Workplace Safety and Health
Enhancing OSHA's Records Audit Process Could Improve the Accuracy of Worker Injury and Illness Data Gao ID: GAO-10-10 October 15, 2009Under the Occupational Safety and Health Act of 1970, the Department of Labor's (DOL) Occupational Safety and Health Administration (OSHA) is responsible for protecting the safety and health of the nation's workers. The act requires DOL to collect and compile work-related injury and illness data. GAO was asked to determine (1) whether DOL verifies that employers are accurately recording workers' injuries and illnesses and, if so, the adequacy of these efforts, and (2) what factors may affect the accuracy of employers' injury and illness records. GAO analyzed OSHA's audits of employers' injury and illness records, interviewed inspectors who conducted the audits, surveyed occupational safety and health practitioners, and obtained the views of various stakeholders regarding factors that may affect the accuracy of the data.
DOL verifies some of the workplace injury and illness data it collects from employers through OSHA's audits of employers' records, but these efforts may not be adequate. OSHA overlooks information from workers about injuries and illnesses because it does not routinely interview them as part of its records audits. OSHA annually audits the records of a representative sample of about 250 of the approximately 130,000 worksites in the high hazard industries it surveys to verify the accuracy of the data on injuries and illnesses recorded by employers. However, OSHA does not always require inspectors to interview workers about injuries and illnesses--the only source of data not provided by employers--which could assist them in evaluating the accuracy of the records. In addition, some OSHA inspectors reported they rarely learn about injuries and illnesses from workers since the records audits are conducted about 2 years after incidents are recorded. Moreover, many workers are no longer employed at the worksite and therefore cannot be interviewed. OSHA also does not review the accuracy of injury and illness records for worksites in eight high hazard industries because it has not updated the industry codes used to identify these industries since 2002. OSHA officials told GAO they have not updated the industry codes because it would require a regulatory change that is not currently an agency priority. The Bureau of Labor Statistics (BLS) also collects data on work-related injuries and illnesses recorded by employers through its annual Survey of Occupational Injuries and Illnesses (SOII), but it does not verify the accuracy of the data. Although BLS is not required to verify the accuracy of the SOII data, it has recognized several limitations in the data, such as its limited scope, and has taken or is planning several actions to improve the quality and completeness of the SOII. According to stakeholders interviewed and the occupational health practitioners GAO surveyed, many factors affect the accuracy of employers' injury and illness data, including disincentives that may discourage workers from reporting work-related injuries and illnesses to their employers and disincentives that may discourage employers from recording them. For example, workers may not report a work-related injury or illness because they fear job loss or other disciplinary action, or fear jeopardizing rewards based on having low injury and illness rates. In addition, employers may not record injuries or illnesses because they are afraid of increasing their workers' compensation costs or jeopardizing their chances of winning contract bids for new work. Disincentives for reporting and recording injuries and illnesses can result in pressure on occupational health practitioners from employers or workers to provide insufficient medical treatment that avoids the need to record the injury or illness. From its survey of U.S. health practitioners, GAO found that over a third of them had been subjected to such pressure. In addition, stakeholders and the survey results indicated that other factors may affect the accuracy of employers' injury and illness data, including a lack of understanding of OSHA's recordkeeping requirements by individuals responsible for recording injuries and illnesses.
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Director: Team: Phone:GAO-10-10, Workplace Safety and Health: Enhancing OSHA's Records Audit Process Could Improve the Accuracy of Worker Injury and Illness Data
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Report to Congressional Requesters:
United States Government Accountability Office:
GAO:
October 2009:
Workplace Safety and Health:
Enhancing OSHA's Records Audit Process Could Improve the Accuracy of
Worker Injury and Illness Data:
GAO-10-10:
GAO Highlights:
Highlights of GAO-10-10, a report to congressional requesters.
Why GAO Did This Study:
Under the Occupational Safety and Health Act of 1970, the Department of
Labor‘s (DOL) Occupational Safety and Health Administration (OSHA) is
responsible for protecting the safety and health of the nation‘s
workers. The act requires DOL to collect and compile work-related
injury and illness data. GAO was asked to determine (1) whether DOL
verifies that employers are accurately recording workers‘ injuries and
illnesses and, if so, the adequacy of these efforts, and (2) what
factors may affect the accuracy of employers‘ injury and illness
records. GAO analyzed OSHA‘s audits of employers‘ injury and illness
records, interviewed inspectors who conducted the audits, surveyed
occupational safety and health practitioners, and obtained the views of
various stakeholders regarding factors that may affect the accuracy of
the data.
What GAO Found:
DOL verifies some of the workplace injury and illness data it collects
from employers through OSHA‘s audits of employers‘ records, but these
efforts may not be adequate. OSHA overlooks information from workers
about injuries and illnesses because it does not routinely interview
them as part of its records audits. OSHA annually audits the records of
a representative sample of about 250 of the approximately 130,000
worksites in the high hazard industries it surveys to verify the
accuracy of the data on injuries and illnesses recorded by employers.
However, OSHA does not always require inspectors to interview workers
about injuries and illnesses”the only source of data not provided by
employers”which could assist them in evaluating the accuracy of the
records. In addition, some OSHA inspectors reported they rarely learn
about injuries and illnesses from workers since the records audits are
conducted about 2 years after incidents are recorded. Moreover, many
workers are no longer employed at the worksite and therefore cannot be
interviewed. OSHA also does not review the accuracy of injury and
illness records for worksites in eight high hazard industries because
it has not updated the industry codes used to identify these industries
since 2002. OSHA officials told GAO they have not updated the industry
codes because it would require a regulatory change that is not
currently an agency priority. The Bureau of Labor Statistics (BLS) also
collects data on work-related injuries and illnesses recorded by
employers through its annual Survey of Occupational Injuries and
Illnesses (SOII), but it does not verify the accuracy of the data.
Although BLS is not required to verify the accuracy of the SOII data,
it has recognized several limitations in the data, such as its limited
scope, and has taken or is planning several actions to improve the
quality and completeness of the SOII.
According to stakeholders interviewed and the occupational health
practitioners GAO surveyed, many factors affect the accuracy of
employers‘ injury and illness data, including disincentives that may
discourage workers from reporting work-related injuries and illnesses
to their employers and disincentives that may discourage employers from
recording them. For example, workers may not report a work-related
injury or illness because they fear job loss or other disciplinary
action, or fear jeopardizing rewards based on having low injury and
illness rates. In addition, employers may not record injuries or
illnesses because they are afraid of increasing their workers‘
compensation costs or jeopardizing their chances of winning contract
bids for new work. Disincentives for reporting and recording injuries
and illnesses can result in pressure on occupational health
practitioners from employers or workers to provide insufficient medical
treatment that avoids the need to record the injury or illness. From
its survey of U.S. health practitioners, GAO found that over a third of
them had been subjected to such pressure. In addition, stakeholders and
the survey results indicated that other factors may affect the accuracy
of employers‘ injury and illness data, including a lack of
understanding of OSHA‘s recordkeeping requirements by individuals
responsible for recording injuries and illnesses.
What GAO Recommends:
GAO is recommending that the Secretary of Labor direct OSHA to (1)
require inspectors to interview workers during records audits, and
substitute other workers when those initially selected are unavailable;
(2) minimize the time between the date injuries and illnesses are
recorded by employers and the date they are audited; (3) update the
list of high hazard industries used to select worksites for records
audits; and (4) increase education and training to help employers
better understand the recordkeeping requirements. OSHA agreed with
these recommendations.
View [hyperlink, http://www.gao.gov/products/GAO-10-10] or key
components. For more information, contact Revae Moran (202) 512-7215 or
moranr@gao.gov.
[End of section]
Contents:
Letter:
Background:
DOL Verifies the Injury and Illness Data in the ODI, but OSHA Does Not
Always Collect Information from Workers, and Excludes Certain
Industries:
Occupational Safety and Health Practitioners and Stakeholders Cited
Worker and Employer Disincentives as Primary Factors That May Affect
the Accuracy of Injury and Illness Data:
Conclusions:
Recommendations for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Scope and Methodology:
Appendix II: Survey Instrument for Occupational Health Practitioners:
Appendix III: Selected Questionnaire Results:
Appendix IV: OSHA's Forms for Recording Work-Related Injuries and
Illnesses:
Appendix V: High Hazard Industries Included in ODI Universe as of
August 2009:
Appendix VI: Comments from the Department of Labor:
Appendix VII: GAO Contact and Staff Acknowledgments:
Related GAO Products:
Tables:
Table 1: Number of Inspections Conducted by OSHA, Fiscal Years 2003-
2007:
Table 2: Number of Records Audits by Type of Industry, 2003-2005:
Table 3: Industries That Would be High Hazard if OSHA Updated Its ODI
Universe:
Table 4: Disposition of Health Practitioner Sample:
Figures:
Figure 1: DOL's Annual Occupational Injury and Illness Surveys:
Figure 2: Number and Rate of Injuries and Illnesses in the United
States, 1990-2007:
Figure 3: Number of Worksites Audited by Size, 2003-2005:
Figure 4: Timeline for Collecting and Auditing Employers' Injury and
Illness Records:
Figure 5: Pressure From Workers to Downplay Injuries and Illnesses and
Awareness of Incentive Programs:
Figure 6: Reported Impact of Misinterpretation of Recordkeeping
Requirements on Record Accuracy:
Figure 7: Industries in Which the Majority of Workers Treated by
Practitioner Respondents Were Employed in 2008:
Figure 8: Number of Years Respondents Had Treated Workers:
Figure 9: Number of Workers Treated by Respondents in 2008:
Figure 10: Practitioners' Opinions on the Efficacy of Safety Incentive
Programs:
Figure 11: Worker and Company Official Behavior Related to Reporting
Injuries or Illnesses in 2008:
Figure 12: Impact of Various Factors on Accuracy of Employers' Injury
and Illness Logs:
Figure 13: Frequency of Experiencing Various Requests From Workers or
Company Officials in 2008:
Abbreviations:
BLS: Bureau of Labor Statistics:
DART: days away from work, restricted activity, or job transfer:
DOL: Department of Labor:
LWDII: lost workday injury and illness (rate):
NAICS: North American Industry Classification System:
NEISS: National Electronic Injury Surveillance System:
NIOSH: National Institute for Occupational Safety and Health:
ODI: OSHA Data Initiative:
OSHA: Occupational Safety and Health Administration:
OSH Act: Occupational Safety and Health Act of 1970:
SIC: Standard Industrial Classification:
SOII: Survey of Occupational Injuries and Illnesses:
[End of section]
United States Government Accountability Office:
Washington, DC 20548:
October 15, 2009:
Congressional Requesters:
In 2007, there were approximately 4 million cases in which workers in
the United States were injured or became ill as a result of unsafe or
unhealthy working conditions, and more than 5,600 workers died as a
result of their injuries, according to data reported by the Department
of Labor's (DOL) Bureau of Labor Statistics (BLS). The rate of nonfatal
occupational injuries and illnesses (hereafter referred to as injuries
and illnesses) among private sector employers as reported by BLS in
2007 has generally declined since 1992; the rate of worker fatalities
decreased from 1992 to 2001, and has remained relatively constant since
2002. Under the Occupational Safety and Health Act of 1970 (OSH Act),
DOL's Occupational Safety and Health Administration (OSHA) is
responsible for protecting the safety and health of the nation's
workers. The OSH Act requires DOL to collect and compile accurate
statistics on worker injuries and illnesses. One of two sources of
these statistics is BLS's Survey of Occupational Injuries and Illnesses
(SOII), which provides nationwide data on workers' injuries and
illnesses in most industries. The other is OSHA's survey of selected
employers' injury and illness records called the OSHA Data Initiative
(ODI), which provides injury and illness data for workers in high
hazard industries. The OSH Act and DOL regulations require employers
with more than 10 employees to record other than minor injuries and
illnesses on logs maintained at each worksite. However, 83 percent of
all employers are generally not required to record work-related
injuries and illnesses, either because the employers are too small
(have fewer than 11 employees) or because they are in industries with
historically low rates of injuries and illnesses and have thus been
exempted by OSHA from recording injuries and illnesses.
At your request, we reviewed DOL's efforts to ensure that injuries and
illnesses are properly recorded by employers. Specifically, you asked
us to determine (1) whether DOL verifies that employers are accurately
recording workers' injuries and illnesses and, if so, the adequacy of
these efforts, and (2) what factors may affect the accuracy of
employers' injury and illness records. To address our first objective,
we interviewed DOL officials to determine the types of verification
efforts the agency conducts for the data collected in its SOII and ODI
surveys, and the agency components responsible for these efforts. We
also reviewed relevant laws and regulations. After determining that
OSHA verifies the ODI data it collects through onsite audits of
selected employers' injury and illness records (records audits), we
interviewed OSHA headquarters officials and collected relevant
documentation regarding the agency's audit procedures. We analyzed data
from records audits conducted by OSHA from 2005 to 2007 of employers'
calendar year 2003, 2004, and 2005 injury and illness records (the most
recent data available).[Footnote 1] We were not able to independently
verify the injury and illness data audited by OSHA because we do not
have access to the injury and illness records of private employers. To
better understand OSHA's records audit procedures, we interviewed OSHA
regional administrators and area directors, as well as inspectors who
conducted the audits in each of OSHA's 10 regions, including inspectors
with various levels of audit experience, to obtain a range of
perspectives. To address our second objective, we interviewed OSHA and
BLS officials; experts, including academics and researchers; labor
representatives and worker advocates; and representatives from an
employer association, and surveyed a representative sample of
occupational health practitioners in the United States. We selected
experts based on the depth of their experience and the extent to which
their work had been cited by other experts, among other criteria. We
selected labor representatives and worker advocacy organizations based
on the number of workers and types of industries they represented. Our
survey of occupational health practitioners included occupational
physicians, occupational physician assistants, and nurse practitioners
specializing in occupational health. We independently selected a random
sample of each of the three groups, resulting in a sample of 409 of the
1,941 physicians; 396 of the 1,246 physician assistants; and 382 of the
861 nurse practitioners, for a total representative sample of 1,187 of
the 4,048 occupational health practitioners. We identified these groups
from information obtained from a firm that manages data on members of
professional medical organizations. Our survey yielded a response rate
that allowed us to generalize our results to the total population of
the three groups. All estimates we report from the survey results have
a margin of error of plus or minus 7 percentage points or less at the
95 percent confidence level. A more detailed description of our scope
and methodology is provided in appendix I. A copy of the instrument we
used to survey health practitioners is provided in appendix II.
Additional findings from our survey are provided in appendix III.
We conducted this performance audit from August 2008 through October
2009 in accordance with generally accepted government auditing
standards. These standards require that we plan and perform the audit
to obtain sufficient, appropriate evidence to provide a reasonable
basis for our findings and conclusions based on our audit objectives.
We believe that the evidence obtained provides a reasonable basis for
our findings and conclusions based on our audit objectives.
Background:
Under the OSH Act, OSHA is responsible for protecting the safety and
health of the nation's workers. The agency helps ensure the safety and
health of over 112.5 million private sector workers in approximately
8.6 million worksites in the United States by setting and enforcing
safety and health standards, rules, and regulations, and inspecting
worksites to ensure employer compliance. OSHA helps to ensure safe and
healthy working conditions for workers through its 11 national office
directorates and 10 regional offices. The national office directorates
include the Directorate of Enforcement Programs, which provides
guidance to OSHA inspectors on how to enforce safety and health
regulations and standards and how employers are to comply with them,
and the Directorate of Evaluation and Analysis, which establishes
policies and analyzes safety and health data. OSHA directly enforces
safety and health regulations and standards in about half the states;
the remaining states have each been granted authority by OSHA to set
and enforce their own workplace safety and health standards for
worksites under a state plan approved by OSHA (state-plan states).
[Footnote 2]
The OSH Act requires nonexempt employers to prepare and maintain
records of injuries and illnesses sustained by their workers and make
them available to OSHA.[Footnote 3] The primary record employers are
required to maintain is OSHA's Form 300 Log of Work-Related Injuries
and Illnesses (see appendix IV). For each work-related injury and
illness that requires medical treatment other than first aid, the
employer is required to record the worker's name; the date; a brief
description of the injury or illness; and the number of days the worker
was away from work, assigned to restricted duties, or transferred to
another job as a result of the injury or illness. Employers are also
required to describe each injury and illness on the Injuries and
Illnesses Incident Report (OSHA's Form 301). About 1.5 million
employers with more than 10 employees--representing about 17 percent of
the approximately 8.6 million private sector worksites and an estimated
53 million employees covered by OSHA--must keep such records. OSHA has
established definitions and recordkeeping guidelines to assist
employers in determining which injuries and illnesses must be recorded
in their injury and illness logs. Injuries and illnesses serious enough
to be recorded include those that result in lost work time, medical
treatment other than first aid, restriction of work, loss of
consciousness, or transfer to another job. OSHA requires employers to
post summaries of their logs annually at each worksite and to provide
them to OSHA and BLS if requested. OSHA's recordkeeping standards,
which took effect in January 2002, were intended to simplify the
recordkeeping rules and forms used to record injuries and
illnesses.[Footnote 4]
OSHA also promotes workplace safety and health by targeting industries
and employers with the highest number of workplace injuries and
illnesses for inspection. OSHA does this through both programmed
(scheduled) inspections and unprogrammed (unscheduled) inspections
conducted by inspectors in area offices throughout its 10 U.S. regions.
OSHA places the highest priority on unprogrammed inspections initiated
in response to fatality investigations, formal complaints, referrals,
and other situations that could pose a risk to the safety and health of
workers. OSHA gives a lower priority to programmed inspections, which
include those selected by OSHA through its Site-Specific Targeting
program, which it uses to target high hazard worksites for
inspection.[Footnote 5] Table 1 shows the number of programmed and
unprogrammed inspections OSHA conducted from fiscal years 2003 through
2007.
Table 1: Number of Inspections Conducted by OSHA, Fiscal Years 2003-
2007:
Number of inspections: Total inspections;
FY 2003: 39,778;
%: 100;
FY 2004: 39,112;
%: 100;
FY 2005: 39,828;
%: 100;
FY 2006: 38,537;
%: 100;
FY 2007: 39,323;
%: 100.
Number of inspections: Programmed inspections;
FY 2003: 22,436;
%: 56;
FY 2004: 21,576;
%: 55;
FY 2005: 21,404;
%: 54;
FY 2006: 21,506;
%: 56;
FY 2007: 23,035;
%: 59.
Number of inspections: Unprogrammed inspections;
FY 2003: 17,342;
%: 44;
FY 2004: 17,536;
%: 45;
FY 2005: 18,424;
%: 46;
FY 2006: 17,031;
%: 44;
FY 2007: 16,288;
%: 41.
Number of inspections: Fatality investigations;
FY 2003: 1,021;
FY 2004: 1,060;
FY 2005: 1,114;
FY 2006: 1,081;
FY 2007: 1,043.
Number of inspections: Complaints;
FY 2003: 7,969;
FY 2004: 8,062;
FY 2005: 7,716;
FY 2006: 7,376;
FY 2007: 7,055.
Number of inspections: Referrals;
FY 2003: 4,472;
FY 2004: 4,585;
FY 2005: 4,787;
FY 2006: 5,019;
FY 2007: 5,007.
Number of inspections: Other;
FY 2003: 3,880;
FY 2004: 3,829;
FY 2005: 4,807;
FY 2006: 3,555;
FY 2007: 3,183.
Source: GAO based on OSHA data.
[End of table]
BLS's SOII includes injury and illness data from employers' logs for
about 241,000 worksites; the ODI survey includes data from about 80,000
worksites in high hazard industries.[Footnote 6] The SOII is a
coordinated federal-state effort that estimates the number of workplace
injuries and illnesses that occur at worksites in most industries in
the United States. Because the data come from OSHA logs, the injuries
and illnesses counted by the survey are only those required by OSHA to
be recorded. As such, the data differ from those collected by other
systems, such as data collected using workers' compensation claims.
While BLS and OSHA collect the same basic information, they largely
collect data from different employers. However, BLS estimates a
potential overlap of less than 10 percent of employers who must
complete both the BLS SOII and OSHA ODI surveys in a given year. In
these cases, employers send the data to both BLS and OSHA because the
agencies do not share data. Figure 1 shows the surveys and how they are
used.
Figure 1: DOL's Annual Occupational Injury and Illness Surveys:
[Refer to PDF for image: illustration]
Employer-reported data from 241,000 worksites:
Bureau of Labor Statistics: SOII survey;
Trend data: Produces industry-based injury and illness statistics used
to identify national trends.
Employer-reported data from 80,000 worksites:
Occupational Safety and Health Administration: ODI survey;
Worksite-level data: Produce injury and illness rates used to direct
OSHA‘s enforcement efforts.
Sources: GAO analysis of DOL‘s Annual Occupational Injury and Illness
Surveys.
[End of figure]
BLS's data show a generally steady decline in the number and rate of
injuries and illnesses reported by employers from 1992 to 2007 (see
figure 2). DOL officials often cite this decline as evidence of the
success of OSHA's workplace safety programs and its enforcement
efforts. However, because of the SOII's sole reliance on employer-
reported injury and illness data, some academic studies have reported
that the survey may undercount the total number of workplace injuries
and illnesses.[Footnote 7] OSHA officials stated that the decline has
been driven by employer improvements to workplace safety and health,
and by the decrease in the number of manufacturing jobs in the United
States. According to BLS, manufacturing jobs in the United States have
declined by almost 24 percent since 1998. The OSHA officials also said
that the decline in the rate of U.S. occupational injuries and
illnesses is consistent with declines in other countries. Data from the
International Labour Organization show that several countries
experienced declines in their rates of injuries and illnesses from 1992
to 2006.[Footnote 8]
Figure 2: Number and Rate of Injuries and Illnesses in the United
States, 1990-2007:
[Refer to PDF for image: multiple line graph]
Year: 1990;
Number of injured and ill workers: 6.8 million;
Rate of injuries per 100 full-time workers: 8.8.
Year: 1991;
Number of injured and ill workers: 6.3 million;
Rate of injuries per 100 full-time workers: 8.4.
Year: 1992;
Number of injured and ill workers: 6.8 million;
Rate of injuries per 100 full-time workers: 8.9.
Year: 1993;
Number of injured and ill workers: 6.7 million;
Rate of injuries per 100 full-time workers: 8.5.
Year: 1994;
Number of injured and ill workers: 6.8 million;
Rate of injuries per 100 full-time workers: 8.4.
Year: 1995;
Number of injured and ill workers: 6.6 million;
Rate of injuries per 100 full-time workers: 8.1.
Year: 1996;
Number of injured and ill workers: 6.2 million;
Rate of injuries per 100 full-time workers: 7.4.
Year: 1997;
Number of injured and ill workers: 6.1 million;
Rate of injuries per 100 full-time workers: 7.1.
Year: 1998;
Number of injured and ill workers: 5.9 million;
Rate of injuries per 100 full-time workers: 6.7.
Year: 1999;
Number of injured and ill workers: 5.7 million;
Rate of injuries per 100 full-time workers: 6.3.
Year: 2000;
Number of injured and ill workers: 5.7 million;
Rate of injuries per 100 full-time workers: 6.1
Year: 2001;
Number of injured and ill workers: 5.2 million;
Rate of injuries per 100 full-time workers: 5.7.
Year: 2002;
Number of injured and ill workers: 4.7 million;
Rate of injuries per 100 full-time workers: 5.3.
Year: 2003;
Number of injured and ill workers: 4.4 million;
Rate of injuries per 100 full-time workers: 5.
Year: 2004;
Number of injured and ill workers: 4.3 million;
Rate of injuries per 100 full-time workers: 4.8.
Year: 2005;
Number of injured and ill workers: 4.2 million;
Rate of injuries per 100 full-time workers: 4.6.
Year: 2006;
Number of injured and ill workers: 4.1 million;
Rate of injuries per 100 full-time workers: 4.4.
Year: 2007;
Number of injured and ill workers: 4 million;
Rate of injuries per 100 full-time workers: 4.2.
Source: BLS.
Note: Rule changes in 2002 may affect the comparability of the data in
this time series.
[End of figure]
From the time the ODI was established in 1995, OSHA has annually
surveyed about 80,000 of the approximately 130,000 worksites with 40 or
more workers it defines as being in high hazard industries.[Footnote 9]
According to OSHA officials, the survey size is based on the budgetary
resources OSHA had when the ODI was established. The agency uses data
from the ODI to target employers for inspections, outreach, and
technical assistance, and to measure its performance in reducing
workplace injuries and illnesses. For example, OSHA provides employers
with onsite assistance to help them identify and correct hazards and
set up safety and health programs. OSHA also provides employers with
training and education to help them reduce worker accidents and
injuries. The 130,000 worksites in the ODI universe are selected from
manufacturing and 22 other industries OSHA defined as high hazard on
the basis of their injury and illness rates reported by BLS in 2002:
worksites with a lost workday injury and illness (LWDII) rate of 5.0 or
higher.[Footnote 10] To expand its coverage of high hazard worksites,
OSHA included 20,000 construction worksites in its 2008 ODI. OSHA has
also proposed including worksites with 30 or more employees in the ODI,
instead of using the current threshold of 40 or more employees.
OSHA and some state-plan states annually conduct onsite audits of
employer injury and illness logs to verify the accuracy of the ODI
data. While OSHA inspectors check employers' injury and illness records
during safety and health inspections, a records audit is the primary
mechanism OSHA uses to verify the accuracy of the data submitted by
employers for the ODI. OSHA annually conducts records audits for a
representative sample of approximately 250 of the 130,000 worksites
included in its ODI survey. The primary purpose of a records audit is
to verify that the injury and illness data submitted to OSHA are
identical to the data in the employer's injury and illness log and that
they are accurate. The records audits OSHA conducted from 2005 to 2007
of employers' 2003, 2004, and 2005 injury and illness data occurred at
a range of worksites of differing sizes based on the average number of
workers at each worksite (see figure 3).
Figure 3: Number of Worksites Audited by Size, 2003-2005:
[Refer to PDF for image: vertical bar graph]
Target year: 2003;
Small worksites (40 to 99 workers): 114;
Medium worksites (100 to 249 workers): 106;
Large worksites (250 or more workers): 31.
Target year: 2004;
Small worksites (40 to 99 workers): 161;
Medium worksites (100 to 249 workers): 71;
Large worksites (250 or more workers): 24.
Target year: 2005;
Small worksites (40 to 99 workers): 124;
Medium worksites (100 to 249 workers): 87;
Large worksites (250 or more workers): 34.
Source: OSHA.
[End of figure]
The audits cover worksites in a variety of industries, including health
services, trucking and warehousing, fabricated metal products, and
printing and publishing (see table 2).
Table 2: Number of Records Audits by Type of Industry, 2003-2005:
Industry: Agricultural production--crops;
Number of audited worksites[A]: 2003: 2;
Number of audited worksites[A]: 2004: 0;
Number of audited worksites[A]: 2005: 2;
Number of audited worksites[A]: Total: 4.
Industry: Agricultural production--livestock;
Number of audited worksites[A]: 2003: 1;
Number of audited worksites[A]: 2004: 0;
Number of audited worksites[A]: 2005: 0;
Number of audited worksites[A]: Total: 1.
Industry: Agricultural services;
Number of audited worksites[A]: 2003: 1;
Number of audited worksites[A]: 2004: 0;
Number of audited worksites[A]: 2005: 1;
Number of audited worksites[A]: Total: 2.
Industry: Food and kindred products;
Number of audited worksites[A]: 2003: 22;
Number of audited worksites[A]: 2004: 14;
Number of audited worksites[A]: 2005: 13;
Number of audited worksites[A]: Total: 49.
Industry: Tobacco manufacturers;
Number of audited worksites[A]: 2003: 0;
Number of audited worksites[A]: 2004: 0;
Number of audited worksites[A]: 2005: 0;
Number of audited worksites[A]: Total: 0.
Industry: Textile mill products;
Number of audited worksites[A]: 2003: 4;
Number of audited worksites[A]: 2004: 2;
Number of audited worksites[A]: 2005: 3;
Number of audited worksites[A]: Total: 9.
Industry: Apparel and other textile products;
Number of audited worksites[A]: 2003: 3;
Number of audited worksites[A]: 2004: 7;
Number of audited worksites[A]: 2005: 5;
Number of audited worksites[A]: Total: 15.
Industry: Lumber and wood products;
Number of audited worksites[A]: 2003: 7;
Number of audited worksites[A]: 2004: 4;
Number of audited worksites[A]: 2005: 11;
Number of audited worksites[A]: Total: 22.
Industry: Furniture and fixtures;
Number of audited worksites[A]: 2003: 7;
Number of audited worksites[A]: 2004: 5;
Number of audited worksites[A]: 2005: 4;
Number of audited worksites[A]: Total: 16.
Industry: Paper and allied products;
Number of audited worksites[A]: 2003: 4;
Number of audited worksites[A]: 2004: 7;
Number of audited worksites[A]: 2005: 6;
Number of audited worksites[A]: Total: 17.
Industry: Printing and publishing;
Number of audited worksites[A]: 2003: 12;
Number of audited worksites[A]: 2004: 14;
Number of audited worksites[A]: 2005: 7;
Number of audited worksites[A]: Total: 33.
Industry: Chemicals and allied products;
Number of audited worksites[A]: 2003: 9;
Number of audited worksites[A]: 2004: 12;
Number of audited worksites[A]: 2005: 9;
Number of audited worksites[A]: Total: 30.
Industry: Petroleum and coal products;
Number of audited worksites[A]: 2003: 1;
Number of audited worksites[A]: 2004: 1;
Number of audited worksites[A]: 2005: 0;
Number of audited worksites[A]: Total: 2.
Industry: Rubber and miscellaneous plastic products;
Number of audited worksites[A]: 2003: 14;
Number of audited worksites[A]: 2004: 16;
Number of audited worksites[A]: 2005: 9;
Number of audited worksites[A]: Total: 39.
Industry: Leather and leather products;
Number of audited worksites[A]: 2003: 1;
Number of audited worksites[A]: 2004: 0;
Number of audited worksites[A]: 2005: 0;
Number of audited worksites[A]: Total: 1.
Industry: Stone, clay, and glass products;
Number of audited worksites[A]: 2003: 5;
Number of audited worksites[A]: 2004: 8;
Number of audited worksites[A]: 2005: 8;
Number of audited worksites[A]: Total: 21.
Industry: Primary metal industries;
Number of audited worksites[A]: 2003: 8;
Number of audited worksites[A]: 2004: 7;
Number of audited worksites[A]: 2005: 9;
Number of audited worksites[A]: Total: 24.
Industry: Fabricated metal products;
Number of audited worksites[A]: 2003: 20;
Number of audited worksites[A]: 2004: 24;
Number of audited worksites[A]: 2005: 21;
Number of audited worksites[A]: Total: 65.
Industry: Machinery, except electrical;
Number of audited worksites[A]: 2003: 23;
Number of audited worksites[A]: 2004: 15;
Number of audited worksites[A]: 2005: 20;
Number of audited worksites[A]: Total: 58.
Industry: Electric and electronic equipment;
Number of audited worksites[A]: 2003: 11;
Number of audited worksites[A]: 2004: 16;
Number of audited worksites[A]: 2005: 12;
Number of audited worksites[A]: Total: 39.
Industry: Transportation equipment;
Number of audited worksites[A]: 2003: 8;
Number of audited worksites[A]: 2004: 3;
Number of audited worksites[A]: 2005: 10;
Number of audited worksites[A]: Total: 21.
Industry: Instruments and related products;
Number of audited worksites[A]: 2003: 8;
Number of audited worksites[A]: 2004: 6;
Number of audited worksites[A]: 2005: 5;
Number of audited worksites[A]: Total: 19.
Industry: Miscellaneous manufacturing industries;
[Empty];
Number of audited worksites[A]: 2003: 4;
Number of audited worksites[A]: 2004: 3;
Number of audited worksites[A]: 2005: 3;
Number of audited worksites[A]: Total: 10.
Industry: Trucking and warehousing;
Number of audited worksites[A]: 2003: 15;
Number of audited worksites[A]: 2004: 22;
Number of audited worksites[A]: 2005: 21;
Number of audited worksites[A]: Total: 58.
Industry: U.S. Postal Service;
Number of audited worksites[A]: 2003: 0;
Number of audited worksites[A]: 2004: 0;
Number of audited worksites[A]: 2005: 0;
Number of audited worksites[A]: Total: 0.
Industry: Water transportation;
Number of audited worksites[A]: 2003: 0;
Number of audited worksites[A]: 2004: 0;
Number of audited worksites[A]: 2005: 0;
Number of audited worksites[A]: Total: 0.
Industry: Transportation by air;
Number of audited worksites[A]: 2003: 6;
Number of audited worksites[A]: 2004: 2;
Number of audited worksites[A]: 2005: 2;
Number of audited worksites[A]: Total: 10.
Industry: Transportation services;
Number of audited worksites[A]: 2003: 0;
Number of audited worksites[A]: 2004: 0;
Number of audited worksites[A]: 2005: 1;
Number of audited worksites[A]: Total: 1.
Industry: Electric, gas, and sanitary services;
Number of audited worksites[A]: 2003: 3;
Number of audited worksites[A]: 2004: 2;
Number of audited worksites[A]: 2005: 2;
Number of audited worksites[A]: Total: 7.
Industry: Wholesale trade--durable goods;
Number of audited worksites[A]: 2003: 5;
Number of audited worksites[A]: 2004: 16;
Number of audited worksites[A]: 2005: 8;
Number of audited worksites[A]: Total: 29.
Industry: Wholesale trade--nondurable goods;
Number of audited worksites[A]: 2003: 8;
Number of audited worksites[A]: 2004: 7;
Number of audited worksites[A]: 2005: 8;
Number of audited worksites[A]: Total: 23.
Industry: Building materials and garden supplies;
Number of audited worksites[A]: 2003: 9;
Number of audited worksites[A]: 2004: 10;
Number of audited worksites[A]: 2005: 13;
Number of audited worksites[A]: Total: 32.
Industry: Health services;
Number of audited worksites[A]: 2003: 30;
Number of audited worksites[A]: 2004: 33;
Number of audited worksites[A]: 2005: 32;
Number of audited worksites[A]: Total: 95.
Industry: Total;
Number of audited worksites[A]: 2003: 251;
Number of audited worksites[A]: 2004: 256;
Number of audited worksites[A]: 2005: 245;
Number of audited worksites[A]: Total: 752.
Source: OSHA.
[A] OSHA surveys a portion of its ODI universe annually and as a
result, an industry may be included one year and excluded the next.
Therefore, industries in this table may not have any records audits for
a given year because the industry was not included in that year's ODI.
[End of table]
Based on its analysis of OSHA's records audits of employers' 2003,
2004, and 2005 injury and illness data, Eastern Research Group, Inc.
[Footnote 11] found an accuracy rate of over 90 percent for the total
number of cases that were required to be recorded and those involving
days away from work, restricted activity, or job transfer (DART).
[Footnote 12] OSHA uses these findings to support the agency's
continued use of the ODI data to target worksites for enforcement and
compliance assistance, and to measure the agency's performance in
reducing workplace injuries and illnesses.
DOL Verifies the Injury and Illness Data in the ODI, but OSHA Does Not
Always Collect Information from Workers, and Excludes Certain
Industries:
Although DOL is not required to, it verifies some of the workplace
injury and illness data it collects from employers on the ODI survey
via OSHA's records audits. However, OSHA's efforts to verify the
accuracy of the data are not adequate because OSHA overlooks some
information it could obtain from workers about injuries and illnesses
during these audits that could help verify the accuracy of the data. In
addition, OSHA excludes certain high hazard industries from its data
collection efforts, which precludes them from being selected for
records audits and makes them unlikely to be targeted by OSHA for
inspections, outreach, and technical assistance. BLS does not verify
the injury and illness data it collects from employers in the SOII that
are used to report national injury and illness statistics and trends,
but it has taken or is planning to take several actions to respond to
concerns about the quality and completeness of the data.
OSHA Does Not Require Inspectors to Interview Workers during Records
Audits:
OSHA does not require inspectors to interview workers during records
audits about injuries and illnesses that they or their co-workers may
have experienced. Although OSHA's procedures manual states that
inspectors must conduct interviews if they believe the records do not
provide full and accurate information, it does not provide criteria for
what constitutes "full and accurate" information. OSHA officials
confirmed that it is optional for inspectors to interview workers
during records audits. As a result, inspectors may miss opportunities
to obtain information from workers about injuries and illnesses that
may not have been properly recorded by employers on their injury and
illness logs. As noted in our previous work, there are potential risks
in relying solely on employer-reported data.[Footnote 13] When OSHA
inspectors conduct records audits, the audit procedures direct them to
inspect the records of a random sample of workers at the worksites,
among other things. These records, which are provided to the inspectors
by the employer, can include workers' compensation records, medical
records, accident reports, and records of absences.
In addition to reviewing these records, OSHA's procedures provide
inspectors with the option to interview workers. Worker interviews are
the only source of information used during the audit not provided by
the employer. If inspectors choose to interview workers, OSHA's audit
software generates a sample of workers to be interviewed from the
initial random sample of workers. For the 753 records audits OSHA
conducted of employers' 2003, 2004, and 2005 injury and illness
records, we found that inspectors chose to interview workers in about
half of the audits. During our interviews, inspectors told us one
challenge they face in interviewing workers is that many workers are no
longer employed at the worksite or are unavailable to be interviewed at
the time of the audit. Of these inspectors who conducted interviews, 9
of 14 reported they are rarely or never able to interview the full
sample of workers. We examined the data for audits conducted from 2005
to 2007, and found that when inspectors interviewed workers, 72 percent
of the time they did not interview the full number of workers
recommended by the audit procedures. OSHA headquarters officials told
us that, although the records audit procedures do not direct inspectors
to substitute other workers to interview when the workers originally
selected are unavailable, they always instruct inspectors to do so
during records audit training. However, OSHA does not conduct all of
the records audit training inspectors receive, and several of the
inspectors we interviewed said they had not received this training.
Lack of Timeliness in Conducting Interviews with Workers Can Affect
Their Usefulness:
Interviewing workers might provide information to help inspectors
evaluate the accuracy and completeness of employer-provided data;
however, the lack of timeliness in conducting the interviews can affect
their usefulness. Some inspectors told us that because OSHA does not
conduct records audits until about 2 calendar years after the injuries
and illnesses are recorded, inspectors rarely learn about underrecorded
injuries or illnesses from the interviews. Because of this lag,
inspectors told us many workers are no longer employed at the worksite
and those who remain may be unable to remember the injury or illness.
OSHA officials said the lag exists because, after the end of the
calendar year in which the injury or illness is recorded, it takes OSHA
a full year to collect the data and up to 9 additional months to
conduct the records audits. For example, in early 2008, OSHA selected
the ODI worksites for the calendar year 2007 injury and illness data.
OSHA then spent a year collecting the data from employers. After
collecting the data, OSHA selected worksites for records audits in
early 2009, and generally gave inspectors until the end of September to
complete the audits. As a result, if a worker was injured in January
2007, OSHA might not examine the employer's records or interview the
worker about the injury until the summer or fall of 2009--2˝ years
after the injury occurred. Figure 4 depicts the timeline for the
process and the activities performed. In comparison, it takes BLS
approximately 10 months to both collect and report the SOII data;
however, BLS does not conduct follow-up verifications like OSHA's
records audits.
Figure 4: Timeline for Collecting and Auditing Employers' Injury and
Illness Records:
[Refer to PDF for image: timeline]
Year 1:
Employers at worksites record worker injuries and illnesses on OSHA‘s
Form 300 Log of Work-Related Injuries and Illnesses.
Year 2:
OSHA selects worksites from which to collect the summary of the
previous year‘s Form 300;
OSHA collects summary of the Form 300 from employers.
Year 3:
OSHA selects worksites for records audits;
Inspectors conduct records audits.
Source: GAO analysis of information provided by OSHA.
[End of figure]
OSHA's ODI Universe Excludes Eight High Hazard Industries:
Worksites under eight high hazard industries cannot be selected for
records audits or targeted for OSHA's enforcement and compliance
activities, because OSHA has not updated its list of high hazard
industries included in the ODI universe since 2002. (See appendix V for
a list of high hazard industries included in the ODI universe.) OSHA
has neither a formal written policy on how or when to update the list
of industries included in the ODI, nor clear documentation that
explains the original construction of the ODI or its subsequent
updates. We first reported on OSHA's lack of documentation for its ODI
industry selection process in 1998.[Footnote 14] By not updating its
high hazard industry list using the most recent BLS SOII data, we found
that OSHA is excluding eight high hazard industries that had an average
DART rate of 4.2, which is higher than twice the national average or
greater, for the three most recent years, from 2005 to 2007. Industries
excluded include amusement parks, industrial launderers, and general
rental centers (see table 3). As a result, worksites in these
industries are precluded from being selected for OSHA's records audits
and they are unlikely to be targeted by OSHA for inspections, outreach,
and technical assistance. Table 3 shows the industries excluded from
the ODI universe.
Table 3: Industries That Would be High Hazard if OSHA Updated Its ODI
Universe:
NAICS code[A]: 22133;
Industry: Steam and air-conditioning supply.
NAICS code[A]: 483113;
Industry: Coastal and Great Lakes freight transportation.
NAICS code[A]: 53212;
Industry: Truck, utility trailer, and RV (recreational vehicle) rental
and leasing.
NAICS code[A]: 5323;
Industry: General rental centers.
NAICS code[A]: 7131;
Industry: Amusement parks and arcades.
NAICS code[A]: 71392;
Industry: Skiing facilities.
NAICS code[A]: 812331;
Industry: Linen supply.
NAICS code[A]: 812332;
Industry: Industrial launderers.
Source: GAO analysis of DOL data.
[A] NAICS = North American Industry Classification System.
[End of table]
OSHA officials told us they have not updated the high hazard list
because an agency regulation requires them to use the Standard
Industrial Classification (SIC) system to classify industries, rather
than the North American Industry Classification System (NAICS) industry
codes currently used by BLS to report injury and illness rates. Prior
to 2003, both OSHA and BLS used the SIC codes to classify industries.
OSHA officials said they would like to switch to the NAICS codes, but
they stated it is not currently an agency priority to pursue the
regulatory change required to do so. In addition to a regulatory
change, switching to NAICS would require OSHA to re-evaluate the
criteria it uses to define industries as high hazard because in 2002,
OSHA switched from using the LWDII rate to the DART rate for measuring
workers' injuries and illnesses.[Footnote 15] Because the LWDII and
DART are not exactly comparable, OSHA would have to identify a DART
rate that is comparable to its LWDII rate of 5.0, which was the
criterion OSHA used in 2002 to define a high hazard industry. According
to our analysis, the results of which we confirmed through discussions
with OSHA officials, a 4.2 DART rate is comparable to a 5.0 LWDII rate.
BLS Does Not Verify Employer-reported Data in the SOII, but Has
Undertaken Actions to Improve the Quality and Completeness of the Data:
BLS is not required to verify the accuracy of the data employers record
on their OSHA forms; however, BLS has acknowledged limitations to the
survey and has taken steps to improve it. BLS uses the SOII to report
national, industry-wide injury and illness data, and policymakers and
employers rely on the data to understand national trends in worker
safety and health. The SOII only includes injury and illness data
provided by employers. In contrast, BLS reports monthly employment
statistics with data from employers on the number of jobs and from
households on the number of people employed. A number of studies have
compared the BLS data on injuries and illnesses to data collected from
other sources, such as workers' compensation, hospital discharge data,
and medical records.[Footnote 16] These studies found discrepancies
between the number of injuries and illnesses reported in the SOII and
the information in the other data sets. Some researchers have also
criticized the scope of the SOII, noting, for example, that the 14.7
percent of all workers in 1999 who were government workers and the 7.3
percent of all workers who were self-employed were not included in the
SOII.[Footnote 17]
In response to questions about the accuracy of the employer-reported
SOII data, BLS has taken several actions designed to improve the
quality and completeness of the data. For example, to address concerns
about the survey's limited scope, BLS expanded the SOII for its 2008
survey to include data on state and local government workers in all
states and conducted a quality assurance study to verify that employers
correctly transcribed information from their 2006 OSHA logs onto BLS's
SOII survey forms. BLS also interviewed employers to determine how they
record injury and illness data on the OSHA and workers' compensation
forms. The aim of this effort was to identify cases where employers
reported an injury or illness to the state's Workers' Compensation
program, but did not record the cases on the OSHA log, despite the fact
that the injury or illness was an OSHA-recordable case. In addition, in
a 2009 research study, BLS examined discrepancies between the number of
workplace injuries and illnesses reported in states' workers'
compensation databases and in the SOII to address concerns about data
accuracy. From the research, BLS identified some factors associated
with discrepancies between the SOII and workers' compensation data, and
is continuing to conduct research to identify additional potential
factors. BLS stated that some of the discrepancies arose from cases
that were compensable, but in which workers had no days away from work,
and cases that entered workers' compensation after the end of the year,
but did appear in the BLS data.
In addition to the actions it has already taken, BLS is planning to
explore the use of other data sets to improve the quality of the SOII
data. For example, BLS officials told us they plan to support the work
of the National Institute for Occupational Safety and Health to explore
the use of occupational injury and illness data collected by emergency
departments to help identify gaps in the SOII data.[Footnote 18] The
emergency department data could be particularly important because they
would capture injuries and illnesses for self-employed workers, who are
currently excluded from the SOII. In addition, since these data are
reported by hospitals and not employers, they could help BLS identify
underrecorded injuries and illnesses. Finally, BLS is planning to work
with the Council of State and Territorial Epidemiologists to evaluate
the quality of the SOII data for certain injuries such as amputations
and carpal tunnel syndrome.[Footnote 19] BLS has issued grants to three
states to evaluate the possibility of using multiple sources of data to
enumerate the quality of the SOII for certain injuries such as
amputations and carpal tunnel syndrome.
Occupational Safety and Health Practitioners and Stakeholders Cited
Worker and Employer Disincentives as Primary Factors That May Affect
the Accuracy of Injury and Illness Data:
Disincentives that influence workers' decisions to report and
employers' decisions to record work-related injuries and illnesses are
primary factors that may affect the accuracy of the data, according to
occupational safety and health practitioners and stakeholders. They
also reported that a lack of understanding of OSHA's recordkeeping
requirements by those responsible for recording injuries and illnesses
may affect the accuracy of the data.
Various Disincentives May Discourage Workers from Reporting and
Employers from Recording Injuries and Illnesses:
Occupational safety and health stakeholders we interviewed and
occupational health practitioners we surveyed told us that primary
factors affecting the accuracy of injury and illness data include
disincentives that affect workers' decisions to report work-related
injuries and illnesses and employers' decisions to record them.
Stakeholders most often cited workers' fear of job loss and other
disciplinary actions as disincentives that can affect workers'
decisions to report injuries and illnesses. Occupational health
practitioners concurred: 67 percent reported observing worker fear of
disciplinary action for reporting an injury or illness, and 46 percent
said that this fear of disciplinary action has at least a minor impact
on the accuracy of employers' injury and illness records. Workers' fear
of disciplinary actions may be compounded by policies at some worksites
that require workers to undergo mandatory drug testing following
incidents resulting in reported injuries or illnesses, regardless of
any evidence of drug use. Several labor representatives described
mandatory drug testing policies as a disincentive that affects workers'
decisions to report injuries and illnesses, and 67 percent of health
practitioners reported they were aware of this practice at the
worksites where they treated workers in 2008.
Stakeholders also said employers' safety incentive programs can serve
as disincentives for workers reporting injuries and illnesses. These
programs reward workers when their worksites have few recordable
injuries or illnesses. One-half of the health practitioners who
responded to our survey reported they were aware of incentive programs
at the worksites where they treated workers in 2008. Safety incentive
programs are designed to promote safe behavior by workers, and 72
percent of health practitioners reported that these programs motivate
workers to work in a safe manner. However, some stakeholders said these
programs can discourage workers from reporting injuries and illnesses;
more than three-quarters of health practitioners said they believed
workers sometimes avoid reporting work-related injuries and illnesses
as a result. Stakeholders also said that in addition to missing the
chance to win prizes for themselves, workers who report injuries and
illnesses may risk ruining their coworkers' chances of winning such
prizes.
Various disincentives may also discourage employers from recording
workers' injuries and illnesses. Stakeholders told us employers are
concerned about the impact of higher injury and illness rates on their
workers' compensation costs. Several researchers and labor
representatives said that because employers' workers' compensation
premiums increase with higher injury and illness rates, employers may
be reluctant to record injuries and illnesses. They also said
businesses sometimes hire independent contractors to avoid the
requirement to record workers' injuries and illnesses because they are
not required to record them for self-employed individuals.[Footnote 20]
Stakeholders also told us employers may not record injuries and
illnesses because having high injury and illness rates can affect their
ability to compete for contracts for new work. The injury and illness
rate for worksites in certain industries, such as construction, affects
some employers' competitiveness in bidding on the same work.
Disincentives that discourage workers from reporting and employers from
recording injuries and illnesses may also result in pressure on
occupational health practitioners to treat workers in a manner that
avoids the OSHA requirement to record injuries and illnesses. From our
survey, we found that more than one-third of health practitioners were
asked by company officials or workers to provide treatment that
resulted in an injury or illness not being recorded, but also was not
sufficient to properly treat the injury or illness. For example, in
some cases, practitioners stated that employers may seek out
alternative diagnoses if the initial diagnosis would result in a
recordable injury or illness. One practitioner said that an injured
worker's manager took the worker to multiple providers until the
manager found one who would certify that treatment of the injury
required only first aid, which is not a recordable injury. Fifty-three
percent of the health practitioners reported that they experienced
pressure from company officials to downplay injuries or illnesses, and
47 percent reported that they experienced this pressure from workers.
Further, 44 percent of health practitioners stated that this pressure
had at least a minor impact on whether injuries and illnesses were
accurately recorded, and 15 percent reported it had a major impact. In
some cases, this pressure may be related to the employers' use of
incentive programs. Of those experiencing pressure from workers, 61
percent reported they were aware of incentive programs at the worksites
where they treated workers (see figure 5). In comparison, of the
practitioners who reported not experiencing pressure from workers in
2008, 41 percent reported being aware of incentive programs at the
worksites where they treated workers.
Figure 5: Pressure From Workers to Downplay Injuries and Illnesses and
Awareness of Incentive Programs:
[Refer to PDF for image: pie-chart and subchart]
Did you experience pressure from workers to downplay injuries or
illnesses in 2008?
Yes: 47%;
No: 48%;
Not sure: 6%.
Did any of the worksites where you treated workers in 2008 have
incentive programs?
Yes: 61%;
No: 24%;
Not sure: 16%.
Source: GAO analysis of occupational health practitioner survey data.
[End of figure]
An OSHA official told us that OSHA does not have an official policy on
incentive programs or practices that may affect workers' decisions to
report injuries and illnesses, but it has authority under the OSH Act
to discourage inaccurate reporting by employers. The official stated
that, under a planned National Emphasis Program, OSHA will explore the
possible impact that incentive programs have on workers' decisions to
report injuries and illnesses. To address disincentives that may affect
employers' decisions to accurately record injuries and illnesses, the
official stated OSHA can issue citations or fine employers when
recordkeeping violations are found.
Lack of Understanding of OSHA's Recordkeeping Requirements and Other
Factors May Also Affect the Accuracy of the Injury and Illness Data:
Several stakeholders and nearly all of the OSHA inspectors we
interviewed said that the lack of understanding of OSHA's recordkeeping
requirements by the individuals charged with recording injuries and
illnesses affects the accuracy of the injury and illness data. Forty-
one percent of occupational health practitioners reported that
misinterpretation of OSHA's recordkeeping requirements by company
officials has an impact on whether injuries and illnesses are
accurately recorded (see figure 6). Several researchers and a
representative from a labor organization with whom we spoke said that
inaccuracies in recording injuries and illnesses can result from a lack
of understanding of the differences between OSHA's recordkeeping
requirements and the eligibility criteria for workers' compensation
claims. They stated that some individuals charged with maintaining
employers' OSHA logs erroneously think that the criteria for recording
injuries and illnesses are the same as the eligibility criteria for
filing workers' compensation claims. Therefore, they may be less likely
to record injuries and illnesses that are not compensable through the
workers' compensation system. In addition, some stakeholders said they
thought the lack of understanding among those recording injuries and
illnesses was likely worse in smaller companies with fewer resources
than larger companies, which have a greater capacity for providing
recordkeeping training.
Figure 6: Reported Impact of Misinterpretation of Recordkeeping
Requirements on Records Accuracy:
[Refer to PDF for image: pie-chart]
What impact does misinterpretation of recordkeeping requirements by
company officials have on records accuracy?
Major impact: 11%;
Minor impact: 30%;
No impact: 21%;
Not sure: 38%.
Source: GAO analysis of occupational health practitioner survey data.
[End of figure]
OSHA provides a number of tools to assist employers in understanding
its recordkeeping requirements. For example, the form employers use to
record injuries and illnesses--the OSHA injury and illness log--
provides examples of which injuries and illness must be recorded and
how to record them. OSHA also posts guidance and frequently asked
questions about its recordkeeping requirements on its Web site. In
addition, OSHA officials told us employers with recordkeeping questions
can phone officials in OSHA headquarters and area offices, or e-mail
questions to OSHA via its Web site. They also said they have considered
creating an online tool to help employers quickly and easily determine
whether to record specific injuries and illnesses on their logs.
Stakeholders also discussed additional factors that may affect the
accuracy of employers' data, including weaknesses in OSHA's enforcement
efforts and the difficulty of determining whether some illnesses are
work related. Several stakeholders pointed to weaknesses in OSHA's
enforcement efforts as a reason for inaccuracies in employers' injury
and illness data. For example, some stakeholders noted that OSHA's
enforcement of recordkeeping practices has diminished in recent years.
Two stakeholders said OSHA's enforcement capabilities could be
strengthened with additional resources. Another factor a few
researchers cited that could affect the accuracy of injury and
illnesses data is that illnesses, particularly those with long latency
periods, are less likely to be reported by workers and recorded by
employers than injuries. They explained that, for many of these
illnesses, it is difficult to prove they were caused by work-related
activities.
Conclusions:
Workers are entitled to safe and healthful workplaces, and it is DOL's
responsibility to track the safety and health of the nation's
workplaces and ensure that employers take steps to minimize workers'
risks of injuries and illnesses. Accurate injury and illness records
are important because they assist Congress, researchers, OSHA, BLS, and
other agencies in describing the nature and extent of occupational
safety and health problems. These records are also vital to helping
employers and workers identify and correct safety and health problems
in the workplace. In addition, these records help OSHA evaluate
programs, allocate resources, and set and enforce safety and health
standards. Without accurate records, employers engaged in hazardous
activities can avoid inspections because OSHA bases many of its safety
inspections on work-related injury and illness rates.
Because injury and illness data are so vital, it important that OSHA
and BLS take steps to ensure that the data are as accurate as possible.
First, OSHA inspectors must take advantage of opportunities to verify
the accuracy and completeness of employer-provided records by
interviewing workers who may be aware of injuries and illness that may
not have been recorded by employers. It is also important that OSHA
conduct its records audits as soon as possible after it collects
employers' injury and illness data to maximize the usefulness of
information collected from worker interviews. In addition, it is
imperative that employers understand which injuries and illnesses
should be recorded under OSHA's recordkeeping standards. Finally,
although BLS has taken steps to improve the quality of the injury and
illness data it collects, these actions will not address all of the
concerns regarding the accuracy of the injury and illness data that BLS
collects and reports. As these data are the only comprehensive source
of national data on workers' injuries and illnesses, it will be
important for BLS to follow through on its efforts.
Recommendations for Executive Action:
To improve OSHA's efforts to verify the accuracy of employer-provided
injury and illness data, the Secretary of Labor should direct the
Assistant Secretary for OSHA to take the following three actions:
* require inspectors to interview workers during the records audits to
obtain information on injuries or illnesses and substitute other
workers when those initially selected for interviews are not available;
* minimize the amount of time between the date injuries and illnesses
are recorded by employers and the date they are audited by OSHA; and:
* update the list of high hazard industries used to select worksites
for records audits and target inspections, outreach, and technical
assistance.
To improve the accuracy of the data recorded by employers on workers'
injuries and illnesses, the Secretary of Labor should direct the
Assistant Secretary for OSHA to:
* increase education and training provided to employers to help them
determine which injuries and illnesses should be recorded under the
recordkeeping standards, such as providing assistance to employers via
the online tool that OSHA is considering.
Agency Comments and Our Evaluation:
We provided a draft of this report to the Secretary of Labor for
comment. We received written comments from the Acting Assistant
Secretary for OSHA, which are reproduced in their entirety in appendix
VI. OSHA and BLS also provided technical comments, which we
incorporated in the report as appropriate.
OSHA agreed with all of our recommendations and stated that it would
move forward to implement them. To address the first two
recommendations, OSHA stated that it would require inspectors to
interview employees during records audits and develop policies to
conduct record audits inspections in a timely fashion. For the third
recommendation, OSHA stated that it would pursue rulemaking at the
earliest possible date to update the industry coverage of the
recordkeeping rule from the SIC system to NAICS, which would ensure
that records audits include emerging high-risk industries. To address
our fourth recommendation, OSHA stated that it would supplement its
current educational outreach and develop a Web-based tool to assist
employers in meeting the requirements of OSHA's recordkeeping
regulations. OSHA also informed us that it implemented a National
Emphasis Program (NEP) on Recordkeeping on October 1, 2009. The purpose
of the NEP is to identify and correct recordkeeping inaccuracies and
complement BLS's efforts to investigate factors accounting for
differences in the number of workplace injuries and injuries estimated
by BLS and other data sources.
As agreed with your offices, unless you publicly announce the contents
of this report earlier, we plan no further distribution until 30 days
from the report date. At that time, we will send copies of this report
to the Secretary of Labor, relevant congressional committees, and other
interested parties. In addition, the report will also be available at
no charge on GAO's Web site at [hyperlink, http://www.gao.gov].
A list of related GAO products is included at the end of this report.
If you or your staff have questions about this report, please contact
me at (202) 512-7215 or moranr@gao.gov. Contact points for our Offices
of Congressional Relations and Public Affairs may be found on the last
page of this report. Key contributors to this report are listed in
appendix VII.
Signed by:
Revae E. Moran:
Acting Director, Education, Workforce and Income Security Issues:
List of Requesters:
The Honorable Tom Harkin:
Chairman:
Committee on Health, Education, Labor, and Pensions:
United States Senate:
The Honorable Patty Murray:
Chair:
Subcommittee on Employment and Workplace Safety:
Committee on Health, Education, Labor, and Pensions:
United States Senate:
The Honorable George Miller:
Chairman:
Committee on Education and Labor:
House of Representatives:
The Honorable Lynn Woolsey:
Chairwoman:
Subcommittee on Workforce Protections:
Committee on Education and Labor:
House of Representatives:
[End of section]
Appendix I: Scope and Methodology:
Review of the Department of Labor's Efforts to Verify the Accuracy of
Employer-Reported Injury and Illness Data:
To examine whether the Department of Labor (DOL) verifies that
employers are accurately recording workers' injuries and illnesses,
and, if so, the adequacy of such efforts, we focused on the efforts of
DOL's Occupational Safety and Health Administration (OSHA) to verify
the data it collects from employers on workers' injuries and illnesses
through its annual OSHA Data Initiative (ODI) survey. We analyzed
OSHA's policies and procedures and interviewed OSHA officials regarding
the agency's employer recordkeeping requirements. In addition, we
reviewed the Bureau of Labor Statistics' (BLS) efforts to verify the
data it collects for the Survey of Occupational Injuries and Illnesses
(SOII).
Analysis of OSHA's Audits of Employer Injury and Illness Records:
We analyzed the results of the onsite audits of employers' injury and
illness records (records audits) OSHA conducted in 2005, 2006, and 2007
of employers' injury and illness logs for 2003, 2004, and 2005--the
most recent period for which data were available. Prior to our
analysis, we assessed the reliability of the database OSHA uses to
track its records audits--the OSHA Recordkeeping Audit Assistant--by
reviewing information obtained from OSHA about the database,
interviewing knowledgeable agency officials, and performing electronic
testing of the software, among other steps. On the basis of our
assessment, we concluded that the data maintained by OSHA in its
database were sufficiently reliable for our reporting purposes.
Interviews of OSHA Inspectors Who Audit Employers' Injury and Illness
Records:
We interviewed selected OSHA inspectors who conducted the records
audits in 2005, 2006, and 2007 to learn about (1) the training they
received, (2) the extent to which they followed OSHA's procedures for
the records audits, and (3) their views on the accuracy of the
employers' injury and illness records they reviewed. Although we did
not seek to generalize the responses of individual inspectors to the
broader group of all inspectors who conducted these audits, we took
steps to ensure that we had a mix of inspectors. We interviewed
inspectors in states where federal OSHA directly enforces safety and
health regulations and standards and those in states that have been
approved by OSHA to conduct such activities (state-plan states).
[Footnote 21] These inspectors had a range of experience as determined
by the number of audits they conducted in 2005, 2006, and 2007. We
selected two inspectors for these interviews in each of OSHA's 10
regions--1 inspector who conducted the greatest number of records
audits and 1 who conducted the fewest number. Although we attempted to
select 2 inspectors in each region, we were only able to interview 1
inspector in 1 of the regions because only 1 inspector in that region
conducted records audits during the 3-year period we reviewed. As a
result, we interviewed a total of 19 inspectors, including 12 federal
and 7 state inspectors. In each of the 10 regions, we also interviewed
other regional staff to obtain their views about the records audits. We
interviewed the regional administrator, the deputy regional
administrator, or someone designated as representing their views in
each region. In addition, we interviewed 8 officials from 6 regions who
were area directors, records audit coordinators, or supervisors.
Analysis of the Methods OSHA Uses to Select Worksites for Records
Audits Using the ODI Universe:
To understand OSHA's process for selecting worksites for records
audits, we interviewed federal OSHA officials about the methods they
use to select worksites from the ODI universe. We also analyzed the
methods they use to compile and update the ODI universe, which is used
to select worksites for records audits, and target worksites for safety
and health inspections, outreach, and technical assistance.
As part of this work, we examined the methods OSHA uses to define
industries as "high hazard," which makes the worksites in these
industries eligible to be selected by OSHA for records audits and
targeted for safety and health inspections.[Footnote 22] In defining
the industries to be included in the ODI, OSHA uses industry-level data
published by BLS prior to 2002 based on the employer data collected in
the Survey of Occupational Injuries and Illnesses (SOII) on the
incidence rates of occupational injuries and illnesses resulting in
lost work days (referred to as Lost Work Day Injuries and Illnesses
[LWDII]) using Standard Industrial Classification (SIC) codes. In 2003,
BLS began publishing SOII data using North American Industry
Classification System (NAICS) codes to categorize industries instead of
SIC codes.
When OSHA last updated its ODI universe, it included manufacturing and
industries with an LWDII rate of 5.0 or greater; at that time, 5.0 was
twice the national injury and illness rate. Since OSHA has not updated
the ODI universe since 2002, it has not yet established a new threshold
for inclusion based on the days away, restricted or transferred (DART)
rate measurement it now utilizes. Based on our analysis of current BLS
data, we determined that a current DART rate of 4.0 was comparable to
OSHA's LWDII rate of 5.0 in 2002. In order to determine which
industries are high hazard using current data, we first converted the
high hazard industries in OSHA's ODI universe from the SIC codes OSHA
provided to GAO into the comparable NAICS codes. We then examined the
incidence of injuries and illnesses in industries that were not in the
ODI universe, and designated as potentially high hazard those that had
a DART rate of 4.0 or higher in any year in the 5-year period from 2003
to 2007, which resulted in a list of 33 potentially high hazard
industries. We asked OSHA officials to review the list of 33 industries
and identify any that were not under their jurisdiction or were
otherwise inappropriate for inclusion in the ODI. The officials stated
that a DART rate of 4.2--twice the national average--is the threshold
they would use to determine which industries are high hazard. After we
removed the 8 industries with DART rates below 4.2, we found 26
industries that might be eligible for inclusion in the ODI universe.
OSHA officials also told us that they used a 3-year average injury and
illness rate to determine eligibility for inclusion in the ODI
universe. Of the 26 industries, we found that 12 had average DART rates
for 2005 to 2007 that were lower than the 4.2 threshold and were
therefore not eligible for inclusion. Five others were not appropriate
for inclusion in the ODI because they did not fall under the agency's
jurisdiction or were comprised mostly of small employers. One remaining
industry of the 26 was already included in the ODI under a different,
but related, NAICS code. After obtaining OSHA's input, we identified 8
industries that could be included in the ODI universe if OSHA updated
the universe using NAICS codes and current BLS data.
Discussions with Stakeholders of Factors That Affect the Accuracy of
Employers' Injury and Illness Records:
To examine the factors that may affect the accuracy of employers'
injury and illness records, we selected various experts and researchers
to interview based on (1) the individual's title, affiliation, and type
and depth of experience; (2) the extent to which the individual's
published work has been cited by other studies, and by OSHA, BLS, and
other relevant organizations; (3) recommendations from other
stakeholders; (4) the relevance of the individual's work; and (5) the
source of funding of the individual's published work. By reviewing the
literature on occupational injury and illness data, and other efforts,
we identified 12 experts and researchers for our interviews.[Footnote
23] We vetted this group with (1) the director of safety and health at
a major organization representing labor issues and concerns; (2) a BLS
official from the Office of Compensation and Working Conditions who
published a 2008 article addressing the accuracy of injury and illness
data; and (3) a researcher at the National Institute for Occupational
Safety and Health (NIOSH) who heads an effort to collect national
occupational injury and illness data from a representative sample of
emergency departments in the United States.
GAO Survey of Occupational Health Practitioners:
We surveyed three categories of occupational health practitioners about
how they treat injured or ill workers; the extent of their involvement
with OSHA recordkeeping responsibilities; their views on worksite
safety incentive programs; and their perspectives on factors that
affect the completeness and accuracy of employer records of workplace
injuries and illnesses. We surveyed (1) occupational physicians
identified on lists compiled by the American Medical Association of all
practicing physicians in the United States with a primary specialty of
occupational medicine, (2) occupational physician assistants identified
on lists compiled by the American Academy of Physician Assistants of
all certified physician assistants in the United States who specialize
in occupational medicine, and (3) nurse practitioners specializing in
occupational health identified on lists compiled by a medical
information broker of all nurse practitioners in the United States.
Study Population, Sample Frame, and Sample Design:
We designed and implemented a dual mode survey (mail and Web-based) to
obtain information from occupational health practitioners. We obtained
lists of the occupational health practitioners from Medical Marketing
Service, a data management firm providing medical lists to marketers,
researchers, and government agencies. We constructed our universe of
physicians from the American Medical Association's Physician Masterfile
of all practicing physicians in the United States with a primary
specialty of occupational medicine; our universe of physician
assistants from the American Academy of Physician Assistants' list of
physician assistants specializing in occupational medicine; and our
universe of nurse practitioners from a comprehensive list of nurse
practitioners specializing in occupational health. We independently
selected a random sample from each of the three groups, resulting in a
sample of 409 of the 1,941 physicians; 396 of the 1,246 physician
assistants; and 382 of the 861 nurse practitioners, for a sample of
1,187 of the total 4,048 occupational health practitioners. Due to the
results of our nonresponse analysis (described below) we restricted our
sample of physician assistants to those who were certified, which
resulted in a sample size of 340 certified physician assistants.
Therefore, our resulting total sample was 1,131 (see table 4).
Out of the sample of 1,131 health practitioners, 504 completed the
questionnaires, for a total response rate of 45 percent. This response
rate allowed us to generalize our results to the total population of
the three groups. All estimates we report from the survey results
(including those in this appendix) have a margin of error of plus or
minus 7 percentage points or less at the 95 percent confidence level.
See table 4 for the disposition of the three separate groups of health
practitioners.
Table 4: Disposition of Health Practitioner Sample:
Practitioner group: Physicians;
Sample size: 409;
Completed responses: 191;
Response rate: 47%.
Practitioner group: Physician Assistants;
Sample size: 340;
Completed responses: 163;
Response rate: 48%.
Practitioner group: Nurse Practitioners;
Sample size: 382;
Completed responses: 150;
Response rate: 39%.
Practitioner group: Total;
Sample size: 1,131;
Completed responses: 504;
Response rate: 45%.
Source: GAO analysis of occupational health practitioner survey data.
The sample size for each practitioner group was determined to be able
to detect a 10 percent difference between the sample estimate and the
true population with a significance level of 0.05. We also oversampled
from each of the populations to account for practitioners who would not
respond to our survey and those we determined to be out of scope, such
as practitioners who did not treat workers for occupational injuries or
illnesses during 2008.
The respondents treated workers in various industries, and varied in
the number of years they had treated workers, but the majority had been
treating workers for 10 years or more (see figs. 7 and 8). The majority
also treated more than 100 workers in 2008 (see figure 9).
Figure 7: Industries in Which the Majority of Workers Treated by
Practitioner Respondents Were Employed in 2008:
[Refer to PDF for image: pie-chart]
Health care (e.g., nursing homes, hospitals): 25%;
Manufacturing: 24%;
Agriculture: 1%;
Oil and gas: 2%;
Chemicals and chemical products: 3%;
Services (e.g., hotels, laundry, cleaning): 4%;
Not sure: 6%;
Construction: 9%;
Other: 12%.
Source: GAO analysis of occupational health practitioner survey data.
Note: Less than 1 percent of respondents reported treating workers in
both the meatpacking or poultry and mining industries.
Responses do not add to 100 percent because 14 percent of respondents
indicated that the majority of the workers they treated in 2008 were
equally divided between two or more industries.
[End of figure]
Figure 8: Number of Years Respondents Had Treated Workers:
[Refer to PDF for image: vertical bar graph]
Year: Fewer than 1;
Number of respondents: 4.
Year: 1 to fewer than 5;
Number of respondents: 70.
Year: 5 to fewer than 10;
Number of respondents: 87.
Year: 10 or more;
Number of respondents: 307.
Source: GAO analysis of occupational health practitioner survey data.
[End of figure]
Figure 9: Number of Workers Treated by Respondents in 2008:
[Refer to PDF for image: vertical bar graph]
Fewer than 100: 102;
100-500: 165;
More than 500: 196;
Not sure: 6.
Source: GAO analysis of occupational health practitioner survey data.
[End of figure]
Developing the Questionnaire, Content, and Question Wording:
To develop survey questions, we drew on information we previously
gathered from interviews with occupational safety and health
stakeholders, as well as from scholarly studies from the field of
occupational safety and health research. Appendix II provides our
survey instrument. Two GAO survey specialists designed the
questionnaire in collaboration with the analysts staffed to the
engagement. We pretested the questionnaire with nine health
practitioners who represented the three study populations and made
appropriate modifications based on their feedback. Appendix III
provides additional selected survey results.
Data Collection and Nonresponse Follow-up:
We conducted the survey using a self-administered questionnaire, and
offered prospective respondents the option of completing and mailing a
hard copy questionnaire or completing the questionnaire online. We
offered both options because during our pretests, health practitioners
advised us to offer a Web-based option; however, a study of
occupational health practitioners showed that, given the choice, 90
percent of respondents chose to respond by mail.[Footnote 24] None of
our three data sources included e-mail addresses, so we mailed a hard
copy of the questionnaire with instructions to either mail the
completed paper version in a prepaid envelope or to go to a Web site
designated for the survey and use a preassigned login identification
and password. To encourage further participation, we mailed a second
questionnaire to all those who had not yet responded. We also
contracted with a survey research firm to make follow-up phone calls
for those who had not responded.
Population Estimates and Sampling Errors for Probability Samples:
Weighting Survey Response:
Since we drew an independent sample from each occupational practitioner
group, each response represented a different number in the population
of the group. To enable data from the survey response to represent the
combined population of three occupational health practitioner groups,
we calculated weights of the responses for the three groups. We
calculated the weights as:
wh= Nh divied by nh:
where:
* wh denotes the weight for the hth occupational practitioner group,
* Nh denotes the population for the hth occupational practitioner
group,
* nh denotes the total number of survey responses for the hth
practitioner group, and:
* h denotes practitioner group: 1 = physicians, 2 = physician
assistants, and 3 = nurse practitioners.
Population Estimates and Confidence Intervals:
We also estimated population statistics for the combined three health
practitioner groups by calculating the difference in weights among the
groups. We calculated the ratio estimate of the overall population by
using the following equation:
R = (Sum h Wh Sum i) divided by (Sum h Wh Sum i X hi)
where:
* wh denotes the sample weight for the hTH stratum,
* yhi represents the ith response of the variable y response in the hth
stratum (for example, yhi =1 if the iTH response was 'Construction' in
Q5, yhi =0 otherwise),
* xhi represents the ith response of the variable x in the hTH stratum
(for example, xhi = 1 if the ith response was 'Less Than 100 Workers'
in Q3, xhi =0 otherwise), and:
* R denotes a population estimate of the ratio (in this example, the
ratio of respondents who treated workers from the construction industry
among those who treated less than 100 workers in calendar year 2008).
To assess the precision of our estimates, we calculated confidence
intervals for each measure. A confidence interval gives an estimated
range of values, calculated from sample data, which is likely to
include the true measure of the population. As is commonly done, we
calculated 95 percent confidence intervals. [Footnote 25] We obtained
the 95 percent confidence intervals of our population estimates by
using methods detailed in Cochran[Footnote 26] and Hansen, Hurwitz, and
Madow,[Footnote 27] since our estimates were calculated from our
survey--that is, from a stratified sample. We estimated the population
percentage and the confidence intervals of those percentages using
specialized software for survey data analysis--SUDAANŽ.[Footnote 28]
Nonsampling Errors:
We took steps in developing the questionnaire, collecting the data, and
analyzing the data to minimize the variability in the survey results
due to nonsampling errors--such as those resulting from the differences
in the way a particular question is interpreted or the sources of
information available to respondents. The data collected were analyzed
by a data analyst working directly with staff who have subject matter
expertise. After the data were analyzed, a second independent data
analyst checked all computer programs for accuracy. We contracted with
an outside company to enter the data from the paper questionnaires into
a database, and we checked a 10 percent sample of the database as a
quality control measure. Respondents who completed questionnaires
online entered their answers directly.
Nonresponse Bias Analysis:
Because only about 45 percent of the health practitioners (47 percent
of physicians, 48 percent of physician assistants, and 39 percent of
nurse practitioners) provided usable responses to our survey, bias from
nonresponse may result. If the views of those who did not respond
differed from the views of those who did respond to some survey
questions, the estimates made solely from those who did respond would
be biased from excluding parts of the population with different
characteristics or views. To limit this kind of error, we made several
attempts to gain the participation of as many occupational health
practitioners as possible, including additional mailings and
contracting with a survey firm to call nonrespondents to encourage
their participation. To assess the likelihood of significant bias, we
collected additional data through the calls made by our contractor
concerning reasons why the practitioners did not respond, and by trying
to persuade them to answer three key questions from our survey on the
phone. We also conducted several analyses of these follow-up data, our
survey data, and data we had about the population from which we
sampled, to attempt to detect any nonresponse bias.
We analyzed practitioner characteristics that may have been related to
what their answers to our survey questions would have been if they had
responded. The variables available to us for this analysis differed by
practitioner type. For physicians, we used age, gender, number of
offices, type of physician (medical doctor or doctor of osteopathic
medicine), and geographic region. For physician assistants we used age,
gender, years since graduation, and certification status. For nurse
practitioners, we used age, gender, and practice setting. Using
logistic regression, we compared the characteristics of nonrespondents
to respondents to determine if any of these characteristics were more
likely to be associated with being a responder. With the exception of
one characteristic for one group, we did not detect a significant
difference between those who chose to respond and those who did not. We
did detect a difference in our sample of physician assistants: those
who were certified were more likely to respond to our survey than those
who were not. Because we could not be sure if this represented a bias
and because we later determined that noncertified physician assistants
were likely out of scope, we removed all noncertified physician
assistants from our estimates, which resulted in eliminating 13
respondents and 43 nonrespondents from our final data.
Our follow-up calls had several purposes related to our nonresponse
analysis. The primary purpose was to attempt to convert nonresponders
to responders by persuading them to complete the survey. If after
several attempts the respondent indicated that he or she would not
complete the survey, our contractor asked the person to answer three
key questions from our survey: (1) whether or not any of their
worksites had incentive programs, (2) whether they had ever observed or
experienced pressure from workers to downplay injuries or illnesses,
and (3) whether they had observed or experienced such pressure from
company officials. Because only 14 nonrespondents answered at least one
of these questions, we were unable to conduct any statistical analyses
to detect whether their responses to these three questions were
different, in aggregate, from those of the respondents. Regardless of
whether or not the respondents answered these three questions, the
respondents were asked why they would not complete the full survey.
Sixty-four nonrespondents answered this question. Of these, 53 (83
percent) offered reasons that suggested they were likely out of scope
because they had changed careers, were retired, or the survey did not
relate to their job. This suggests that nonresponse bias may not be
substantial as it is possible that many nonresponders were actually out
of scope and would not have been able to complete the survey.
Finally, we analyzed the differences in response patterns between those
who answered in the earlier period of the survey timeframe (early
responders) and those who responded only after follow-up attempts (late
responders). It is possible that the late responders more closely
resemble the nonresponders than the early responders. Based on chi-
square tests, we detected no significant difference in survey responses
to our three key questions between the early and the late groups, which
may suggest that actual nonrespondents would not have answered in a
substantially different way from those who responded. While the
possibility exists that the true results for the entire population
might be different from those we estimated in our report, based on
these various nonresponse analyses, we believe that nonresponse bias is
unlikely.
Statement of Compliance with Generally Accepted Government Auditing
Standards:
We conducted this performance audit from August 2008 through October
2009 in accordance with generally accepted government auditing
standards. These standards require that we plan and perform the audit
to obtain sufficient, appropriate evidence to provide a reasonable
basis for our findings and conclusions based on our audit objectives.
We believe that the evidence obtained provides a reasonable basis for
our findings and conclusions based on our audit objectives.
[End of section]
Appendix II: Survey Instrument for Occupational Health Practitioners:
Introduction:
This questionnaire asks for information about treatment; actions such
as OSHA recordkeeping pertaining to work-related injuries and
illnesses; work site safety-incentive programs; and your perspectives
on factors that affect the completeness and accuracy of employer
records of workplace injuries and illnesses.
Background:
The U.S. Government Accountability Office (GAO) is an agency that
assists the U.S. Congress in evaluating federal programs. We have been
asked to provide Congress with information about the accuracy of the
injury and illness records that OSHA requires employers to keep for
work-related injuries and illnesses. As a part of this review, we are
conducting a survey of occupational physicians who diagnose, treat,
and/or care for workers with work-related injuries and illnesses. You
were randomly selected from the American Medical Association list of
practicing occupational physicians to participate in this survey. It
should take you about 15 minutes to complete this questionnaire.
Your individual responses to the survey will be kept confidential and
we will not release individually identifiable information from this
questionnaire unless compelled by law or required to do so by the
Congress. In addition, as a part of GAO protocols, any dissemination of
data compiled in this survey will be stripped of all personally
identifiable information. In reporting the results of this
questionnaire, we will only present aggregated data, not information
that identifies any individual occupational health provider. We will
not identify any individuals, occupational physicians, employers, work
sites, or workers.
Because you are par of a statistical sample, your cooperation is
critical to providing the Congress complete and balanced information
about the perspectives of occupational physicians on factors that may
affect the accuracy of injury and illness records. The information you
provide will aid in evaluating the safety and health of workers.
Instructions:
The questionnaire is structured in five main sections. Most of the
questions are short and may be easily answered by checking a box next
to the appropriate response. Most questions allow for space to provide
additional comments.
There are two ways to complete this questionnaire: (1) You can complete
it in paper form, or (2) you can go to our Website to complete the Web
version if you prefer.
Paper Version: Please complete and return your questionnaire in the
enclosed pre-addressed business reply envelope or by fax within 10
business days of receipt. If you should lose or misplace the envelope,
please send the completed questionnaire to:
U.S. Government Accountability Office Attn: Sara Pelton:
Applied Research and Methods:
P.O. Box 50654:
Washington, DC 20077-0075:
Fax: (202) 512-2514:
Web Version: If you would prefer to complete the web version of this
questionnaire instead of the paper version, please follow the
instructions on the postcard enclosed in this envelope.
If you have any questions, please contact:
Sara Pelton:
Tel: (202) 512-8856:
Email: peltons@gao.gov:
Thank you for your time and assistance!
ID:
Section 1: Your Role in Treating Work-Related Injuries and Illnesses:
Instructions: Please check the box next to or below the appropriate
response. If you would prefer to complete the web version of this
questionnaire, please follow the instructions on the postcard enclosed
in the envelope.
Q1. In calendar year 2008, did you routinely treat or evaluate workers
for
occupational injuries in your capacity as an occupational physician?
(Check only one answer):
Yes:
No:
Not Sure:
Thank you for your cooperation. We do not need any further information
from you at this time. Please follow the instructions on the cover
sheet to return this questionnaire. It is very important that we get
your questionnaire back, even if you only answered this one question.
Q2. Think about the workers you treated in calendar year 2008. Did any
of them work for employerS subject:to OSHA recordkeeping requirements
for recording occupational injuries and illnesses? Check only one
answer):
Yes:
Not Sure:
No:
Thank you for your cooperation. We do not need any further information
from you at this time. Please follow the instructions on the cover
sheet to return this questionnaire. It is very important that we get
your questionnaires back, even if you only answered the first two
questions.
Q3. Approximately how long have you treated workers as an occupational
physician?
(Check only one answer):
Less Than 1 Year:
1 Year To Less Than 5 Years:
5 Years To Less Than 10 Years:
10 Years Or More:
No Response:
Q4. In calendar year 2008, about how many workers did you treat or
evaluate for work-related injuries or illnesses? (Check only one
answer):
Less Than 100 Workers:
100 To 500 Workers:
More Than 500 Workers:
Not Sure:
Q5. In calendar year 2008, in which of the following industries were
the workers you treated for work-related injuries and illnesses
employed? (Please choose one response for each item)
Construction:
Yes:
No:
Not Sure:
Chemicals and chemical products:
Yes:
No:
Not Sure:
Manufacturing:
Yes:
No:
Not Sure:
Oil and gas:
Yes:
No:
Not Sure:
Meatpacking or poultry:
Yes:
No:
Not Sure:
Health care (e.g., nursing homes, hospitals):
Yes:
No:
Not Sure:
Services (e.g., hotels, laundry, cleaning):
Yes:
No:
Not Sure:
Mining:
Yes:
No:
Not Sure:
Agriculture:
Yes:
No:
Not Sure:
Other:
Yes:
No:
Not Sure:
(if other, please specify):
Q6. In calendar year 2008, in which industry was the majority of
workers you treated for work-related injuries and illnesses employed?
(Check only one answer)
Construction:
Chemicals and chemical products:
Manufacturing:
Oil and gas:
Meatpacking or poultry:
Health care (e.g., nursing homes, hospitals):
Services (e.g., hotels, laundry, cleaning):
Mining:
Agriculture:
Equally divided between two or more industries (please specify
which below):
Other (please specify below):
Not sure:
(Other industry or list Industries if you chose "Equally
divided"):
Q7. In calendar year 2008, in what capacity did you treat workers?
(Please choose one response for each item)
I was a contractor at one company:
Yes:
No:
No Response:
I was a contractor at two or more companies:
Yes:
No:
No Response:
I was an employee at one company:
Yes:
No:
No Response:
I was an employee at two or more companies:
Yes:
No:
No Response:
I was an employee at one or more occupational health clinics:
Yes:
No:
No Response:
Other:
Yes:
No:
No Response:
(If other capacity, please specify):
Section 2: Records and Actions Pertaining to Work-Related Injuries and
Illnesses:
Q8. Which of the following types of records do you or your office keep
when you treat workers? (Please choose one response for each Item)
Log of patients seen:
Yes:
No:
Not Sure:
First aid log:
Yes:
No:
Not Sure:
Patient records:
Yes:
No:
Not Sure:
OSHA 300 Log:
Yes:
No:
Not Sure:
Incident report other than OSHA 300 Log:
Yes:
No:
Not Sure:
Other:
Yes:
No:
Not Sure:
(If other record, please specify):
Q9. In calendar year 2008, what interaction, if any, did you have with
the OSHA 300 Log for workers you treated with work-related injuries and
illnesses?
(Please choose one response for each item)
I knew what got entered into the Log for workers I treated on one or
more occasions:
Yes:
No:
Not Sure:
I provided input on completing the Log on one or more occasions:
Yes:
No:
Not Sure:
I was asked to review the Log on one or more occasions:
Yes:
No:
Not Sure:
I was the primary person to complete the Log at one or more work sites:
Yes:
No:
Not Sure:
Other:
Yes:
No:
Not Sure:
(If other Interaction, please specify):
Q10. In calendar year 2008, did you treat workers on-site (at workers'
employment sites), off-site (medical offices or health clinics), or
some combination of both?
(Check only one answer)
On-Site Only At One Or More Work Sites:
A Combination Of On-Site And Off-Site Locations:
Off-Site Only At One Or More Locations: (Go To Q17).
Q11. At how many on-site work sites did you treat workers?
(Write number in box):
Q12. Consider the on-site work site(s) you counted in Q11. To the best
of your knowledge, how often, if ever, did the following actions occur
after a worker reported a work-related injury or illness in calendar
year 2008?
If one or more of these actions took place at multiple worker
employment sites, please, select only one work site to answer the
questions listed below. You will then be asked to provide answers for
up to two additional work sites in Q14 and Q16.
(Please choose one response for each item)
Drug testing for worker responsible for incident:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Work-safety training for the worker:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Meeting between the worker and the health and safety officer:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Incident report is added to worker's personnel file:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker signs an affirmation of responsibility for incident:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Light duty (e.g., requiring limited standing, lifting) for
workers unable to perform usual work duties:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker is forced to return to regular work even if not
physically capable of performing the work duties:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker receives physical therapy:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker receives an official disciplinary warning:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker is fired just for reporting an injury or illness:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Other:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
(If other, please specify):
Q13. Did you treat workers at two or more worker employment sites, in
your capacity as an occupational physician? (Check only one answer)
Yes:
No:
Not Sure
(Go to Q17):
Q14. If you treated workers at two or more worker employment sites,
please select a second site about which to answer the questions listed
below. To the best of your knowledge, how often, if ever, did the
following actions occur in calendar year 2008 after a worker reported a
work-related injury or illness? (Please choose one response for each
item)
Drug testing for worker responsible for incident:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Work-safety training for the worker:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Meeting between the worker and the health and safety officer:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Incident report is added to worker's personnel file:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker signs an affirmation of responsibility for incident:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Light duty (e.g., requiring limited standing, lifting) for
workers unable to perform usual work duties:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker is forced to return to regular work even if not
physically capable of performing the work duties:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker receives physical therapy:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker is fired just for reporting an injury or illness:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Other:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
(If other, please specify):
Q15. Did you treat workers at three or more worker employment sites, in
your capacity as an occupational physician? (Check only one answer)
Yes:
No:
Not Sure:
(Go To Q17):
Q16. If you treated workers at three or more worker employment sites,
please select a third site to answer the questions below. To the best
of your knowledge, how often, if ever, did the following actions occur
after a worker reported a work-related injury or illness in calendar
year 2008? (Please choose one response for each item)
Drug testing for worker responsible for incident:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Work-safety training for the worker:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Meeting between the worker and the health and safety officer:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Incident report is added to worker's personnel file:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker signs an affirmation of responsibility for incident:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Light duty (e.g., requiring limited standing, lifting) for workers
unable to perform usual work duties:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker is forced to return to regular work even if not physically
capable of performing the work duties:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker receives physical therapy:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker receives an official disciplinary warning:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Worker is fired just for reporting an injury or illness:
Never:
On Occasion:
Fairly Often:
Very Often:
Always:
Not Sure:
Other:
(If other, please specify):
Section 3: Your Opinions and Experiences with Safety-Incentive
Programs:
Q17. Some work sites have incentive programs that reward workers, team
leaders, and/or health and safety officers for going a certain amount
of time (e.g., 12 months) with few or no work-related injuries or
illnesses. Do you disagree or agree with the following statements on
worker safety incentive programs? (Please choose one response for each
Item)
Done correctly, work site safety-incentive programs provide an
effective way to improve work site safety:
Strongly Disagree:
Disagree:
Agree:
Strongly Agree:
Not Sure:
In general, incentive programs motivate workers to work in a safer
manner:
Strongly Disagree:
Disagree:
Agree:
Strongly Agree:
Not Sure:
Workers sometimes avoid reporting work-related injuries and illnesses
at work sites that use incentive programs:
Strongly Disagree:
Disagree:
Agree:
Strongly Agree:
Not Sure:
Workers at work sites that use incentive programs generally prefer
occupational health practitioners who provide medical treatment that is
not recordable in OSHA Logs:
Strongly Disagree:
Disagree:
Agree:
Strongly Agree:
Not Sure:
Work site incentive programs are the best way to encourage the proper
use of personal protective equipment and behavior that can help avoid
accidents:
Strongly Disagree:
Disagree:
Agree:
Strongly Agree:
Not Sure:
Q18. In calendar year 2008, were there any such incentive programs at
work sites where any of the workers you treated were employed? (Check
only one answer)
Yes:
Not Sure:
No:
(Go To Q22):
Q19. In calendar year 2008, what kind(s) of rewards were provided to
workers for going a period of time with no work-related injuries or
illnesses at work site(s) where the workers you treat are employed?
(Please check applicable responses for up to three work sites where
workers you treated were employed)
Cash or gift card:
Work Site #1:
Work Site #2:
Work Site #3:
Bonus in paycheck:
Work Site #1:
Work Site #2:
Work Site #3:
Free meals (e.g., steak dinner):
Work Site #1:
Work Site #2:
Work Site #3:
Certificate or plaque:
Work Site #1:
Work Site #2:
Work Site #3:
Work benefits (e.g., paid time off, parking):
Work Site #1:
Work Site #2:
Work Site #3:
Other type of award:
Work Site #1:
Work Site #2:
Work Site #3:
(If other type of award, please specify):
Q20. In calendar year 2008, who was offered rewards for going a period
of time with no work-related injuries or illnesses at work site(s)
where the workers you treated were employed? (Please check applicable
responses for up to three work sites where workers you treated
were employed)
All workers in the work site:
Work Site #1:
Work Site #2:
Work Site #3:
Workers in specific work teams or departments:
Work Site #1:
Work Site #2:
Work Site #3:
Managers:
Work Site #1:
Work Site #2:
Work Site #3:
Team or group leaders:
Work Site #1:
Work Site #2:
Work Site #3:
Work site health and safety officers:
Work Site #1:
Work Site #2:
Work Site #3:
Other category of worker:
Work Site #1:
Work Site #2:
Work Site #3:
(If other category of worker, please specify):
Q21. In your opinion, what impact, if any, did any of the incentive
programs have on decisions you made regarding the treatment of-workers
under your care in calendar year 2008? (Please check applicable
responses for up to 3 work sites where workers you treated were
employed):
Major Impact:
Work Site #1:
Work Site #2:
Work Site #3:
Minor Impact:
Work Site #1:
Work Site #2:
Work Site #3:
No Impact:
Work Site #1:
Work Site #2:
Work Site #3:
Not Sure:
Work Site #1:
Work Site #2:
Work Site #3:
(Please provide additional details about the impact of incentive
programs):
Section 4: Your Experiences With Recordkeeping and Workplace Injury
Logs:
Q22. In calendar year 2008, how often did you observe or experience the
following types of behavior from workers you treated? (Please choose
one response for each item)
Worker requested incident not be recorded in OSHA log:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Worker discomfort in reporting work site injuries or illnesses:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Worker fear of disciplinary action for reporting injuries:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Worker pressured me to downplay injuries or illnesses:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Q23. In calendar year 2008, how often did you observe or experience the
following types of behavior from company officials? (Please choose one
response for each item):
Overrecording of injuries:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Underrecording of injuries:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Overrecording of illnesses:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Underrecording of illnesses:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Misinterpretation of OSHA recordability rules:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Willful misrecording of injuries or illnesses:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Pressure on me to downplay injuries or illnesses:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Not Sure:
Q24. In your experience, do any of the following factors have an impact
on whether accurately work-related injuries and illnesses get entered
into the OSHA 300 Log (Please check one response for each item):
Work site safety-incentive programs:
Major Impact:
Minor Impact:
No Impact:
Worker discomfort in reporting work site injuries or illnesses:
Major Impact:
Minor Impact:
No Impact:
Worker fear of disciplinary action for reporting injuries or illnesses:
Major Impact:
Minor Impact:
No Impact:
Overrecording of injuries or illnesses by company officials:
Major Impact:
Minor Impact:
No Impact:
Underrecording of injuries or illnesses by company officials:
Major Impact:
Minor Impact:
No Impact:
Misinterpretation of OSHA recordability rules by company officials:
Major Impact:
Minor Impact:
No Impact:
Willful misrecording of injuries or illnesses by company officials:
Major Impact:
Minor Impact:
No Impact:
Pressure on occupational health practitioners to downplay injuries or
illnesses:
Major Impact:
Minor Impact:
No Impact:
Other factor(s):
Major Impact:
Minor Impact:
No Impact:
(If other factors have an impact on whether injuries and illnesses get
entered into the OSHA 300 Log, please specify):
Q25. In calendar year 2008, how-often did you experience the following
types of requests from workers or company officials? (Please check one
response for each item):
Requests to:
Send workers back to work to avoid recording lost work days:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Send workers home to recover from work injuries:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Turn treatment of workers over to staff without medical training:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Provide a less expensive treatment than I would order:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Provide a treatment that is not recordable in the OSHA 300 Log, but is
equivalent (e.g., prescribing over-the-counter pain relievers instead
of prescription pain relievers):
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Provide a treatment that is not recordable in the OSHA 300 Log, and is
not sufficient to properly treat the injury or illness:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Other type of request:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
(If other types of requests were made of you, please
describe):
Q26. In calendar year 2008, how often did you experience pressure to
follow or obey requests you checked in Q25 from the following
categories of people? (Please check one response for each item):
Pressure from:
Injured or ill worker seeking treatment:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Team or group leader:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Work site health and safety officer:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Other work site or company official:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
Other people:
Never in 2008:
1-5 times:
6-20 times:
21-50 times:
51+ times:
(If other people, please describe):
Section 5: Final Comments:
Q27. If there are any other issues, details, or information regarding
factors affecting the accuracy of employers' injury and illness records
that you would like us to know about, please use the space below to
provide this information.
[End of section]
Appendix III: Selected Questionnaire Results:
All estimates we report from the survey results have a margin of error
of plus or minus 7 percentage points or less at the 95 percent
confidence level.
Health practitioners provided their opinions on the efficacy of safety
incentive programs (see figure 10).
Figure 10: Practitioners' Opinions on the Efficacy of Safety Incentive
Programs:
[Refer to PDF for image: pie-chart]
Done correctly, worksite safety incentive programs provide an effective
way to improve worksite safety.
Agree: 55%;
Strongly agree: 22%;
Disagree: 11%;
Strongly disagree: 5%;
Not sure: 7%.
Source: GAO analysis of occupational health practitioner survey data.
[End of figure]
In addition to experiencing pressure to downplay injuries and
illnesses, respondents also observed behavior by workers and company
officials that would result in underrecording (see figure 11).
Figure 11: Worker and Company Official Behavior Related to Reporting
Injuries or Illnesses in 2008:
[Refer to PDF for image: horizontal bar graph]
Types of behavior from workers or company officials:
Worker requested incident not be recorded in employer log:
One or more times in 2008: 138;
Never in 2008: 281;
Not sure: 47.
Worker discomfort in reporting worksite injuries or illnesses:
One or more times in 2008: 355;
Never in 2008: 88;
Not sure: 27.
Company officials overrecording injuries:
One or more times in 2008: 50;
Never in 2008: 297;
Not sure: 119.
Company officials underrecording injuries:
One or more times in 2008: 140;
Never in 2008: 179;
Not sure: 145.
Company officials overrecording illnesses:
One or more times in 2008: 35;
Never in 2008: 283;
Not sure: 145.
Company officials underrecording illnesses:
One or more times in 2008: 78;
Never in 2008: 222;
Not sure: 161.
Source: GAO analysis of occupational health practitioner survey data.
[End of figure]
Finally, health practitioners reported the impact they thought various
factors had on whether injuries and illnesses are recorded accurately
in the employers' log (see figure 12). They also reported how often
they experienced various requests from workers or company officials
(see figure 13).
Figure 12: Impact of Various Factors on Accuracy of Employers' Injury
and Illness Logs:
[Refer to PDF for image: four pie-charts]
Worksite Safety Incentive Programs:
Not sure: 25%;
No impact: 34%;
Minor impact: 23%;
Major impact: 18%.
Worker Fear of Disciplinary Actions for Reporting Injuries or
Illnesses:
Not sure: 26%;
No impact: 28%;
Minor impact: 30%;
Major impact: 16%.
Misinterpretation of Recordkeeping Requirements by Company Officials:
Not sure: 21%;
No impact: 38%;
Minor impact: 30%;
Major impact: 11%.
Pressure on Practioners to Downplay Injuries or Illnesses:
Not sure: 35%;
No impact: 21%;
Minor impact: 29%;
Major impact: 15%.
Source: GAO analysis of occupational practitioner survey data.
[End of figure]
Figure 13: Frequency of Experiencing Various Requests From Workers or
Company Officials in 2008:
[Refer to PDF for image: horizontal bar graph]
Requests from workers or company officials:
Send workers back to work to avoid recording lost work days;
One or more times in 2008: 295;
Never in 2008: 166.
Send workers home to recover from work injuries:
One or more times in 2008: 302;
Never in 2008: 156.
Turn treatment of workers over to staff without medical training:
One or more times in 2008: 44;
Never in 2008: 421.
Provide a less expensive treatment than I would order:
One or more times in 2008: 172;
Never in 2008: 293.
Provide a treatment that is not recordable in the OSHA log, but is
equivalent (e.g., prescribing over-the-counter pain reliever instead of
prescription pain relievers:
One or more times in 2008: 288;
Never in 2008: 171.
Source: GAO analysis of occupational health practitioner survey data.
[End of figure]
[End of section]
Appendix IV: OSHA's Forms for Recording Work-Related Injuries and
Illnesses:
Twelve page representation of OSHA's Forms for Recording Work-Related
Injuries and Illnesses.
[End of section]
Appendix V: High Hazard Industries Included in ODI Universe as of
August 2009:
SIC: 0181;
Industry: Ornamental Floriculture and Nursery Products.
SIC: 0182;
Industry: Food Crops Grown Under Cover.
SIC: 0211;
Industry: Beef Cattle Feedlots.
SIC: 0212;
Industry: Beef Cattle, Except Feedlots.
SIC: 0213;
Industry: Hogs.
SIC: 0214;
Industry: Sheep and Goats.
SIC: 0219;
Industry: General Livestock, Except Dairy and Poultry.
SIC: 0241;
Industry: Dairy Farms.
SIC: 0251;
Industry: Broiler, Fryer, and Roaster Chickens.
SIC: 0252;
Industry: Chicken Eggs.
SIC: 0253;
Industry: Turkey and Turkey eggs.
SIC: 0254;
Industry: Poultry Hatcheries.
SIC: 0259;
Industry: Poultry and Eggs, Not Elsewhere Classified.
SIC: 0291;
Industry: General Farms, Primarily Livestock and Animal Specialties.
SIC: 0783;
Industry: Ornamental Shrub and Tree Services.
SIC: 4212;
Industry: Local Trucking Without Storage.
SIC: 4213;
Industry: Trucking, Except Local.
SIC: 4214;
Industry: Local Trucking With Storage.
SIC: 4215;
Industry: Courier Services, Except by Air.
SIC: 4221;
Industry: Farm Product Warehousing and Storage.
SIC: 4222;
Industry: Refrigerated Warehousing and Storage.
SIC: 4225;
Industry: General Warehousing and Storage.
SIC: 4226;
Industry: Special Warehousing and Storage, Not Elsewhere Classified.
SIC: 4231;
Industry: Trucking and Joint Terminal Maintenance Facilities for Motor
Freight Transportation.
SIC: 4491;
Industry: Marine Cargo Handling.
SIC: 4492;
Industry: Towing and Tugboat Service.
SIC: 4493;
Industry: Marinas.
SIC: 4499;
Industry: Water Transportation Services, Not Elsewhere Classified.
SIC: 4512;
Industry: Air Transportation, Scheduled.
SIC: 4513;
Industry: Air Courier Services.
SIC: 4581;
Industry: Airports, Flying Fields, and Airport Terminal Services.
SIC: 4783;
Industry: Packing and Crating.
SIC: 4953;
Industry: Refuse Systems.
SIC: 5012;
Industry: Automobiles and Other Motor Vehicles.
SIC: 5013;
Industry: Motor Vehicle Supplies and New Parts.
SIC: 5014;
Industry: Tires and Tubes.
SIC: 5015;
Industry: Motor Vehicle Parts, Used.
SIC: 5031;
Industry: Lumber, Plywood, Millwork, and Wood Panels.
SIC: 5032;
Industry: Brick, Stone, and Related Construction Materials.
SIC: 5033;
Industry: Roofing, Siding, and Insulation Materials.
SIC: 5039;
Industry: Construction Materials, Not Elsewhere Classified.
SIC: 5051;
Industry: Metals Service Centers and Offices.
SIC: 5052;
Industry: Coal and Other Minerals and Ores.
SIC: 5093;
Industry: Scrap and Waste Materials.
SIC: 5141;
Industry: Groceries, General Line.
SIC: 5142;
Industry: Packaged Frozen Foods.
SIC: 5143;
Industry: Dairy Products, Except Dried or Canned.
SIC: 5144;
Industry: Poultry and Poultry Products.
SIC: 5145;
Industry: Confectionery.
SIC: 5146;
Industry: Fish and Seafoods.
SIC: 5147;
Industry: Meats and Meat Products.
SIC: 5148;
Industry: Fresh Fruits and Vegetables.
SIC: 5149;
Industry: Groceries and Related Products, Not Elsewhere Classified.
SIC: 5181;
Industry: Beer and Ale.
SIC: 5182;
Industry: Wine and Distilled Alcoholic Beverages.
SIC: 5211;
Industry: Lumber and Other Building Materials Dealers.
SIC: 8051;
Industry: Skilled Nursing Care Facilities.
SIC: 8052;
Industry: Intermediate Care Facilities.
SIC: 8059;
Industry: Nursing and Personal Care Facilities, Not Elsewhere
Classified.
Source: OSHA.
[End of table]
[End of section]
Appendix VI: Comments from the Department of Labor:
U.S. Department of Labor:
October 2, 2009:
Revae Moran:
Director:
Education, Workforce, and Income Security Issues:
U.S. Government Accountability Office:
441 G Street NW:
Washington, DC 20548:
Dear Ms. Moran:
Thank you for the opportunity to comment on the Government
Accountability Office's (GAO) proposed report, Enhancing OSHA's Records
Audit Process Could Improve the Accuracy of Worker Injury and Illness
Data. OSHA welcomes GAO's analysis and suggestions for improving the
accuracy of the occupational injury and illness data.
The Occupational Safety and Health Act of 1970 mandates that both
regulatory and non-regulatory measures be taken for assuring workplace
safety and health. Accurate injury and illness records are vital to
achieving this mandate. The Agency uses these records to allocate both
enforcement and outreach resources, evaluate the effectiveness of its
programs, and set standards development priorities. Furthermore, these
records are used by Congress, researchers, employers, and employees to
evaluate the nature and extent of occupational safety and health
problems in individual worksites and in the Nation as a whole. GAO's
analysis makes clear that there is a need to improve the accuracy of
employer-provided injury and illness data.
GAO made the following recommendations to OSHA: 1) require inspectors
to interview workers during record audits and interview replacements
when selected workers are unavailable; 2) minimize the time between the
date injuries and illnesses are recorded by employers and the date they
are audited by OSIIA; 3) update the list of high hazard industries used
to select worksites for records audits and other purposes; and 4)
increase education and training to help employers better understand the
recordkeeping requirements.
The Agency shares the concerns raised in the GAO's report and will move
forward to implement GAO's recommendations as follows. To address the
first recommendation, OSHA will require inspectors to interview
employees during record audits. Regarding the second recommendation,
OSHA will develop policies to conduct record audits inspections in a
timely fashion. With respect to the third recommendation, OSHA agrees
that it is necessary to pursue rulemaking at the earliest possible date
to update the industry coverage of the recordkeeping rule from SIC to
NAICS. This will allow the Agency to use current BLS data to redefine
the scope of the ODI and the recordkeeping audits to include emerging
high risk industries. Finally, to fulfill the last recommendation, the
Agency will supplement its current educational outreach, and will
develop a web based tool to assist employers in meeting the
requirements of OSHA's recordkeeping regulation.
I would also like to inform you that OSHA implemented its National
Emphasis Program on Recordkeeping effective October 1, 2009. You will
be able access the compliance directive from OSHA's website. If you
have questions concerning this response, or if we can be of further
assistance, please do not hesitate to contact me.
Sincerely,
Signed by:
Jordan Barab:
Acting Assistant Secretary:
[End of section]
Appendix VII: GAO Contact and Staff Acknowledgments:
GAO Contact:
Revae Moran, Acting Director, (202) 512-3863 or moranr@gao.gov:
Staff Acknowledgments:
In addition to the contact named above, Gretta L. Goodwin, Assistant
Director, and Mary A. Crenshaw, Analyst in Charge, managed all aspects
of this assignment and Sara Pelton, Analyst, and Tanya Doriss, Analyst,
made significant contributions to all phases of the work. Shana B.
Wallace, Pamela R. Davidson, Dae B. Park, Catherine M. Hurley, Amanda
K. Miller, and Carl M. Ramirez provided assistance in developing and
applying the methodologies and analyzing the data. James M. Rebbe
provided legal assistance, Susan L. Aschoff assisted with message and
report development, and Mimi Nguyen and James E. Bennett drafted the
report's graphics.
[End of section]
Related GAO Products:
OSHA's Voluntary Protection Programs: Improved Oversight and Controls
Would Better Ensure Program Quality. [hyperlink,
http://www.gao.gov/products/GAO-09-395]. Washington, D.C.: May 20,
2009.
Workplace Safety and Health: Safety in the Meat and Poultry, While
Improving, Could Be Further Strengthened. [hyperlink,
http://www.gao.gov/products/GAO-05-96]. Washington, D.C.: January 12,
2005.
Occupational Safety and Health: Efforts to Obtain Establishment-
Specific Data on Injuries and Illnesses. [hyperlink,
http://www.gao.gov/products/GAO-98-122]. Washington, D.C.: May 22,
1998.
Occupational Safety and Health: Changes Needed in the Combined Federal
and State Approach. [hyperlink,
http://www.gao.gov/products/GAO/HEHS-94-10]. Washington, D.C.: February
28, 1994.
[End of section]
Footnotes:
[1] Hereafter, all years cited in this report are calendar years unless
otherwise noted. Records audits are almost always conducted 2 calendar
years after the target data year. Of the 753 records audits that were
conducted for 2003-2005 records, 99.7 percent were conducted in 2005-
2007; two records audits were conducted in January and February of
2008.
[2] In these states, the state standards must be at least as effective
as the federal standards. See 29 U.S.C. § 667(c)(2). Most of the state-
plan states cover public and private sector worksites. However, four
states (Connecticut, New Jersey, New York, and the Virgin Islands)
cover public sector (state and local government) worksites only;
private sector worksites are covered by federal OSHA. Under the
Occupational Safety and Health Act of 1970, "state" is defined to
include the District of Columbia, Puerto Rico, the Virgin Islands,
American Samoa, Guam, and the Trust Territory of the Pacific Islands.
See 29 U.S.C. § 652(7).
[3] Generally, in addition to employers with 10 or fewer employees,
DOL's regulations exempt worksites in specific low hazard retail,
service, finance, insurance, or real estate industries from OSHA's
recordkeeping requirements. However, all employers must report to OSHA
any workplace incident that results in a fatality or the
hospitalization of three or more employees. In addition, employers are
required to respond to the OSHA and BLS surveys even if they are
otherwise exempt from OSHA's recordkeeping requirements.
[4] 66 Fed. Reg. 5916.
[5] In addition to targeting worksites for inspection through its Site-
Specific Targeting program, OSHA also targets worksites through its
national, regional, and local emphasis programs.
[6] The SOII excludes the self-employed; farms with fewer than 11
employees; private households; federal government agencies; and, for
national estimates, employees in state and local government agencies.
[7] See, for example, Leslie I. Boden and Al Ozonoff, "Capture-
Recapture Estimates of Nonfatal Workplace Injuries and Illnesses,"
Annals of Epidemiology, vol. 18, no. 6 (2008); Kenneth D. Rosenman, et
al., "How Much Work-Related Injury and Illness is Missed By the Current
National Surveillance System?," Journal of Occupational and
Environmental Medicine, vol. 48, no. 4 (2006); and J. Paul Leigh, James
P. Marcin, and Ted R. Miller, "An Estimate of the U.S. Government's
Undercount of Nonfatal Occupational Injuries," Journal of Occupational
and Environmental Medicine, vol. 46, no. 1 (2004).
[8] The International Labour Organization is the United Nations agency
that brings together representatives of governments, employers, and
workers of its member states to jointly shape polices and programs that
promote decent and productive employment.
[9] OSHA generally excludes from the ODI worksites with fewer than 40
employees; those in states that do not participate in the ODI; and all
construction sites, hospitals, and general merchandise stores. The ODI
also excludes worksites in the mining and railroad industries because
their injuries and illnesses are tracked separately by the Mine Safety
and Health Administration and the Federal Railroad Administration,
respectively.
[10] Until 2002, DOL used the LWDII rate to compare the rates of
injuries and illnesses among worksites of varying sizes. The rate was
calculated based on the total number of injuries or illnesses resulting
in lost work days. In 2002, after revising its recordkeeping
requirements, DOL began using the days away from work, restricted
activity, or job transfer (DART) rate to compare injuries and illnesses
among worksites instead of the LWDII rate.
[11] Eastern Research Group, Inc. is a private consulting firm that
annually analyzes the records audit data collected by inspectors.
[12] The DART rate is calculated by totaling the number of work-related
injuries and illnesses that resulted in days away from work, job duty
restrictions, or job transfer at a worksite; dividing by the total
number of hours worked by all workers during the calendar year; and
multiplying this number by 200,000, which represents a base for 100
full-time workers working 50 weeks per year.
[13] GAO, Occupational Safety and Health: Changes Needed in the
Combined Federal-State Approach, [hyperlink,
http://www.gao.gov/products/GAO/HEHS-94-10] (Washington, D.C.: Feb. 28,
1994).
[14] GAO, Occupational Safety and Health: Efforts to Obtain
Establishment-Specific Data on Injuries and Illnesses, [hyperlink,
http://www.gao.gov/products/GAO-98-122] (Washington, D.C.: May 22,
1998).
[15] The DART rate is calculated using the same formula as the LWDII
rate; however, the rates do not count the exact same injuries and
illnesses.
[16] SM Marsh, SJ Derk, and LL Jackson, "Nonfatal Occupational Injuries
and Illnesses Among Workers Treated in Hospital Emergency Departments-
-United States, 2003," Morbidity and Mortality Weekly Report, vol. 55,
no. 16 (2006); Rosenman, et al., "How Much Work-Related Injury and
Illness is Missed By the Current National Surveillance System?,"
Journal of Occupational and Environmental Medicine, vol. 48, no. 4
(2006); J. Paul Leigh, James P. Marcin, and Ted R. Miller, "An Estimate
of the U.S. Government's Undercount of Nonfatal Occupational Injuries,"
Journal of Occupational and Environmental Medicine, vol. 46, no. 1
(2004).
[17] Leigh, Marcin, and Miller, "An Estimate of the U.S. Government's
Undercount of Nonfatal Occupational Injuries," Journal of Occupational
and Environmental Medicine, vol. 46, no. 1 (2004).
[18] The National Institute for Occupational Safety and Health (NIOSH),
part of the Centers for Disease Control and Prevention within the
Department of Health and Human Services, is the federal agency
responsible for conducting research and making recommendations to
prevent workplace injuries and illnesses. One of the research projects
that NIOSH is conducting is the national surveillance of nonfatal
occupational injuries using the National Electronic Injury Surveillance
System (NEISS). This project collects nationally representative,
timely, nonfatal occupational injury surveillance data by using a
sample of U.S. hospital emergency departments through NEISS.
[19] The Council of State and Territorial Epidemiologists is a
professional organization of public health epidemiologists working in
state, territorial, or local health departments, and individuals from
federal health agencies or academia. It works to establish more
effective relationships among states and other health agencies and
provides technical advice and assistance to partner organizations.
[20] However, under DOL regulations, if an employer supervises a
contractor's employee on a day-to-day basis, the employer must record
the employee's injury or illness. 29 C.F.R. § 1904.31(b)(3).
[21] In some state-plan states, federal OSHA inspectors conduct these
audits and, in others, state inspectors conduct the records audits.
[22] OSHA only verifies the accuracy of employers' injury and illness
records for worksites in industries defined by OSHA as being high
hazard industries--industries with an average occupational injury and
illness rate of 5.0 or higher based on injuries or illnesses that
result in lost work days due to injuries and illnesses--based on rates
published by BLS prior to 2002.
[23] Although we interviewed all 12 of the experts and researchers, we
did not include the results from 1 researcher because that individual's
responses were not pertinent to our questions.
[24] B. Baker, et al., "Occupational Medicine Physicians in the United
States: Demographics and Core Competencies," Journal of Occupational
and Environmental Medicine, vol. 49, no. 4 (2007).
[25] If independent samples are taken repeatedly from the same
population, and a confidence interval calculated for each sample, then
a certain percentage of the intervals will include the unknown
population measure. The confidence interval is often calculated so that
the percentage is 95 percent.
[26] W.G. Cochran, Sampling Techniques, 3rd ed., Wiley Series in
Probability and Mathematical Statistics, section 11.7 (New York, N.Y.:
John Wiley & Sons, 1977), 303.
[27] M.H. Hansen, W.N. Hurwitz, and W.G. Madow, Sample Survey Methods
and Theory, vol. I, Methods and Applications, Wiley Publications in
Statistics, sections 6.6 and 6.7 (New York, N.Y.: John Wiley & Sons,
Inc., 1953), 252-259.
[28] B.V. Shah, B.B. Barnwell, and G.S. Bieler, SUDAAN: User's Manual,
Release 7.5, vols. 1 and 2 (Research Triangle Park, N.C.: Research
Triangle Institute, 1997). SUDAANŽ is a registered trademark of the
Research Triangle Institute.
[End of section]
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