State plan states have been a strong national force in recognizing emerging workplace hazards and
originating new methods for addressing those hazards, including the adoption of new standards. State
plans emphasize that whatever the emerging issue, employers are still required to provide a safe and
healthful place of employment
In particular, California was the first state in the nation to adopt an ergonomic standard in 1997.
State plans are continuing efforts to reduce the number and severity of musculoskeletal disorders
caused by risk factors in the workplace.
In 1999, California was first in the nation to place stronger requirements on employers to protect
healthcare workers by preventing needlestick injuries. In addition, several state programs are
developing formal rules as well as voluntary guidelines to help prevent workplace violence.
Ergonomics
California
California adopted the first workplace ergonomic standard in the nation, effective July 3, 1997. The
standard is triggered only when at least two employees at the employer’s worksite who are performing
identical tasks are diagnosed with repetitive motion injuries (RMI) by a licensed physician within
12 consecutive months.
 California’s workplace repetitive motion injury standard deals with musculoskeletal injuries caused
by a repetitive job, process or operation. The Cal/OSHA ergonomic standard contains three
independent elements:
- Worksite evaluation of each job, process or operation of identical work activity–such as assembly,
loading, word processing.
- Control measures to correct in a timely manner the exposures causing repetitive motion injury.
- Employee training.
The Cal/OSHA Consultation Service gives presentations on workplace ergonomics, back injury
prevention and musculoskeletal disorders to help employers and employees understand the scope of the
problem and use preventive measures to minimize repetitive motion injury. Publications on the
subject are available from the California Department of Industrial Relations website. (See
directory.)
Washington
Washington adopted a new ergonomics rule on May 26, 2000, which differs from California’s workplace
repetitive motion injury standard–its requirements are triggered by specific hazards in the
workplace rather than occurrence of musculoskeletal disorder symptoms or injuries. Intended to
reduce work-related musculoskeletal hazards (WMSDs) that cripple or injure more than 50,000
Washington workers each year, the Washington rule was adopted after a 20-month rulemaking process
that included conferences across the state, extensive work with two large advisory committees,
publishing a proposed rule with supporting documents, and 14 public hearings in seven cities
statewide.
Key elements of Washington’s ergonomics rule are:
- The rule applies only to employers with “caution zone” jobs where an employee’s typical work
activities include exposure to specific physical risk factors listed in the rule.
- Employers with caution zone jobs must ensure that employees working in or supervising these jobs
receive ergonomics awareness education. These employers also must analyze the caution zone jobs to
determine whether they involve hazards that need to be controlled.
- Employers may choose their own method and criteria for identifying and reducing hazards–as long as
they are at least as effective as a number of widely used methods listed in the rule–or may use the
checklist provided in the ergonomics rule.
- If the analysis of caution zone jobs shows that exposures are above a hazardous level, the
employer must reduce exposures to below that level or to the extent technologically and economically
feasible.
- Employers must provide for and encourage employee participation.
- An extended implementation schedule based on industry type and employer size allows employers,
especially small businesses, ample time to prepare for compliance.
- The department will assist employers and employees in implementing the rule. These activities
include developing guides and models, identifying industry best practices, establishing inspection
policies and procedures, conducting demonstration projects, and sharing information on workplace
ergonomics.
- Employers may continue to use effective methods of reducing hazards that were in place before the
rule adoption date as long as the methods, taken as a whole, are as effective as the requirements of
the rule.
Requirements of Washington’s ergonomics rule are phased in over a two through six year period,
depending on the size of the business and its industry sector. First to comply in the state will be
larger businesses in the 12 industries showing the highest risk of WMSDs. These employers have two
years to come into compliance with several of the requirements and three years for total compliance.
Smaller businesses not in the 12 highest-risk industries are given up to five years to come into
compliance with those requirements and six years for total compliance.
Some employers and labor organizations are eligible for direct financial incentives–safety and
health grants or workers’ compensation premium discounts–to help them implement the ergonomics rule.
The state has convened a panel of experts to help determine whether employer and employee technical
assistance activities are successful and sufficient before compliance with the new rule begins.
Copies of Washington’s ergonomics rule, supporting documents, and other workplace ergonomics
information and links are available on the Washington Department of Labor and Industries’ website.
(See directory.)
North Carolina
North Carolina provides consultation on ergonomics, and the North Carolina Ergonomics Resource
Center (NCERC) is a partnership between the state’s Department of Labor and North Carolina State
University. Funds were appropriated to the Department of Labor for establishment of the center,
which is housed at the university. NCERC opened in November 1994. Its services cover ergonomics
consulting and training workshops, on-site ergonomic training individually tailored to a company’s
needs, a variety of publications, a series of ergonomics tips dealing with specific industries and
environments, and two employee video training packages.
Emphasizing applied research and timely delivery of programs, NCERC identifies, analyzes and
corrects ergonomic deficiencies in the workplace. Its primary goal is to act as a bridge for
technology transfer and information exchange between the university, state agencies and industry.
Michigan
Michigan’s Strategic Plan includes musculoskeletal disorders as one of the targeted injuries and
illnesses to be reduced 15 percent over the next five years. Even without a standard, MIOSHA can
enforce the General Duty requirement and issue citations and penalties in the most extreme cases.
Citations are issued where the state finds repetitive motion injuries of which the employer was
aware and knew how to prevent, but did not make any reasonable effort to prevent them.
MIOSHA works to “educate before we regulate.” For a number of years the MIOSHA Consultation
Education and Training Division has been working with employers and employees to reduce MSD
injuries. MIOSHA has an Ergonomics Advisory Committee that was established in 1991 as a proactive
voluntary compliance initiative. The committee’s main goals are to promote training regarding
ergonomics and to advise on workplace ergonomics issues. The committee also oversees an awards
program that recognizes voluntary ergonomic innovations and activities. The MIOSHA ergonomics
recognition awards are given to companies that either do innovative ergonomics activities or can
show through performance a significant reduction in ergonomics-related injuries.
Connecticut, Oregon
Connecticut is developing training programs to complement its ergonomics enforcement, and plans to
make such training available on CDs. Oregon plans no regulatory action, and is conducting increased
training and outreach. A stakeholder advisory group has been formed to work on volunteer programs, a
conference, publications and a website.
Utah, Virgin Islands
Utah has not adopted an ergonomics regulation, yet has worked with nursing homes and similar types
of businesses since 1993 on the benefits of applying ergonomic principles and practices to help
reduce workplace injuries and illnesses. Virgin Islands has not adopted state-specific ergonomics
regulations, and its General Duty Clause is used when an employer should have known existing
abatement methods for an injury that occurred.
Minnesota
Although it does not have a state ergonomic standard, Minnesota was one of the first states to
examine and cite ergonomic problems in the workplace. The ergonomics team, which produced Guidelines
for Resident Handling in Long-term Care Facilities, conducts comprehensive inspections of selected
facilities that include a thorough review of injury and illness records, a complete walkaround
inspection, and abatement recommendations.
Federal Perspective
On March 20, 2001, the President signed a joint resolution of Congress rescinding federal OSHA’s
ergonomics standard and, at the same time, pledging to find a solution to ergonomic-related problems
affecting the nation’s workforce. Federal OSHA’s ergonomics program standard had been issued
November 14, 2000, and took effect January 16, 2001. Congress acted under authority of the
congressional Review Act of 1996. As a result, the standard is no longer in effect, and employers
and workers are not bound by federal requirements. In testimony before the U.S. Senate, the
Secretary of Labor has stressed an approach based on cooperation and prevention, rather than the
adversarial approach of years past.
Needlesticks
California
Attention nationwide is focused on incorporating into OSHA requirements the new technologies of
engineered sharps devices and systems without needles. Needlestick injuries are the primary mode of
transmission of bloodborne pathogens in the workplace. On July 1, 1999, Cal/OSHA adopted major
revisions to its bloodborne pathogens standard to strengthen protection of healthcare workers from
the transmission of bloodborne pathogens, particularly Hepatitis B, Hepatitis C and HIV. California
was first in the nation to place stronger requirements on employers to use needles and other sharps
devices engineered to reduce the chances of inadvertent needlestick injuries.
 California’s revised standard covers all employers whose employees may be reasonably anticipated to
have contact with blood or other potentially infectious material–including emergency and public
safety services, correctional and custodial care facilities–and providers of services to these
employers, such as plumbers and launderers, whose employees risk exposure to bloodborne pathogens.
Many factors came together to prompt the revised standard, including state legislation requiring
amendments to the existing standard, an advisory committee convened by Cal/OSHA, demands by unions
representing healthcare workers for protective action, intensive media coverage and industry input.
The concerted action by all parties involved helped ensure that healthcare workers not continue to
incur needlestick injuries despite the availability of new technology.
Unions representing healthcare workers view the adoption of the California requirements and issuance
of the new federal compliance directive as an important milestone in their effort to obtain
protection for healthcare workers from potentially life-threatening exposures to bloodborne
pathogens.
The Cal/OSHA standard as adopted has two major components:
- Where a choice is available, a needleless system must be used.
- If a needleless system is not available, needles or other sharps with anti-stick features must be
used.
Other revisions are:
- New requirements for using needleless systems and sharps devices with anti-stick features,
including some exceptions. Additional requirements for workers actually involved in providing
healthcare to be actively involved in developing a program to evaluate and select needleless systems
and sharps devices with anti-stick features appropriate for the procedures conducted.
- A requirement to keep a sharps injury log that records the date and time of each sharps injury
resulting in an exposure incident. Employers must record the type and brand of device involved in
the exposure incident and the details of the incident that will be useful in taking preventive
action in the future. The requirement to maintain a sharps log is unique to Cal/OSHA. The log should
serve as a tool for the employer, occupational health researchers and Cal/OSHA in evaluating the
effectiveness of devices.
- Addition of Hepatitis C as a specifically named bloodborne pathogen.
- A series of new requirements, which improve the effectiveness of the exposure control plan.
Issues in California to be resolved are: training employees, including frontline workers in
decision-making, and ensuring that employers select the best and safest devices available.
Publications and resources are on the California Department of Industrial Relations website. (See
directory.)
Alaska, Hawaii, Minnesota, Tennessee
Since California’s breakthrough in July 1999, Alaska,
Hawaii, Minnesota and Tennessee subsequently
passed legislation for changes to their bloodborne pathogen standards. Hawaii’s state legislators
adopted Senate Resolution 112, S.D. 1 for all healthcare facilities to have a workplace safety
protocol in place by January 1, 2000. Alaska adopted a statute that requires employers to use new
needlestick controls and mandates training. The new legislation took effect January 1, 2001.
Tennessee legislators enacted a law requiring the commissioners of labor and health to jointly
review sharps injury technology to include needles with engineered sharps injury protection and
systems without needles–and to jointly determine the environments where standards require that
sharps injury prevention technology be employed.
Employers are required to revise their exposure control plans to reflect improvements in sharps
prevention technology. They also must do the following to comply with Tennessee law:
- Document the type and brand of device in use when there is an exposure incident.
- Document when sharps injury prevention devices are not used because they are medically
contraindicated or not more effective than alternative measures used by the employer to prevent
exposure incidents.
Minnesota
Minnesota’s new law, which aims at reducing occupational exposure to bloodborne diseases through
sharps injuries, is enforced by Minnesota OSHA in conjunction with the bloodborne pathogens
standard. The exposure control plan must document evaluation and implementation of the engineering
controls designed to eliminate or minimize exposure to bloodborne pathogens. If an engineering
control is evaluated but not put into use, an explanation of why the device was not used should be
included in the update to the exposure control plan.
The new law specifies that employee involvement must be through the employer’s safety committee, and
this committee is responsible for recommending use of effective engineering controls. Half of the
safety committee members must be representatives of job classifications that could use or encounter
any device in the category evaluated. Employers not required to establish such a committee must
involve their employees in evaluating the engineering controls. Committee recommendations are not
binding on the employer.
Employers must establish internal procedures to document the route of exposure and detail the
circumstances of any exposure incident. This information should include: engineering controls in use
at the time; work practices followed; description and brand name of the device in use; protective
equipment or clothing used at the time of the exposure incident; location where the incident
occurred; employee training; and the injured employee’s opinion about whether any other engineering,
administrative or workpractice control could have prevented the injury. The new law is on their
website. (See directory.)
New Mexico
New Mexico has worked extensively with the Emergency Medical Services (EMS) Operations Bureau to
develop statewide training and prevention programs for reducing needlestick injuries. The program
also encourages local EMS providers to coordinate activities, training and equipment with local
hospitals to ensure compatibility of equipment and use of safe needle devices.
Iowa
Two states have passed legislation requiring the agency to prepare a study and make recommendations.
Iowa’s labor commissioner and Department of Public Health are to “…study state and federal laws and
regulations relating to protection of persons who may be at risk of needlestick injuries in the
course of employment,” with a report to be submitted “…to the governor and the general assembly by
December 15, 2001. The report shall include any recommendations for changes in state law or rules…”
The Consultation and Education Bureau is providing presentations and training to long-term
healthcare facilities and hospitals on needlesticks, sharps containment and bloodborne pathogens. In
2001, Iowa engaged in a Local Emphasis Program with long-term care facilities with emphasis on
needlestick issues.
Maryland
The Maryland legislature set a committee of Department of Health and
MOSH staff to review existing bloodborne pathogen standards and recommend ways to improve worker
protection against needlesticks in the healthcare industry. State-specific regulations are pending
a legislative hearing.
Puerto Rico
Puerto Rico approved a Local Emphasis Program on bloodborne pathogens exposure in clinic and
reference laboratories covering 677 establishments identified by the Board of Medical Technicians.
Emphasis was on the severity of violations to the regulations, and the concentrated enforcement was
expected to eliminate these serious issues. In 1996 PROSHO successfully litigated a discrimination
case on behalf of three employees required by their employer to either sign a waiver to the
Hepatitis B vaccine or bring a certificate of vaccination as a condition for keeping their jobs. The
court ordered back pay with accrued interest and reinstallation.
Federal Perspective
The Needlestick Safety and Prevention Act, which was passed unanimously by Congress, took effect
November 6, 2000. The act specified revisions to federal OSHA’s bloodborne pathogens standard and
directed the agency to make these changes within six months. The revisions clarify the need for
employers to select safer needle devices as they become available, and to involve employees in
identifying and choosing the devices. The changes went into effect April 18, 2001.
Specifically, the changes to the federal standard obligate employers to consider safer needle
devices when they conduct their annual review of their exposure control plan. The agency conducted a
90-day outreach and education effort before enforcing the regulations.
Workplace Violence
Alaska, California, Connecticut, Indiana, Michigan, Minnesota, New Mexico,
Utah, Virgin Islands, Virginia, Washington
 Workplace violence is an occupational safety and health hazard that demands action. Whether the risk
of violence comes from a coworker, client, patient or the public, employers must be provided with
tools to develop comprehensive plans that reduce levels of risk. State programs are developing
formal rules as well as voluntary guidelines to help prevent this type of workplace hazard.
Alaska, California, Connecticut, Indiana, Michigan, Minnesota, New Mexico,
Utah, Virgin Islands, Virginia and Washington have conducted
special emphasis or training programs related to workplace security. Indiana
and Minnesota have issued general duty clause citations on workplace violence.
Oregon
Oregon takes a strong information and training approach to raise awareness and encourage action. By
creating several publications and working directly with the Associated Oregon Industries and other
groups, statewide education network training forums address this emerging area. Oregon offers
on-line training for employers: Developing Your Violence Prevention Program.
California
California’s 1994 conference on workplace security, the first of its kind, was part of a drive to
promote additional research and develop guidelines for preventing workplace violence. California
issued Guidelines for Security and Safety of Health Care and Community Service Workers,
Cal/OSHA Guidelines for Workplace Security and a Model Injury and Illness Prevention Program for Workplace
Security.
Cal/OSHA has been investigating violent worksite events since 1993. Although workplace violence is
part of a larger societal problem, the employer in California is still required to provide a safe
and healthful place of employment. Employers at risk of robbery or other violent assaults must
include workplace security in their injury and illness prevention program. And in response to the
growing recognition of violence in the workplace, government agencies that oversee workplace safety
are incorporating security issues into safety plans. Fatalities from assaults and violent acts
accounted for 18.8 percent of the 1999 California workplace fatality total, down from 23.4 percent
in 1998 and decreasing steadily: from 194 in 1995 to 111 in 1999.
Minnesota
Minnesota’s Workplace Violence Prevention Program helps employers and their employees reduce the
incidence of violence in their workplaces by providing on-site consultation, telephone assistance,
education and training seminars and a resource center. This program targets workplaces at high risk
of violence: convenience stores, service stations, taxi and transit operations, restaurants and
bars, motels, guard services, patient care facilities, schools, social services, residential care
facilities and correctional institutions. The program is administered by the Workplace Safety
Consultation (WSC) Division.
Outreach tools include a brochure, Workplace Violence: Are You at Risk?
to increase awareness of workplace violence and outline steps to minimize its threat, and a guide,
Minnesota Workplace Violence Prevention–A Comprehensive Guide for Employers and
Employees, providing sample policies, checklists and tools to help assess and prevent violent incidents.
Washington
Washington developed safety and health standards for the late-night retail industry in 1990, and
uses enforcement and consultation for hazard abatement and prevention. The Workplace Violence
Awareness and Prevention workshop helps participants assess risk factors and develop preventive
measures. A written guide covering these topics and a sample prevention program were developed by
WISHA with over 30 representatives of labor, business and the academic community. WISHA’s video Is
It Worth Your Life? with real-life scenarios demonstrates what workers and employers can do to
prevent injuries. The video is distributed to employer networks and associations.
In 1997 the Washington State Department of Labor and Industries’ Safety and Health Assessment and
Research for Prevention program completed a comprehensive study of workplace violence based on
federal and state data for 1992-95. Homicide was the fourth leading cause of workplace deaths in
Washington, and most incidents were consistent with well-known risk factors. Most were committed by
persons unknown to the victims, and most of the victims worked in retail trade, security services or
transit. The majority of non-fatal injuries also occurred in predictable settings, but in contrast
to the fatal assaults, most of these injuries occurred in a setting where the victim and attacker
were in a custodial or client-caregiver relationship such as healthcare or social services. While
the trend for assaults against private-sector workers in the state was downward, that for state
government workers was rising. This study counters the notion that violence on the job is a random
event and impervious to remedy. Prevention strategies such as hazard assessment and de-escalation
training address risk factors in the work setting.
Utah
Utah believes that substance abuse and workplace violence need to be addressed together because of
their relationship to each other. Utah has provided seminars for employers and their employees on
workplace violence prevention and drug-free workplace programs for the past five years. Since
statistics show that over 70 percent of those using illegal drugs are employed, the effect of
illegal drug use in the workplace is an issue that demands attention. Since 1997 Utah has been
promoting its Take Safety Seriously campaign during prime time with award-winning 30-second spot
television announcements, and is one of the first states to produce these infomercials on the
effects of substance abuse in the workplace.
Virgin Islands
Virgin Islands’ Workplace Violence Prevention Program helps employers and their employees reduce the
incidence of violence in their workplaces by providing on-site consultation, telephone assistance,
education and training seminars and a resource center. In 1999 there were three workplace violence
employee-to-employee incidents that required workers’ compensation claims filing. VIDOSH recognizes
the need to address workplaces at high risk of violence: convenience stores, service stations, taxi
and transit operations, restaurants and bars, motels, guard services, patient care facilities,
schools, social services, residential care facilities and correctional institutions. Staff are being
trained to provide workplace violence prevention assistance.
Virginia
During the 2000 session of the General Assembly, the Virginia
Department of Labor and Industry was requested to study workplace violence in the commonwealth and
submit its written findings and recommendations to the governor and 2001 session of the General Assembly.
Michigan
Michigan has recently completed work on a "Violence in the Workplace" program. The heightened
awareness of the population to workplace exposures due to terrorism, domestic violence and
potentially out-of- control workers, along with many requests from employers for assistance, has led
to the development of outreach materials by the Consultation Education and Training (CET) Division.
Seminars, workshops and training materials are available to assist employers in developing their own
workplace violence prevention protocols. The CET Division has developed a program that can be
adapted to any workplace, however special segments will focus on high-risk areas such as nursing
facilities, late-night establishments and occupations where employees work alone.
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