May 24, 2000

John DiCarlo
President, USWA Local 8972
and
Robert DeCicco,
Manager, Safety, Health and Environmental
Johnson Matthey
Precious Metals Division
2001 Nolte Drive
West Deptford, NJ 08066

Gentlemen:

Thank you for your letter of February 18, 2000 requesting "clarification as to what constitutes the 'second or subsequent visit to medical personnel' and its implications in determining medical treatment and recordability." I will respond by referring to the Recordkeeping Guidelines for Occupational Injuries and Illnesses.

Question: Employee visits on-site occupational health nurse to report an incident. No treatment of any kind is rendered. Later in the day, employee returns, is examined and is given a hot compress. Does this constitute "a second visit" meeting the definition for medical treatment and recordability?

Answer: Yes, "the second or subsequent visit" is the determining factor to make this application of a hot compress medical treatment and the case recordable for OSHA recordkeeping purposes (See Recordkeeping Guidelines, Page 43).

Question: Same facts as above except employee receives first aid, a BAND-AID® for a scrape but not a compress, during the first visit. How is the second visit, when a compress is given, now viewed?

Answer: Again, "the second visit or subsequent visit" is the determining factor making the application of a hot compress medical treatment and the case recordable for OSHA recordkeeping purposes.

Question: You refer to guidance used by your local labor union which indicates that treatment on the second visit is recordable regardless of any treatment or no treatment during a first visit to medical personnel. But you point out that there is conflicting information regarding the above questions in Letters of Interpretation (LOI) written in responses to Sikorsky Aircraft Corporation's letter of 09/02/97 and United Technologies Corporation's letter of 07/23/97. A reading of these LOI would indicate that the second treatment is the determining factor for recordability. You ask, "The intent of this language would be to make what would normally be a first aid treatment a recordable event when treated similarly the second time. Or, should this be interpreted as if a first time application on the second visit would determine recordability? If this is the case, what time limits can be established between visits?"

The time elapsed between the first and second visits does not matter in determining that two visits were made. OSHA's position regarding the application of antiseptics as medical treatment is contingent on whether the antiseptic is a prescription medication or not. In the case referenced by the Sikorsky Aircraft Corporation Letter of Interpretation, the employee had suffered a bruise and was given a cold pack during his first visit for treatment. Later in the day, still feeling sore, the employee made a second visit for treatment and was given another cold pack. Thus, he had "a second visit or subsequent visit" during which a cold compress was applied. Even if he had received no cold pack during the first visit and had received a cold pack during the second visit, the case would have been recordable because of the second or subsequent visit during which a cold compress was applied (See Recordkeeping Guidelines, Page 43).

United Technologies asked, "How should strains/sprains in which a second treatment of heat or cold is applied be recorded?" The writer failed to indicate whether the second treatment was being applied on a first or second visit and our response sought to clarify that the application of heat or cold therapy was recordable if it was applied during a second or subsequent visit to medical personnel.

We apologize for the seemingly conflicting information. This can happen when the original letter is not posted to the OSHA Web Site along with the Letter of Interpretation.

The guidance given concerning cold treatments in the local labor union document is correct.

Question: While working, an employee bumped his back on a valve. He reported to the nurse, who found a small abrasion at the point of impact and applied an antiseptic cream and a BAND-AID®. One and one-half hours later, the employee sneezed and felt a muscle pain in the general area in his back approximately 2 to 3 inches above the abrasion. A hot compress was applied. There was no medical evidence indicating a relationship between the two injuries. The employee returned to his normal duties and there was no need for additional treatment by our medical personnel.

Are we correct in considering these to be two separate incidents, each requiring individual first aid and therefore not recordable for OSHA recordkeeping purposes? If, however, a causal relationship had been medically determined, would the treatment for the muscle pain result in what would be a second visit, been treated with a compress and be recordable even though no similar treatment was applied on the first visit?

If, in fact, the two cases are two separate incidents and not medically linked, then neither case would be recordable. If, however, the two medical complaints that prompted the employee's visits to the medical personnel resulted from the same occupational event or exposure, then the hot compress applied during what would be considered a second visit to medical personnel would make the case recordable for OSHA recordkeeping purposes.

I hope you find this information helpful. If you have any further questions or comments, please contact the Division of Recordkeeping Requirements at: 202-693-1702.

Sincerely,

Cheryle A. Greenaugh
Director, Directorate of Information Technology