March 11, 1992

Pat Beecher, M.D.
Ford Motor Co.
900 Parklane Towers
West One Parklane Boulevard
Dearborn, Michigan 48126

Dear Dr. Beecher:

Thank you for your letter of January 25, 1992, requesting interpretations for a series of injury and illness recordkeeping questions. I will answer these questions by first restating each one and then answering it. Wherever possible, I will reference The Recordkeeping Guidelines for Occupational Injuries and Illnesses, 1986, by referencing the page number and question(s) that apply.

Question 1. Are separate logs needed for the following

conditions:

a. One plant name with 2 buildings. Same management, employees rotate from 1 building to another (ex. stamping and assembly)

b. One plant name with 2 buildings. Employees do not rotate. Processes are the same.

c. One plant name with 2 buildings. Employees do not rotate. Processes are different.

d. One building, all salaried employees, with different organizations.

Answer: This question really asks, "What is an establishment?"

The locations described in parts a and b seem to reflect a single establishment, given that the two buildings are a "single physical location" and are engaged in a like economic activity. (page 19, question A-1)

The location described in part c may or may not be a single establishment. The answer rests with the difference in the processes involved. If the individual processes represent distinctly different economic activities, then there may be two establishments at a single physical location. As stated in the Standard Industrial Classification Manual, 1987, each distinct and separate activity should be considered an establishment when:

1. no one industry description (Standard Industrial Classification, 1987) includes such combined activities, and

2. the employment in each such economic activity is significant, and

3. separate reports can be prepared on the number of employees, their wages and salaries, sales or receipts, or other types of establishment information.

(pages 19 and 20, section A)

The establishment described in part d appears to be a single establishment. Even though the employees may belong to different organizations, they all work for the same firm, Ford Motor Company. Of course, the concept of a "firm" is blurred somewhat by the existence of multi-corporate business structures. If the building is being shared by employees of separate firms, then each firm is responsible for its own log. Be aware that the exemptions from recordkeeping requirements would still apply. (Pages 5-6, Question C-2, Pages 19-20 Questions A-1 through A-9)

Question 2. Can entries be made in pencil for restricted/lost days and then erased to be kept current?

Answer: It is acceptable to fill out the OSHA injury and illness records (OSHA 200 and 101) with a pencil, pen, typewriter or any other media you wish to use. You may also use correction fluid or any other technique of entry removal that you desire. The main issue is not the writing instrument used to maintain the injury and illness records but rather that the records be legible, complete and accurate.

Question 3. Should description of an injury or illness be changed after entry made on log? Example: initial entry was contusion of hand and one week later x-ray showed fracture.

Answer: Section E on page 23 of the Guidelines states that employers are required to update the log to reflect changes which occur in recorded cases after the end of the calendar year. As stated on page 11 of the guidelines, good entries for column F briefly describe the nature of the injury or illness and the part(s) of the body affected. An accurate description of the case increases the utility of the records for any user.

Question 4. Define what is "temporary" assignment.

Answer: A temporary assignment is any assignment where the person is expected to return to their normal job at some future time. The definition becomes important when counting lost workdays for employees with long-term restrictions. If long-term restrictions result in permanent assignments to modified jobs, the count of lost workdays ceases once the transfer or modification is made permanent. There are three main points to consider when using this rationale:

1. For injuries, the reasoning is used to discontinue the count of lost workdays, not to avoid it altogether. The same reasoning would apply to cases resulting in total disability. Injuries resulting in permanent transfers should not be recorded as injuries without lost workdays.

2. Illnesses resulting in permanent transfer may or may not have lost workdays. For illnesses that result in permanent transfer or termination, an asterisk is to be placed in the appropriate illness column.

3. If, at a later date, the employee is able to transfer back to his or her original job, the transfer can no longer be considered permanent. The original log entry (and any affected annual totals) should be corrected with the actual number of lost workdays.

(Page 49, questions B-9, B-10, B-11, and B-13)

Question 5. If an individual receives his/her paycheck from one location and is assigned on a temporary basis to another location where the injury occurred, on which log should the entry be made?

Answer: The case should be entered on the records of the establishment in which they were injured or became ill. (page 20, question A-10)

Question 6. Should log be updated when employees move from plant to plant? Example: employee is injured at one plant and is recorded. Employee is transferred to another company plant in another state. Should we continue to update the recorded case in the first plant?

Answer: Yes, unless the transfer results in a permanent job modification.

Question 7. STS questions.

Answer: In June of 1991 OSHA issued a memo to its field offices directing them to cite employers for failing to record work related shifts in hearing of an average of 25 dB or more at 2000, 3000, and 4000 Hz in either ear on the log. As a result, companies are in compliance if they record any unilateral or bilateral 25 dB shift, or if they record lesser shifts, such as STS.

a. Should all unilateral [hearing loss] be entered at 25 dB?

This recording policy would be in compliance.

b. Is the 25 dB an average or actual 25?

The 25 dB criterion is based on an average at 2000, 3000 and 4000 Hz.

c. Should bilateral be entered at 10 dB?

Recording 10 dB unilateral or bilateral shifts would be well within the criteria from the June 4 memo. This recording policy would be in compliance.

d. If entry made on unilateral and next year another STS, same ear and no change in work or exposure, is another entry made?

Employees are not limited to one recordable hearing loss per ear per lifetime. At a minimum, employers should record a work related hearing loss case for each incremental 25 dB shift from the employees original baseline.

e. When should entry be made on log--at the time of possible STS or when retest confirms STS?

A retest audiogram may be substituted for an annual audiogram if it is obtained within 30 calendar days of the date the annual audiogram was obtained. However, 29 CFR 1904.2 requires employers to record occupational injuries and illnesses within 6 days of receiving knowledge of their existence. Thus, if the annual audiogram indicted that an employee had suffered a recordable hearing loss, an entry on OSHA Form 200 would be required. However, if the retest audiogram indicates that the shift was not persistent, the original entry should be lined out or removed.

Question 8. What is considered "new" exposure with CTD (as 1 week since last visit to medical department)?

Answer: As found in the enclosed Ergonomics Program Management Guidelines for Meatpacking Plants on page 15, a case is considered to be complete once there is complete resolution of the signs and symptoms. Failure of the worker to return for care after 30 days indicates symptom resolution. Any visit to a health care provider for similar complaints after the 30-day interval indicates reinjury or reexposure to a workplace hazard and would constitute a "new" case.

Question 9. To record upper extremity CTDs must there be: -One physical finding (as an objective symptom)

centerR>or -A subjective symptom with medical treatment or lost workdays?

Answer: As found in the Ergonomics Program Management Guidelines for Meatpacking Plants on page 14, and the enclosed June 4 memorandum, either of the above situations would be considered a recordable case.

Question 10. If over the counter medication does not have the dosage, time or number of pills dispensed, is the case recordable?

Answer: As found in the Recordkeeping Guidelines for Occupational Injuries and Illnesses on page 42, the use of nonprescription medications is considered first aid treatment and should not be recorded if the work-related injury does not involve loss of consciousness, restriction of work or motion, or transfer to another job.

Question 11. Is "soreness" on the first day of a job recorded as an illness?

Answer: See question #9. Soreness, pain or other subjective symptoms may be recordable as a CTD if they meet the recordkeeping criteria which include medical treatment, loss of consciousness, restriction of work or motion, or transfer to another job.

Question 12. If an employee with an injury is sent home or given a restriction on the day of injury, and no medical treatment is provided, is the case recordable? If yes, what column is checked?

Answer: As found in the Recordkeeping Guidelines for Occupational Injuries and Illnesses on page 52, question C-2, if the restriction does not go beyond the day of injury or onset of illness, the case is to be recorded as a nonfatal case without lost workdays in either column 6 or 13.

Question 13. Are needlesticks recordable if treatment refused?

Answer: Needlesticks are to be recorded using the instructions in the enclosed OSHA CPL 2-2.44C. The medical treatment criterion focuses on whether the injury was serious enough that medical treatment was actually provided or should have been provided. Cases should be recorded where medical treatment was clearly required, but for one reason or another, was not actually provided. (page 44, question F-5)

Question 14. If employee sustains several injuries at the same incident, should separate entries be made on the log? Example: Traumatic bursitis shoulder and traumatic epicondylitis.

Answer: Multiple injuries or illnesses resulting from a single accident or exposure would be recorded as a single case on the log.

Question 15. If antiseptic ointment is given to employees to apply at home, and no second visit to medical department, is case recordable.

Answer: See questions 17 and 19.

Question 16. Name and address of physician/hospital on #101: -On original visit only? -Any time referral is made (5 year period)? -Are multiple physicians, hospitals to be listed? -Is physical therapy to be listed as one of these?

Answer: The OSHA Supplementary Record #101 should be completed as early as practicable but no later than 6 workdays after the employer receives information that a case has occurred. Whatever information that is available, pertaining to physicians or hospitals visited, at the time the form is being completed should be included. Thus, subsequent referrals need not be recorded. Physical therapists are not normally considered to be physicians and are not required to be entered on the #101.

Question 17. If a physician or nurse directs an employee to self administer multiple heat soaks or cold treatments at home, is such treatment considered "medical treatment" for the purpose of recordability.

Answer: No. The medical treatment list states that medical treatment includes "use of hot or cold soaking therapy (or hot or cold compresses) during second or subsequent visit to medical personnel. Since the use of hot or cold treatments at home do not occur during a second or subsequent visit to medical personnel, they do not constitute medical treatment.

In the meatpacking ergonomics guidelines, this concept was expanded slightly to include self-administered treatment when made available to employees by their employer. This would include such treatments as heat or cold therapy provided on the employer's premises, but not necessarily supervised by medical personnel.

Question 18. If an employee has subjective symptom (headache) from vapors, and comes in two or three days later with the same complaint, is this a new event?

Answer: As found in the Recordkeeping Guidelines for Occupational Injuries and Illnesses on page 31, question B-12, some occupational illnesses may recur as the result of new exposures and should be recorded as new cases. If there is no additional exposure, it should not be recorded as a new event.

Question 19. During the redressing of a wound, are the following procedures considered medical treatment:

a) Application of antibiotics b) Cleansing the wound with phisophex or betadine which are both antibacterial agents c) Cleansing the wound with prescription strength phisophex which is utilized by many implant clinics?

Answer: If the use of antiseptics on second or subsequent visits is the only criterion for making a case recordable, the case should not be recorded unless the antiseptic involved is one that requires a prescription in order to obtain it and is used beyond a single dose on the first visit. The recordability would then be based on our guidelines for the use of a prescription medication as medical treatment. Prescription antibiotics are handled similarly.

Question 20. Are elastic bandages inclusive of:

a) other types of tapes (Coban, etc.) b) "tennis elbow" splints c) wrist splints d) back corsets

Answer: This question revolves around the issue of medical treatment vs first aid for various orthopedic devices. Our interpretation of the recordkeeping guidelines is that the use of casts, splints or orthopedic devices designed to immobilize a body part are considered medical treatment. Wraps or non- constraining devices such as wristlets or elastic bandages are considered first aid treatment, regardless of how long or how often they are used.

I hope this information will answer your questions about the recordkeeping requirements. If you have further questions please contact my staff at (202) 523-1463.

Sincerely,



Stephen A. Newell
Acting Director
Office of Statistics

Enclosures