November 15, 2005

Mr. Steve M. Olson
Vice President, Safety and Training
Nabors Well Services Ltd.
515 West Greens Rd., Suite 1170
Houston, TX 77067

Dear Mr. Olson:

Thank you for your letter of July 15, 2005 concerning OSHA's occupational injury and illness recordkeeping regulation at 29 CFR 1904. Your letter raises the issue of whether an employer may rely on a second medical opinion from a health care provider in determining whether to record a work-related injury or illness under Part 1904. Your letter states the question as follows:

When making an injury or illness recordkeeping decision, may an employer use the opinion of a contemporaneous second provider (i.e., a physician who specializes in occupational injury and illness) even though the employee already received a prescription medication (medical treatment) from an emergency room physician?

Section 1904.7(b) states that a work-related injury or illness must be recorded on the OSHA 300 Log if it results in death, days away from work, restricted work or transfer to another job, medical treatment beyond first aid, loss of consciousness, or diagnosis of a serious injury or illness. In certain circumstances, OSHA's recordkeeping requirements permit an employer to choose between two conflicting medical opinions. When an employer receives contemporaneous recommendations from two or more physicians or other licensed health care professionals about the need for medical treatment, the employer may decide which recommendation is the most authoritative and record the case based on that recommendation. However, once a prescription medication has been provided, the case must be recorded.

OSHA has addressed this specific issue in a Frequently Asked Question (FAQ) to the Part 1904 recordkeeping requirements on OSHA's website at http://www.osha.gov/recordkeeping.

Question 7-10a. If a physician or other licensed health care professional recommends medical treatment, days away from work or restricted work activity as a result of a work-related injury or illness can the employer decline to record the case based on a contemporaneous second provider's opinion that the recommended medical treatment, days away from work or work restriction are unnecessary, if the employer believes the second opinion is more authoritative?

Yes. However, once medical treatment is provided for a work-related injury or illness, or days away from work or work restriction have occurred, the case is recordable. If there are conflicting contemporaneous recommendations regarding medical treatment, or the need for days away from work or restricted work activity, but the medical treatment is not actually provided and no days away from work or days of work restriction have occurred, the employer may determine which recommendation is the most authoritative and record on that basis. In the case of prescription medications, OSHA considers that medical treatment is provided once a prescription is issued.

Accordingly, the scenario you describe in your letter is a recordable work-related injury under OSHA's recordkeeping requirements.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. In addition, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov. If you have any further questions, please contact the Office of Statistical Analysis at 202-693-1876.

Sincerely,



Keith Goddard, Director
Directorate of Evaluation and Analysis