October 22, 2024

Brandi Edmonds, RN, FNP-C
9314 McCombs Court
Lafayette, IN  47905

Dear Ms. Edmonds:

Thank you for your letter to the Occupational Safety and Health Administration (OSHA) regarding the recordkeeping regulation contained in 29 CFR Part 1904 - Recording and Reporting Occupational Injuries and Illnesses.  Specifically, you asked whether the use of paraffin wax as a form of topical heat application is considered medical treatment beyond first aid for OSHA recordkeeping purposes.

In your letter, you state that the application of paraffin wax is a well-known reputable source among the medical community, similar to the use of heat wraps and Epson soaks in warm water.  You indicate that thermal modalities may help to relieve stiff muscles and joints by improving circulation and increasing blood flow.  You also state that the application of paraffin wax does not require formal training or specialized degrees, and that paraffin wax may be purchased over the counter and is often applied in spas and salons.  

Section 1904.7(a) of OSHA's recordkeeping regulation requires employers to record work-related injuries and illnesses that result in medical treatment beyond first aid.  Section 1904.7(b)(5)(I) states that medical treatment means "the management and care of a patient to combat disease or disorder."  Under Part 1904, medical treatment does not include "first aid" as defined in section 1904.7(b)(5)(ii).  Section 1904.7(b)(5)(iii) goes on to state that the list of treatments in section 1904.7(b)(5)(ii) is a comprehensive list of first aid treatments.  Any treatment not included on this list is not considered first aid for OSHA recordkeeping purposes.

The regulation at section 1904.7(b)(5)(ii)(E) specifically states that the use of hot and cold therapy to treat a work-related injury or illness is first aid for purposes of OSHA recordkeeping.  
OSHA has determined that the use of paraffin wax to treat a work-related injury or illness is a heat treatment within the meaning of “hot or cold therapy” in section 1904.7(b)(5)(ii)(E) because the warm temperature of the paraffin wax in this application is used to relieve pain by increasing blood flow, reducing joint stiffness, and relaxing muscles. As such, when heated paraffin wax is used alone to treat a work-related injury or illness, the treatment is considered first aid, and the injury or illness is not recordable.  Please note that the use of such treatments is considered first aid regardless of the number of times paraffin wax is applied, where it is applied, or the injury or illness to which it is applied.

However, in many cases, heated paraffin wax is used in combination with other methods to treat work-related injuries and illnesses.  For example, paraffin wax may be used along with physical therapy, exercise, or prescription medication.  In such cases, the use of paraffin wax, in combination with another method that meets the general recording criteria, such as medical treatment beyond first aid, job transfer, restricted work activity, or days away from work, would make the case recordable.  In situations where a worker sustains a significant injury or illness, the case almost always involves some other form of medical treatment (such as prescription drugs, physical therapy, or chiropractic treatment), restricted work, or days away from work. See, OSHA’s discussion of hot and cold therapies in the preamble to OSHA’s January 19, 2001, Occupational Injury and Illness Recording and Reporting Requirements final rule, published in the Federal Register at 66 FR 5916, 5990.

The State of Indiana operates its own occupational safety and health program under a plan approved and monitored by OSHA.  Indiana Division of Occupational Safety and Health (IOSHA) adopts and enforces standards and investigates safety and health concerns in workplaces throughout the state.  State Plans are required to have standards and enforcement programs that are at least as effective as OSHA’s but may have different or additional requirements.
You may wish to contact Indiana OSHA (IOSHA) at:
Indiana Occupational Safety and Health Administration (IOSHA)
402 West Washington Street, Room W195
Indianapolis, IN 46204
Tel: (317) 232-2693
(317) 233-3790

Indiana State Plan

We hope you find this information helpful.  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.

Sincerely,

Lee Anne Jillings, Director
Directorate of Technical Support and Emergency Management