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March 31, 2016
Standing up to workplace slips, trips, and falls

American workers can’t seem to get out of our own way—or out of the way of objects in our path, wet and slippery surfaces, uneven flooring, and other hazards. Slips, trips, and falls (STFs) befall us entirely too often, and the impact is staggering. This Compliance Report steps into the subject of falls with insight from an insurance risk specialist, a researcher, and one of OSHA’s top experts on the topic.

Facts speak volumes

Fall protection perennially tops OSHA’s list of most commonly cited standards, although many incidents don’t show up on official tallies because they do not involve a violated standard or a recordable injury. But the impact of these incidents is undeniable. Consider the facts:

  • STFs make up the majority of general industry incidents and 15 percent of all accidental deaths.
  • Over 17 percent of all disabling occupational injuries result from falls.
  • One-quarter of reported claims involve STFs.
  • Falls account for about 8 million hospital emergency room visits, representing the leading cause.
  • Slips and falls are the leading cause of lost days from work.
  • One-half of all accidental deaths in the home are caused by falls.
  • Most STF incidents could have been prevented.

The experts say a fall prevention plan is your best hedge against STFs. The approach is the same recommended for other types of risks—first identify, then assess, control, and monitor the hazards. Make sure employees are trained on the program and that you regularly review it to determine needed changes. The Pulp and Paper Safety Association describes six categories of safety controls:

  • Eliminate the hazard, including those at the design stage.
  • Substitute with a safer option.
  • Isolate people from hazards.
  • Minimize by redesign.
  • Use administrative controls.
  • Provide personal protective equipment (PPE).

Age, distraction, and other factors

As second vice president of workers’ compensation for Travelers Insurance—Risk Control, it’s part of Woody Dwyer’s job to keep employees on their feet. He explains that falls “fall” into three categories—indoor, outdoor, and those related to changes in level. “One of the challenges is that there isn’t a big frequency around STF compared to the severity,” he adds, noting that the average cost of a workplace fall is about $43,000.

Dwyer works with insured companies to make sure they’re paying attention to issues that include the aging of their workforce. Dwyer, who uses the term “multigenerational workforce,” cites the National Safety Council’s Injury Facts, which acknowledges significant increases in severity from falls among those over the age of 65. “As we age, our gait patterns and visual capability change, which means greater potential for injury,” explains the study. The challenge is getting businesses to understand the risk and to put in place controls that affect walkways, lighting, and general behavior—changes that benefit older workers and their younger colleagues.

According to Dwyer, employers need to periodically assess the workplace to identify trip hazards, ideally at the change of seasons. In early spring, for example, look for the effects of cold or wet winter weather like chips or shifts in concrete. In autumn, be sure to eliminate piles of wet, slippery leaves. In all seasons, assess lighting for sources of shadow, especially in darker areas like parking lots.

Dwyer stresses the importance of observing employees to see what they are doing. If you find workers are taking a particular shortcut from one building to another, consider paving it over to create a new walkway that reduces the hazard of employees walking through brush and tall grass. In manufacturing and construction settings, Dwyer advises a daily walk-around/site observation by a trained professional to look for trip and fall hazards.

Another trend to note is injuries due to distracted walking while using cell phones. Everyone has seen videos of people walking into fountains and other objects while talking on their phones. But distraction is not a laughing matter, especially when an employee could walk into a dangerous hazard like machinery.

Dwyer also makes the point that fall risks can change from day to day. For example, a food manufacturing plant may produce a wetter product on Tuesday than it manufactured on Monday. As a result, there is more liquid runoff and more opportunity for a slip or fall injury. Awareness and communication of such changes is the key to preventing them.

If you measure it, you can manage it

The first step in addressing fall potential is to know your risk and to review mitigation procedures. An important tool is the coefficient of friction (COF) test, which assesses the slip resistance of various flooring materials. Dwyer says the test should be performed when building out a space or changing flooring. One factor affecting slipperiness is transitions between flooring types (from tile to wood, wood to carpet, etc.), which should be minimized as much as possible. The COF rating should be greater than 0.6.

Like other types of hazards, falls should be addressed according to the hierarchy of controls that advises elimination and substitution, engineering out risks, using administrative practices, and safe work practices. Dwyer encourages supervisors to model safe behaviors and to take the time to observe how employees behave in real work settings. For example, he advises businesses to station someone at the exit to the break room to observe employee habits that may contribute to falls. A big culprit is failing to use tops for take-out coffee and other beverages.

A few steps with an overly full cup, and the inevitable sloshing of liquid onto the floor creates a significant yet easy-to-avoid hazard. Safety leaders also need to be sure that employees who need them are wearing slip-resistant shoes and that a policy explaining the requirement is in place.

Eye on housekeeping

Good housekeeping practices help keep employees on their feet. Dwyer says a first priority is to check for sources of leaks. Proper maintenance and storage of hoses, cables, and cords can significantly reduce STF hazards.

Be mindful of what cleaning products are used and how. Some products leave potentially harmful residue or react in hazardous ways with the flooring material, substantially changing the coefficient of friction and making the surface slippery. Also pay attention to cleaning schedules. At one business Dwyer visited, housekeeping personnel were scrubbing floors in the elevator at 5:00 p.m. just as large numbers of workers were exiting the building.

Fall-prevention training insights

Training employees to be aware of their surroundings and reduce risks is essential to a successful STF program. At the Washington University School of Medicine in St. Louis, Missouri, occupational therapist and associate professor Vicki Kaskutas is involved in emerging research on fall-prevention training.


Does slip-resistant footwear really reduce slip-related injuries in the food service industry? NIOSH researcher Jennifer Bell, MD, is currently wrapping up a 4.5-year project studying that question.

The short answer is yes. In collaboration with industry partners, Bell and her team examined the effects of slip-resistant shoes on workers’ compensation claims related to slipping on surfaces contaminated with liquid or grease.

Participants in the study included about 15,000 food service workers employed at schools in 24 states. Workers who voluntarily chose to wear the shoes received free footwear throughout the study. Employees of school districts that did not receive the shoes continued wearing regular footwear, including their own slip-resistant shoes if they wished.

Preliminary findings revealed a reduction of more than 80 percent in workers’ compensation claims related to these slips among workers that had received protective shoes who had not been using them previously. The researchers were studying whether use of the shoes would continue to prevent incidents, and if using them is cost-effective.

Advice for all employers

Asked about other steps employers across diverse industries can take to reduce STFs, Bell listed the following:

  • Keep walking surfaces clean and dry.
  • Keep parking lots and outdoor walkways clear of ice and snow.
  • Keep indoor walkways clear of objects.
  • Use appropriate slip-resistant footwear in environments that can become unexpectedly wet or slippery.
  • Educate employees about the risk of an STF injury.

Bell also noted the role of risk-taking behaviors like rushing, not taking the time to clear up a spill immediately, or not taking the time to report or remedy an icy driveway. “A workplace with a good safety culture would be one where employees knew that these things were injury risks, and would be empowered to take time out to remedy the risks, and [would be] given the tools and education to remedy the risks as they occur.”

The more Kaskutas saw of workers whose lives were changed by falls the more she wanted to do something to promote prevention. Before becoming an academic researcher, Kaskutas had worked in underground coal mines to help injured miners get back on the job. Her team’s current research projects are in partnership with the Center for Construction Research and Training (CPWR) and the local carpenters’ union.

A 5-year-project, begun in 2008, sought to identify ways to improve fall prevention training among new workers in the residential construction industry. Kaskutas explains that while commercial construction worker safety receives considerable attention, there’s less concern for those who toil on lower buildings (i.e., homes).

Understand learning style

The researchers looked at the fall prevention curriculum used by the carpenters’ union. And although the training was advanced in some areas, there were still problems. For example, trainers would ask students to open the OSHA regulations to a certain page as the trainer read from the text. “These people get enjoyment from doing—they want to use their hands,” explains Kaskutas.

She and her colleagues surveyed more than 1,000 apprentices to find out how they like to learn, their work practices, and other key information. Then, the team visited approximately 200 residential construction worksites and observed training and work practices in action. The team discovered that the way employees were being trained was not necessarily the way they wanted to learn.

The research team used these insights to create a new curriculum for foremen. It addressed the need for communication, including how to speak up about safety issues, how to problem-solve throughout the course of a building project, and how to select and use equipment. Based on this and a second project, the researchers were able to measure changed behaviors on the part of foremen and the workers under them. For example, not only did they conduct more on-site safety talks but the talks were also more participatory and featured more relevant topics.

Kaskutas offers this takeaway for employers: “Use high-engagement activities. Get workers up and learning and engage all their senses.” She also advises safety trainers to avoid coming off as the experts whose job is to train those who know less. “These are adult learners and they have a wealth of experience under their belt. You have to make a connection between what they’ve experienced and how you want them to change. Find a hook you can hang it on,” she adds.

OSHA stands up for stand-down

One of OSHA’s most visible successes in recent years is the National Fall Prevention Safety Stand-Down, now in its third year. The event, which reached some 4 million employees in 2014 and 2015, most in construction, is set for May 2–6, 2016. According to the agency, the purpose of the event is to raise awareness of preventing fall hazards, which accounted for 337 of the 874 preventable construction fatalities recorded in 2014.

Anyone can get involved, and while OSHA and its partners (including the National Institute for Occupational Safety and Health (NIOSH) and CPWR) offer recommendations and resources, there is no one right way to participate, says Dean McKenzie, deputy director of OSHA’s directorate of construction. “The stand down has taken off like it has because it resonates with everyone. We’ve all been exposed to a fall at some point in our working career.” Calling the issue of workplace falls “huge,” McKenzie points to some 700,000 incidents per year, making falls OSHA’s highest volume citation.

According to McKenzie, many employers believe that going from no program to a working fall protection plan is a huge hurdle. But once the plan is in place and construction crews get used to wearing protective gear, the result is not only fewer incidents but also greater productivity. One reason is that workers feel more confident when they are protected, which allows them to move about the worksite confidently, “rather than walking gingerly across the steel because they’re afraid they’re going to fall,” McKenzie adds.

Cultural shift

Resistance to change is one of the chief obstacles when it comes to getting crew members to comply with safety rules, including those around PPE. McKenzie, who spent 35 years in construction before joining OSHA, recalls that as a young man, he would hear older employees make comments like, “If you can’t walk that beam yet [without protection] you’re not an iron worker yet.” Or, “If you can’t walk that top plate, you’re not a carpenter yet.”

As attitudes began to change, he would see the younger workers walk over to the gang box and put on their safety harnesses, while the older workers continued to resist using PPE. McKenzie believes that this cultural shift continues but acknowledges that it will take time. “Think back to the anti-litter campaigns in the late 1950s and 1960s,” he says. “Kids got it first.” And then there’s the financial imperative, which is hard to deny when you compare the cost of a good safety harness at about $500 with the cost of a serious injury at upwards of $100,000.

‘We don’t care what you do’

As for the upcoming stand-down in early May, McKenzie said there are no rules about participating, and nonconstruction workplaces are welcome. The key is to do something meaningful for your staff. “Engage your workers,” he recommends. “Find out what they think of your slips, trips, and falls program and what issues they are seeing.”

McKenzie suggests that employers not hesitate to share with their employees incidents that convey the personal and financial toll of falls. “We don’t care what you do, but do something,” McKenzie urges. Combating falls is complex, and creative solutions are encouraged.

According to OSHA’s stand-down webpage (, companies may wish to take a break for a toolbox talk or other safety activity, such as conducting safety equipment inspections, developing rescue plans, or discussing job-specific hazards. Managers are encouraged to find the program that works best for their workers.

Employers will have an opportunity to provide feedback about the experience and to download a certificate of participation signed by Secretary of Labor Thomas E. Perez.

The following are examples of what’s been done during the past two stand-downs:

  • Conducted fall protection training with staff members who said they liked participating and vowed to do so for 5 years;
  • Had an in-depth discussion about fall protection, reevaluating what’s working and where improvements are needed;
  • Shared their stories, then participated in a toolbox talk on fall protection;
  • Attended a workshop on fall prevention;
  • Reviewed case studies and videos on fall incidents, discussed how they were preventable, and reviewed the fall protection standard at 1926.500; and
  • Invited a manufacturer on-site to conduct a fall protection awareness presentation and to show different types of lanyards.
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