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Management Briefing: Managers are responsible for supporting the Workplace Ergonomics Program in their areas. Division chiefs, directors, service unit heads, and some administrative officers will attend briefings by their service unit ergonomics team, with possible input from key trainers.
Training for Supervisors: Supervisors ensure that employees follow safe work practices and receive appropriate training to do so. They must therefore attend the job-specific training for the positions they supervise. In addition, supervisors need briefings similar to those provided for managers in order to gain a complete understanding of their responsibilities.
Support Training: All support offices have a responsibility to keep ergonomic knowledges and skills current and to apply ergonomic principles in performing their duties. Appropriate technical training should be provided for support staff on an as-needed basis.
Evaluation.
The WEPCC will develop evaluation mechanisms for training courses.
SURVEILLANCE
The purpose of health and job risk factor surveillance is to provide an ongoing systematic method of identifying and evaluating cumulative trauma disorders (CTDs) and workplace ergonomic risk factors; and to monitor trends in their occurrences in specific areas, over time and between locations. The information developed in the process is used to plan ergonomic interventions and determine the need for action. Data collected through surveillance makes up the epidemiological (incidence, distribution, and control of disease in a population) tools used in assessing the workplace and employees and determining trends, costs, and interventions.
The service unit ergonomics teams conduct surveillance in both passive and active modes. The responsibilities for surveillance are interdisciplinary. See Program Management.
Passive Surveillance involves the analysis of existing records and data.
1. Analysis of Existing Records. Medical and safety professionals review certain records for implications of ergonomic factors such as overexertion, forceful exertions, awkward postures, and repeated motion type injuries. They forward information applicable to the Workplace Ergonomics Program to the appropriate ergonomics committee/team. This records review process is a first step in determining the ergonomic program direction and for performing the job analysis.
Medical Records.
Medical records include Occupational Health and Safety Administration (OSHA) logs, compensation reports, medical visits, and as necessary, personal medical records. Information of a personal nature regarding treatment and the injury may not go forward to the ergonomics committee/teams.
Safety Review.
Safety Services conducts injury/illness reviews and/or investigations which identify suspect mishap cause factors useful. The resulting reports are useful in identification of specific jobs for ergonomic analysis.
Complaint Records/Suggestions.
Service unit ergonomics teams can use employee complaints and/or suggestions relating to a work process to identify potential ergonomic problem areas. Safety Services can assist the service unit ergonomics teams in the review of such records.
2. Early Reporting of Symptoms. Employees are encouraged to report early signs and symptoms of discomfort to their supervisor, service unit ergonomics team or directly to Health Services. This allows for timely and appropriate evaluation, documentation and treatment or referral.
Active Surveillance
Active Surveillance is the solicitation of information before the occurrence of an event which would precipitate a complaint. Active surveillance can be conducted at two levels of specificity.
Level 1. Active Surveillance is less detailed.
a. Periodic Walkthroughs. A walkthrough is useful in increasing the visibility and accessibility of ergonomic team and health and safety professional. It also acquaints health care and safety staff with various areas.
b. Surveys. The symptoms survey is a widely-used tool in active surveillance. It is useful in early identification of problems as well as for assessing the effectiveness of interventions. There are other such survey tools e.g., fatigue surveys, back history surveys.
c. Hazard Evaluations. Service unit ergonomics teams evaluate jobs. Use of checklists facilitates this process. The purpose is to observe, document and assess risk factors present.
Level 2. Active Surveillance is more detailed.
a. Health Interviews and Physical Examinations. To assure effective medical management, it is necessary to establish an approach which incorporates a baseline evaluation, a postconditioning period evaluation and a periodic assessment. These are in the form of health interviews and physical examinations. The target population is asymptomatic employees already in or being placed in high risk jobs, as well as symptomatic employees.
ANALYSIS AND DESIGN OF JOBS
Job Analysis
Job Analysis in an ergonomics program is a systems approach to identify work activities that may result in or contribute to overexertion injuries and disorders of the back and upper extremities, often referred to as cumulative trauma disorders (CTDs). The objective is to identify work activities that may result in or contribute to overexertion injuries and disorders of the back and upper extremities, often referred to as cumulative trauma disorders (CTDs). The systems approach identifies generic risk factors such as forceful exertions, awkward postures, localized contact stresses, vibration, temperature extremes, and repetitive motions or prolonged activities which may contribute to injury/illness. The process involves documentation and study of the work by service unit ergonomics teams. It includes the worker, the supervisor, and specialists trained and experienced in recognition and assessment of ergonomic risk factors. Completion of the job analysis results in identification of ergonomic stresses, design of interventions and follow-up evaluation of the interventions.
There are two levels of job analysis. They are:
Surveys/Walkthroughs (Level 1) are a basic method of identifying risk factors associated with the performance of work. Service unit ergonomics teams, in consultation with health care and safety professionals, conduct the surveys. Checklists are useful in completion of the survey/walkthrough. Other resource material is available in Safety Services.
Analysis (Level 2): Ergonomics team members conduct detailed job analysis in work areas after determining and prioritizing those jobs that warrant analysis. All personnel conducting ergonomic job analysis must have received specific training in ergonomic job analysis and intervention techniques. The job analysis process identifies and ranks specific risk factors, documents job attributes, and assesses ergonomic stress factors.
a. Documentation: The following constitute documentation of the job analysis:
(1) Position description: The official position description permits the analyst to compare job function to the intended goal/objective. It is possible that the findings of the analysis may support changes in position descriptions.
(2) Direct observation: Risk factors in a job or work area studied can be determined by direct observation. The analysis includes, as necessary, upper extremity repetitive measurements for total hand manipulations per cycle, cycle time and total manipulations or cycles per shift. Where appropriate force measurement determinations are needed these can be estimated as an average effort or peak force. Force measurements can be obtained using appropriate test equipment (if available).
(3) Supervisor/employee interviews: Staff, including labor organization representatives, provide a broad knowledge base regarding job history and problems. All job analysis includes on-site interviews with employees, supervisors, and labor organization representatives.
(4) Videotaping is the preferred method of documenting a specific job analysis, in most cases. It helps the analyst understand the task demands on the worker, and how each worker accomplishes the task. Videotaping requires the presence and activity of the worker. Use of a checklist aids in accurate documentation of conditions present during the analysis. Where videotape equipment is not available use of a checklist is even more important.
b. Assessment of Ergonomic Stresses: During the detailed analysis, some specific actions and/or potential stressors are evaluated for impact on the worker. There are four specific stressors for which the analyst should be alert. They are noted below.
(1) Repeated and sustained static exertions: Does the performance of work, required in the position description, require these exertions, or do they result from a work practice?
(2) Forceful exertions: Where forceful exertions are identified in the analysis some specific steps may be required for evaluation and intervention. It may be necessary to estimate loads and friction resistance, make posture adjustments, determine need for mechanical aids, consider use of gloves, and evaluate muscle use with tools such as resistance meters and surface electromyography equipment.
(3) Localized mechanical stresses: Does the work require specific forces and/or contact with areas of the worker's body?
(4) Posture stresses: Identification of posture stresses can be accomplished through job analysis observation and/or video tape. The analysis may be supplemented with instrumentation noted in (2) above, analysis of orientation of the worker in relation to the work, review of types of tools used, and use of anthropometric data.
Design of Jobs.
When considering design or redesign of jobs the objective is to minimize ergonomic stresses present in the performance of the work. Interventions considered must eliminate or reduce employee exposure to the potential for suffering from CTDs and other back and upper extremity pain, while allowing accomplishment of the organization's mission.
1. Propose interventions. A complete job analysis includes reporting of the findings, recommendations for design of control measures, and evaluation of actions taken. The report may be formal or less formal, depending on the extent of recommendations for change. Intervention is accomplished through the application of appropriate engineering changes, and/or implementation of
administrative control for the work. Intervention is followed by evaluation.
1.1 Engineering Changes include actual modifications to the physical work site and any tools or equipment used in the work process. Determination of needed changes may require assistance of medical, safety and other recognized experts.
(1) Tools - Are power assists available? Can handles be changed?
(2) Machines/Equipment - Are changes necessary to the equipment? Economic impact may be a necessary consideration in some cases.
1.2 Administrative Controls are necessary as interim protective measures, pending completion of required engineering changes. In some situations administrative controls may be the only intervention needed.
(1)Work area - Can changes be made in the work/equipment location and orientation? Are proper chairs used?
(2) Methods - Is there another way to do the work? Is job rotation allowed?
(3) Standards - If standards are established for the work, are they realistic, up-to-date?
(4) Schedules - Are schedules flexible enough to provide periodic rest breaks and/or on-the-job exercises? Are work schedules flexible?
(5) Education/Training - Are employees trained to recognize problems and take proper action?
(6) Maintenance - Is equipment with moving parts, e.g., wheels, lifts, etc., properly inspected and maintained?
Evaluation. Each intervention action taken to prevent/reduce CTDs and other related disorders requires follow-up evaluation to assess effectiveness of the action. The evaluation can be accomplished through:
Job Analysis - using the methods described above, and/or
Active/Passive Surveillance - methods described in Surveillance.
Assessment - evaluation of information from a. and b. above to determine whether the goal has been achieved
MEDICAL MANAGEMENT
The goal of medical management is to ensure evaluation, diagnosis and treatment of repetitive strain disorders, and to provide avenues for prevention. Integration of medical management is essential to the success of the program. All medical evaluations, records, and data as well as results of surveys etc. are handled in a manner which preserves the anonymity of individual employees and maintains the confidentiality of personal and medical information. The components of this program are: Accessibility; Health Surveillance; Identification of Restricted-Duty Jobs; Medical Intervention; and Record-keeping, Data Evaluation, and Action.
Employee investment in the problems, along with early medical intervention and good open communications between Health Services and other treating clinicians, are key to success.
Accessibility
The health care providers must be accessible to the employees to facilitate treatment, surveillance activities, and recording of information. This may be accomplished via walkthroughs and educational initiatives. The walkthrough increases visibility and provides a forum for interaction and exchange of information.
Health Services undertakes educational initiatives for different types of cumulative trauma disorders (CTDs), their causes, prevention, etc. These are carried out through new employee orientation, health forums, _Gazette_ articles, brochures, posters, etc.
Health Surveillance.
The Health Services Office serves as a principal member of the surveillance team assessing and analyzing symptoms surveys, and encouraging and receiving early reports of symptoms. This role is more clearly outlined under Surveillance.
Identification of Restricted-Duty Jobs
The objective of a restricted-duty assignment is to provide a chance for healing or rehabilitation of an injured area by assigning the worker to a position that does not involve the use of the injured muscle-tendon group. This type of assignment is individualized to each worker. A list or data base of jobs categorized according to ergonomic risk from high to low is to be developed. The identification process requires job analysis (see Analysis and Design of Jobs). As these job analyses are completed, relevant information is added to the official position description.
Medical Intervention.
Appropriate medical evaluation and care is essential to prevent the development of more serious medical problems. The main objective of medical management is to identify and treat disorders at a very early stage, and minimize progression or exacerbation. This includes health interviews and examinations. These examinations are in the form of, a baseline evaluation, a post conditioning period evaluation, and a periodic assessment. The baseline or preplacement exam would determine capabilities (as opposed to disabilities) and identify required job restrictions. The examinations are job-specific, based on the official position description, initiated by the supervisor or Human Resources, and administered by Health Services. The post-conditioning evaluation is done no later than 1 month after a new position is assumed to determine if there are symptoms consistent with the breaking in of muscles as opposed to the onset of a cumulative trauma disorder (CTD). The periodic assessment is oriented towards early detection of health changes in at-risk workers Responsibilities are outlined in Program Management.
Record-keeping, Data Evaluation, and Action.
It is important to maintain accurate records. OSHA logs, medical records, compensation reports, and Safety Services injury reports, as well as the results of symptoms surveillance, are the epidemiological tools in assessing the workplace and employees and determining trends and costs.
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