Back to Basics is a weekly feature that highlights important but possibly overlooked information that any EHS professional should know. This week, we examine the costs of slip, trip, and fall hazards.
Did you know slips, trips, and falls cost American employers billions of dollars every year?
In its 2024 Workplace Safety Index (WSI), insurer Liberty Mutual cautioned employers to be vigilant in addressing slip, trip, and fall hazards, like wet floors and slippery or uneven walkways.
“The 2024 WSI identifies a need for a renewed vigor against slips, trips, and falls,” Liberty Mutual said in a white paper accompanying its report.
Falls on the same level cost employers $9.99 billion annually in medical expenses and lost wage claims, while slips or trips without a fall cost $2.34 billion.
Liberty Mutual’s breakdown by industry is illuminating:
- Falls on the same level became the third most costly cause of losses in construction, moving up from fourth.
- Falls on the same level remained the top cause of losses for the leisure and hospitality industry, with an increased injury count compared with the previous year’s index.
- Manufacturing saw an increase in the number of falls on the same level and the average cost.
- Falls on the same level moved up from the third- to the second-highest cause of loss for the wholesale trade.
- Same-level falls became the leading cause of losses in health care and social assistance, overtaking overexertion injuries as the industry’s top-ranked cause of losses. Slips or trips without a fall entered the industry’s top five causes of loss.
Earlier this year, the National Institute for Occupational Safety and Health (NIOSH) published its findings on injured homecare workers. 117,000 homecare workers were treated in emergency departments for work-related injuries over a five-year period. While more than half of the injuries (52%) were from overexertion and repetitive motions, falls, slips, and trips accounted for 15% of injuries. Violent acts by people or animals also accounted for 15% of injuries.
Home health and personal care workers monitor the condition of people, often elderly, with chronic illnesses or disabilities and assist them with daily living activities. They often work alone with their clients in private homes, leading to unique safety challenges.
NIOSH examined ways of addressing the safety challenges of home health and personal care work, publishing another study this fall on working with homecare clients to make their homes safer working environments. The institute’s researchers found that two-thirds of clients who received coaching made suggested safety changes, which were often to reduce slip, trip, and fall hazards in the home.
Data on slips, trips, and falls
Falls on the same level are the fourth leading cause of days away from work, job restriction, or transfer (DART) cases—414,400 in 2022, according to the National Safety Council (NSC). Resulting injuries include soreness or pain (in 26% of incidents); sprains, strains, and tears (24%); bruises and contusions (19%); and fractures (14%).
Eighty percent of cases occurred in service industries, according to the NSC, including health care and social services, retail trade, transportation and warehousing, and accommodations and food services. Twenty percent occurred in goods-producing industries, with 13% in manufacturing alone.
The median DART number is 20, and the median number of days away from work is 12.
The group emphasizes the importance of effective signage to help prevent injuries, regulatory violations, or higher insurance premiums.
Floors, surfaces, and walkways are major sources of nonfatal workplace injuries among retail salespersons, according to the Department of Labor’s Bureau of Labor Statistics (BLS), accounting for 5,170 cases involving days away from work in 2020. The BLS reported 5,630 falls on the same level in the occupation that year.
Workers’ compensation insurer Travelers released a workplace injury impact report this summer. In its analysis of claims data, Travelers found that slips, trips, and falls were the second-leading cause of workplace injuries, after overexertion, accounting for 23% of injuries. However, slips, trips, and falls were the leading driver of “severe claims,” or those costing $250,000 or more.
OSHA enforcement
The Occupational Safety and Health Administration’s (OSHA) walking-working surfaces standards (29 Code of Federal Regulations (CFR), Part 1910, Subpart D) cover most slip, trip, and fall hazards. Violations of walking-working surface regulations usually show up in OSHA citations along with more commonly cited standards like lockout/tagout and machine guarding.
Earlier this fall, OSHA cited a Watertown, Wisconsin, animal food manufacturer with two dozen safety violations, including exposing employees to hazards from walking and working surfaces. The agency proposed penalties totaling $161,332.
This summer, OSHA cited a Sandusky, Ohio, pork processing facility with 43 safety violations, proposing penalties that totaled $528,441. The 40 serious violations, one repeat violation, and two other-than-serious violations included unsafe walking-working surfaces and stairways, along with the lack of a hazard communication program, lockout devices, and personal protective equipment (PPE).
OSHA also cited an Arlington, Texas, pet products manufacturer and distributor this summer, proposing penalties totaling $278,851. The agency cited the employer with a serious violation of walking-working surfaces regulations for failing to maintain walkways free of leaking hydraulic fluid, exposing employees to slips, trips, and falls.
The agency also cited a Texas commercial flooring manufacturer for exposing employees to slip, trip, fall, and other hazards this summer, proposing penalties totaling $299,591.
OSHA has an ongoing National Emphasis Program (NEP) for warehouses and distribution centers, and it launched the three-year NEP in July 2023. The NEP authorizes its agency compliance safety and health officers (CSHOs) to conduct comprehensive safety inspections focused on hazards related to walking-working surfaces, as well as powered industrial vehicle operations, material handling and storage, means of egress, and fire protection.
NIOSH slip, trip, fall prevention tips
NIOSH encourages employers to provide young workers with information on staying safe at work, pointing to slips, trips, and falls as common causes of workplace injuries. Causes of slips, trips, and falls in the workplace include greasy floors, ice, loose mats or rugs, rain and snow, and spills.
NIOSH suggests that employers remind young workers to:
- Clean up spills and anything slippery, checking with supervisors about how to use cleaning products and not using cleaners that could make floors slippery.
- Clear walkways, stairs, and lobbies of anything that might be a tripping hazard, such as clutter, cords, empty boxes, and wires.
- Make sure floor mats lay flat and aren’t wrinkled or bunched.
- Clean off any slippery material on the rungs, steps, or feet of a ladder before use.
- Don’t go over the load limit noted on the ladder.
NIOSH also has slip, trip, and fall prevention guidance for healthcare employers. According to NIOSH, the top slip, trip, and fall hazards in health care include:
- Contaminants (fluids, food, grease, oil, and water) on the floor;
- Improper use of floor mats and runners;
- Inadequate lighting;
- Poor drainage of drains and pipes;
- Stairs and handrails;
- Step stools and ladders;
- Tripping hazards like clutter, hoses, loose cords, medical tubing, and wires;
- Walking surface irregularities both indoors and outdoors, like uneven flooring or ground and holes, protrusions, and rocks; and
- Weather conditions like ice and snow.
NIOSH’s guidance provides employers with an extensive checklist of slip, trip, and fall hazards that should be addressed in healthcare facilities.
NIOSH also offers a fact sheet for wholesale and retail employers. Like the institute’s advice for healthcare employers and those that employ young workers, it points to risk factors in the wholesale and retail trades that include boxes and containers; ice, rain, and snow; loose mats and rugs; poor lighting; spills on walking surfaces; and walking surfaces in disrepair. NIOSH has detailed recommendations for employers on footwear, planning and workplace design, and training, as well as advice for wholesale and retail workers concerning housekeeping and material handling.
Specific recommendations for the industry include:
- Selecting flooring material according to the work performed in an area.
- Using mats to provide slip-resistant walking surfaces by absorbing liquid and removing dirt, debris, and liquid from shoes. Mats should be large enough that several footsteps fall on the mat and clean contaminants off shoes.
- Providing umbrella bags to prevent rainwater from dripping onto the floor and cleanup supplies—paper towels, absorbent material, “wet floor” signs, etc.—at convenient locations in the facility.
- Ensuring all indoor and outdoor areas have proper lighting to reduce shadows, dark areas, and glare so tripping hazards or surface irregularities are visible.
- Developing a written slip, trip, and fall prevention policy spelling out employer and worker responsibilities.
NIOSH has also researched the effectiveness and value of wearing slip-resistant shoes.
For several years, there was little research on their effectiveness, but laboratory studies of slip-resistant footwear used to reduce slips, trips, and falls have shown promise.
A 2019 study looked into the effectiveness of slip-resistant shoes in a study of 17,000 food service workers in 226 school districts serving kindergarten through 12th grade. Workers were randomly assigned to either a group that received no-cost, “five-star-rated” slip-resistant shoes or a group that bought their own slip-resistant shoes.
Researchers looked at workers’ compensation injury claims for accidents caused by slipping on wet or greasy surfaces to evaluate the effectiveness of the shoes worn.
The group provided with highly rated slip-resistant shoes saw a 67% reduction in claims for slip injuries.
There was a baseline of 3.54 slipping injuries per 10,000 months worked among the intervention group, which was reduced to 1.18 slipping injuries per 10,000 months worked after the slip-resistant shoes were provided.
Workplace housekeeping is also critical in preventing slip, trip, and fall hazards, as it can help control fire hazards and prevent falling objects.
Housekeeping interventions recommended by the Canadian Centre for Occupational Safety and Health (CCOSH) include the following:
- Cleaning all spills immediately;
- Mopping or sweeping debris from floors;
- Marking spills and wet areas;
- Removing obstacles from walkways and keeping walkways free of clutter;
- Securing carpets, mats, and rugs that don’t lay flat—for example, tacking or taping floor coverings;
- Ensuring file cabinet or storage drawers are closed;
- Covering cables or cords that cross walkways; and
- Keeping working areas and walkways well lit and replacing faulty light switches and used light bulbs.
While some safety experts suggest “how to fall” training can help mitigate slip, trip, and fall injuries, the CCOSH suggests that specialty footwear and training on “proper walking” and “safe falling” can never be fully effective without adequate housekeeping practices.
Insurers’ analyses of their workers’ compensation claims data show slips, trips, and falls can generate significant medical expenses and lost wage claims. Shouldn’t you take advantage of the extensive guidance available to control these hazards?