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Set Descending Direction
2020 really is the year that PPE (or, for those who don’t yet know, personal protective equipment) went mainstream. For those of us active in the safety sector, PPE has been a huge concern for years. In every issue of COS, we shine a light on a key piece of PPE. We’re lucky enough to speak with experts all over Canada for insider tips, the best of which are below.

Hearing protection

In our first PPE feature of the year, our writer Linda Johnson revealed that excessive noise can pose a hazard in occupations not generally associated with a high risk of hearing loss such as hospitality or healthcare. To prevent against this issue, hearing protection is of course essential, but Anna Van Maanen, audiologist at WorkSafeBC, also had this very simple piece of advice:

“Ideally, you do not start off with hearing protection; the first step in hearing conservation is reducing the noise at its source,” says Maanen.

Protective clothing for women

One of our more recent features concludes that one size very definitely does not fit all. Well-fitting PPE has been a struggle for many female workers for decades. Ill-fitting PPE can be hazardous for all workers leading to trips or falls for too-big shoes, hard hats falling off or large, oversized clothing getting caught or snagged.

Professor Jim Brophy, of the University of Windsor, said that in certain industries which require PPE, female voices are not being seen: “and because they’re not visible, and because of the nature and stratification of our workforce — which is reinforced by gender — their voices are lacking in power or just simply ignored.”

Heat protection

An essential article that came out during the warmer months – heat protection is key for many workers outdoors and certain indoor settings. One key piece of advice from Kelly Fernandes, occupational hygienist at Workplace Safety and Prevention Services (WSPS)?

All companies should begin planning for heat stress before temperatures climb. Many companies don’t start considering the risk of heat stress until the summer is well underway: “Seasonal organizations are probably on top of it. But newer facilities, it’s not really on their radar until it gets hot out,” she says. “That’s when assessments happen, and they start creating their heat stress program for the next year.”

Foot protection

With our feature on hand protection due in our upcoming Jan/Feb 2021 issue, we’ll have all extremities covered! Linda Johnson writes that safety footwear is getting more and more technically advanced, with footwear best suited to their task essential for workers.

How should a proper boot fit? Graeme Hill, owner of Reddhart Workwear Stores, says:

“You want your toes to be able to wiggle around freely, not touching the cap. Yet, you also want the rest of the boot to fit snugly. Snugly is the word we like to use, not tight but snug. As you wear the boots, over the first couple of weeks, the inside lining and the boot tend to mould to your own feet, and the boots will become more comfortable.”

Fall protection

According to the CCOHS, 42,000 workers get injured annually due to fall accidents in Canada. It is essential for those working at heights to have correct fall protection equipment. There is a wealth of PPE available for workers at heights.

One piece of equipment, though, that is often overlooked is dropped object prevention: “You have to think about what’s beneath you, what happens if that worker drops a wrench or a hammer. If you drop that at six foot or above height, serious injury or even a fatality could occur,” says Erica Cole, product manager at Pure Safety Group.


The practice of culture change recognizes that everything is connected. From worker safety to your customers’ experience, your organization is an ecosystem full of variables that are difficult to measure and even more difficult to adjust.

Safety is a profession that has understood this for a while. With its emphasis on active listening, example-setting and collaboration, it teaches practitioners how to put people first. With its emphasis on design, technical specifications and systems, it teaches practitioners how to plan, do, check and act.

But others in your organization may not be as proactive about culture change or may not even see its value. That’s a problem, say researchers Mark Lundell, GSP, and Cheri Marcham, Ph.D., CSP, CIH, CHMM, FAIHA, because only leadership can drive and develop a culture in which looking out for each other is a shared priority.

“Leaders or managers who place profit and production over the safety of their employees, who are willing to overlook their faltering safety culture or bypass safeguards to get the job done, or who fail to support and follow regulatory requirements merely because they don’t have the time, can create an unsafe work environment.”

So how do you use your unique skill set to advocate for culture change and protect workers? It begins with the understanding that improving safety culture is a business skill requiring everyone’s participation — from your CEO to front-line workers. And as an initiative with personal, professional and financial implications for everyone in your organization, it is worthy of respect and attention.

If you’re struggling to stay committed to your path of safety culture improvement — or need some persuasive talking points to share with your boss — keep these five things in mind.

1. Business is about connections and relationships.

Your organization invests extensively in learning what customers need to be successful and communicating how it can help them solve problems. Getting that process right, then delivering on promises, leads to greater trust and stronger relationships.

Part of your role as a safety professional is to convince other leaders why it’s important to make the same type of investment in improving safety culture. According to Lundell and Marcham, the research is clear: Companies that create psychologically safe workplaces where workers are encouraged to raise concerns and propose solutions have stronger safety cultures and better outcomes.

“With a weak psychosocial safety climate, employees will use coping mechanisms that can lead to drug use, neglect of duties, exhaustion, post-traumatic stress and low morale.”

2. Safety management systems exist within cultures.

Occupational safety and health management system standards, such as ANSI/ASSP Z10 and ISO 45001, help establish accountability for safety and health performance throughout your organization. But while safety management systems help drive positive culture change, they also reflect cultural norms that may go back decades prior to implementation. That’s one reason keeping your leadership team aware of cultural complexities influencing safety is a critical and ongoing business function, according to Lundell and Marcham.

“The keys to safety culture within any organization are the creation of leadership and management systems that 1) specify safety objectives; 2) distribute responsibility for safety; and 3) plan, organize and control the organizational environment according to safety objectives and precautions.”

3. Strong organizations are clear about their values.

Successfully translating organizational values into budgetary, operational, product and marketing decisions is good business — but it’s also easier said than done. Unfortunately, when cuts need to be made, safety programs are often one of the first things called into question. That’s where you come in.

“Support for identifying obvious hazards and risks within an organization, the concern for equipment safety, facility safety, fire safety, PPE and the standard hierarchy of controls is common, although concern for the individual worker may be overlooked,” say Lundell and Marcham.

By working with your team to clarify and use resources according to values that keep people at the center, you will be better able to go beyond quick fixes and manage many different types of risk.

4. Safety affects your company’s financial outlook.

Improving safety culture directly affects your organization’s bottom line. By reducing costly worker injuries, illnesses and incidents, improving worker well-being, increasing operational efficiency, avoiding OSHA penalties and more, safety professionals have earned their seat at the table where financial decisions are made.

Need a refresher on how to estimate safety’s impact on profitability before an important meeting? OSHA has a free worksheet you can use as part of its $afety Pays Program.

“Safety professionals must be accepted as the experts they are and for the vast knowledge base that they offer,” say Lundell and Marcham. “They must be respected for their specialized input, analysis and evaluation of all facets of an organization’s operation.”

5. Safety culture helps attract and retain top talent.

Would you rather work for an organization in which people take care of each other and leaders exercise sound moral judgment, or one in which short-sighted corporate goals lead to an unsafe culture? When skilled workers have a choice, they seek employers with a reputation for social responsibility. When workers end up at organizations that don’t support safety and health, they are more likely to seek greener pastures.

According to Lundell and Marcham, safety culture is directly related to a safe and healthful working environment that addresses the risks of absenteeism (when workers don’t show up), presenteeism (when workers show up but aren’t able to function properly) and high turnover.

“Leadership is the most critical element in keeping pace with the changing occupational environment and the promotion of positive safety culture.”


The Advisory Committee for Immunization Practices (ACIP) voted 13-1 on December 1 on the stance that healthcare workers should be the first to receive a COVID-19 vaccination upon approval by the FDA, reports CNN.

Health care workers and residents and staff of long-term care facilities will be included in “Phase 1A” of the CDC’s coronavirus vaccination plan.

“Anybody that works within a health care institution that could have contact with an individual who has Covid should receive vaccination,” said Dr. Jose Romero, chair of ACIP. “That includes individuals such as the persons delivering food, those persons in housekeeping who rapidly turn over rooms in the emergency room or who perform cleaning in the patient’s rooms.”

According to the CDC, over 240,000 health care workers have been infected by COVID-19, while 858 have died of the virus. Efforts to reduce the number of infections among health care workers have been made by states like California, who recently mandated weekly testing for those employees.


The Occupational Safety and Health Administration (OSHA) issued respiratory protection guidance for assisted living, nursing home, and other long-term care facilities. The guidance focuses on the use of respirators while emphasizing a primary reliance upon engineering and administrative controls for controlling exposures, consistent with good industrial hygiene practice and the agency’s traditional adherence to the “hierarchy of controls.”

The industrial hygiene “hierarchy of controls” is a series of workplace safety and health interventions that begins with elimination of hazards, followed by substitution, then engineering controls, administrative controls (including work practices), and personal protective equipment (PPE).

OSHA has instructed its compliance safety and health officers in its area offices to exercise discretion in the enforcement of the respiratory protection standard during the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus.

The agency insists that workers wear respirators when necessary, such as when in close contact with a resident of a long-term care facility with suspected or confirmed coronavirus infection. Employees then must wear an N95 filtering facepiece respirator (FFR) or equivalent or a higher-level respirator approved by the National Institute for Occupational Safety and Health (NIOSH).

The guidance describes other source control measures, including the use of cloth face coverings, face masks, and U.S. Food and Drug Administration (FDA)-cleared or -authorized surgical masks. Healthcare workers should wear such source control products or devices at all times while inside a long-term care facility, according to the agency, including in break rooms or other spaces where they might encounter other people.

OSHA told employers that they should reassess their engineering and administrative controls, such as ventilation and practices for physical distancing, hand hygiene, and cleaning and disinfecting surfaces, to identify changes that could avoid over-reliance on respirators and other PPE. OSHA reminded employers that the agency has temporarily allowed for some enforcement flexibility regarding respirators, including requirements for annual fit testing that consumes disposable respirator supplies.

However, the agency also reminded employers that when respirators must be used, employers must implement a written, worksite-specific respiratory protection program that includes medical evaluation, fit testing, training, and other elements of the agency’s respiratory protection standard (29 CFR 1910.134).

OSHA offered employers the following advice for administering a respiratory protection program during the ongoing pandemic:

● Consider alternatives to N95 FFRs, including other FFRs (for example, P100s and N99s); reusable elastomeric respirators; and powered air-purifying respirators (PAPRs), given shortages of N95 FFRs during the pandemic.
● Choose eye and face protection to be worn with the type of respirator used, but exercise care to ensure the eye or face protection does not interfere with the seal of the respirator.
● Consult NIOSH’s list of approved N95 FFRs and warnings about counterfeit respirators or misrepresentation of NIOSH approval.
● Assign a suitably trained program administrator to oversee all elements of the program, such as an infection prevention and control practitioner or a nurse administrator, or consider hiring a local industrial hygiene consulting service if no suitably trained administrator is available on staff.
● Conduct a risk assessment to identify which workers are at risk of exposure to any airborne hazards such as SARS-CoV-2, tuberculosis (TB), Legionella, or certain hazardous chemicals, and classify exposure risk to SARS-CoV-2, according to OSHA’s four risk exposure levels.
● Implement procedures for performing medical evaluations of workers required to use respirators to determine their ability to safely wear a respirator before needing to wear one in the workplace; identify a physician or other licensed healthcare professional who can conduct medical evaluations and maintain confidentiality.
● Ensure that any worker using a tight-fitting respirator is fit tested following OSHA-approved fit-test protocols before initial use and whenever a different respirator size, style, model, or make is used.
● Establish procedures and schedules for the maintenance and storage of any respirators used beyond a single use, including procedures for cleaning, disinfecting, storing, repairing, and discarding respirators.
● Train workers who wear respirators on how to properly put them on (donning) and take them off (doffing), as well as how to conduct proper user seal checks and recognize respiratory hazards in their workplace and the capabilities and limitations of respirators.


This guidance was updated on 26 November and comes into force on 2 December. It is for everyone who has been identified as clinically extremely vulnerable (via letter from the NHS or GP).

The guidance has been updated to support the clinically extremely vulnerable in protecting themselves from exposure to coronavirus . It replaces previous guidance on shielding that was in place during the 4-week period of National Restrictions. The guidance is set out in 2 parts:

● Updated advice on protecting the clinically extremely vulnerable, based on the tiers of local restrictions in your area. The advice sets out the additional things people at the highest risk from COVID-19 are advised to do to keep themselves safe for each tier.
● Updated shielding advice that is more targeted and will only apply in some of the worst affected areas and only for a limited period of time. People are only advised to follow shielding advice if they receive a new written shielding notification.

What has changed

On 2 December the country is moving back to a tiered system of local restrictions. The government has reinstated this guidance for clinically extremely vulnerable people linked to these tiers.

It offers additional advice to the clinically extremely vulnerable over and above the rules for the tiers, which apply to everyone. According to the government, the guidance aims to strike a better balance between providing practical steps to help keep people in this category safe while reducing some of the potentially harmful impacts on mental and social wellbeing that were associated with previous strict shielding. It sets out the steps clinically extremely vulnerable people can take to protect themselves for each local tier.

In the future, the government will only reintroduce formal shielding advice in the very worst affected local areas and for a limited period of time. This will only apply to some, but not all, Tier 3 areas and will be based on advice from the Chief Medical Officer. The government will write to those affected separately to inform them if they are advised to shield. The guidance states that people in this category are not advised to follow formal shielding advice again unless they receive a new shielding notification advising them to do so.

Advice during the Christmas period

It is recognised that many people may want to be with their friends and family over the festive period. As a result, the government will be changing some restrictions on social contact, allowing the formation of a ‘Christmas bubble’ in which people can spend time indoors and outdoors, including inside a home, with people from up to three households.

This will only apply for a very limited period of time, from 23 December to 27 December.

Those who are clinically extremely vulnerable can choose to be part of a Christmas bubble but it does involve greater risks as the number of people you have contact with will be increasing.

It is important that you and the other people in your Christmas bubble consider these risks carefully before agreeing to form a bubble. Forming a Christmas bubble is a personal choice and should be balanced against the increased risk of infection, says the guidance.

Advice is set out for those in this category who do decide to form a Christmas bubble.

Advice from the Scientific Advisory Group for Emergencies (SAGE) has been published to help households safely plan for gatherings in the home. The advice from SAGE includes how to make a household plan. This is a practical plan to help you prepare for social interactions in the home, which is agreed by all those who will be attending. Preparing a household plan will help to reduce your risk of transmitting COVID-19, says the document.

A checklist of ten points is summarised below:

1. Consider whether meeting up is essential and cannot be postponed or replaced by safer forms of interaction.

Identify where in-person interactions could be replaced by online events or postponed until an appropriate future date, for example when in a lower tier.

2. Consider replacing indoor events with outdoor activities or using larger spaces to host events.

Outdoor and larger spaces may provide more physical space and better ventilation compared to households with less space.

3. Remember most infections happen indoors in private homes where people get close to friends and family.

Within the home we may be more likely to assume people and places we know are safe.

4. Take special care to protect people who are particularly vulnerable to serious consequences from infection.

This includes older people and those with underlying health conditions. It is also important to reduce the risk of infection among those who have close contact with particularly vulnerable people, for example carers or nurses.

5. Ensure people who are emotionally vulnerable have social support.

Special care should be taken to interact safely with people who are socially isolated, including meeting outside if possible, online or by phone.

6. People who have very little contact with others are unlikely to be infected and may be able to meet together safely.

People who have to self-isolate or quarantine should not meet with anyone. If people have to self-isolate due to COVID-19 symptoms or a positive test, or quarantine because they have been in contact with a confirmed case, then it is essential to do so regardless of the occasion.

7. Limit interactions to the same small group of people as much as possible.

This reduces the probability that someone will come into contact with the virus and limits how far the virus can spread if there is transmission. Meeting two groups of different people in the same week increases the risk of spreading the virus compared with meeting the same group of people twice. Limiting or avoiding interactions with other people in the 7-14 days before meeting, and reducing travel across different parts of the country can further reduce the likelihood of transmission.

8. Limit the time spent together, especially if meeting indoors.

Indoor interactions should be restricted as much as possible and reserved for short duration quality time. Children should meet vulnerable relatives, including grandparents, outside where possible; brief meetings such as walking or playing outside are safest.

9. Think about the space your event will take place in, and how people will interact.

You will need to think about cleaning, ventilation (fresh air) and the layout of rooms to allow for social distancing. Think about hygiene and any activities associated with the event, such as games or serving food. Transmission through airborne, droplet and surface contact routes can be reduced by following guidance on reducing the spread of COVID-19 in your household. Children should meet older or vulnerable relatives outside where possible. Brief outside meetings such as walking or playing are safest.

10. Agree the plan with friends and family before the event so that everyone knows the safest way to meet.

A plan is likely to be most successful if it is agreed in advance. This includes explaining it to children. Examples of household plans published by SAGE are available.


Workers who spend a great deal of time working at height depend on their fall protection PPE harnesses. They want their gear to be comfortable and lightweight, not hot and heavy. Some harnesses can claim they are lighter weight, but that doesn’t always equate to comfort, especially for workers of varying shapes and sizes. Let’s explore some of the things that can make fall protection harnesses more comfortable, lighter weight and easily incorporated with other PPE.

Since “falls from height” rank first in cause of death for the construction industry, it’s critical that workers are appropriately protected. These features will make it easier for workers to be compliant by encouraging them to wear their gear properly and keep themselves and the jobsite safe:

■ Ergonomic safety
■ Lightweight and Flexible
■ Integration with other PPE

Ergonomic Safety

Comfort is key to performance and that is where ergonomics comes in. Ergonomics has been defined as the study of people’s efficiency in their working environment, but in the world of health and safety, it tends to define fitting a job or task around the employee.

We can all remember a time when we weren’t comfortable and we just couldn’t get our minds off it. The same can be true for a worker who is wearing a fall harness, except they can do without this type of distraction. If it isn’t comfortable, he or she is more likely to shift it or wear it in an unapproved position to seek comfort. This can have unintended consequences since wearing a fall harness incorrectly affects the protection it can provide and can lead to musculoskeletal disorders (MSDs). According to the CDC, MSDs are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. Work-related musculoskeletal disorders (WMSD) are conditions in which the work environment and performance of work contribute significantly to the condition and/or the condition is made worse or persists longer due to work conditions.


Both Visual Literacy and Human and Organizational Performance (HOP) emphasize slowing down with purpose.

As humans, about half of our personalities are wired more towards action, fast-paced, and getting things done, making it harder to slow down and get help. The other half of us are wired more toward needing additional information, being more methodical. This makes it harder for us to speed through tasks. For those of us who don’t naturally slow down, factors in addition to our personality wiring include production pressures, time pressures, peer pressure, rewards for output, customer demands, and a focus on outcomes.

Those are external drivers of moving too fast. The consequences can be serious, leading to near misses, minor and serious injuries, even fatalities. Rushing through jobs can lead to overlooking hazards, taking risks, working with faulty equipment, dispensing with personal protective equipment (PPE), short-cutting safety rules and procedures, and half-hearted attempts at facility housekeeping.

There are also internal drivers, called personal tendencies, that can cause us to move too fast. Equilibria’s Personality Diversity Indicator identifies action-oriented, task-oriented, information-oriented and people-oriented individuals. Subsets of these personal tendencies are: doers, thinkers, socializers and relators. Doers may rush and take calculated risks. Or they may possess too little information or too little time to process information. Socializers may jump in to help others without thinking of potential risks. Relators may be over-reliant on others.

Visual Literacy and HOP assert that you cannot simply tell individuals to slow down, especially if they do not know what to do while slowing down. There must be a reason, a purpose.

The notion of “slowing down” is often unpopular and resisted in organizations. Organizational leaders may preach using caution and stopping work that poses imminent risks. But this can be lip service, and actions on the factory floor or at a construction site may not match what management says it wants. This is especially true if safety and production are not on equal footing, getting equal respect, in an organization.

Speed can be the enemy of safety, but the ally of production. Safety and production should not be an either/or proposition. The goal, every day, should be safe production. Safety and production intertwined, integrated.

Another perceived problem with slowing down in the eyes of many is the baggage the term carries. It’s easy to equate slowing down with stagnation, obstruction, delay, slackening, inactivity, downshifting, downtime, tying up or holding up work.

Persuading, influencing or coaching a organization to slow down can overcome resistance by emphasizing that we are slowing down with purpose. Slowing down cannot be an empty edict or a top-down command, ordered without a reason. Slowing down has a purpose, an objective.

What is the justification?

Slowing down, according to both Visual Literacy and HOP, gives you an avenue to see more of the big picture, to see in greater detail, and to see with better analysis and interpretation. You gain from both a better understanding, or in the language of HOP, an expanded capacity to apply what you’ve learned. Applying the tools associated with Visual Literacy and HOP helps us to move from our fast brain to our slow brain. This improves our ability to draw meaning and improved interpretation of what we are seeing.

Many safety professionals struggle with “selling” or promoting the necessity to slow down. Visual Literacy and HOP both counsel that you don’t need to slow things down for hours. A minute, even 30 seconds, can be enough time to look at the environment in a larger, more complete way before taking on a specific task. This gives you brain time to interpret what it sees.

One “baby step” to slowing down is to verbalize, to describe and communicate what it is you are seeing during job observations, audits and risk assessments. By verbalizing you naturally slow down your brain and make more objective observations.

Other HOP error reduction tools for slowing it down: 1) Verbalize, Point and Touch©; 2) Self-check, self-monitor, reflect; 3) Receive verbal commands and repeat back; 4) Have a positive, questioning attitude – take time to ask questions; 5) Job site walk down; 6) Task review; and 7) Stop when unsure. Fisher Improvement Technologies (FIT) defines "unsure" by using the triggers of OOPPPPS© (Outside Of Procedures, Programs, Processes, Parameters, or the Situation as you expected it to be). There’s often a problem with this last point. Most organizations do not adequately define “unsure.”

They leave it up to a fallible individual to determine what “unsure” means, and that person continually second-guesses themselves after-the-fact. Fisher Improvement Technologies (FIT) has this copyrighted definition of unsure: anything that falls outside of procedures, programs, processes, parameters, or the situation as you expected.

Visual Literacy slows down observations and mental processing by asking individuals: What do you see? What meaning do you attach or interpret to what you see? And what do you do about what you observe? This is called Seeing the Whole PICTURE®. Visual Literacy also slows down observations by using the elements of art. Look at an environment, a job, a piece of equipment, a work layout or process in terms of spacing, colors, lines (alignment or misalignment of equipment, tools, safeguards), shapes (is work organized neatly or loosely?), and texture (is there sufficient traction to prevent slips and falls?).

Slowing down with purpose benefits you, your peers and your organization with many positives: better judgment, decision-making, hazard recognition, risk assessments, housekeeping, communication, audits and incident investigations to name a few. Don’t slow down because it seems to make obvious common sense. What seems reasonable may be no match for reaching or exceeding production quotas and ensuring profitability. Slow down with purpose to reap the positive consequences that in the end will improve productivity, quality, customer satisfaction and ensures that business is conducted safety – safe production.


As several biotechnology and pharmaceutical companies begin to apply for and receive emergency use authorization from the Federal Drug Administration (FDA) for their COVID-19 vaccines, the U.S. Centers for Disease Control and Prevention (CDC) has activated the distribution phase of its Operation Warp Speed Strategy for Distributing a COVID-19 Vaccine. The playbook for this phase of the plan is complex and relies on several critical components including the need for appropriate IT architecture to support an extensive data monitoring infrastructure.

The data monitoring infrastructure will be relied upon to identify when a person needs a potential second dose, to monitor outcomes and adverse events, and to account for products the U.S. government is spending billions of dollars to research, develop and produce. Organizations that administer vaccines will need the capability to accurately capture and share data at the federal, state, local and tribal levels to ensure efficient management of the vaccine program.

Because the initial supply will be limited, the CDC has recommended that healthcare personnel be the first to receive the vaccination, followed by workers in essential and critical industries, people at high risk for severe COVID-19 illness due to underlying medical conditions, and people 65 years and older. With healthcare workers at the top of the priority list, the impact of the delivery of COVID-19 vaccines is significant for many healthcare systems.

Enterprise Health, an employee health IT solution used by several large employers and health systems to manage the health, compliance and wellness of their employees, has been working behind the scenes to configure a COVID-19 immunization workflow within the solution. Dr. Rich Hammel, chief product evangelist and on-staff medical director and Emily McComb, director of account management for Enterprise Health have been leading the effort in partnership with a large healthcare system client in New York.

The COVID-19-specific workflow within Enterprise Health is based on modifying the proven existing mass immunization functionality already routinely used by the company’s health system and other large employer clients to manage large-scale employee vaccination events such as annual flu immunizations. The workflow will be finalized by the Enterprise Health team as soon as published contraindications, administration schedules, CDC CVX codes, VIS and associated barcodes, and other details for each vaccine become available.

According to Dr. Hammel, the Enterprise Health COVID-19 immunization workflow will enable employers to manage vaccine administration to employee populations based on prioritization using rules-based health surveillance panels. These panels can be based on factors such as job role, department, work location or other criteria established to identify critical populations.

Employers will also be able to automate the sending of invitation and reminder emails to notify employees they are eligible for a vaccine and direct employees to a portal to schedule a vaccine and provide electronic consent or declination. Clinicians will use a mass injection screen to rapidly document vaccine administration, and because all employee health information is stored in one place, the system will alert clinicians of missing consents prior to vaccination.

Dr. Hammel and the Enterprise Health team are also closely monitoring the CDC’s position on requiring organizations to report COVID-19 vaccines to a registry. Enterprise Health already has real-time interfaces established with many state immunization information systems (IIS) which should simplify reporting if the CDC leverages these existing systems to electronically feed information to a COVID-19 registry.

As the delivery of the COVID-19 vaccines begins, organizations that will be administering vaccines are quickly ramping up to ensure a rapid and safe distribution. Enterprise Health’s comprehensive occupational health IT solution with its extensive immunization functionality is already several steps ahead and positioned to help its health system clients rapidly vaccinate their employee populations.


Washington — Five Senate Democrats are imploring the Mine Safety and Health Administration to lower its exposure limit for crystalline silica – a carcinogen found in sand, stone and artificial stone.

In a letter dated Nov. 20 and addressed to MSHA administrator David Zatezalo, Sens. Joe Manchin (WV), Sherrod Brown (OH), Bob Casey (PA), Tim Kaine (VA) and Mark Warner (VA) write that the findings of a recent Department of Labor Office of Inspector General report contending MSHA’s silica exposure limit is out of date “illustrates the need for urgent action.”

The agency’s silica exposure limit of 100 micrograms per cubic meter of air was established in 1969. Although OSHA has since lowered its silica exposure limit to 50 micrograms per cubic meter, “both OSHA and NIOSH warned that 50 μg/m³ is the lowest feasible limit, not the safest,” DOL OIG states in the report released Nov. 16.

Further, DOL OIG says a recent increase in progressive massive fibrosis – the most severe form of black lung disease – has been linked to “high-volume mechanized mining of decreasing deposits of coal, which releases more silica dust.” According to the report, more than three times as many coal miners were identified as having black lung disease from 2010 to 2014 compared with 1995 to 1999.

“Our nation’s coal miners have done their jobs, working tirelessly to help win wars, power the nation and keep the lights on,” the senators write. “It’s time for MSHA to do its job and update its regulations to ensure our coal miners have a safe working environment.”

In a Nov. 23 press release, United Mine Workers of America President Cecil Roberts called the DOL OIG report “right on the money,” adding that it supports UMWA’s long-standing position calling for a lower exposure limit for silica.

“It is long past time for MSHA to fulfill its responsibilities and act to protect miners from silicosis or progressive massive fibrosis (PMF),” Roberts said. “MSHA knows what measures it must take in order to ensure safe and healthy work environments for the nation’s miners and it has known it for years. The agency has a responsibility to enact those measures.”

DOL OIG recommends that MSHA establish a separate standard to allow the agency to issue citations and monetary penalties for silica exposure limit violations. Additionally, it advises MSHA to increase the frequency of inspector samples “where needed” to enhance its sampling program. One example is by implementing a risk-based approach.

In a response to DOL OIG dated Oct. 27, Zatezalo wrote that his agency does not agree with the recommendations of lowering the silica exposure limit or penalizing operators solely for exposure violations. He added that MSHA plans to issue a proposed rule on exposure to respirable quartz – one of the most common types of respirable crystalline silica.

Zatezalo said MSHA will study DOL OIG’s final recommendation, including the risk-based approach, to see if sampling needs to increase under certain mining conditions.


The Centers for Disease Control and Prevention (CDC) and its National Institute for Occupational Safety and Health (NIOSH) provided updated resources on coronavirus disease 2019 (COVID-19) for employers. These include a fact sheet on case investigation and contact tracing, critical infrastructure sector response planning, and information for school administrators and school nurses.

The CDC offered a cleaning, disinfection, and hand hygiene toolkit for school administrators, as well as disease information for school nurses. It also explained that successful cleaning and disinfection in schools requires administrators to develop and implement a plan, as well as maintain and revise it. The toolkit includes handouts and posters for cleaning and disinfecting school classrooms and other campus facilities. The EPA maintains current lists of disinfectants effective against SARS-CoV-2, the virus that causes COVID-19.

The CDC also combined its “Implementing Safety Practices for Critical Infrastructure Workers Who May Have Had Exposure to a Person with Suspected or Confirmed COVID-19” and “COVID-19 Critical Infrastructure Sector Response Planning” documents, consolidating and clarifying essential public health information. The combined and streamlined document addresses the following issues:

● Growing evidence of transmission risk from infected people without symptoms (asymptomatic) or before the onset of recognized symptoms (presymptomatic);
● Ongoing community transmission in many parts of the country; and
● Continued focus on reducing transmission through social distancing and other personal prevention strategies that include cleaning and disinfecting commonly touched surfaces, hand-washing, and wearing cloth face coverings.

The CDC emphasized the need for community use of face coverings to curtail the number of COVID-19 infections. It suggested cloth face coverings may provide some “filtration for personal protection,” although cloth face coverings and surgical masks are not approved for respiratory protection. Whatever protection they may offer combined with droplet source control has been shown to reduce exposures to SARS-CoV-2.

The CDC said protection from infection increases as more people wear face coverings consistently and correctly.

The CDC and NIOSH also released a fact sheet for employers covering COVID-19 case investigations and contact tracing. Local public health departments are responsible for leading case investigations, contact tracing, and outbreak investigations.

Employers can help local public health departments by:

● Establishing a COVID-19 coordinator or team to serve as a resource for the health department and the workplace to help develop and put into action hazard assessment activities;
● Creating and implementing a COVID-19 preparedness, response, and control plan to help evaluate the risk of the spread of COVID-19 in the workplace and to choose actions to prevent its spread;
● Preparing information about the workplace, including work schedules, attendance records, and building map or floor plans for the health department, without revealing confidential personnel information;
● Performing a workplace hazard assessment to identify potential exposures to COVID-19 and using a hierarchy of control methods to limit the spread of COVID-19 in the workplace; and
● Encouraging employees to discuss their symptoms, exposures, and contacts with the health department.


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