To help you see where OSHA is heading, Industrial Safety & Hygiene News is offering this step-by-step analysis of OSHA's draft requirements. The April issue discussed the scope of the standard (who's covered); Step 1 - Management Leadership & Employee Participation; and Step 2 - Hazard Identification & Information. The May issue looked at Step 3 - Job Hazard Analysis and Control; and Step 4 - Training. This month our series concludes by examining Step 5 - Medical Management; and Step 6 - Program Evaluation. The series can be accessed at www.ishn.com.
Medical Management What's your obligation?
When an employee reports signs or symptoms of a work-related musculoskeletal disorder you must check out the report to see if you need to provide medical management. You must provide medical management, including recommended work restrictions, at no cost to the employee. This standard does not specify types of medical treatments - that's left up to health care professionals.
How do you respond to employee reports?
- You must give employees fast access to health care professionals for evaluation, treatment, and follow up. Health care professionals are defined as "persons educated and trained in the delivery of health care services who are operating within the scope of their license, registration, certification, or legally authorized practice when performing the requirements of this standard."
- You must give information to these professionals to help ensure effective medical management.
- You need to obtain a written opinion from the health care professional and ensure that the employee is promptly given a copy of it.
What information must you provide?
- Descriptions of the employee's job and ergonomic hazards identified.
- Descriptions of available changes to the job or temporary alternative duty during the recovery period.
- A copy of the ergonomics standard, with medical management provisions highlighted.
- The chance for the professional to conduct a workplace walkthrough.
What information must the health care professional give you?
The professional's written opinion must include:
- Medical conditions associated with the employee's work-related signs and symptoms.
- Recommended work restrictions where necessary, and medical follow-up for the employee during the recovery period.
- A statement that the professional has informed the employee about the results of the evaluation and any medical conditions resulting from the exposure to the job hazards.
- A statement that the professional has told the employee about other physical activities that could aggravate the job-related musculoskeletal disorder during the recovery period.
You must instruct the health care professional not to reveal in the written opinion (or in any other communication with you) specific findings, diagnoses, or information not related to ergonomic hazards in the employee's job.
How do you handle work restrictions?
- Work restrictions recommended by the health care professional must be provided during the recovery period.
- The employee's total normal earnings, seniority, rights and benefits must be maintained when restrictions are prescribed or voluntarily provided by you.
- You must ensure that the health care professional periodically follows up on the employee during the recovery period.
How long must work restrictions be provided at no cost to the employee?
Until the first of these occurs:
- The employee recovers and is able to return to the job.
- Effective measures are put in place that control job- related musculoskeletal disorder hazards to the extent that the job does not risk harm to the employee even during the recovery period.
- A final medical determination is made that the employee is permanently unable to return to the job.
- Six months have passed.
What happens if an employee files a workers' comp claim?
You may reduce your obligation to maintain the employee's total normal earnings, seniority, rights and benefits by the amount the employee receives during the work restriction period from any of the following:
- Workers' compensation payments for lost earnings.
- Payments for lost earnings from a compensation or insurance program that is publicly-funded or funded by you.
- And, income from employment with another employer made possible by virtue of the work restrictions.
Program Evaluation What's your obligation?
You must evaluate your ergonomics program and controls periodically - at least every three years - to ensure compliance with this standard.
How do you evaluate your program?
- You must monitor program activities to make sure that all the elements of your ergonomics program are functioning.
- You must select effectiveness measures and use them to evaluate the programs and the controls you've put in place. Your effectiveness measures must include both activity measures and outcome measures.
Activity measures check interim accomplishments of your program. They assess activities such as the number of hazards identified and the number of employees trained.
Outcome measures assess long-term results, such as number of lost workdays, number of hazards controlled and severity of work-related musculoskeletal disorders.
- You must establish baseline measurements, so you have a starting point for measuring the effectiveness of your program.
What if your evaluation uncovers problems?
If your evaluation indicates that your program is not controlling work-related musculoskeletal disorder hazards, you must promptly correct the deficiencies in your program.
You must keep written records if:
- You have more than one worksite where a job has been identified as a "problem job" (a manufacturing or manual handling job where known ergonomic hazards exists or a job-related musculoskeletal disorder is reported); or
- The job involves more than one level of supervision; or
- The job involves shiftwork.
If you have ten or fewer full-time employees (including temps and contingent workers) at any time during the preceding year, you are not required to keep records.
Types of records:
- Employee reports and your responses must be kept for three years.
- Results of job hazard analyses; plans to control hazards; and evaluations of your program and controls must be maintained for three years or until replaced by updated records.
- Medical management records must be kept for the duration of the injured employee's employment plus three years.
STOPPING YOUR PROGRAM
Can you discontinue certain aspects of your ergonomics program?
As long as you have problem jobs, you must maintain all elements of the program as required by the standard. If you don't have a problem job for three years, OSHA says:
- If you have manufacturing and material handling operations, you still must follow requirements for management leadership and employee participation; hazard identification and information; and you must maintain implemented controls and training relating to those controls.
- If you have other jobs with work-related musculoskeletal disorders, you must maintain implemented controls and training relating to those controls.