June 18, 1993

Ms. Monica Verros, R.N., C.O.H.N.
Occupational Health Advisor
IBP, Inc.
Dakota City, Nebraska 68731

Dear Ms. Verros:

Thank you for your letter dated April 27, requesting interpretations on a number of OSHA injury and illness recordkeeping issues. I will restate each of your questions and follow with my response. Whenever possible, I will refer to either the Recordkeeping Guidelines for Occupational Injuries and Illnesses (Bluebook) or the Ergonomics Program Management Guidelines for Meatpacking Plants (Greenbook).

Q1 Does the 30 day rule apply only to CTDs?

A1 Yes.

Q2 Is an application of an over-the-counter antibiotic ointment (example: Neosprin) on a second or subsequent visit to medical personnel considered medical treatment or first aid?

A2 Any use of nonprescription medications is considered first aid for OSHA recordkeeping purposes (page 43, Bluebook). Any use of prescription medications, except a single dose administered on first visit for minor injury or discomfort, is considered medical treatment.

Q3 Are all applications of butterfly adhesives dressing(s) and steri-strip(s) considered medical treatment?

A3 Yes.

Q4 Is drilling a hole through a fingernail to relieve pressure (subungual hematoma) considered medical treatment?

A4 Yes. The draining of any fluids or blood is to be considered medical treatment.

Q5 Is the development of a friction blister considered a recordable illness even with the use of protective equipment (i.e., gloves)?

A5 For OSHA recordkeeping purposes, an occupational illness is defined as any abnormal condition which results from a non-instantaneous event or exposure in the work environment. All occupational illnesses are recordable. Friction blisters are caused by non-instantaneous exposures and are therefore recordable conditions. Whether or not personal protective equipment was involved is not relevant to evaluating the case. On premises, work relationship is presumed. If the condition was either caused, contributed to, or aggravated by something in the work environment it is considered work related.

Q6 If non-prescription medication (ex: Ibuprofen) is used in prescription strength (ex: 600 or 800 mg), is this considered medical treatment or first aid?

A6 Any use of nonprescription medications is considered first aid for OSHA recordkeeping purposes, even when used at prescription strengths (page 43, Bluebook).

Q7 If medical personnel direct an employee to use heat treatment or cold treatment at home, is this considered medical treatment or first aid?

A7 As found in the Greenbook on page 14, medical treatment is defined to include self-administered treatment when made available to employees by their employer. Thus, 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. If the treatment is self-administered at home, it is not considered medical treatment.

Q8 If an employee reports a subjective complaint of pain which he alleges was caused by repetitive motion and is treated with one application of heat or cold, is the case a recordable case?

A8 The OSHA 200 recording criteria for conditions classified as CTDs can be found on pages 14 and 15 of the Greenbook. As listed in Section 11(a)(2) on page 14, if only subjective symptoms exist, there must be at least one of the following to be a recordable case: 1) medical treatment; 2) lost workdays; or 3) transfer/rotation to another job.

Heat or cold therapy is only considered medical treatment when it is administered on a second or subsequent visit to medical personnel, including self-administered as defined above. If the treatment was given on the initial visit, it is considered first aid and would not constitute medical treatment (page 43, Bluebook).

Q9 If an employee reports a subjective complaint of pain which he alleges was caused by repetitive motion and is treated with one dose of over-the-counter Ibuprofen, is the case a recordable illness?

A9 The OSHA 200 recording criteria for conditions classified as CTDs can be found on pages 14 and 15 of the Greenbook. As listed in Section 11(a)(2) on page 14, if only subjective symptoms exist, there must be at least one of the following to be a recordable case: 1) medical treatment; 2) lost workdays; or 3) transfer/rotation to another job.

Any use of nonprescription medications is considered first aid for OSHA recordkeeping purposes, even when used at prescription strengths (page 43, Bluebook).

Q10 If a cotton swab or tissue is used to remove a foreign body which is stuck in an inner or outer canthus of the eye, but is not embedded, is this considered medical treatment or first aid?

A10 If the foreign body is not embedded, removal by means of irrigation or the use of a cotton swab is considered first aid. Any other means of removal must be considered medical treatment, e.g spuds, etc.

Q11 If a magnet is used to remove a foreign body from the eye, is this considered first aid or medical treatment?

A11 This is considered medical treatment. See question 10 above.

Q12 Is a single treatment by a physical therapist or chiropractor considered medical treatment or first aid?

A12 Physical therapy on a first visit to medical personnel, is considered first aid. Physical therapy on a second or subsequent visit to medical personnel is medical treatment (page 43, Bluebook). Chiropractic treatment, however, is handled differently. A series of treatments (two or more) by a chiropractor is considered medical treatment. A single treatment, on the first or a subsequent visit is first aid (Q&A F-14, page 45, Bluebook).

Q13 During a single visit to a chiropractor if an employee is given some form of treatment modality in addition to a spinal manipulation, is this considered medical treatment or first aid?

A13 If an employee is given a series of treatments (two or more) by a chiropractor, it is considered medical treatment (see question 12 above). Because the employee received more than one treatment as described above, it is considered medical treatment.

Q14 If an employee is returned to his regular job with the restriction that he is to perform at "1/2 count or 1/4 count" are those days considered restricted duty? For example, if a meatpacking employee normally pulls and trims every fourth piece of meat and is directed to pull and trim every eighth piece instead.

A14 No, this is not counted as restricted work activity. Production rate or production output does not enter into the restricted work activity criteria.

Q15 When a physician treats an employee's CTD condition conservatively with work restrictions for several weeks or months in an attempt to avoid surgery, is it possible to stop counting the lost work days on the basis that the employee has been "permanently assigned" to a different job or a modified version of his old job even though the restrictions are expected to change as a result of the treatment in the future or days away from work may be incurred?

A15 An employer may stop counting days of restricted work activity if long-term restrictions result in permanent assignments to modified jobs (Q&A B-9, page 49, Bluebook). In the scenario described above, the modified assignment is expected to change. This is not considered a "permanent assignment" and therefore the day count should not stop.

Q16 If an injured employee has reached maximum medical improvement and the physician has given permanent work restrictions, do the days cease to accumulate at the time the restrictions are given or when the employee is permanently assigned to a job within those restrictions?

A16 The count of days of restricted work activity ceases once the employee is transferred to his or her new or modified job and the decision has been made that the modified job is permanent (Q&A B-9, page 49, Bluebook). 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.

Q17 Should an employer rely on medical information from a treating physician to determine an employee's need to be permanently assigned to a modified job?

A17 It is not necessary for a physician to make this decision. Non-medical personnel can make the decision of assigning permanent restrictions to an injured or ill employee. However, if a doctor's opinion is available, that opinion should be given the greatest amount of weight in the OSHA injury and illness recordkeeping decision process.

Q18 Should an employer retroactively record a 25 dB STS onto the year's log where the STS is first identified?

A18 Yes. A work related 25 dB shift in hearing should be recorded on the Log for the year in which the audiogram showing the shift was given.

Q19 If an employee's annual hearing test shows a recordable 25 dB STS in both ears, should one entry or two entries be made on the 200 log?

A19 Only one entry should be made. If, however, the annual hearing test showed a 25 dB shift in only one ear and a later test showed a 25 dB shift in the other, two entries would be required on the Log.

Q20 If an employee is on vacation, military leave or suffering the effects of a head cold or sinus problems, is the employer out of compliance if the employee's annual audiogram is not completed within 365 days of the previous test?

A20 Based upon discussion with the Office of Health Compliance Assistance, an employee's annual audiogram is required to be made within 365 days of the employee's previous audiogram. If it is known beforehand that the employee will be unavailable at the time the audiogram is due (e.g scheduled military leave or vacation), the employer would be expected to make every effort to satisfy the annual audiogram requirement before that time. If however, the employee is unavailable because of unforseen circumstances, the employer would be expected to satisfy the annual audiogram requirement at the earliest possible opportunity after the due date.

Q21 If a 25 dB STS is recorded on the 200 log and the following year's annual audiogram reveals the STS is no longer present, is it appropriate to line the case off the 200 log?

A21 No. An audiogram may not be substituted for an initial audiogram unless it is obtained within thirty calendar days of the date of the initial audiogram.

Q22 Please comment if days away from work should be counted under the following circumstances:

Employee reports an injury/complaint of pain to the employer. Employee is examined by a physician and returned to regular duty. After doing his regular duty for one day, the employee reports the pain is worse and he is not able to perform his regular duty. Employer sends the employee home since he is not able to perform his regular duty as determined by the examining physician one day earlier.

A22 For recordkeeping purposes, an occupational illness occurs on the date the illness is diagnosed/recognized. For repetitive trauma cases involving subjective symptoms only, the illness is recognized/diagnosed when it involves medical treatment, lost workdays or job transfer/rotation. Lost workdays should not be counted on the initial day of the onset of illness (page 47, Bluebook). The day the employee was sent home should not be counted as a day of restricted work activity since it is considered the day of the onset of illness. Any subsequent days that the employee is unable to work or is restricted should be counted as lost workdays.

Q23 Following the resolution of a CTD problem, a physician says an employee may return to work full duty. The employer recognizes that the employee may need a "break-in" period to work harden back into the job to prevent additional injury/illness. Do the days of work hardening, following CTD resolution, need to be counted as restricted work activity?

A23 Yes. Until the employee is performing all of his or her normal job duties for an entire shift, days of restricted work activity must be counted.

Q24 To facilitate an eye exam to check for the presence of a foreign body, a prescription anesthetic eye drop is sometimes used. Whether or not a foreign body is found, a medical provider may elect to instill one dose of antibiotic eye drops. Would the use of these two types of prescription medications under the above described circumstances be considered medical treatment?

A24 The case described above resulted in the use of 1) a single dose of prescription eye drops employed as a local anesthetic and 2) a single dose of prescription eye drops used to treat/prevent infection. The treatment of this case clearly involved the use of two doses of prescription medication and is therefore considered medical treatment for OSHA recordkeeping purposes (page 43, Bluebook).

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