March 16, 1995

Mr. William K. Principe Constangy,
Brooks & Smith
Suite 2400
230 Peachtree Street, N.W.
Atlanta, Georgia 30303-1557

Dear Mr. Principe:

Thank you for your letter dated February 20, requesting an interpretation regarding the proper recording of Cumulative Trauma Disorder (CTD) cases on the OSHA Log 200. I will address each question in the order it was presented in your letter and reference the Recordkeeping Guidelines for Occupational Injuries and Illnesses by stating the appropriate page and Q&A numbers.

Q1a Are days spent in a ramp-in or work hardening program following a physician's release to full duty considered to be days of restricted work activity?

A1a The count of days of restricted work activity should center on the employee's ability to perform all of his or her normal job duties. Time spent in ramp-in programs due solely to adherence to company policy (and not to the employee's ability to perform all of his or her normal job duties) is not counted as days of restricted work activity. (Q&A B-17, page 50) The focus of decisionmaking is on the employee's ability to work. Such a decision, when made by a qualified health care professional, is given significant weight in the OSHA injury and illness recordkeeping system.

Q1b What if the ramp-in assignment consists of performing all of the regular job duties, but rotating from job to job every hour instead of every two hours as would normally be the case after the ramp-in period is concluded?

A1b See A1a above.

Q1c. What if the ramp-in consists of performing all of the regular job duties during a regular rotation scheme, but also adds an additional rotation during the shift of less strenuous tasks?

A1c See A1a above.

Q2 An employee develops an upper extremity CTD, which is treated for a few days without imposing any restrictions on the employee's ability to perform his job. The plant nurse then notes that the employee's condition has resolved, indicating that treatment is no longer necessary. A week later the employee develops the same symptoms and is given medical treatment that would result in a recordable case. Although the first case is clearly recordable, is the recurrence considered a new recordable case or does the recurrence fit within the meaning of the 30-day rule?

A2 A case is considered to be complete once there is complete resolution of the signs and symptoms. After resolution of the problem, if signs and symptoms recur, a new case is established and must be evaluated as such. (See page 15, section c of the Ergonomics Program Management Guidelines For Meatpacking Plants) Under the circumstances outlined in the scenario above (the plant nurse noted that the employee's condition had resolved), the recurrence should be recorded as a new case.

Q3 If an employee develops a blister or callous from performing repetitive work, in which section of Column 7 should the case be recorded?

A3 Friction blisters should be recorded in column 7(f). For OSHA injury and illness recordkeeping purposes, callouses are not regarded as abnormal health conditions or disorders and need not be recorded.

Q4 A plant nurse manipulates an employee's arm and wrist during a physical examination of the employee as part of the assessment of the employee's condition following a complaint about CTD symptoms. If she induces and observes pain during the examination, is this considered an objective, physical finding, making the case recordable?

A4 Pain, in and of itself, should by regarded as a subjective symptom. If the pain, however, is indicative of a positive Tinel's, Phalen's or Finkelstein's test, it should be regarded as a physical finding.

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

Sincerely,



Bob Whitmore
Chief Division of Recordkeeping Requirements