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OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov.
May 5, 2000
LSG Sky Chefs
Sky Chefs, Inc.
6901 West Imperial Hwy.
Los Angeles, CA 90045
Dear Mr. Graham:
Thank you for your recent FAX of a copy of your original letter dated September 11, 1998, requesting our review of several cases to determine if they are OSHA recordable or not, based on whether first aid or medical treatment was administered. Please excuse the long delay in our response.
As I am sure you are aware, most employers in California, including State and Local governments, are under the jurisdiction of California OSHA (CAL/OSHA), not Federal OSHA. Therefore, such California employers are subject to CAL/OSHA's recordkeeping requirements rather than Federal OSHA's recordkeeping requirements. Injury and illness recordkeeping and reporting requirements promulgated by State plans are required to be substantially identical to those in 29 CFR Part 1904. Therefore, the definitions used to determine recordability must be identical to ensure national uniformity of collected information. However State Plan States may impose stricter recordkeeping requirements; for example, States may impose recordkeeping on employers exempt from Federal recordkeeping requirements (See 29 CFR 1952.4). Although you are subject to the recordkeeping requirements of CAL/OSHA, we will provide you with answers under the Federal recordkeeping requirements, citing the Federal Recordkeeping Guidelines for Occupational Injuries and Illnesses (Recordkeeping Guidelines) by page and Q&A number(s) whenever possible. CAL/OSHA may be reached at 415/975-4310 for more information on its requirements.
Case #1 Employee suffered laceration to left index finger. Steri-Strip™ skin closures were used for closure (stitches not required) and a bottle of 20 pills of 200 mg Motrin® was dispensed. Restriction was to keep finger clean and dry. Employee was seen a second time by doctor, during which time, the Steri-Strip™ skin closures were removed, and no further medical treatment was provided. Employee had a third follow-up appointment, but did not keep it. I classified the injury treatment as first aid and not OSHA recordable, but OSHA auditors feel that it is medical treatment and OSHA recordable. Who is right?
The OSHA auditors are right. The use of nonprescription medications, such as 200 mg Motrin®, is considered to be first aid treatment (See Recordkeeping Guidelines, Page 43). The fact that there were 20 pills in the bottle dispensed does not change the result. However, the application of Steri Strip™ skin closures is considered to be medical treatment, making the case OSHA recordable (See Recordkeeping Guidelines, Page 43). In addition, there was a restriction placed upon the employee to keep the wound "clean and dry." This restriction may make the case recordable as an injury involving restricted work activity if, as a result of the work related injury, the employee was unable to perform "all or any part of his or her normal assignment during all or any part of the workday or shift" (See Recordkeeping Guidelines, Page 43, Section 3). If this restriction affects the employee's ability to perform his or her normal job duties, then a check mark should be entered in Column 2 of the OSHA No. 200 Log.
Case #2 Employee suffered laceration to left hand thumb. Steri Strip™ skin closures were used for closure (stitches not required), a tetanus shot was given, and 200mg Motrin® were dispensed. The only restriction was to keep thumb clean and dry. Employee was seen a second time by doctor, but no medical treatment was provided. Employee had a third follow-up appointment, but did not keep it. I classified the injury treatment as first aid and not OSHA recordable. Is this correct?
No. The administration of either a tetanus shot or 200 mg Motrin® or both would not make the case recordable. However, as indicated in the answer above, the application of Steri-Strip™ skin closures is considered to be medical treatment, making the case OSHA recordable. Again, the case would involve restricted work activity if, as a result of the work related injury, the employee was unable to perform "all or any part of his or her normal assignment during all or any part of the workday or shift" (See Recordkeeping Guidelines, Page 43, Section 3). If the employee was unable to perform his or her normal job duties, then a check mark should be entered in Column 2 of the OSHA No. 200 Log.
Case #3 Employee was seen by medical doctor on 08/09/98 for a contusion to the left knee. A negative X-ray was taken, the knee was wrapped with an Ace® bandage, and Motrin® was dispensed. There were no restrictions placed on the employee and the employee returned to full duty on 08/09/98. Employee had a follow-up appointment, but did not keep it. At management insistence he returned to the doctor for a second follow-up visit and was discharged. I classified the injury treatment as first aid and not OSHA recordable. Is this correct?
While the use of casts, splints or orthopedic devices designed to immobilize a body part is considered medical treatment for OSHA recordkeeping purposes, wraps or non-constraining devices such as wristlets or elastic bandages are generally considered first aid treatment (See Recordkeeping Guidelines, Page 43). Thus, use of the ACE® bandage, a brand name for "All Cotton Elastic" by BD (Becton, Dickinson and Company), is considered first aid for OSHA recordkeeping purposes. However, from the documentation enclosed in your letter, the strength and dosage of the Motrin® dispensed is unclear. If Motrin® (200 mg) was dispensed, then the treatment for the injury was still first aid and the case is not OSHA recordable. But, if prescription strength Motrin® (400 mg, 600 mg, or 800 mg) was dispensed, and more than a single dose was administered, then the treatment for the injury involved medical treatment and the case is OSHA recordable (See Recordkeeping Guidelines, P 43).
1) Does Motrin® 200 mg, which is a nonprescription medication or any other nonprescription medication, become a prescription medication when issued to employees by the doctor in a bottle of twenty (20) pills?
No. Even a physician's writing a formal prescription for a nonprescription medication; for example, a prescription for regular aspirin, two tablets four times daily, does not make it a "prescription medication." Nonprescription medications are regarded as first aid treatment for OSHA injury and illness recordkeeping purposes (Recordkeeping Guidelines, P 43).
2) Does using Steri-Strip™ skin closures, and, in the opinion of the doctor, stitches are not required, and no further treatment is given other than on the first visit, and there are no restrictions that would keep the employee from doing their usual and customary job duties, make the injury treatment first aid treatment and not OSHA recordable or medical treatment and OSHA recordable?
As explained above, the use of wound closures, including Steri Strip™ skin closures, is considered medical treatment for OSHA injury and illness recordkeeping purposes. Thus, the injury is recordable because of the medical treatment involved.
3) When the employee refuses to go back to see the doctor after the first visit, and that information was documented, and the employee was treated for the injury within the guidelines of first aid, can the injury be classified as first aid?
If only first aid treatment is administered, and none of the other recording criteria are met, then the case is not recordable.
4) Although the following may be a legal matter, and a medical legal opinion rendered, as the employer, am I required to look at the medical records and the doctor's notes of the employee other than the doctor's first report of occupational injury and medical status reports in order to determine what is OSHA recordable and what is first aid? Matters of a personal nature told to the doctor in confidence by the employee, in my opinion, are not the employer's business, and therefore, I, as the employer, should not have that option.
Employers have the responsibility pursuant to the OSH Act and the regulations in 29 CFR Part 1904 to maintain the OSHA Form No. 200, Log and Summary of Occupational Injuries and Illnesses, for each establishment. Employers are obligated to use the information in their possession, and to make good faith efforts to obtain the information necessary to maintain these records. Generally, sufficient information can be gleaned from employees, supervisors, and records already in the possession of the employer, to determine recordability and to make the necessary and correct entries on the OSHA Log. "Matters of a personal nature told to the doctor in confidence by the employee" would seem to be unrelated to the type of information generally necessary for the proper recording of occupational injuries and illnesses, and generally would not be disclosed to the employer.
I hope you find this information useful. If you have any further questions or comments, please contact the Division of Recordkeeping Requirements at (202) 693-1702.
Cheryle A. Greenaugh
Director, Directorate of Information Technology