Key Takeaways Engineering controls are one of the most effective means of reducing construction worker exposure to health hazards. However, given the variability of construction tasks and the dynamic nature of construction work sites, assessing worker exposure and selecting the most appropriate controls at the outset of a project is challenging. This article discusses the development, functionality and application of the Exposure Control Database, an evidence-based solution that estimates construction worker exposure to four common health hazards: silica, welding fumes, noise and lead. It also highlights the limitations and lack of consistency in air sampling procedures and outlines a new approach to standardize and continuously improve data collection and data sharing processes. Despite efforts to create safer and healthier workplaces, construction workers in the U.S. still experience a noticeably high rate of fatal and nonfatal injuries and illnesses. The construction industry has experienced a fatality rate of 10.2 per 100,000 full-time employees, approximately three times higher than all other industries average (CPWR, 2018). These fatalities are, to a large extent, attributed to acute safety incidents or exposure to hazardous substances and materials on construction jobsites. However, approximately 95,000 workers died in 2017 from chronic occupational diseases (AFL-CIO, 2019), and up to 50% of occupational cancer deaths are attributed to exposures in the construction industry (Hutchings & Rushton, 2012). National Occupational Research Agenda (NORA) Construction Sector Council (2018) has identified silica, welding fumes, noise and lead as research priorities in the construction industry. Silica causes a number of chronic illnesses and fatalities among construction workers. OSHA (2016) reported that about two million construction workers are exposed to hazardous levels of silica dust every year. OSHA promulgated a comprehensive silica standard in 2016 in an effort to reduce construction worker exposure to hazardous levels of silica dust. Lead is a persistent health hazard in construction. To reduce construction worker exposure to lead, OSHA released a comprehensive standard in 1993. However, NIOSH has reported that about 32 of 100,000 construction workers still have elevated levels of lead in their blood, defined as 10 Μg/dL or higher (CPWR, 2018). This concerning fact calls for more robust preventive solutions.

Key Takeaways Hearing loss is the third most common chronic health condition in the U.S. Occupational noise exposure is maintained, while recreational noise has been shown to exceed regulatory limits without proper controls. Annually administered workplace audiograms often cannot distinguish between occupational and nonoccupational noise damage and, consequently, the employer must assume liability. Safety professionals must establish more effective hearing conservation programs to reduce noise-induced hearing loss. Noise is among the most common hazards employees are exposed to in the workplace. OSHA (2020) states that millions of employees are exposed to excessive noise in their work environment. The agency reports that U.S. businesses paid more than $1.5 million in penalties for negligent protection from noise, and also that an estimated $242 million is spent annually on workers' compensation for hearing loss disability (OSHA, 2020). Regulatory agencies and companies have aimed to reduce noise exposure and protect employees throughout the workplace through enforcement and mitigation measures. For example, a hearing conservation program is required when employees are exposed to noise levels that meet or exceed the permissible exposure limit in decibels (OSHA, 2008). However, the reach of these efforts does not extend outside the work environment. This article discusses the harmful effects of noise and several nonoccupational activities that generate excessive noise levels. Noise in recreational activities such as target shooting, exercise classes, sporting events, motorsports, landscaping, visiting bars or nightclubs, and playing a musical instrument can affect individual health. While noise remains prevalent throughout industry, it is critical to remain aware of nonoccupational noise exposure and its harmful effects.

Key Takeaways Alternative seat designs claim to improve posture, performance and activity, but supporting research is limited. This systematic review analyzes the effects of nontraditional alternative seat designs on productivity and complaints of office workers compared to standard office chairs. Researchers evaluated quality-controlled trials that compared different seating designs. The authors provide recommendations based on the conclusions of the analysis. Low Back Pain (LBP) has become a common cause of pain and disability in the U.S., especially among office workers (Janwantanakul, Pensri, Mookay, et al., 2011). Not only does office work leave an individual inactive, but also, as time progresses, inadequate desk and chair ergonomics, as well as other factors can lead to fatigued muscles, poor posture and pain (Cho, Freivalds & Rovniak, 2017; Janwantanakul, et al., 2011). Over time, this disability can affect overall performance and has the potential to result in lost work hours (Ramdan, Hashim, Kamat, et al., 2014). If this condition is not treated properly or if the underlying cause is not addressed, it often leads to chronic LBP (Petit, Fouquet & Roquelaure, 2015). In fact, approximately 73% of individuals with LBP still have symptoms 1 year later (Carragee, 2005). Depending on the severity or chronicity of LBP, medical treatment varies. The average cost per patient for a period of 12 months with LBP is approximately $2,380 but may exceed $76,080 if the severity and longevity of the LBP has progressed to the point of surgical intervention (Stewart, Yan, Boscarino, et al., 2015). A solution to this expensive impairment associated with sedentary seated occupations is alternative ergonomic seat designs. Typically, an ergonomic seat design incorporates the appropriate seat height, depth, width, backrest dimensions, backrest angle, seat angle, armrests, legroom and the seat surface (Pheasant & Haslegrave, 2005). More recently, it is believed that constructing a chair to incorporate dynamic movement with the attributes noted may further improve the ergonomic design (Jackson, Banerjee-Guénette, Gregory, et al., 2013; Pheasant & Haslegrave, 2005).

Key Takeaways Employers today often balance employer/employee relationships through the use of internal and external hiring practices. Research sought to investigate the possibility of worker arrangement influencing occupational health. A contextual analysis explores the complexities of contingent worker arrangement versus the traditional core worker arrangement and how it has come to flourish in society. A literature review provides real-world examples to be analyzed against a backdrop of relevance determined through legalities, workplace culture and economic influences. Solutions are suggested on the basis of data surveillance and culture change. Since the transcendence from hunter-gatherer to agrarian societies, humans have maintained a hierarchical arrangement between those willing to compensate and those willing to perform work. Looking beyond the antiquated modes of production (e.g., slavery, feudalism), capitalism and its socialized variants have given rise to varying balances of employer/employee relationships. Motivated by stability and flexibility harmonization, employers today will often balance those relationships through their use of internal and external hiring practices (Kalleberg, Reynolds & Marsden, 2003). External hiring practices, or externalization, refers to "an organization's use of workers who are not its regular, full-time employees"; internal hiring practices, or internalization, refers to "regular full-time employment" (Kalleberg, et al., pp. 525–526). A plethora of terms can and have been used to describe the employment arrangements that both externalization and internalization produce. For the sake of fluidity, this review recognizes two specific terms as the parent descriptors of types of employment. The term core workers is defined as those with traditional ties to their employer and treated as though they have a stake in the company (Belous, 1990). The other term, which is the focus of this review, is contingent workers , defined by Bureau of Labor Statistics (BLS, 2005) as "those who do not have an implicit or explicit contract for ongoing employment." Also, to be noted, the term precarious worker is used interchangeably with contingent worker . More often, however, precarious worker is a term used to define a contingent worker who is more vulnerable to job insecurities such as having no enduring contract and lacking control over future income opportunities (Landsbergis, Grzywacz & LaMontagne, 2014).

Key Takeaways OSH practitioners frequently use technical communication to convey information to a wide range of audiences. Documents and reports should be written and effectively communicated using applicable standards. This article details seven key elements that will make technical writing for OSH communication more effective: project preparation and purpose, structure, audience, graphics and visuals, use of technology, review process, and communication of knowledge. Written communication is a fundamental skill required of all OSH practitioners. As described in "The Occupational Health and Safety Professional Capability Framework," an OSH practitioner must prepare professional reports or documentation for a variety of audiences (INSHPO, 2017). These documents should be written and effectively communicated using applicable standards. The form of written communication most frequently used in OSH is technical or scientific writing. Society for Technical Communication (STC, 2019) defines technical communication as any method of communication that has at least one of the following characteristics: covers a specialized or technical topic; uses technology such as websites or social media; or gives instructions to accomplish a task. In short, the purpose of technical or scientific writing is to communicate information to an audience. When performing technical writing for OSH communication, an OSH practitioner should consider or include several key elements. Proper consideration and inclusion of these elements will make the technical communication more effective; however, failing to consider or include these elements will decrease the chances that the document will satisfy its intended purpose. Detailed in the following sections, these key elements include project preparation and purpose, structure, audience, graphics and visuals, use of technology, review process and communication of knowledge.

Key Takeaways A comparison of OSHA and BLS data about workplace fatalities that occurred from 2014 to 2017 shows that only one-fourth of BLS-reported workplace fatalities have been investigated by OSHA, although OSHA requires employers to report worker fatalities and states that "OSHA investigates all work-related fatalities in all covered workplaces." The ratio of OSHA fatality investigation cases between states with the federal plan and states with an OSHA-approved state plan is similar to that of BLS-reported workplace fatalities. However, the percentage of OSHA-investigated/BLS-reported workplace fatalities varies greatly between different states. Also, investigations by federal OSHA had higher penalties than that of state OSHA. U.S. workplace fatalities continue each year at an alarming rate. According to Bureau of Labor Statistics' (BLS, 2018a) data, 5,147 occupational fatalities occurred in 2017. OSHA requires that employers provide a workplace free from recognized hazards that can cause death or serious injury. Unfortunately, not all workplace hazards that may contribute to fatal injuries can be recognized by employers. To identify fatality causes and to prevent future similar incidents, OSHA requires employers to report any worker fatality within 8 hours; "OSHA investigates all work-related fatalities in all covered workplaces" (OSHA, 2019a). To better understand the profile of OSHA fatality investigations and to identify any gaps preventing the reduction of fatality rates, all work-related fatality investigation cases available on the agency's fatality inspection data website were analyzed for the calendar year 2017 (OSHA, 2019a). Especially, this study strived to assess the degree that OSHA exerts its efforts in workplace fatality investigations, as a whole and between different states. The authors have identified several interesting facts not previously widely or thoroughly discussed in the occupational safety literature.

Key Takeaways It is critical for safety professionals to change the paradigm of looking first to PPE as an easy solution to any workplace hazard. Safety professionals must start using that which makes the profession marketable and useful by working with production and maintenance to find creative ways of reducing the hazard or eliminating it altogether, instead of only using PPE to work around the hazard, thereby stalling the process at the least effective level of the hierarchy of controls. The safety management role has grown exponentially more important in today's workforce. Regardless of the specific professional title this function holds, a safety professional's objectives and reasons for being employed remain the same. An OSH professional's primary goal is to ensure safe working conditions for employees and the workplace. Through establishing policies, plans, procedures and gaining company participation, a safety professional aims to reduce injuries while maintaining productivity. According to Bureau of Labor Statistics (BLS, 2019a), overall employment of OSH specialists and technicians is projected to grow 8% between 2016 and 2026. Industries that show an increasing number of these jobs include construction, manufacturing, petroleum, management, scientific fields and technical consulting services. With the development of technology, a changing workforce and fast-paced work environments, employers look to OSH professionals to establish safety management systems. Among a safety professional's primary responsibilities is abating hazards by following the hierarchy of controls; however, it seems that some practitioners have turned the hierarchy of controls model on its head.

Key Takeaways Heat-related illness in the U.S. construction industry is an underreported and under-researched OSH hazard, and these workers are potentially exposed to extreme temperatures that can adversely affect their well-being. This study used OSHA data to locate heat-related events. Most heat-related cases were found in California, although this is due to that state's emphasis program on heat and indicates underreporting or under-identification of work-related heat illnesses in other states. Without a specific heat-related standard, OSHA uses the General Duty Clause to cite employers, but only after an incident occurs. This article aims to increase awareness of the hazard of heat stress, which seems to be underreported, and to encourage policymakers to improve reporting requirements in all U.S. states. In construction, large portion of the work is performed outdoors. Extreme temperatures influence worker safety, and during summer months workers experience heat stress. The aim of this article is to increase awareness of the underreported hazard of heat stress in the U.S. through an epidemiological analysis of the heat-related fatalities and hospitalization cases recorded in the OSHA incident report database. This article adds to the body of knowledge by identifying heat stress as an overlooked occupational health hazard in the U.S. construction industry, and it aims to add value to industry practitioners and policymakers seeking to positively impact overall safety and health in construction. Heat stress is the overall heat load on the human body that includes temperature, humidity and radiant heat in the thermal environment, and metabolic heat generated by physical activities (Lopez, 1996). Heat illness is the result of the body's inability to expel heat, causing excessive sweat loss or an overly high body core temperature. Ailments that arise on construction sites because of excess heat are heat stroke, heat exhaustion, heat syncope (fainting) and heat rash (Lopez, 1996; McKinnon & Utley, 2005).

Key Takeaways This article presents research that shows how value stream maps (VSMs) were used to document the procurement process for office equipment to establish better methods of helping users obtain equipment to reduce the risk of overuse injuries in their office jobs. The research consisted of two parts: a survey to employees regarding office equipment; and three focus groups with employees who were active in the procurement process. VSMs of the current process were created from the survey data and improved with focus group input. The benefits of using a VSM include obtaining user input, creating better documentation and offering recommendations to streamline the process. VSMs are recommended as a structured way for OSH professionals to obtain information about user needs and ways to improve processes to reduce workplace injuries. Safety professionals use user-centered approaches in their everyday work to keep employees safe and healthy. Such approaches include walking the site (Gemba walks), conducting task analyses and seeking user input through formal or informal methods. While in small organizations obtaining information about processes and functions in need of improvement may be easy, large organizations pose a greater complexity because of their multiple departments and sometimes conflicting processes. In these types of organizations, a more structured approach is needed that allows for canvasing employees and understanding potentially differing methods or challenges. Typical methods of obtaining user ideas include surveys or channels that allow anonymous suggestions. While these methods provide valuable information, a weakness is that they may consider the individual's viewpoint singularly rather than within the larger organizational context. This is not a fault, but a potential risk of using those types of input. For many years, lean manufacturing practitioners have used value stream maps (VSMs) to understand how a product flows through the system and as a method for identifying value and non-value-added steps. A VSM provides a visual representation of a system's process by illustrating the various stages and cycle times of the process (Hofacker, Santos & Santos, 2012; Teichgraber & de Bucourt, 2011). VSMs track a product from its origin with the supplier through its arrival at the end user (Tan, 2001). Typical uses for VSMs include tracking a product through the manufacturing process or following it through the procurement process. A VSM includes processing, travel and wait times. Some VSM examples used for safety include the procurement process for endovascular stents in healthcare (Teichgraber & de Bucourt, 2011), a management process on hip procedure in healthcare (Simon & Canarcari, 2012), and construction procurement for a public building (Hofacker, et al., 2012). VSMs can be present or future; a future VSM applies possible solutions to implement waste reduction and reduce cycle time (Abdulmalek & Rajgopal, 2007; Hofacker, et al., 2012).

Key Takeaways Legionnaires' disease is a form of pneumonia whose symptoms include fever, chills, cough, muscle aches, headaches, diarrhea and shortness of breath. Legionnaires' disease is on the rise. The rate of reported cases has increased more than five times since 2000. The disease can be prevented. A properly maintained water system can eliminate the creation of Legionella bacteria that can cause Legionnaires' disease. Some businesses in the U.S. may have a health hazard lurking in their water system and be unaware of it. This health hazard is known as Legionella, which is a significant health concern that can lead to substantial, yet avoidable, cost. Legionella is a bacteria that lives in water and includes more than 50 bacterial species. The main species connected to Legionella is L. pneumophila, which was the cause of a 1976 Legionnaires' disease outbreak among members of the American Legion and is still responsible for most cases of Legionnaires' disease in the U.S. and Europe. Legionnaires' disease is a form of pneumonia whose symptoms include fever, chills, cough, muscle aches, headaches, diarrhea and shortness of breath. The disease has not been proven to be transmitted from person to person (CDC, 2016). While it was not discovered until 1976, Legionella has existed since about 1968 when the first cases of Pontiac fever were identified in Pontiac, MI. In 1976, public health officials demonstrated that both the Pontiac fever and newly discovered Legionella had the same bacterium (Montopoli, 1993). Legionnaires' disease is on the rise, and CDC (2018a) says that the rate of reported cases of the disease has increased 5.5 times since 2000. In the U.S., waterborne disease outbreaks associated with Legionella have been tracked through the Waterborne Disease and Outbreak Surveillance System since 2001. According to CDC (2018c), Legionnaires' disease outbreaks occur when two or more people are exposed to Legionella in the same place and get sick at about the same time. The disease may be underdiagnosed due to the symptoms it mimics; the number of cases could be higher.

Key Takeaways This article examines the potential consideration of exoskeletons as PPE for shoulder injury prevention. It provides a brief introduction to injury prevention and ergonomic assessment, and examines studies that have investigated shoulder muscle fatigue and ergonomic assessments of exoskeletons. The authors introduce a series of studies conducted to assess the potential use of exoskeletons as PPE. Test methods presented provide quantitative data to support decisions about whether exoskeletons should be classified as PPE. This article focuses on the prevention of shoulder musculoskeletal disorders (MSDs) commonly associated with muscle fatigue and repetitive overuse in an occupational setting. The authors' purpose and motivation are the potential consideration of exoskeletons as PPE for shoulder injury prevention. An upper body exoskeleton is a wearable technology engineered to improve upper extremity musculoskeletal health in professionals and skilled trade workers who engage in repetitive arm motion or static elevation of the arms. Some upper body exoskeletons (such as the one shown in the photos on pp. 32 and 34) are lightweight and transfer the weight of the arms from the shoulders, neck and upper back to the body's core, evenly distributing energy to reduce stress. Injury Prevention & Ergonomic Assessment OSHA offers advice for evaluating how to best protect a worker from injury. The first step is to try to eliminate the hazard. When elimination is not possible, it is best to identify a suitable engineering control. If that does not work, then the use of administrative controls should be considered. For example, a study found that welding tasks entail the risk of developing supraspinatus tendinitis and that shoulder pain decreased after relaxation and job modification (Herberts, Kadefors, Andersson, et al., 1981). Unfortunately, workers are sometimes expected to push through the pain associated with poorly designed jobs because an injury prevention solution is expensive to implement. Lastly, where the hazard cannot be eliminated or controlled, PPE must be used. PPE is any device or appliance designed to be worn by an individual when exposed to one or more safety and health hazards.

Key Takeaways Cardiac hospital monitoring technicians monitor 800,000 alarms per month and vital signs for 30 patients per day. These healthcare professionals are exposed to many distractions per shift and are expected to act on too much information. The authors make recommendations to reduce information processing load on technicians. The study presented in this article was undertaken because risk managers in this hospital system became concerned about the number of alarm-related deaths occurring in the healthcare industry and commissioned the study. The monitoring technician position and the work setting studied are similar to industrial operations such as oil and gas processing operations, pharmaceutical manufacturing, paper manufacturing, specialty chemical manufacturing and power plant operations. A technician sits at a monitoring station watching the feedback from the operating system and responds accordingly depending upon what the feedback from the system indicates (or, in this case, what patient monitoring data indicate). This article presents the results of an analysis of the cognitive information processing workload of patient monitoring technicians in the cardiac floor central monitoring units (CMU) at five U.S. hospitals. The researchers conducted the analyses during a physical visit to four of the hospitals and through conversations with the management team, nurses and technicians at all five hospitals June 1–2, 2016. The study's objective was to determine whether technicians' information processing (IP) workload was too high for error-free operation.

Key Takeaways Leading indicators are a well-documented component of occupational safety and health management systems to evaluate OSH performance. This two-part article presents research that examines the use of leading ergonomic safety performance indicators in the American workplace for reducing risk and experiencing fewer ergonomic loss events. Part 1 of this article discusses the impact of ergonomic musculoskeletal disorders in the workplace and safety performance indicators. It describes the research performed and discusses several of the findings. Part 2 discusses additional research findings and the implications for the OSH profession. Finally, the author presents several conclusions. Part 1 of this article, presented in the October 2018 issue ( PS , pp. 60–67), discusses the impact of ergonomic musculoskeletal disorders (MSDs) in the workplace and safety performance indicators (SPIs). The author describes the research performed and discusses several of the findings. Part 2 presented here discusses additional research findings and the implications for the OSH profession. Finally, the author presents several conclusions. As noted in Part 1 of this article, this study asked respondents to consider 10 leading ergonomic SPIs regarding their ranking of importance, degree of implementation in the workplace and potential barriers to implementation: measuring workers' perceptions of top/line management commitment to ergonomics safety (e.g., safety perception survey); tracking the number of new hires being trained in ergonomics safety before the assignment of their work duties; tracking the number of new hires assigned an OSH mentor to coach them in avoiding the ergonomic hazards of their work duties; tracking the use of prehazard controls to avoid ergonomic hazards (e.g., prevention through design and/or management of change); tracking the number of job hazard analyses (JHA) conducted to avoid ergonomic hazards; measurement of workers' early reporting of strains/sprains they experience (e.g., ergonomic symptoms survey); measuring worker participation in management-led stretch-and-flex exercises; measuring ergonomic losses investigated for root causes within 24 hours; measuring ergonomic improvements implemented; conducting an annual audit of the written ergonomic management control programs (EMCP).

Key Takeaways Leading indicators are a well-documented component of occupational safety and health management systems to evaluate OSH performance. This two-part article presents research that examines the use of leading ergonomic safety performance indicators in the American workplace for reducing risk and experiencing fewer ergonomic loss events. Part 1 of this article discusses the impact of ergonomic musculoskeletal disorders in the workplace and safety performance indicators. It describes the research performed and discusses several of the findings. Part 2 discusses additional research findings and the implications for the OSH profession. Finally, the author presents several conclusions. Can the use of leading OSH indicators reduce the lagging results? The short answer is yes. Leading indicators have been a well-documented component of global occupational health and safety management systems (OHSMS) to evaluate their OSH performance. Effectively operating OHSMS reduce risk and prevent loss events that result in lagging indicators. While leading indicators have been researched in this realm and the field of quality control, leading ergonomic safety performance indicators (SPIs) have not been specifically studied for evaluating the effectiveness of ergonomic management control programs (EMCP). The author recently completed OSH research to assess the degree to which leading ergonomic SPIs are valued and utilized, identify the perceived difficulties in implementing leading ergonomic SPIs, and examine the impact the person assigned OSH responsibilities has on the use and importance placed on leading ergonomic SPIs. This research sought a reduction in ergonomic risk and related loss events due to the increased use of leading ergonomic SPIs to measure EMCP effectiveness. An SPI is a lagging or leading indicator to measure performance and evaluate whether a certain OSH or OHSMS goal has been achieved. This research is believed to be the first to study the perceived importance of leading ergonomic SPIs in the evaluation of EMCPs and therefore functions as a baseline for the perception and use of these SPIs, and the possible obstacles to implementation faced by today's OSH professionals.

Key Takeaways Expanding legalization of marijuana for medicinal purposes creates a significant challenge for workplaces where physical impairment may lead to mishaps and injuries. While medicinal use of marijuana in federal workplaces is still restricted, states legalizing medical marijuana leave nonfederal workplaces to figure out how to accommodate these changes and still protect their workforce. Organizations must decide how to address medical marijuana use while promoting a safe and healthful work environment, and not reconciling the legalization, permitted use and lawful drug testing. This article explores some of the challenges and possible approaches for meeting this evolving workplace dilemma. The increasing legalization of medical marijuana use presents a greater risk in the workplace. It presents organizational challenges to maintaining productivity, protecting equipment and property, and preserving employee safety and health. Historically, organizations developed anti-drug use policies and randomly drug tested employees to determine potential impairment at work; however, this strategy must evolve as the use of medical marijuana grows. While medical marijuana is legal, employers may not know if employees are impaired at work. This is a growing problem as several states have already legalized medical marijuana use (see the "Marijuana Legalization Status" sidebar), public support for marijuana legalization rises and many other states continue to consider bills on varying levels of reform (Ingraham, 2017; NCSL, 2018). With the expansion of medical marijuana reform, previous workplace policies may potentially violate employee rights. While federal law still classifies marijuana as a Schedule I substance under the Controlled Substances Act (i.e., drugs with no currently accepted medical use and a high potential for abuse) (U.S. DEA, 2018), U.S. Department of Justice (DOJ) deferred enforcement to each state in 2013 (J.M. Cole, personal communication, Aug. 29, 2013; U.S. DOJ, 2013). Organizations must be wary of state laws regarding marijuana use and understand how the use can affect workplace safety and health, all while clarifying both employer and employee rights through the lawful execution of workplace drug policies.

Key Takeaways Workplace cancer statistics from around the world reflect the seriousness of the global workplace cancer situation and reveal which worker groups are at greatest risk. This article discusses why workplace cancer prevention has a lower profile than workplace injury and what actions must be taken to elevate the profile of workplace cancer prevention. It also discusses important factors that influence workplace cancer cluster investigations. Worldwide, workplace cancer prevention has a significantly lower profile than workplace injury prevention despite a real and present need to elevate the profile of workplace cancer prevention globally. Many organizations worldwide attest to the high number of annual work-related cancers and cancer deaths, but then say that workplace cancer statistics are underestimated, that the problem is worse than statistics bear out, and that the profile of workplace cancer prevention must be elevated. This apparent consensus begs a few questions. Supported by reputable resources from around the globe, this article explores several questions: What is occupational cancer, how prevalent is it and what are its causes? Why does cancer prevention have a much lower profile than workplace injury prevention? Are current occupational exposure limits (OELs) for carcinogens adequate? What are the problems associated with cancer cluster investigations, how reliable are they and what must be done to improve them? What must be done to advance the cause of workplace cancer prevention? What are some valuable resources available to those who want to help advance the cause of workplace cancer prevention? What Is Cancer & How Prevalent Is It? According to the U.S. Department of Health and Human Services' 14th Report on Carcinogens, cancer affects almost everyone's life, either directly or indirectly; approximately one out of two men and one out of three women living in the U.S. will develop cancer at some point in his/her lifetime (NTP, 2016). According to American Cancer Society (ACS, 2017a), cancer is the second most common cause of death in the U.S. and accounts for nearly one of every four deaths. World Health Organization (WHO, 2017) estimates that worldwide in 2012 (the most recent data), 14 million new cancer cases and 8.2 million cancer-related deaths occurred, and that the number of new cancer cases is expected to rise by about 70% over the next 20 years.

Key Takeaways Working alone is generally an accepted practice in the U.S. Working alone when performing high-risk work presents an unacceptable risk to workers. Educating management and affected employees regarding the risk of lone work and integrating the related risk-reducing controls of a working alone safety program will contribute to the eventual unacceptance and discontinuance of high-risk work by lone workers. Imagine it is a hot summer day and David the field technician receives an electronic text for a service call in the middle of his morning schedule. David adjusts his schedule to accomplish an assigned urgent task: the repair or replacement of a cooling fan for a natural-gas-fired HVAC unit atop the roof of a customer's correctional facility. Arriving at the work site 30 minutes later via a company vehicle, David positions an extension ladder to gain access to the client's roof. He troubleshoots the HVAC unit and determines the malfunction to be a faulty bearing set. David climbs down to his vehicle to obtain the replacement part and returns to the roof with an extension cord and a reciprocating saw to complete the work. He locates a rooftop electrical outlet to power his saw and begins to disassemble the unit. When the repair is completed, David intends to return to ground level, lower and stow the ladder and proceed to a nearby fast food establishment to take his lunch break and cool off. OSH professionals will quickly grasp the serious injury and fatality (SIF) hazard potentials that this worker encountered while working alone, remotely or in isolation. Consider the motor vehicle operation, ladder ascent/descent, fall from an elevated working surface, flammable gas under pressure, electrical contact through a power tool and extension cord, energized electrical HVAC components, unexpected HVAC start-up, workplace violence potential and heat stress exposure due to elevated temperature extremes. The risk appetite of U.S. employers is maturing to recognize and respond to the hazards of lone work. Old business paradigms of minimal staffing to achieve maximum profits are being countered with wise risk management decisions to produce quality service and products in a safe manner. An estimated 53 million people are lone workers in the U.S., Canada and Europe (Myers, 2015). Once OSH professionals begin pondering the topic, work environments and tasks for which lone work has been accepted in the past, despite the related SIF potentials, are easily identified and countered.

In Brief In this pilot study, the authors selected the ecological momentary assessment research model as a tool to record the activities of environmental health and safety staff supporting an academic research institution conducted during typical work days. The researchers determined that the primary activities performed were routine safety surveillance activities, responding to client service requests and necessary safety services, accounting for 45% of the recorded time expenditures. Managers of safety and health programs may be interested in learning more about this tool to make more informed decisions about staffing and resource allocation and to better articulate to upper management what safety programs do. A variety of safety and health risks exist on college and university campuses based on the types of teaching and research activities conducted. OSH programs are typically implemented to help identify and control these risks to keep students, faculty, staff and visitors safe. A significant challenge for decision makers at these institutions is how to determine appropriate staffing and resourcing levels for such programs. A further challenge to staffing is ensuring that the job description and duties accurately represent those activities that truly fall under the purview of the position. Existing methods of measuring efforts often include some level of intense observation or surveillance, which staff may consider to be intrusive and cumbersome (Sewell, Barker & Nyberg, 2012). As a result, the Hawthorne Effect, described in other time and motion studies, may alter the way a staff member conducts his/her routine activities leading to an observed effect further from the normal (Fernald, Coombs, De Alleaume, et al., 2012). Brown, Emery, Delclos, et al.'s (2015), recently developed predictive models provide the ability to estimate staffing and resourcing needs in academic settings using institutional drivers such as total net assignable square footage, but the models do not account for staff productivity. In this pilot study the authors utilized the ecological momentary assessment (EMA) research technique to record the work activities being undertaken by OSH personnel during a typical 8-hour work day in an effort to augment the Brown, et al., models by addressing worker productivity. Practicing OSH professionals were evaluated 1 day per week over a 5-week period (for a total of 5 work days, all weekdays) to determine the type of work conducted during the normal 8-hour work shift.

In Brief Successful companies recognize that a reactive approach to worker health is less effective than preventive approaches. Adding traditional wellness programs to group health benefits is a first step, but can be slow and ineffective. This article discusses comprehensive healthy workforce programs that companies can employ to address the total health of the workforce and improve not only health insurance premiums, but also workers' compensation costs, absenteeism, morale and other indirect costs. Early adopters of this shift in employee wellness will be able to effectively manage the health and productivity of their workforce. Most successful businesses are beginning to understand that the reactive approach to employee health, providing group health insurance to cover employees when they get sick, is far less effective than one that combines preventive efforts with transparent/reactive medical services. In the past, adding a traditional wellness program to group health benefits was the first step for employers that sought to proactively reign in their increasing group healthcare costs. This approach is slow, sometimes ineffective and makes measuring success difficult. More importantly, this philosophy is becoming obsolete. By adding new, nontraditional wellness programs to existing healthy workforce strategies, employers can take their programs to a new level. Employers can look to a new generation of comprehensive healthy workforce programs to address not only nutrition, cessation education, exercise and disease management, but also disease prevention, functional employment testing, job analysis, ergonomic assessment and injury prevention.

In Brief Workers may express concerns to an OSH professional about reproductive and developmental health effects, prenatal exposure or exposure during breastfeeding. Little guidance on risk assessments for susceptible workers is available to practicing OSH professionals. Risk assessments for susceptible workers should be conducted as part of a comprehensive safety management system or industrial hygiene program. This article presents a model for evaluating susceptible workers, including new and expectant parents, developed by the authors to help OSH professionals evaluate workplace risks and hazards. OSH professionals may experience an increased interest in and concerns about providing gender equal protection from their employer's management team, occupational medicine providers and human resources partners. The protection of reproductive health for all genders must be ensured in the workplace. There have been significant changes to regulatory and legal aspects of gender equal protection in recent years (Pisko, 2016). International conversations have re-energized the discussion about providing inclusive and gender equal protection in the workplace. In the U.S., state-based laws have generally been termed a Pregnant Workers Fairness Act (PWFA) or similarly named acts. As of November 2017, 22 states, the District of Columbia, and four municipalities have enacted PWFA legislation, including: Alaska, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Jersey, New York, North Dakota, Rhode Island, Texas, Utah, Vermont, Washington and West Virginia (National Partnership for Women and Families, 2017). A PFWA has been proposed at the federal level (S.1512), but progress in passing the act is slow. Congress has "attempted multiple times to pass" the federal PWFA, but the law has been opposed by several sessions of Congress (Pisko, 2016). Upcoming regulatory changes associated with revisions to EPA's Toxic Substances Control Act are also relevant. As part of the Frank R. Lautenberg Chemical Safety for the 21st Century Act (2016), a definition for "potentially exposed or susceptible subpopulation" has been established to include a group of individuals with greater risk than the general population for adverse health effects relating to chemical exposure. This greater risk is further explained to be either from greater susceptibility or greater exposure, and includes infants, children, pregnant women, workers and the elderly.