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ABD0CT117653T ANSI Z16.4-1977 for uniform recordkeeping for occupational injuries and illnesses ANSI Z16.4-1977 ABDOO117634 ANSI Z16.4-1977 American National Standard for Uniform Recordkeeping for Occupational Injuries and Illnesses \ Secretariat American Insurance Association National Safety Council Approved July 8, 1977 American National Standards Institute, Inc ABDOO117635 American National Standard An American National Standard implies a consensus of those substantially concerned with its scope and provisions. An American National Standard is intended as a guide to aid the manu facturer, the consumer, and the general public. The existence of an American National Stan dard does not in any lespect preclude anyone, whether he has approved the standard or not, from manufacturing, marketing, purchasing, or using products, processes, or procedures not conforming to the standard. American National Standards are subject to periodic review and users are cautioned to obtain the latest editions. CAUTION NOTICE: This American National Standard may be revised or withdrawn at any time. The procedures of the American National Standards Institute require that action be taken to reaffirm, revise, or withdraw this standard no later than five years from the date of publication. Purchasers of American National Standards may receive current information on all standards by calling or writing the American National Standards Institute. \v Published by American National Standards Institute 1430 Broadway, New York, New York 10018 Copyright 1977 by American National Standards Institute, Inc All rights reserved. No part of this publication msy be reproduced in any form, in an electronic retrieval system or otherwise, without the prior written permission of the publisher. Printed in the United States of America PI Mil 78/4 ABDOO117636 Foreword (This Foreword is not a part of American National Standard for Uniform Recordkeeping for Occupational In juries and Illnesses, Z16.4-1977.) The Williams-Steiger Occupational Safety and Health Act of 1970 mandated a comprehensive method for recording and reporting work accident and illness experience. Congress felt that American National Standard Method of Recording and Measuring Work Injury Experience, Z16.1-1967 (R1973), had grown too sophisticated in its effort to assure uniformity of re porting and, in so doing, did not accurately reflect the actual industrial occupational accident and illness experience. A study group was recruited by the American National Standards Institute which filed a de tailed recommendation with the Secretary of Labor in August 1970,* and the Bureau of Labor Statistics-Occupational Safety and Health Administration (OSHA) Recordkeeping Require ments! were issued based upon this work. In 1975, American National Standards Committee' Z16 on Standardization of Methods of Recording and Compiling Accident Statistics began work to render American National Standard Z16.1-1967 (R1973) compatible with the new reporting system. It was soon realized that what was needed was a national standard that would define and provide for uniform interpretation of OSHA-required recordkeeping plus rates that would be used by those industries that wished to convert to an ``OSHA system," and for con test and award purposes. Three rates have been selected: the incidence rate of total recordable cases (in which all record able cases are counted); the incidence rate of death cases plus lost workday cases with days away from work (in which all recordable cases that resulted in death, plus lost workday cases with days away from work, are counted); and an incidence of lost workdays, which is a measure of severity.^ \ Suggestions for improvement of this standard will be welcome. They should be sent to the American National Standards Institute, 1430 Broadway, New York, N.Y. 10018. This standard was processed and approved for submittal to ANSI by American National Stan dards Committee on Standardization of Methods of Recording and Compiling Accident Statis tics, Z16. Committee approval of the standard does not necessarily imply that all committee members voted for its approval. At the time it approved this standard, the Z16 Committee had the following members: Harry W. Becker, Chairman John Mark, Secretary Organization Represented Aerospace Industries Association of America . ....................................... American Association of State Compensation Insurance Funds............ American Conference of Governmental Industrial Hygienists............... American Council on Education............................................................... American Federation of Labor & Congress of Industrial Organizations American Gas Association.......................................................................... American Hospital Association.................................................................. American Hotel and Motel Association....................................'............... American Industrial Hygiene Association................................................ American Insurance Association........................... .. ................................ American Iron and Steel Institute............................................................... American Mutual Insurance Alliance......................................................... Name ofRepresentative M. L. Williams Ralph Langley Vernon E. Rose Donald Dedrick (Representation Vacant) Philip S. Runge William J. Van Cleve W. G. Bohm Raymond E. Kary David Curley John A. Janous Thomas F. Bresnahan Proposed National System for Uniform Recording and Reporting of Occupational Injuries and Illnesses, SRI. New York: American National Standards Institute, 1970. f Recordkeeping Requirements under the Occupational Safety and Health Act of 1970. Washington, D.C.: U.S. Department of Labor, Occupational Safety and Health Administration, revised 1975. jOther rates can, of course, be derived from the given data. ABDOO117637 Organization Represented Name ofRepresentative American Paper Institute..................................................................................................... Burl E. McCarrahan E. G. Reneghan (Alt) American Petroleum Institute........................... ............................................................... David Johnston James D. Manney (Alt) American Society of Mechanical Engineers.....................................................................Hany J. Eiermann American Society of Safety Engineers............................................................................. Arthur H. Christian F. W. Wischmeyer (Alt) American Statistical Association...................................................................................... (Representation Vacant) American Transit Association............................................................................................ John J. Moran Herbert J. Scheuer (Alt) American Water Works Association................................................................................... Harry W. Becker Associated General Contractors of America.....................................................................Arthur L. Schmuhl Association of American Railroads................................................................................... N. J. Andrews Association of School Business Officials.......................................................................... Ridgiey M. Bogg Canadian Standards Association (Liaison)....................................................................... R. Litster Electric Light and Power Group......................................................................................... L. H. Faulkingham Electronic Industries Association...................................................................................... George R. Orth Federal Railroad Administration...................................................................................... John A- McNally Forging Industry Association............................................................................................Michael Winn Industrial Medical Association............................................................................................ K. S. Lane International Association of Governmental Labor Officials......................................... Paul N. Rasmussen Manufacturing Chemists Association................................................................................ (Representation Vacant) Milk Industry Foundation.................................................................................................. (Representation Vacant) Motor Vehicle Manufacturers Association....................................................................... Benjamin J. Qeslik T. C Mather (Alt) National Education Association..................... ....................................................................S. A. Abercrombie National Electrical Manufacturers Association..................... ....................................... William H. Ziefel National Restaurant Association................................................;................................... C. V. Culbertson National Safety Council..................................................................................................... J. L. Recht Portland Cement Association............................................................................................ James A. Hickey The Society of the Plastics Industry................................................................... J.P. Carroll The Telephone Group............................................................................................... . V. A-Sielert B. M. May (Alt) U.S. Department of Agriculture......................................................................................... W. E. Schlumpf U.S. Department of the Army............................................................................................ David F. Abemethy Quentin Martin (Alt) U.S. Department of the Interior, Mine Enforcement and Safety Administration . . . .D. E. Redmon U.S. Department of Labor, Bureau of Labor Statistics...................................................Maurice F. Bresnahan U.S. Department of Labor, Occupational Safety and Health Administration............ George J. Yatsko U.S. Department of Labor, Office of Workers' Compensation Programs..................... J. L. Jones U.S. Department of the Navy............................................................................................ George F. Hughes Western Wood Products Association................................................................................ Kenneth L. Patrick Individual Members.............................................................................................................. Russell De Reamer J. E. Gillan The Ad Hoc Committee of American National Standards Committee Z16, which was respon sible for developing this standard, had the following members: Nixon deTamowsky, Chairman John Mark, Secretary Maurice F. Bresnahan Thomas F. Bresnahan Benjamin J. Cieslik L. H. Faulkingham David Johnston J. W. Pardee D. E. Redmon ABDOO117638 Contents SECTION Introduction............................................................................................. 1. Scope, Purpose, and Application........................................................ 1.1 Scope........................................................................................ 1.2 Purpose ..................................................................................... 1.3 Application................................................................................ 2. Definitions.......................................................................................... 2.1 Employee...................... ............................................................ 2.2 Exposure or Employee-Hours................................................... 2.3 Work Environment.................................................................... 2.4 Establishment............................................................................ 2.5 First Aid................................................................................... 2.6 Medical Treatment.................................................................... 2.7 Work-Related Case.................................................................... 2.8 Recordable Case........................................................ .............. 2.9 Lost Workdays......................................................................... 2.10 Lost Workday Case.................................................................... 3. Date of Recordability......................................................................... 3.1 Occupational Injuries.............................................. ................ 3.2 Occupational Illnesses............................................................... 4. Measurability of Recordable Injury and Illness Experience............ ^ 4.1 General.................................................................. .................vk 4.2 Incidence Rate of Total Recordable Cases................................ 4.3 Incidence Rate of Deaths plus Lost Workday Cases with Days Away from Work............................................................. 4.4 Incidence Rate of Lost Workdays............................................ Appendix Guiding Interpretations and Examples................................ Table A1 Tabulation of Scheduled Charges.......................................... Fig. A1 Chart of Scheduled Charges for Hand and Foot...................... PACE .. 7 .. 7 .. 7 .. 7 .. 7 .. 7 .. 7 .. 7 .. 7 .. 7 .. 7 .. 7 .. 8 .. 8 .. 8 .. 8 .. 8 .. 8 .. 8 .. 8 .. 8 .. 8 .. 8 .. 9 . . 10 . . 14 . . 15 ABDOO117639 m American National Standard for Uniform Recordkeeping for Occupational Injuries and Illnesses Introduction The methods outlined in this standard for classifying cases are independent of workmen's compensation laws and rulings of workmen's compensation agencies but compatible with the recordkeeping requirements of the Bureau of Laboi Statistics and Occupational Safety and Health Administration of the U.S. Department of Labor. The fact that the employee or employer did not have control over the cause of a work-related case shall not be a criterion for excluding the case from being re corded under the provisions of this standard. Thorough investigation of all factors relating to the occurrence of each reported work-related case is essen tial. Determination as to whether or not the case should be considered recordable under.the provisions of this standard shall be based upon the evidence de veloped in such investigations. Unless there is a pre ponderance of evidence that the case did not result from the work activity or environment of employment, the case shall be considered a work-related case. (See the Appendix for suggestions as to factors to be con sidered.) When the proper classification of, or the recordability of, a work-related case is in doubt, nine copies of a full report of the circumstances of the incident or ill ness, including all pertinent medical information, may be submitted to the American National Standards In*, stitute, 1430 Broadway, New York, N.Y. 10018 for an advisory opinion by the Z16 Committee on Interpreta tions.1 1.Scope, Purpose, and Application 1.1 Scope. This standard covers the definitions and guidelines necessary to maintain basic occupational illness and injury records and incidence rates suitable for statistical purposes that are compatible with the recordkeeping requirements of the Occupational Safe ty and Health Act of 1970. 1.2 Purpose. The purpose of this standard is to pro mote uniformity in recording, classifying, and report ing occupational illness and injuries as a means of evaluating programs designed to control such injuries and illnesses, and for contest and award programs. 1.3 Application. It is recommended that this standard apply to all records of occupational illness and injuries effective January 1, 1977. 2. Definitions \ ' 2.1 Employee. As used in this standard, any person en gaged in activities for an employer from whom direct payment for services is received. Included are working owners and officers. 2.2 Exposure or Employee-Hours. The total number of hours worked by all employees, including those in op erating, production, maintenance, transportation, cleri cal, administrative, sales, and other activities. (See A2.2 of the Appendix.) 2.3 Work Environment. The environment comprised by the physical location, equipment, materials processed or used, and the kinds of operations performed by an employee in the performance of his work, whether on or off an employer's premises. 2.4 Establishment. A single physical location where business is conducted or where services or industrial operations are performed. 2.5 First Aid. Any one-time treatment and subsequent observation of minor scratches, cuts, bums, splinters, and so forth, which do not require medical care even though provided by a physician or registered profes sional personnel. 2.6 Medical Treatment. Any treatment (other than first aid) administered by a physician or by registered pro fessional personnel under the standing orders of a physician. (See A2.6 of the Appendix.) 7 ABDOO117640 AMERICAN NATIONAL STANDARD Z16.4-1977 2.7 Work-Related Case. Any occupational injury suf fered by an employee which results from a work ac cident or from an exposure involving a single incident in the work environment, and any illness caused by ex posure to environmental factors associated with em ployment. (See A2.7 of the Appendix.) 2.7.1 Occupational Injury. Any injury such as a cut, fracture, amputation, etc, that results from a work accident or from an exposure involving a single inci dent in the work environment. 2.7.2 Occupational Illness. Any abnormal condition or disorder of an employee, other than one resulting from an occupational injury, caused by exposure to environmental factors associated with employment. 2.8 Recordable Case. Any work-related injury case re quiring more than first aid, and all occupational ill nesses. Recordable cases include: (See A2.8 of the Ap pendix.) (1) Deaths, regardless of the time between occupa tional injury or illness and death (2) Ail occupational illnesses (3) All occupational injuries resulting in any of the following: (a) Lost workdays -- either days away from work or days of restricted work activity (b) Medical treatment other than first aid (c) Loss of consciousness (d) Restriction of work or motion (e) Temporary or permanent transfer (0 Termination of injured or ill employee NOTE: Any case that involves lost workdays must be recorded since it always involves one or more of the criteria for recordability. 2.9 Lost Workdays1 2.9.1 Lost Workdays -- Days Away from Work. Days away from work are those workdays (consecutive or not) on which the employee would have worked but could not because of occupational injury or illness. The number of lost workdays should not include the day of injury or onset of illness or any days on which the employee would not have worked even though able to work. 2.9.2 Lost Workdays -- Days of Restricted Work Activity. Days of restricted work activity are those workdays (consecutive or not) on which, because of the occupational injury or illness, the employee was assigned to anotherjob on a temporary basis, worked at a permanent job less than full time, or worked at a permanently assigned job but could not perform all1 1 Only full days are counted. The day of the accident or onset of illness is not to be included. 8 duties normally connected with it. The number of lost workdays should not include the day of injury or onset of illness or any days on which the employee would not have worked even though able to work. 2.10 Lost Workday Case. Any recordable case that re sults in lost workdays away from work or workdays of restricted activity. 2.10.1 Lost Workday Case with Days Away from Work. Any recordable case that results in 1 or more days away from work as defined in 2.9.1. (See A2.10.1 of the Appendix.) 2.10.2 Lost Workday Case with Days of Restricted Work Activity. Any recordable case that results in 1 or more days of restricted work activity as defined in 2.9.2. (See A2.10.2 of the Appendix.) 3. Date of Recordability 3.1 Occupational Injuries. The date of recordability for occupational injuries is the date on which the work ac cident or single incident exposure occurred. 3.2 Occupational Illnesses. The date of recordability for occupational illnesses is the date of initial diagnosis as an occupational illness, or, if the diagnosis follows a period during which a person has been unable to per form for unknown reasons, the date should be the first day of absence attributable to the illness which was later diagnosed or recognized. 4. Measurability of Recordable Injury and Illness Experience 4.1 General. Injury and illness experience can best be expressed as an incidence rate. Expressions of incidents per 200 000 employee-hours worked (approximately 100 employee-years) have been selected as given in 4.2 through 4.4. 4.2 Incidence Rate of Total Recordable Cases. This in cidence rate is based upon the total number of record able cases, as defined in 2.8, that occurred during the period covered by the rate. The following formula should be used: Incidence rate of recordable cases No. of recordable cases X 200 000 Exposure or employee-hours 4.3 Incidence Rate of Deaths plus Lost Workday Cases with Days Away from Work. This incidence rate is based upon the total number of recordable cases which ABDOO117641 resulted in death plus the number of lost workday cases with days away from work, as defined in 2.10.1, that occurred during the*period covered by the rate. The following formula should be used: Incidence rate of deaths plus lost workday cases with time away from work _ No, of recordable cases X 200 000 Exposure or employee-hours 4.4 Incidence Rate of Lost Workdays. This incidence AMERICAN NATIONAL STANDARD Z16.4-I977 rate is based upon the total number of workdays lost, as defined in 2.9.1, that occurred during the period covered by the rate. The following formula should be used: (See A4.4 of the Appendix.) Incidence rate of lost workdays No. of lost workdays X 200 000 Exposure or employee-hours NOTE: See A4.4 of the Appendix fox an alternate measure of severity. vv 9 ABDOO117642 Appendix (This Appendix is not a part of American National Standard for Uniform Recordkeeping for Occupational Injuries and Illnesses, Z16.4-1977, but is included for information purposes only.) Guiding Interpretations and Examples (The subdivisions of the Appendix are numbered to correspond with the section numbers in the standard. Since it is not necessary to have Appendix matter for every section in the standard, there are gaps in the numbering in the Appendix.) ( A2. Definitions A2.2 Exposure or Employee-Hours. Determination of employee-hours of exposure: Employee-hours of ex posure for calculating incidence rates are to be actual hours worked. When actual hours are not available, estimated hours may be used. Employee-hours should calculated as given under A2.2.1 and A2.2.2. A2.2.1 Actual Exposure Hours. Employee-hours of exposure for nonexempt employees are to be taken from payroll or time-clock records and include only actual straight-time hours worked and actual overtime hours worked. A2.2.2 Estimated Exposure Hours. When actual em ployee-hours of exposure are not available, estimated hours may be used. Such estimated hours should be ob tained by multiplying the total employee-days worked for the period by the average number of hours worked per day. If the hours worked per day vary among de partments, a separate estimate should be made for each department and these estimates added to obtain the total hours. Estimates of overtime hours should be in cluded. If employee-hours are estimated, indicate the basis on which estimates are made. A2.2.2.1 Employees Living on Company Prop erty. In calculating hours of exposure for employees who live on company property, only those hours dur ing which employees were actually on duty are to be counted. A2.2.2.2 Employees with Undefined Hours of Work. For traveling salesmen, executives, and others whose working hours are not defined, an average of 8 hours per day is to be assumed in computing exposure hours. A2.2.2.3 Standby Employees. For standby em ployees, including seamen aboard vessels, who are re stricted to the confines of the employer's premises, all standby hours must be counted. 10 A2.6 Medical Treatment. Medical treatment versus first aid: The important point to be stressed is that the decision as to whether a case involves medical treat ment should be made on the basis of whether the case normally would require medical treatment. The deci sion cannot be made on the basis of who treats the case. First aid can be administered by a physician and medical treatment by someone other than a physician. It is not possible to list qll types of medical pro cedures and treatments and on that basis alone deter mine if first aid or medical treatment was involved. For example, whirlpool treatments, heat treatments, appli cation of hot or cold compresses, or elastic bandages are not in and of themselves either first aid or medical treatment. What follows is a discussion of diagnostic pro cedures and preventive procedures and treatments, both of which are not in and of themselves medical treatment. Next is a discussion of treatments that are almost always medical treatment, and comments on medical treatment and first aid for certain types of injuries. A2.6.1 Diagnostic Procedures A2.6.1.1 Hospitalization for observation, where no medical treatment is rendered other than first aid, is not considered medical treatment. A2.6.1.2 Visits to a physician or nurse for ob servation only or for a routine change of dressing are not considered medical treatment. A2.6.1.3 X-ray examination for fractures is considered diagnostic procedure and as such is not considered medical treatment or first aid. Where the x-ray is negative, the case is not recordable unless the injury required other medical treatment or met one of the other criteria for recordability. A2.6.I.4 Physical examination yielding few or no findings and not substantiating subjective com plaints in questionable cases is not considered medical treatment. ( ABDOO117643 A2.6.1.5 Reactions to or effects of diagnostic procedures that are necessitated by a work-related in jury or illness and which meet the criteria for recordability should be recorded. A2.6.2 Preventive Procedures and Treatments A2.6.2.1 Tetanus shots, either initial shots or boosters, are considered preventive in nature and are not in and of themselves considered medical treatment. However, treatment of a reaction to a tetanus shot ad ministered because of an injury would be considered medical treatment and would make the case recordable. A2.6.2.2 Any use of prescription medication normally constitutes medical treatment. However, it should be considered first aid when a single dose or application of a prescription medication is given on the first visit merely for relief of pain or as preventive treatment for a minor injury. This situation can occur at facilities having dispensaries stocked with prescrip tion medications frequently used for preventive treat ment and relief of pain and attended by a physician or registered professional personnel operating under the standing orders of a physician. The administration of nonprescription medication in similar circumstances would be considered first aid. A2.6.2.3 The application of ointments and salves to prevent the drying or cracking of skin at the site of a minor injury can be considered first aid. A2.6.2.4 The application of antiseptics to minor injuries which do not themselves require medical treat ment can be considered first aid. Changing the bandage or dressing on an injury which did not require medical treatment, because the bandage or dressing has become dirty, is considered first aid. A2.6.2.5 Reaction to preventive medication (not administered because of an occupational injury or ill ness) administered in-plant (such as flu shots) would not constitute a recordable case. A2.6.2.6 In-plant treatment of off-the-job in juries and illnesses is not recordable. A2.6.3 Treatments that Are Almost Always Medical Treatment. These treatments are as follows: (1) Suturing of any wound (2) Treatment of fractures (3) Application of a cast or other professional means of immobilizing an injured part of the body (4) Treatment of infection arising out of an injury (5) Treatment of a bruise by the drainage of blood (6) Surgical debridement, that is, the removal of dead or damaged tissue (7) Treatment of abrasions that occur to greater than full skin depth (8) Treatment of second- anti third-degree burns NOTE: Administration of prescription medicines is usually considered medical treatment (see A2.6.2.2). A2.6.4 Medical Treatment and First Aid for Certain Types of Injuries A2.6.4.I Cuts and Lacerations A2.6.4.1.1 First Aid. Treatment is limited to cleaning of the wound, soaking, application of antisep tic or nonprescription medication, and bandaging on the first visit. Followup visits are limited to observa tion, including changing of the dressing and bandage. Additional cleaning and application of antiseptic are permissible as first aid where required by work duties that are likely to soil the bandage. Application of but terfly closures for cosmetic purposes only can be con sidered first aid. A2.6.4.1.2 Medical Treatment. The injury re quires butterfly closures (for noncosmetic purposes), sutures (stitches), surgical debridement (cutting away dead tissue), treatment of infection, or other profes sional treatment. A2.6.4.2 Abrasions A2.6.4.2.1 First Aid. This is the same as for cuts and lacerations except that ointments can be added on followup visits to prevent drying and crack ing of skin. A2.6.4.2.2 Medical Treatment. The injury requires careful examination''for removal of embedded foreign material, multiple soakings, whirlpool treat ment, treatment of infection, or other professional treatment. This is any case involving more than a minor, spot-type injury. Treatment of abrasions occur ring to greater than full skin depth is considered medi cal treatment. A2.6.4.3 Bruises A2.6.4.3.1 First Aid. Treatment is limited to a single soaking or application of cold compresses on a minor bruise. Followup visits are limited only to observation. A2.6.4.3.2 Medical Treatment. The injury requires multiple soakings, draining of collected blood, or other extended care beyond observation. A2.6.4.4 Splinters and Puncture Wounds A2.6.4.4.1 First Aid. Treatment is limited to cleaning of the wound, removal of a foreign object(s) by tweezers or other simple techniques, application of antiseptics and nonprescription medications, and bandaging on the first visit. Followup visits are limited to observation, including changing of the bandage. Ad ditional cleaning and application of antiseptic are per missible as first aid where required by work duties that are likely to soil the bandage. A2.6.4.4.2 Medical Treatment. The injury requires removal of a foreign object(s) by a physician due to the depth of embedment, size or shape of the ob jects), or location of the wound. This is also injuries requiring treatment for infection, treatment of a reac- 11 ABDOO117644 APPENDIX tion to a tetanus booster, or other professional treat ment. A2.6.4.5 Bums, Thermal and Chemical (Result ing in Destruction of Tissue by Direct Contact) A2.6.4.5.1 First Aid. Treatment is limited to cleaning or flushing of the surface; soaking; application of cold compresses, antiseptics, or nonprescription medications; and bandaging on the First visit. Followup visits are restricted to observation, changing of band ages, or additional cleaning. Most first-degree burns are amenable to First-aid treatment. A2.6.4.5.2 Medical Treatment. The injury re quires a series of treatments including soaks, use of whirlpools, and surgical debridement (cutting away dead tissue). Most second- and third-degree bums re quire medical treatment. A2.6.4.6 Sprains and Strains A2.6.4.6.1 First Aid. Treatment is limited to soaking, application of cold compresses, and use of an elastic bandage on the First visit. Followup visits r-e for observation, possibly including reapplying a bandage. A2.6.4.6.2 Medical Treatment. The injury requires a series of hot and cold soaks, use of whirl pools, diathermy treatment, or other professional treatment. A2.6.4.7 Eye Injuries A2.6.4.7.I First Aid. Treatment is limited to irrigation, removal of foreign material not em bedded in the eye, and application of nonprescrip tion medications. A precautionary visit (special ex amination) to a doctor is still considered First aid if treatment is limited to the aforementioned items. Followup visits are for observation only. A2.6.4.7.2 Medical Treatment. This is cases involving removal of embedded foreign objects, use of prescription medications, or other professional treatment. A2.6.4.8 Inhalation of Toxic or Corrosive Gases A2.6.4.8.1 First Aid. Treatment is limited to removal of the employee to fresh air or the one-time administration of oxygen for several minutes. A2.6.4.8.2 Medical Treatment. This is any professional treatment beyond the aforementioned. It includes all cases involving loss of consciousness. A2.7 Work-Related Cases. The broad concept is that any injury or illness "occurring in and attributable to the work environment" is "work-related." Work en vironment is comprised of the physical location, equipment, materials processed or used, and the kinds of operations performed by an employee in the per formance of his work, whether on or off the em 12 ployer's premises. There are no stated exclusions of place or circumstance. Therefore, injuries or illnesses occurring in such places as the employee parking lot, lunchroom, or restroom, or during rest or lunch period on the employer's premises, can be work-related. The Final determination of whether any case is work-related must be made by the employer. Responsibility or fault does not enter into the decision of whether a case is work-related. In doubtful situations, a case should be recorded. A2.8 Recordable Cases. Recordable work-related cases are those that involve any of the following: (1) Deaths, regardless of the time between occupa tional injury or illness and death (2) All occupational illnesses, including, but not limited to, the following categories and examples: (a) Occupational skin diseases or disorders Examples: contact dermatitis, eczema, or rash caused by primary irritants and sensitizers, or poi sonous plants; oil acne; chrome ulcers; chemical bums or inflammations. (Direct contact causing tissue dam age only, resulting from a thermal or chemical burn, is classified as an injury, not ah illness case.) (b) Dust diseases of the lungs (pneumonconioses) Examples: silicosis, asbestosis, coal worker's pneu moconiosis, byssinosis, and other pneumoconioses. (c) Respiratory conditions due to toxic agents Examples: pneumonitis; pharyngitis; rhinitis or acute congestion due to chemicals, dusts, gases, or fumes; farmer's lung. (d) Poisoning (systemic effects of toxic ma terials) Examples: poisoning by lead, mercury, cadmium, arsenic, or other metals; poisoning by carbon mon oxide, hydrogen sulfide, or other gases; poisoning by benzol, carbon tetrachloride, or other organic solvents; poisoning by insecticide sprays such as parathion, lead arsenate; poisoning by other chemicals such as formal dehyde, plastics, and resins. (e) Disorders due to physical agents (other than toxic materials) Examples: heatstroke, sunstroke, heat exhaustion, and other effects of environmental heat; freezing; frostbite and effects of exposure to low temperatures: caisson disease; effects of ionizing radiation (isotopes, x-rays, radium); effects of nonionizing radiation (weld ing flash, ultraviolet rays, microwaves, sunburn). (f) Disorders associated with repeated trauma Examples: noise-induced hearing loss; synovitis, tenosynovitis, and bursitis; raynaud's phenomenon; and other conditions due to repeated motion, vibra tion, or pressure. (g) All other occupational illnesses ABDOO117645 Examples: anthrax, brucellosis, infectious hepa titis, malignant and benign tumors, food poisoning, histoplasmosis, coccidioidomycosis. (3) Injuries resulting in any of the following: (a) Lost workdays -- either days away from work or days of restricted work activity (b) Medical treatment other than first aid (c) Loss of consciousness (d) Restriction of work or motion (e) Temporary or permanent transfer (f) Termination of injured or ill employee Loss of consciousness of the employee for any peri od of time is self-explanatory. Restriction of motion is not defined specifically. Each case must be judged individually to determine if there is more than a trivial amount of restricted motion, such as would occur when a small adhesive bandage was placed on the sec ond joint of the finger. It should be noted here that damage to prostheses (such as false teeth) is not in and of itself grounds for recordability unless accompanied by other damage to the body that meets the recordabil ity criteria. A2.10.1 Lost Workday Cases with Days Away from Work. These are cases that result in 1 or more days away from work. Days away from work are those workdays (consecutive or not) on which the employee would have worked but could not because of occupa tional injury or illness. The number of lost workdays should not include the day of injury or onset of illness or any days on which the employee would not have worked even though able to work. For example, if an employee who is scheduled to work Monday through Friday has a recordable case on Friday and returns to work on Monday, the case does not involve any days away from work even if the employee was unable to work on Friday, Saturday, or Sunday. If this same employee had been scheduled to work on Saturday, even if that Saturday constituted overtime, the Saturday would be counted as days away from work, and the case would be classified as a lost workday case with days away from work. For employees not having a regularly scheduled shift, for example, certain truck drivers, construction workers, farm labor, casual labor, part-time employees, etc, it may be necessary to estimate the number of lost workdays. Estimates of the number of days that the employee would have worked should take into account the prior work history of the employee and days worked by employees, not ill or injured, working in the same department or occupation as the ill or injured employee. In some cases an injured or ill employee will miss one or more scheduled days or shifts besides the day of injury or onset of illness, but it will be uncertain APPENDIX whether the employee was truly unable to work on the days missed. Such cases may arise when a doctor judges that the employee is able to work but the em ployee decides that he is not. In such cases, the em ployer should not rely solely on the doctor's opinion. He should make the final judgment himself based on all the evidence at his disposal. Again, the rule should be "when in doubt, record the case " A2.10.2 Lost Workday Cases with Days of Re stricted Work Activity Only. These are cases that re sult in 1 or more days of restricted work activity but do not result in any days away from work. Days of restricted work activity include those days (consecutive or not, but excluding the day of injury or onset of illness) on which one of the circumstances described in A2.10.2.1 through A2.10.2.3 occurred. A2.10.2.1 Temporary Assignment. The employee was assigned to another job on a temporary basis. Even if the employee normally shifts from job to job within an occupational classification, if any switch or transfer is occasioned by a work-related injury or illness, the case involves days of restricted work activity. Such days are meant to cover all days on which the em ployee was unable to contritate a full day's work on all parts of his permanent job. In cases where an em ployee is not working at his regular job and is injured or becomes ill and is transferred back to his original job, which he can perform without limitation, there are no days of restricted work activity. A2.10.2.2 Loss of Part of Shift. The employee worked at a permanent job less than his full shift or normal day. Loss of a full day or shift would con stitute a lost workday away from work. A2.10.2.3 Restricted Work Activity. The em ployee worked at a permanently assigned job but could not perform all duties normally connected with it. All days (excluding the day of injury or onset of illness) for which the employee was scheduled to work and could not perform all or any part of his normal assignment during all or any part of the work day or shift should be considered days of restricted activity. A4. Measurability of Recordable Injury and Illness Experience A4.4 Incidence Rate of Lost Workdays (Alternate Method) A4.4.1 Each death resulting from occupational in* juiy or illness is assigned a time charge of 6000 days. A4.4.2 Each permanent total disability resulting from an occupational injury or illness is assigned a time charge of 6000 days. (A permanent total disability is 13 appendix ABDOO117646 Table A1 Tabulation of Scheduled Charges A. For Loss of Member - Traumatic or Surgical Amputation Involving All or Part of Bone* Distal phalange Middle phalange Proximal phalange Metacarpal Hand at wrist Amputation Involving All or Part of Bone* Distal phalange Middle phalange Proximal phalange Metatarsal Foot at ankle , Any point above elbow, including shoulder joint Any point above wrist and at or below elbow Any point above knee Any point above ankle and at or below knee Fingers, Thumb, and Hand (see Fig. Al) Hand Thumb Index Fingers Middle Ring Little _ _ 3000 300 -- 600 900 - 100 200 400 600 - Toe, Foot, and Ankle (see Fig. Al) 75 150 300 500 - 60 120 240 450 - 50 100 200 400 - Foot Great Toe Each of Other Toes _ - 2400 150 \ 35 - 75 300 150 600 350 _-- Arm 4500 3600 Leg 4500 3000 B. Impairment of Function One eye floss of sight), whether or not there is sight in the other eye Both eyes (loss of sight) in one accident One ear (complete industrial loss of hearing), whether or not there is hearing in the other ear Both ears (complete industrial loss of hearing) in one accident Unrepaired hemia 1800 6000 600 3000 50 *If the bone is not involved, use actual days lost. The tuft of the distal bone of a finger or toe is con sidered bone if it shows in x-rays. 14 ABDOO117647 appendix FOOT NOTES: (1) Numbers on the bones are (2) The tuft of the distal bone the charges for loss in a finger or toe is involving part or considered bone all of the bone, if it shows in x-rays. Fig. A1 Chart of Scheduled Charges for Hand and Foot IS ABDOO117648 APPENDIX any injury or illness other than death that permanent ly and totally incapacitates an employee from follow ing any gainful occupation, or which results in the loss or the complete loss of use of any of the following in one accident: both eyes; one eye and one hand, arm, leg, or foot; any two of the following not on the same limb: hand, arm, foot, or leg.) A4.4.3 Each case of permanent loss or loss of use of a part of the body resulting from an occupational in jury or illness is assigned a time charge in days in accor dance with schedules given in Table A1 and Fig. A1. Dis regard any actual lost workdays; use scheduled days only. The days charged due to permanent impairment of function are that percentage of the scheduled charge corresponding to the percentage of loss of function determined by the physician treating the case. A4.4.4 To determine the incidence rate of lost workdays, add the days lost in lost workday cases with days away from work and any scheduled days charged as determined in A4.4.1 through A4.4.3 for deaths, cases of permanent total disability, or loss of parts of the body or their function, and enter the total days in the following formula: Incidence rate of lost workdays Total lost workdays or days charged _ as described in A4.4.4 X 200 000 Exposure or employee-hours v 16 ABDOO117649 American National Standards The standard in this booklet is one of nearly 8500 standards approved to date by the American National Standards Institute. The Standards Institute provides the machinery for creating voluntary stan dards. It serves to eliminate duplication of standards activities and to weld conflicting standards into single, nationally accepted standards under the designation "American National Standards." Each standard represents general agreement among maker, seller, and user groups as to the best current practice with regard to some specific problem. Thus the completed standards cut across the whole fabric of production, distribution, and consumption of goods and services! American National Standards, by reason of Institute procedures, reflect a national consensus of manufacturers, consumers, and scientific, technical, and professional orga nizations, and governmental agencies. The completed standards are used widely by industry and commerce and often by municipal, state, and federal governments. The Standards Institute, under whose auspices this work is being done, is the United States clearinghouse and coordinating body for voluntary standards activity on the national level. It is a federation of trade associations, techni cal societies, professional groups, and consumer organizations. Some 1000 companies are affiliated with the Institute as company members. The American National Standards Institute is the United States member of the International Organization for Standardization (ISO) and the Interna tional Electrotechnical Commission (IEC). Through these channels U.S. stan dards interests make their positions felt on the international level. American National Standards are on file in the libraries of the national standards bodies of more than 60 countries. American National Standards Institute, Inc 1430 Broadway New York, N.Y. 10018