Heat illness, Personnel Safety

What to Expect From OSHA’s New Focus on Heat Stress

Will you be ready when an Occupational Safety and Health Administration (OSHA) inspector shows up at your facility or worksite for a heat-related illness inspection? Have you thought about how you would comply with a new federal heat stress standard?

On September 20, the White House and OSHA announced new steps to address worker exposures to excessive heat and heat-related illnesses, including an enforcement initiative already in place, a National Emphasis Program (NEP) similar to an existing regional program, and the start of work on a federal workplace heat standard.

Workers at outdoor sites in construction, farm labor, landscaping and tree care, and surface mining clearly are at risk for heat-related illnesses, but workers in hot environments like bakery workers, boiler room workers, fac­tory and warehouse workers, and firefighters also are at risk.

Without an existing standard, OSHA uses its enforcement authority under the General Duty Clause of the Occupational Safety and Health Act of 1970 in cases involving heat-related illnesses, which members of the Occupational Safety and Health Review Commission, as well as labor unions and public health advocates, have criticized. Public Citizen has repeatedly petitioned OSHA for a formal heat stress standard.

The new enforcement initiative, which relies on the agency’s General Duty Clause authority, prioritizes heat-related inspections on days when the heat index exceeds 80 degrees Fahrenheit and applies to both indoor and outdoor workplaces. Under the enforcement initiative, OSHA area offices are expected to prioritize inspections of heat-related complaints, referrals, and employer-reported illnesses, initiating on-site investigations where possible, and to direct their compliance safety and health officers (CSHO) to inspect or intervene at worksites whenever they observe workers performing strenuous work in hot conditions and expand the scope of any inspection to address heat-related hazards where worksite conditions or other evidence indicates heat hazards may be present.

During heat-related inspections, CSHOs are expected to review the employer’s OSHA 300 injury and illness logs for any entries indicating a heat-related illness, review injury and illness reports (OSHA Form 301), and obtain records of emergency room visits and/or ambulance transport, even if hospitalizations did not occur.  

Inspectors also will review any employer heat illness prevention plan and its acclimatization procedures, especially for new and returning workers; work-rest schedules; access to shade and water, with electrolytes when needed; and any training records associated with the program.

CSHOs will interview employees for reports of headache, dizziness, fainting, dehydration, or other symptoms that may indicate heat-related illnesses. They also will use the OSHA-NIOSH Heat App (available for Android and iOS mobile devices) to document the heat index, using the screen-save feature on a mobile phone or tablet.

Inspectors will identify conditions and activities relevant to heat-related hazards, including, but not limited to:

  • Potential sources of heat-related illnesses, such as working in direct sunlight, a hot vehicle, or areas with hot air or near a gas engine, a furnace, a boiler, or steam lines;
  • WetBulb Globe Temperature (WBGT) calculations, a formula used by the National Weather Service to measure the heat stress in direct sunlight, which takes into account temperature, humidity, wind speed, sun angle, and cloud cover (solar radiation); other temperature measurements; and any weather service heat advisories, warnings, or alerts;
  • The use of heavy or bulky clothing or equipment;
  • The types of activities performed by the employees and whether those activities can be categorized as moderate, heavy, or very heavy work, as well as the length of time a worker is continuously or repeatedly performing moderate to strenuous activities;
  • Heat-related illnesses among new workers, as well as any recent vacation time or breaks in employment before complaints of heat-related symptoms; and
  • The availability of rest breaks, shade, and water on-site.

NEP on heat illnesses

The planned NEP for heat illnesses likely will be modeled on the agency’s Regional Emphasis Program (REP) already in place in Arkansas, Louisiana, Oklahoma, New Mexico, and Texas (Region 6) focusing on heat illnesses—heat cramps, heat exhaustion, and heat stroke—among outdoor workers.

The heat illness inspections under the REP are triggered on days when the weather service’s heat index is forecast to exceed 80 degrees. Region 6 inspectors are checking that employers have a number of heat-related illness precautions in place, including employee training on the hazards of hot temperatures; the availability on-site of drinking water and shade or a climate-controlled (air-conditioned) area for rest breaks; a heat-acclimatization protocol to protect vulnerable new workers and those who have just returned from an extended absence; and the provision of first aid or prompt medical attention if a heat-related illness occurs.

Federal heat illness standard

An advance notice of proposed rulemaking (ANPRM) for a heat stress or heat illness prevention standard is expected in October, according to the White House and OSHA announcements.

What might a federal heat exposure standard look like? What would you need to do to comply?

OSHA could adapt one of the existing recommendations or standards, such as the National Institute for Occupational Safety and Health’s (NIOSH) 2016 update to the Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments (DHHS (NIOSH) Publication 2016-106), which replaced criteria documents for a recommended standard issued in 1972 and 1986, or one of the state standards issued by agencies in California, Oregon, and Washington.

The U.S. Army and Air Force also have a technical bulletin on heat stress management and handling heat stress illnesses and injuries. Army-Air Force heat stress control measures include heat acclimatization, rest breaks, and access to water or sports drinks with electrolyte replacement.

Let’s look at what a federal heat exposure standard might require. NIOSH’s recommendations for a standard include medical monitoring and workplace surveillance; employee information, training, and warning signs; and recordkeeping, in addition to exposure control measures and emergency medical care.

Medical monitoring is intended to assess employees’ health and physical well-being before and during work in hot environments, and the institute suggests both preplacement and periodic follow-up medical evaluations.

Immediate emergency medical treatment should be provided, such as calling 911 and cooling down workers, whenever they exhibit signs or symptoms of heat stroke, heat exhaustion, or rhabdomyolysis (a muscle tissue breakdown caused by heat and exertion). A non-life-threatening heat-related illness like heat rash can be treated with appropriate first-aid procedures.

Recommended control measures in a heat stress standard might include:

  • Heat-acclimatization plans for new workers and workers recently returned from time off;
  • Reducing workloads by using machinery or adding workers to a site;
  • Limiting time spent in the heat or a hot environment;
  • Providing cool, potable water near the work area; encouraging all workers who have been in the heat for up to two hours and involved in moderate work activities to drink a cup of water (about 8 ounces (oz.)) every 15 to 20 minutes; and providing sports drinks that contain balanced electrolytes to replace those lost during pro­longed sweating lasting more than two hours; and
  • Training workers and supervisors to rec­ognize early signs and symptoms of heat-related illnesses and implementing a buddy system in which workers are responsible for observ­ing fellow workers for early signs and symptoms of heat intolerance.

The employee information and training recommended by NIOSH include:

  • Heat stress hazards and predisposing risk factors, potential health effects of excessive heat stress, and signs and symptoms of heat injury and illness;
  • The effects of alcohol, caffeine, over-the-counter medications, and prescription drugs that all can increase the risk of heat injury or illness by reducing heat tolerance;
  • Workers’ responsibilities for following proper work practices and other control measures to help protect themselves and fellow workers, including instructions to immediately report to a supervisor the development of signs or symptoms of heat-related illnesses;
  • The purpose for and description of workplace surveillance and medical monitor­ing programs and the advantages to the worker of participating in these surveil­lance programs;
  • Proper use of protective clothing and equipment, if necessary; and
  • General and worksite-specific first aid and emergency medical procedures.

California, Oregon, and Washington standards

Existing state standards also provide some perspective on what a federal standard might include. California’s heat illness prevention standard applies to outdoor employment, covering agriculture, construction, landscaping, oil and gas extraction, and transportation, except for operating an air-conditioned vehicle when no loading or unloading is involved. Employers must have a written heat illness prevention plan under the California standard. Control measures in the California standard include heat-acclimatization procedures, providing water and access to shade, and high-heat communication and surveillance procedures when the temperature equals or exceeds 95 degrees. Training required by the California standard must cover risk factors for heat stress; types, signs, and symptoms of heat illnesses; the importance of consuming water; first aid and emergency medical procedures; and the employer’s responsibility to provide water, shade, cool-down rests, and access to first aid and emergency medical services.

Oregon’s temporary heat illness prevention plan rule (Oregon OSHA is at work on a permanent standard) applies when the weather service’s heat index equals or exceeds 80 degrees and has additional requirements when the heat index exceeds 90 degrees. The Oregon rule requires access to shade and water (32 oz. per hour), communication procedures for emergency events, and training on workplace heat risks.

When the heat index exceeds 90 degrees, employers must observe and monitor employees for signs and symptoms of heat-related illnesses and determine whether medical attention is necessary, provide a cool-down or rest period of at least 10 minutes every two hours, and develop and implement both acclimatization and emergency medical procedures.

Washington state’s updated outdoor heat exposure rules are in effect each year from May 1 through September 30. Employers must develop and implement outdoor heat exposure safety plans as part of their written accident prevention plans. Control measures required by the Washington standard include heat-acclimatization procedures and providing cool-down rest breaks, shade, and water. Employers must train all workers and supervisors on the signs and symptoms of various heat-related illnesses, and companies’ outdoor heat exposure plans also must cover plan procedures, cool-down rest breaks, and ways to cool down.

Current state standards and OSHA’s existing enforcement initiative suggest a federal standard could include requirements for heat-acclimatization programs; water, rest, and shade provided on-site; worksite surveillance for signs and symptoms of heat-related illnesses; first aid and emergency medical procedures; and training for both employees and supervisors.