EHS Administration, Heat illness

Preparing for New Heat Regulation, Enforcement

The signs are clear that federal and state occupational safety and health officials are intently focused on the risks of excessive heat and are responding with outreach, regulation, and enforcement:

  • California issued another “Cal/OSHA Reminder: Protect Outdoor Workers from Heat Illness During Period of Excessive Heat in California” announcement.
  • Oregon’s Occupational Safety and Health Administration (Oregon OSHA) just issued a permanent heat exposure standard, and Washington reissued an emergency temporary heat standard, effective through the end of September, while it develops a permanent standard.
  • OSHA regional offices in Boston; Chicago; Dallas; Kansas City, Missouri; and Sioux Falls, South Dakota, recently have cautioned employers to protect workers from the hazards of excessive heat.
  • OSHA established a National Emphasis Program (NEP) of outreach, inspection, and enforcement regarding heat-related hazards while it develops a rulemaking to establish the first federal heat illness prevention standard for both indoor and outdoor work settings.

The consequences of worker heat illnesses can be dire and can include hospitalization and death. At a worksite in Inman, Nebraska, a worker collapsed after working 12½ hours and was pronounced dead of hyperthermia, with a body temperature of 106.3 degrees Fahrenheit (F).

In Florida’s Apalachicola National Forest, as temperatures neared 100 degrees, a member of a crew assigned to clear invasive plants began sweating heavily. His hands were trembling, and he seemed confused and unable to respond to commands, according to an inspection report. The worker rested while other crew members finished their tasks. The man was later found unresponsive. Without a cellphone signal, workers had to get help from a ranger station 14 miles away from the jobsite. By the time an ambulance arrived, the worker had stopped breathing, and responders found no pulse. The worker was transported to a hospital, where doctors pronounced him dead.

OSHA’s NEP targets over 70 industries that OSHA considers “high risk” based on incidence reports to the Bureau of Labor Statistics, elevated numbers of fatalities and hospitalizations reported to OSHA, and high numbers of General Duty Clause violations and Hazard Alert Letters issued over a 5-year period (January 2017 through December 2021). Targeted industries include those in the agricultural, construction, manufacturing, and wholesale sectors, as well as automobile dealerships, postal service, and freight and rail transportation.

Under the NEP, area offices can initiate inspections when the National Weather Service has issued a heat warning or an advisory for the local area. However, OSHA compliance safety and health officers (CSHOs) in area offices may conduct self-referred inspections, and area offices may act on referrals from the Department of Labor’s Wage and Hour Division.

During a heat-related inspection, agency CSHOs will:

  • Review the employer’s OSHA 300 injury and illness logs and 301 incident reports for entries indicating heat-related illnesses.
  • Review records of heat-related emergency room visits and/or ambulance transport without hospitalization. Such record review may require the use of a Medical Access Order.
  • Determine if the employer has a heat illness and injury program.
  • Interview workers, including both new employees and any employees who have recently returned to work, for symptoms of dehydration, dizziness, fainting, headache, or other conditions that may indicate heat-related illnesses.

During an inspection, agency personnel will evaluate the employer’s heat illness and injury prevention program, examining employee training on heat illness signs, prevention, and the importance of hydration; how employees are instructed to report signs and symptoms; and procedures for first aid and contacting emergency personnel.

An evaluation of a heat illness and injury prevention program will look at whether it is a written program and whether it includes heat-acclimatization periods for new and returning workers. Inspectors also will want to know how ambient temperatures and levels of work exertion at the worksite are monitored. OSHA personnel also will want to know the following:

  • Is unlimited cool water easily accessible to all employees?
  • Are there scheduled rest breaks, with access to shaded areas, and does the employer require additional breaks for hydration?
  • Are administrative controls like earlier start times and employee/job rotation used to limit heat exposures?
  • Is there a “buddy” system of worker observation used on hot days?

Because there is no federal heat stress or heat illness prevention standard, OSHA cites employers for heat-related illnesses and fatalities under the General Duty Clause (Section 5(a)(1)) of the Occupational Safety and Health Act.

General Duty Clause enforcement questioned

In 2019, the Occupational Safety and Health Review Commission vacated an OSHA heat illness citation and questioned the agency’s use of the General Duty Clause.

On August 1, 2012, an A.H. Sturgill Roofing crew was working on replacing an approximately 18-foot-high, large, flat roof of a bank in Miamisburg, Ohio. A member of the crew, a 60-year-old man with preexisting medical conditions that included congestive heart failure and hepatitis C, collapsed and began shaking. Emergency medical personnel transported the worker to a nearby hospital, where his core body temperature was determined to be 105.4 degrees F. The worker later died. A coroner determined that complications from heat stroke were the cause of death.

In citing the employer, OSHA alleged that Sturgill exposed the employee to “excessive heat while working on a commercial roof in the direct sun.”

The commissioners ruled that OSHA and a commission administrative law judge erred when they concluded that an excessive heat hazard existed at the time of the worker’s collapse. The commissioners pointed to evidence that when work began, the temperature was approximately 72°F, with 84% relative humidity. When the worker collapsed, the temperature was approximately 82°F, with 51% relative humidity.

The commissioners also concluded that that day’s tasks were not strenuous:

  • Cutting the existing roof’s membrane and Styrofoam sheets into small pieces;
  • Putting the pieces into a four-wheel handcart; and
  • Pulling the cart to the edge of the roof to discard the materials in a dumpster below.

Members of the federal review board called the agency’s use of the General Duty Clause for hazards, injuries, and illnesses not covered by a formal safety and health standard a “gotcha” or “catchall.”

Commissioners concluded that employers are left confused about compliance when OSHA fails to set a formal standard. They argued that Congress’s intent was for the Labor Department to set standards for hazards identified under the General Duty Clause.

OSHA’s heat rulemaking

The review commission ruling challenged OSHA’s normal operating procedures for addressing heat stress and heat illness hazards without a specific standard. Several lawmakers have introduced bills in Congress that would have compelled OSHA to establish a federal heat standard.

Then on September 20, the White House announced a multiagency effort to protect communities and workers from extreme heat. OSHA immediately released an enforcement initiative and announced plans for an NEP and a rulemaking to address heat hazards in indoor and outdoor work settings.

On October 27, OSHA issued an advance notice of proposed rulemaking (ANPRM) that contained no proposed regulatory text but 114 questions for stakeholders about a potential standard. While OSHA’s NEP targets some 70 industries, a federal heat standard could apply to hundreds. In its ANPRM, the agency reported a least 1 heat-related inspection in 0ver 230 industries across indoor and outdoor work settings since 2018. It also noted 789 heat-related hospitalizations and 54 heat-related fatalities across nearly 275 industries where the agency conducted inspections and issued citations.

OSHA also is considering whether a federal standard would apply to small businesses, noting a study that found that almost half of workplace heat-related fatalities occurred in “very small establishments” with fewer than 10 employees.

The agency expressed interest in receiving comments on the:

  • Best metric for defining and assessing heat hazards using either ambient temperatures, heat index, or Wet Bulb Globe Temperature (WBGT);
  • Elements of successful employer-led heat injury and illness prevention programs and controls, both engineering and administrative controls; acclimatization protocols; and monitoring methods; and
  • Best planning and response practices for heat-related emergencies.

Heat illnesses include heat cramps, heat exhaustion, and heat stroke.

Heat stroke is the most serious and can lead to permanent disability or death. It happens when the body can no longer control its temperature. The body’s sweating mechanism fails, and the body is unable to cool down. With heat stroke, the body temperature can rise to 106°F or higher within 10 to 15 minutes.

Heat stroke symptoms include:

  • Altered mental status, which shows up as confusion or slurred speech, that may lead to loss of consciousness (coma);
  • Hot, dry skin or profuse sweating;
  • Seizures; and
  • Very high body temperature.

Heat stroke requires emergency medical treatment.

What does successful heat illness prevention look like?

Heat illness prevention, as detailed in existing state regulations, includes acclimatization programs, work practices like scheduling work for cooler days or cooler times of day or splitting shifts to reduce individual workers’ exposures, and procedures for responding to heat illness emergencies, as well as training and access to cool water, shade, or air-conditioned structures or vehicles and scheduled and requested rest breaks. 

NIOSH recommends an acclimatization schedule involving a day of limited heat exposure for new and returning workers, followed by days of increased exposure. The institute’s formulas are:

  • A schedule of no more than a 20% exposure on day 1 for new workers and an increase of no more than 20% on each additional day; and
  • An acclimatization regimen of no more than a 50% exposure on day 1 for workers who have had previous experience with the job, then 60% on day 2, 80% on day 3, and 100% on day 4.

Key control measures in a heat illness prevention program include access to cool drinking water (potable, cooler than 59°F, and accessible to the work area), shade, and rest breaks. Workers and supervisors also should receive training in the signs and symptoms of heat illness and emergency response procedures. A buddy system pairs off workers who observe each other during a work shift for signs and symptoms of heat illness. It also is critical to have a person on-site trained and equipped to render first aid in an emergency and to have the means on-site to summon emergency medical services.

Now that more regions of the country are experiencing periods of excessive heat and agencies are establishing regulation and enforcement, heat illness prevention is becoming an essential part of workplace safety and health management.