still required to count days of restricted work activity if such work is available? Or are no lost workdays recorded?

A6 If the employee is released by the doctor to do restricted work activity, and refuses to do so, the employer should count the lost work time as days of restricted work activity. If no restricted work is available, count days away.

Q7 Recent clarification (Stephen Newell, Office of Statistics, 7-2-92) of the issue of medical treatment vs first aid for various orthopedic devices indicated that "the use of wraps or nonconstraining devices such as wristlets, tennis elbow bands or elastic bandages are considered first aid treatment, regardless of how long or how often they are used." "The use of casts, splints, or orthopedic devices designed to immobilize a body part are considered medical treatment." For definition purposes, can "orthopedic devices designed to immobilize" be described as those rigid in part or in whole?

A7 Yes. The main issue is the immobilization of the body part.

Q8 Refer to Attachment 1, Defining Recurrence of Cumulative Trauma Disorders (CTDs). Is this interpretation accurate?

A8 Yes.

I hope you find this information useful. If you have any further questions, please contact my staff at Area Code (202) 219-6463.

Sincerely,



Stephen A. Newell
Director
Office of Statistics