oversight

Workplace Safety and Health: Better OSHA Guidance Needed on Safety Incentive Programs

Published by the Government Accountability Office on 2012-04-09.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

             United States Government Accountability Office

GAO          Report to Congressional Requesters




April 2012
             WORKPLACE
             SAFETY AND
             HEALTH

             Better OSHA
             Guidance Needed on
             Safety Incentive
             Programs




GAO-12-329
                                            April 2012

                                            WORKPLACE SAFETY AND HEALTH
                                            Better OSHA Guidance Needed on Safety Incentive
                                            Programs
Highlights of GAO-12-329, a report to
congressional requesters




Why GAO Did This Study                      What GAO Found
OSHA relies on employer injury and          Little research exists on the effect of workplace safety incentive programs and
illness records to target its               other workplace safety policies on workers' reporting of injuries and illnesses, but
enforcement efforts. Questions have         several experts identified a link between certain types of programs and policies and
been raised as to whether some safety       reporting. Researchers distinguish between rate-based safety incentive programs,
incentive programs and other                which reward workers for achieving low rates of reported injuries or illnesses, and
workplace safety policies may               behavior-based programs, which reward workers for certain behaviors, such as
discourage workers' reporting of            recommending safety improvements. Of the six studies GAO identified that
injuries and illnesses. GAO examined        assessed the effect of safety incentive programs, two analyzed the potential effect
(1) what is known about the effect of       on workers’ reporting of injuries or illnesses, but they concluded that there was no
workplace safety incentive programs         relationship between the programs and injury and illness reporting. Experts and
and other workplace safety policies on      industry officials, however, suggest that rate-based programs may discourage
injury and illness reporting, (2) the       reporting of injuries and illnesses. Experts and industry officials also reported that
prevalence of safety incentive              certain workplace polices, such as post-incident drug and alcohol testing, may
programs as well as other policies that     discourage workers from reporting injuries and illnesses. Researchers and
may affect reporting, and (3) actions       workplace safety experts also noted that how safety is managed in the workplace,
OSHA has taken to address how               including employer practices such as fostering open communication about safety
safety incentive programs and other         issues, may encourage reporting of injuries and illnesses.
policies may affect injury and illness
reporting. GAO reviewed academic            The Two Types of Safety Incentive Programs
literature, federal laws, regulations,
and OSHA guidance; surveyed a
nationally representative sample of
manufacturing worksites; and
interviewed federal and state
occupational safety and health officials,
union and employer representatives,         In 2010, from its survey, GAO estimated that 25 percent of U.S. manufacturers had
and researchers.                            safety incentive programs, and most had other workplace safety policies that,
                                            according to experts and industry officials, may affect injury and illness reporting.
What GAO Recommends                         GAO estimated that 22 percent of manufacturers had rate-based safety incentive
                                            programs, and 14 percent had behavior-based programs. Almost 70 percent of
GAO recommends that OSHA provide            manufacturers also had demerit systems, which discipline workers for unsafe
guidance about safety incentive             behaviors, and 56 percent had post-incident drug and alcohol testing policies
programs and other workplace safety         according to GAO’s estimates. Most manufacturers had more than one safety
policies consistently across the            incentive program or other workplace safety policy and more than 20 percent had
agency's cooperative programs, and          several. Such programs and policies were more common among larger
add language about safety incentive         manufacturers.
programs and other workplace safety
policies to the guidance provided to        Although the Occupational Safety and Health Administration (OSHA) is not
inspectors in its field operations          required to regulate safety incentive programs, it has taken limited action to
manual. OSHA agreed with the                address the potential effect of such programs and other workplace safety policies
recommendations, and noted its plans        on injury and illness reporting. These programs and policies, however, are not
to address them.                            addressed in key guidance such as OSHA's field operations manual for
                                            inspectors. OSHA has cooperative programs that exempt employers with
                                            exemplary safety and health management systems from routine inspections. One
                                            such program prohibits participants from having rate-based safety incentive
                                            programs, but guidance on OSHA’s other cooperative programs does not
                                            address safety incentive programs. Similarly, OSHA inspectors and outreach
View GAO-12-329. For more information,      specialists provide information to employers about the potential benefits and risks
contact Revae Moran at (202) 512-7215 or    of safety incentive programs, but the guidance provided to inspectors in its field
moranr@gao.gov.                             operations manual does not address these programs.
                                                                                         United States Government Accountability Office
Contents


Letter                                                                                      1
               Background                                                                   2
               Safety Incentive Programs and Policies May Affect Injury and
                 Illness Reporting                                                          7
               Three-Quarters of U.S. Manufacturers Had Safety Incentive
                 Programs or Other Workplace Safety Policies                              12
               OSHA Has Taken Limited Actions to Address Safety Incentive
                 Programs and Other Workplace Safety Policies                             19
               Conclusions                                                                23
               Recommendations for Executive Action                                       24
               Agency Comments                                                            24

Appendix I     Scope and Methodology                                                      27



Appendix II    Studies on the Effect of Safety Incentive Programs, Workplace Safety
               Policies, and Safety Culture on Workplace Safety                           32



Appendix III   Questionnaire Used for GAO’s Survey of Manufacturing Worksites             35



Appendix IV    Comments from the Department of Labor                                      43



Appendix V     GAO Contact and Staff Acknowledgments                                      45



Table
               Table 1: Studies on the Effect of Safety Incentive Programs on
                        Workplace Safety                                                    9


Figures
               Figure 1: The Two Types of Safety Incentive Programs                         6
               Figure 2: Manufacturers with Safety Incentive Programs and Other
                        Policies, by Type, 2010                                           13



               Page i                                   GAO-12-329 Workplace Safety and Health
Figure 3: U.S. Manufacturers with Only One Program or Other
         Workplace Safety Policy, Compared with Manufacturers
         with Multiple Programs or Other Policies, 2010                                   15
Figure 4: Manufacturers with Safety Incentive Programs and Other
         Workplace Safety Policies, by Size, 2010                                         17




Abbreviations
BLS            Bureau of Labor Statistics
Labor          Department of Labor
OSH Act        Occupational Safety and Health Act of 1970
OSHA           Occupational Safety and Health Administration
SHARP          Safety & Health Achievement Recognition Program
VPP            Voluntary Protection Programs


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Page ii                                           GAO-12-329 Workplace Safety and Health
United States Government Accountability Office
Washington, DC 20548




                                   April 9, 2012

                                   Congressional Requesters

                                   In March 2005, 15 workers died and 180 others were injured during an
                                   explosion at the BP Texas City refinery. The refinery had a safety incentive
                                   program that tied workers’ bonuses to achieving low rates of injuries and
                                   illnesses. A January 2007 study conducted by an independent panel after
                                   the explosion found, among other issues, that workers feared reprisals for
                                   reporting potentially risky conditions at the refinery. 1 In October 2009, we
                                   reported that safety incentive programs can provide disincentives for
                                   workers to report injuries and illnesses to their employers. 2

                                   The Department of Labor’s (Labor) Occupational Safety and Health
                                   Administration (OSHA) uses employer data on occupational injuries and
                                   illnesses to, among other purposes, target its efforts in enforcing
                                   workplace safety and health regulations, including selecting worksites for
                                   inspection. OSHA relies on workers to report work-related injuries and
                                   illnesses to their employers, and on employers to accurately record and
                                   report this information to OSHA. Accurate injury and illness data also help
                                   employers and others identify patterns of work-related injuries and
                                   illnesses and try to prevent them. For example, many insurance
                                   companies use employers’ injury and illness rates among other factors to
                                   set their workers’ compensation insurance premium rates.

                                   According to some workplace safety and health experts, certain safety
                                   incentive programs and other workplace safety policies may discourage
                                   workers from reporting workplace injuries and illnesses. Because of
                                   ongoing concerns that injuries and illnesses are not always reported, you
                                   asked us to examine the following questions: (1) What is known about the
                                   effect of workplace safety incentive programs and other workplace safety
                                   policies on injury and illness reporting? (2) How prevalent are workplace
                                   safety incentive programs, as well as other workplace safety policies that
                                   may affect injury and illness reporting? (3) What actions has OSHA taken


                                   1
                                    The BP U.S. Refineries Independent Safety Review Panel, The Report of the BP U.S.
                                   Refineries Independent Safety Review Panel (January 2007).
                                   2
                                    GAO, Workplace Safety and Health: Enhancing OSHA’s Records Audit Process Could
                                   Improve the Accuracy of Worker Injury and Illness Data, GAO-10-10 (Washington, D.C.:
                                   Oct. 15, 2009).




                                   Page 1                                          GAO-12-329 Workplace Safety and Health
             to address how workplace safety incentive programs and other policies
             may affect injury and illness reporting?

             To learn what is known about the effect of safety incentive programs and
             other workplace safety policies on injury and illness reporting, 3 we
             interviewed OSHA and state occupational safety and health agency
             officials, union and employer representatives, and researchers; and
             identified and analyzed 26 studies that appeared in peer-reviewed journals
             from 2001 to 2011. To describe the prevalence of workplace safety
             incentive programs and other policies, we surveyed a nationally
             representative sample of manufacturing worksites about their safety
             incentive programs and workplace safety policies and analyzed the
             results. 4 To identify the actions OSHA has taken to address safety
             incentive programs and policies that may affect injury and illness reporting,
             we reviewed relevant federal laws, regulations, and OSHA program
             guidance; analyzed OSHA inspection data; and interviewed OSHA and
             state occupational safety and health agency officials and experts.

             We conducted this performance audit from September 2010 to April 2012
             in accordance with generally accepted government auditing standards.
             Those standards require that we plan and perform the audit to obtain
             sufficient, appropriate evidence to provide a reasonable basis for our
             findings and conclusions based on our audit objectives. We believe that
             the evidence obtained provides a reasonable basis for our findings and
             conclusions based on our audit objectives. For more information on our
             scope and methodology, see appendix I.


             OSHA administers the Occupational Safety and Health Act of 1970 (OSH
Background   Act), which was enacted to assure so far as possible safe and healthful
             working conditions for the nation’s workers.5 OSHA helps ensure the safety
             and health of 106 million private sector workers at approximately 8.7 million
             worksites in the United States by operating over 80 area offices that report to
             1 of 10 regional offices. OSHA sets occupational safety and health standards


             3
              In this report, we use the term “injury and illness reporting” to refer to the reporting of
             occupational injuries and illnesses by workers to their employers.
             4
              Manufacturing accounted for over 11 million workers or about 10 percent of total U.S.
             employment in 2009.
             5
              Pub. L. No. 91-596, 84 Stat. 1590, codified as amended at 29 U.S.C. §§ 553, 651-78.




             Page 2                                                GAO-12-329 Workplace Safety and Health
                       and is responsible for enforcing them. The agency directly enforces these
                       standards in about half the states; the remaining states have been granted
                       authority by OSHA to set and enforce their own workplace safety and health
                       standards under a state plan approved by OSHA.6


OSHA’s Recordkeeping   The OSH Act and OSHA’s regulations generally require employers to
Requirements           prepare and maintain records of work-related injuries and illnesses
                       sustained by their workers and make them available to OSHA upon
                       request. 7 These requirements are referred to as OSHA’s recordkeeping
                       requirements. OSHA has established definitions and guidelines to assist
                       employers in determining which injuries and illnesses must be recorded. 8
                       Employers are required to maintain a log of recordable injuries and
                       illnesses incurred at each worksite. OSHA requires employers to post
                       summaries of these injury and illness logs annually at each worksite and
                       provide them to OSHA if requested. In addition, under a section of the OSH
                       Act referred to as the whistleblower protection provision, employers are
                       prohibited from retaliating against employees for taking certain protected
                       actions, including reporting work-related injuries or illnesses, and OSHA is
                       responsible for investigating workers’ complaints of retaliation. 9

                       To help ensure compliance with federal occupational safety and health
                       standards and OSHA’s recordkeeping requirements, OSHA conducts
                       enforcement activities such as on-site inspections of worksites. OSHA
                       conducts these inspections in response to fatalities, serious injuries,


                       6
                         In these states, the state standards and their enforcement must be at least as effective
                       as the federal standards. 29 U.S.C. § 667(c)(2). Most of these state plans cover both
                       public and private sector worksites. However, the state plan in five states (Connecticut,
                       Illinois, New Jersey, New York, and the Virgin Islands) only covers public sector (state and
                       local government) worksites; private sector worksites are covered by federal OSHA.
                       Under the OSH Act, “state” is defined to include the District of Columbia, Puerto Rico, the
                       Virgin Islands, American Samoa, and Guam. 29 U.S.C. § 652(7).
                       7
                         Employers that are generally exempt from OSHA’s recordkeeping requirements include
                       employers with 10 or fewer employees, and those in specific low-hazard retail, service,
                       finance, insurance, or real estate industries. 29 C.F.R. §§ 1904.1-1904.2. However, all
                       employers must report to OSHA any work-related incident that results in a fatality or the
                       hospitalization of three or more employees. 29 U.S.C. § 1904.39.
                       8
                         See generally 29 C.F.R. §§ 1904.4 -1904.29. Work-related injuries and illnesses that must be
                       recorded include, among others, those that result in days away from work, restricted work or
                       transfer to another job, medical treatment beyond first aid, and loss of consciousness.
                       9
                        29 U.S.C. § 660(c), 29 C.F.R. § 1904.36.




                       Page 3                                              GAO-12-329 Workplace Safety and Health
                          complaints from workers, and referrals. In addition, OSHA targets
                          industries and employers with a high number of workplace injuries and
                          illnesses for inspection. When inspecting worksites, OSHA inspectors
                          identify hazards that could lead to workers’ injuries or illnesses, review
                          worksites’ injury and illness records, evaluate employers’ safety and
                          health management systems, and meet with employers and worker
                          representatives to discuss their findings and possible courses of action to
                          correct hazards and improve their systems. Employers that fail to comply
                          with the safety and health standards may face sanctions, such as paying
                          penalties for violations. In its field operations manual, OSHA provides
                          guidance to inspectors, employers, and workers on compliance with
                          safety and health standards, inspections, and penalty assessments.


OSHA Cooperative          To help employers comply with safety and health standards and
Programs, Outreach, and   recordkeeping requirements, OSHA supplements its enforcement efforts
Training                  with voluntary cooperative programs, outreach, and training in which
                          OSHA invites employers to collaborate with the agency and uses a
                          variety of methods to encourage employers to adopt practices designed
                          to foster safer and healthier working conditions. For example, OSHA’s
                          Voluntary Protection Programs (VPP) recognize employers with
                          exemplary safety and health systems and relatively low injury and illness
                          rates, and exempts them from routine inspections. 10 Small employers that
                          request on-site consultation services may be recognized through OSHA’s
                          Safety & Health Achievement Recognition Program (SHARP), which
                          exempts those with exemplary safety and health management systems
                          from routine inspections for up to 3 years. 11

                          OSHA also trains employers and workers on how to comply with its
                          standards and other regulations by, for example, providing online materials
                          and reaching out directly to employer and worker groups. For example,
                          each OSHA area office typically has one outreach specialist who serves as
                          a resource to a variety of groups including businesses, trade associations,



                          10
                            VPP worksites are reevaluated every 3 to 5 years to determine whether they merit
                          staying in the program. To maintain VPP status, worksites must maintain an average
                          injury and illness rate that is below the average rate published by the Bureau of Labor
                          Statistics (BLS) for their industry for 1 of the most recent 3 years. VPP worksites are
                          required to report their injury and illness rates to OSHA annually.
                          11
                            OSHA may inspect VPP and SHARP worksites with fatalities or other serious injuries or
                          complaints about safety or health hazards.




                          Page 4                                             GAO-12-329 Workplace Safety and Health
                       unions, and community groups. 12 Outreach specialists provide information
                       on OSHA’s cooperative programs, training resources, and tools available
                       on the agency’s website. In addition, during inspections, OSHA’s inspectors
                       provide information to employers on the strengths and weaknesses of their
                       safety and health management systems.


Workplace Safety and   OSHA encourages employers to take a multifaceted approach to
Health Management      preventing and controlling hazards and creating an effective safety and
Systems                health management system or a positive safety culture. 13 According to
                       OSHA, the four elements of an effective safety and health management
                       system are as follows:
                       (1) Management commitment and employee involvement
                       Employers should develop a safety and health policy, communicate it to all
                       employees, and demonstrate commitment to it by, for example, instilling
                       accountability for safety and health and ensuring an open exchange of
                       information about safety issues. Employees should be involved in safety-
                       and health-related activities such as accident investigations.
                       (2) Worksite analysis
                       Employers should have a thorough understanding of all hazardous
                       situations to which employees may be exposed, as well as the ability to
                       recognize and correct these hazards. Accurate injury and illness records
                       can be used to identify and prevent work-related injuries and illnesses.
                       (3) Hazard prevention and control
                       Employers should have clear procedures for preventing and controlling
                       hazards identified through worksite analysis, such as a hazard tracking
                       system and a written system for monitoring and maintaining workplace
                       equipment.
                       (4) Safety and health training
                       Training is necessary to reinforce and complement management’s
                       commitment to safety and health and to ensure that all employees
                       understand how to avoid exposure to hazards.



                       12
                         OSHA refers to these individuals as compliance assistance specialists.
                       13
                         In this report, we use the term “safety culture,” which is used by industry officials to refer to
                       “safety climate,” a term commonly used by researchers. We use the terms "safety culture"
                       and "workplace safety and health management system" interchangeably in this report.




                       Page 5                                                 GAO-12-329 Workplace Safety and Health
Safety Incentive Programs   As part of their safety and health management systems, many employers
                            use safety incentive programs to encourage safety in the workplace.
                            These programs provide workers with rewards for achieving certain safety
                            goals. Examples of these rewards include cash, meals, tangible goods,
                            and public recognition. Employers can provide such rewards on the basis
                            of individual or group performance depending on the program’s design.

                            There are two types of safety incentive programs: rate-based programs,
                            which reward workers for achieving low rates of reported injuries or
                            illnesses, and behavior-based programs, which reward workers for certain
                            behaviors such as recommending safety improvements (see fig. 1). Rate-
                            based programs provide workers or groups of workers with rewards such
                            as bonuses and prizes for having no or a low number of work-related
                            injuries and illnesses during a specified period. For example, an employer’s
                            rate-based program may reward workers with $100 bonuses for having no
                            reported work-related injuries or illnesses in a given year. Behavior-based
                            programs provide workers or groups of workers with rewards for
                            demonstrating safe behaviors but are not tied to low injury and illness rates.
                            For example, an employer’s behavior-based program may reward workers
                            with gift cards for identifying hazardous conditions and suggesting safety
                            improvements. Some experts we interviewed used the term behavior-
                            based safety programs to describe an approach to workplace safety that
                            focuses on worker behavior as the cause of work-related injuries and
                            illnesses. However, in this report, we use the term behavior-based program
                            to define a type of safety incentive program that is a component of an
                            employer's safety and health management system. These systems may
                            include other workplace safety policies such as demerit systems that
                            discipline workers for failing to follow safety procedures.

                            Figure 1: The Two Types of Safety Incentive Programs




                            Page 6                                      GAO-12-329 Workplace Safety and Health
Other Workplace Safety         Employers’ safety and health management systems often include other
Policies                       workplace safety policies. For example, some employers require the
                               participation of frontline workers and management in safety committees to
                               help foster communication and address safety-related issues and
                               encourage workers to promptly report injuries or illnesses and address
                               safety hazards. Other workplace safety policies are designed to prevent
                               injuries and illnesses by holding workers accountable for using safe work
                               practices. Demerit systems discipline workers for unsafe work practices
                               such as failing to follow safety procedures. For example, some employers
                               have policies that discipline workers for not wearing protective gear or for
                               other unsafe practices linked to reported injuries. In addition, some
                               employers have drug and alcohol testing policies, which provide for the
                               testing of workers (1) prior to employment, (2) at random intervals for
                               some or all workers, (3) at scheduled times for all workers, (4) when there
                               is evidence that suggests a worker may have used drugs or alcohol, or
                               (5) after a workplace incident, such as an injury, occurs.



Safety Incentive
Programs and Policies
May Affect Injury and
Illness Reporting

Research on the Effect of      Little conclusive academic research exists on whether safety incentive
Safety Incentive Programs      programs and other workplace safety policies affect workers’ injury and
Is Inconclusive, but Several   illness reporting, but several experts stated that rate-based programs may
                               discourage injury and illness reporting. Of the 26 studies of workplace
Experts Agree Certain          safety we reviewed, we identified 6 that evaluated the effect of safety
Programs and Policies May      incentive programs on workplace safety, but only 2 of these studies
Discourage Reporting           specifically evaluated the programs’ effect on reporting of injuries. 14 Each
                               of the six studies, however, had methodological limitations that prevent



                               14
                                 We reviewed studies from peer-reviewed journals published from January 2001 to
                               October 2011. We included studies that evaluated the effect of safety incentive programs,
                               workplace safety policies, or safety culture on workers’ injury and illness rates, reporting of
                               injuries or illnesses, or use of safe behaviors. We excluded studies that were reviews of
                               other studies or in which the primary research was not conducted in the United States. For
                               more information on our methodology, see appendix I.




                               Page 7                                              GAO-12-329 Workplace Safety and Health
generalizing the effects of these programs on injury and illness reporting
for all workers. 15

The six studies that evaluated safety incentive programs reached different
conclusions about their effect on workplace safety. Three studies—
including the two that specifically evaluated the programs’ effect on
reporting of injuries—focused on one type of safety incentive program
and found that their effect on workplace safety was inconclusive or that
the programs had no effect. For example, one study in which nurses were
surveyed to determine how often injuries and illnesses were reported in
their workplaces found that rate-based safety incentive programs had no
effect on injury reporting. 16 This study relied on perceptions about injury
reporting which may differ from actual reporting due to, for example, faulty
memories, and thus its results are not definitive. 17 The three studies that
did not focus on only one type of safety incentive program found that the
programs reduced injuries; however, these studies did not quantify the
programs’ effect on injury and illness reporting. The authors of these
studies acknowledged that, when the programs provide incentives for not
reporting an injury—such as providing a monetary reward for having a low
injury and illness rate—workers may underreport injuries. For example,
the authors of one study noted that workers may “intentionally fail to
report injuries in an effort to preserve potential bonuses for their work
groups.” 18 Information on the six studies is summarized in table 1.




15
  Each of the six studies focused on a profession, industry, or geographic region, so the
results may not apply to other professions, industries, or regions. For example, two of the
studies focused on the construction industry and the results cannot be generalized to
workers in other industries or to all construction workers because of their sample designs.
16
  Jean Geiger Brown, Alison Trinkoff, Kenneth Rempher, Kathleen McPhaul, Barbara
Brady, Jane Lipscomb, and Charles Muntaner, “Nurses Inclination to Report Work-Related
Injuries: Organizational, Work-Group, and Individual Factors Associated with Reporting,”
AAOHN Journal, vol. 53, no. 5 (2005): 213-217.
17
  In addition, this study focused on nurses in two states, so the results may not apply to all
nurses or other workers.
18
  Kristy J. Lauver and Scott W. Lester, “Get Safety Problems to the Surface: Using
Human Resource Practices to Improve Injury Reporting,” Journal of Leadership and
Organizational Studies, vol. 14, no. 2 (2007): 168-179.




Page 8                                              GAO-12-329 Workplace Safety and Health
Table 1: Studies on the Effect of Safety Incentive Programs on Workplace Safety

Study author(s)                 Dependent                    Effect of rate-       Effect of behavior-       Acknowledgment of
(publication year)              measure(s)                   based programs        based programs            potential for underreporting
Brown et. al. (2005)a           Reporting of injuries        No effect             Not studied               Yes
                           a
Lauver and Lester (2007)        Reported and                 Not studied           No effect                 Yes
                                unreported injuries
                                and near misses
Ludwig et. al. (2001)           Use of safe practices        Not studied           Inconclusive              Not applicable
Alavosius et. al. (2009)        Injury rate                              Injury rate reductionb              Yes
                                                                                               b,c
Gangwar and Goodrum (2005)      Injury rate                              Injury rate reduction               Yes
Hinze (2002)                    Injury rate                  No effect             Injury rate reduction     Yes
                                          Source: GAO analysis.
                                          a
                                           The study analyzed workers’ perceptions of reporting behavior which may differ from actual reporting
                                          behavior; therefore, the results are not definitive.
                                          b
                                           The authors combined rate-based and behavior-based safety incentive programs in their analysis;
                                          therefore, the effect of each type of program on workplace safety could not be determined.
                                          c
                                           Injury rate reductions were short-term and occurred a few years after the safety programs were
                                          implemented.


                                          In addition to reviewing existing studies, we interviewed over 50 experts
                                          and industry officials from academia, employer associations, a law firm, a
                                          consulting firm, unions, and state and federal safety and health agencies
                                          to obtain their opinions about the effect of safety incentive programs and
                                          other workplace safety policies on injury and illness reporting. Several of
                                          them told us that an unintended consequence of rate-based programs
                                          may be discouraging workers from reporting injuries and illnesses. For
                                          example, when workers’ injuries are relatively minor or easy to hide, and
                                          if the rewards provided under the program are relatively large, workers
                                          may not report their injuries to preserve their rewards. Potential
                                          underreporting of injuries and illnesses is even greater when an incentive
                                          creates peer pressure on workers to not report injuries. For example,
                                          when all workers on a team get a reward only if no one on the team has
                                          an injury, there may be pressure on all members of the team to not report
                                          injuries. According to some experts we interviewed, it is difficult to
                                          quantify the effect safety incentive programs may have on injury and
                                          illness reporting partly because researchers do not have access to
                                          workers’ medical records. Without such access, workers who do not
                                          report their injuries cannot be identified and this information cannot be
                                          used to explore whether workers’ decisions to not report their injuries
                                          were linked to their employers’ safety incentive programs.




                                          Page 9                                                     GAO-12-329 Workplace Safety and Health
                           Several experts and industry officials we interviewed also mentioned that,
                           along with safety incentive programs, some workplace safety policies may
                           discourage workers from reporting injuries and illnesses. For example,
                           policies that punish workers for unsafe practices that are linked to injuries
                           may—depending on the nature of the injury and the policy—inhibit them
                           from reporting injuries. Such policies include demerit systems that have
                           consequences for workers who report injuries or illnesses, such as giving
                           workers warnings, demotions, or terminating them for recurrences.
                           However, some employers use demerit systems to discipline workers who
                           engage in unsafe practices such as not wearing protective gear, and such
                           demerit systems may have no effect on workers’ reporting of injuries and
                           illnesses. According to officials from a union, workplace safety policies
                           that single out workers who report injuries or illnesses by, for example,
                           requiring them to wear identifying clothes such as an orange vest, may
                           also discourage them from reporting. In addition, according to several
                           experts, policies that require drug and alcohol testing after an injury is
                           reported—compared to those that are applied on a routine basis to all
                           workers—may deter workers from reporting injuries. 19 We found only one
                           study that evaluated the effect of these other workplace safety policies
                           mentioned by experts and industry officials as having a potentially
                           adverse effect on injury and illness reporting. This study evaluated the
                           effect of post-incident drug testing on injury and illness reporting and
                           found evidence that such testing may discourage reporting of relatively
                           minor injuries that are easy to hide. 20


How Employers Manage       While some safety incentive programs and other workplace safety
Safety Can Affect Injury   policies may discourage injury and illness reporting, research we
and Illness Reporting      reviewed indicated that how employers manage safety has a greater
                           influence on workers’ actions, including whether they are likely to report
                           injuries and illnesses, than any one program or policy. Among the 26


                           19
                             In some industries, such as transportation, post-incident drug or alcohol testing may be
                           required. For example, regulations issued by the Department of Transportation’s Federal
                           Motor Carrier Safety Administration require employers to test drivers of commercial motor
                           vehicles for alcohol and controlled substances after certain types of accidents. 49 C.F.R. §
                           382.303.
                           20
                             The study was based on research at a large retail chain. See A. Morantz and A. Mas,
                           “Does Post-Accident Drug Testing Reduce Injuries? Evidence from a Large Retail Chain,”
                           American Law and Economics Review, vol. 10, no. 2, (2008): 246-302. In our review of
                           the literature, we did not identify any studies of the effect of demerit systems that punish
                           workers for unsafe work practices.




                           Page 10                                            GAO-12-329 Workplace Safety and Health
studies we reviewed, most found that employers that promote a positive
safety culture may encourage workers to use safe behaviors, report
injuries and illnesses, or reduce the incidence of injuries and illnesses.
We identified 21 studies that evaluated the effect of an employer’s safety
culture on workplace safety. 21 Of these studies, 16 indicated that having a
good safety culture has a positive effect on workers’ use of safe
behaviors, injury and illness rates, or reporting of injuries and illnesses,
and 5 indicated that a good safety culture had a mixed or inconclusive
effect.

According to the studies we reviewed, workplaces with a positive safety
culture placed a strong emphasis on safety by, for example, encouraging
open communication about safety issues, placing a high priority on safety
training, and having procedures that prevented breakdowns in workplace
safety. Some researchers concluded that in such environments, workers
felt that they could report injuries and illnesses without fear of reprisal or
blame from management or fellow workers. Of the four studies we
reviewed that evaluated the effect of a positive safety culture on reporting
of work-related injuries or accidents, 22 three found that having a positive
safety culture increased the likelihood of injury and illness reporting. 23
Policies that help employers create a positive safety culture and keep
workers safe and healthy were generally perceived as being proactive
versus reactive. For example, employers with proactive policies that
require workers to report near-miss incidents to help identify hazards and
other safety concerns before an injury takes place were more likely to
have a positive effect on injury and illness reporting.




21
  Several of these studies relied on nongeneralizable surveys of workers to measure
safety culture. In addition, many relied on workers’ memories to measure the incidence of
injuries and illnesses, whereas others used documentation, such as employers’ OSHA-
required injury and illness logs or records of workers’ compensation claims.
22
   Each of the studies had a methodological issue that may limit the generalizability of the
findings. For example, three of the four studies included nonrandom samples and the
results may be affected by selection bias.
23
  Two of the three studies share an author.




Page 11                                             GAO-12-329 Workplace Safety and Health
                       In contrast, according to the studies we reviewed, workplaces with a
                       negative safety culture do not place a strong emphasis on safety. These
                       employers do not encourage open communication about safety issues or
                       prioritize safety training. According to two experts we interviewed, some
                       employer safety programs focus on workers' behaviors as the cause of
                       work-related injuries and illnesses, and have policies that discipline
                       workers for failing to follow safety procedures. As a result, workers in
                       these environments may be less likely to report injuries or illnesses
                       because, if they lack safety training, communication is poor, or they are
                       not encouraged to report injuries and illness, they may not know how to
                       report them, or may fear being disciplined.


                       According to our survey, in 2010, an estimated 116,000 of about 153,000
Three-Quarters of      manufacturers in the United States (75 percent) had safety incentive
U.S. Manufacturers     programs or had other workplace safety policies that, according to several
                       experts, may affect workers’ reporting of injuries and illnesses. 24
Had Safety Incentive   However, we estimated that safety incentive programs were less
Programs or Other      prevalent than other workplace safety policies, such as demerit systems,
Workplace Safety       that discipline workers for unsafe work practices. 25 We also estimated that
                       a quarter of manufacturers had some type of safety incentive program
Policies               and most had a demerit system or post-incident drug and alcohol testing




                       24
                         The manufacturers included in our survey sample were private sector workplaces with
                       11 or more employees. According to BLS, there are roughly 153,000 manufacturers
                       nationwide in this population. This estimate includes manufacturers with one or more of
                       the following types of safety incentive programs and other workplace safety policies: rate-
                       based programs, behavior-based programs, demerit systems and post-incident drug and
                       alcohol testing. The 95 percent confidence interval for the estimate of 75.5 percent is
                       (68.7, 82.2). Our survey excluded post-incident drug and alcohol testing required by law
                       for driving accidents. Post-incident drug and alcohol testing may be limited or prohibited
                       by law in some states; for example, according to an official from the Vermont Occupational
                       Safety and Health Administration, it is generally against the law for employers in Vermont
                       to conduct post-incident drug and alcohol testing. GAO did not independently evaluate
                       state laws or policies on post-incident drug and alcohol testing.
                       25
                         The estimate for safety incentive programs includes manufacturers with one or more of
                       the following types of safety programs: rate-based and behavior-based. The estimate for
                       workplace safety policies includes manufacturers with one or more of the following types
                       of policies: demerit systems and post-incident drug and alcohol testing. The 95 percent
                       confidence interval for the safety incentive programs estimate of 25.4 percent is (20.6,
                       30.1), and for the other workplace safety policies estimate of 74.9 percent is (68.2, 81.6).




                       Page 12                                             GAO-12-329 Workplace Safety and Health
policy. Demerit systems were the most common policy reported, followed
by post-incident drug and alcohol testing policies (see fig. 2). 26

Figure 2: Manufacturers with Safety Incentive Programs and Other Policies, by
Type, 2010




26
  The 95 percent confidence interval for the demerit systems estimate of 68.9 percent is
(62.2, 75.6), and for the post-incident drug and alcohol testing estimate of 55.9 percent is
(49.0, 62.8).




Page 13                                             GAO-12-329 Workplace Safety and Health
Very few manufacturers had only one type of safety incentive program, and
few had only one type of other workplace safety policy.27 Most
manufacturers had more than one safety incentive program or other
workplace safety policy, and more than 20 percent had several, according to
our estimates.28 For example, one manufacturer who participated in our
survey had a program that rewarded workers with a luncheon for having no
injuries that resulted in lost time on the job, and provided a separate reward
to the worker who submitted the best safety suggestion during the month.
Manufacturers with multiple types of programs or policies were more than
twice as likely to have a demerit system or conduct post-incident drug and
alcohol testing than they were to have a rate-based or behavior-based
program (see fig. 3). 29




27
  The 95 percent confidence intervals for these data are as follows: manufacturers that
had only a rate-based program estimate of 0.3 percent is (0.0, 1.0), manufacturers that
had only a behavior-based program estimate of 0.3 percent is (0.0, 1.0), manufacturers
that had only a post-incident drug and alcohol testing estimate of 6.0 percent is (3.7, 9.2),
and manufacturers that had only a demerit system estimate of 16.6 percent is (11.6, 22.7).
28
  The estimate for manufacturers with multiple safety incentive programs or other workplace
safety policies includes manufacturers with two or more of the following types of programs
and policies: rate-based programs, behavior-based programs, demerit systems, and post-
incident drug and alcohol testing policies. The 95 percent confidence interval for the estimate
of 55.2 percent is (48.4, 62.0). The estimate for manufacturers with several safety incentive
programs or other workplace safety policies includes manufacturers with three or more of the
same types of safety incentive programs and policies. The 95 percent confidence interval for
the estimate of 21.5 percent is (17.0, 25.9).
29
  The 95 percent confidence intervals for these data include manufacturers that had the
following: demerit systems and at least one other program or policy estimate of 50.5
percent is (43.9, 57.1), post-incident drug and alcohol policies and at least one other
program or policy estimate of 49.0 percent is (42.4, 55.5), rate-based programs and at
least one other program or policy estimate of 21.7 percent is (17.3, 26.2), and behavior-
based and at least one other program or policy estimate of 13.3 percent is (10.1, 17.0).




Page 14                                             GAO-12-329 Workplace Safety and Health
Figure 3: U.S. Manufacturers with Only One Program or Other Workplace Safety
Policy, Compared with Manufacturers with Multiple Programs or Other Policies, 2010




Page 15                                       GAO-12-329 Workplace Safety and Health
Large manufacturers were more likely to have safety incentive programs
and demerit systems than smaller manufacturers. 30 We estimated that
large manufacturers were more than three times as likely to have safety
incentive programs compared with small manufacturers. Although safety
incentive programs and other workplace safety policies were less
common among small manufacturers, most small manufacturers had
demerit systems and many had post-incident drug and alcohol testing
policies (see fig. 4). 31




30
  We defined large manufacturers as those with 250 or more workers, medium
manufacturers as those with 50 to 249 workers, and small manufacturers as those with 11
to 49 workers. The 95 percent confidence interval for large manufacturers which had the
estimate of 89.1 percent for demerit systems is (81.0, 94.6), 45.0 percent for rate-based
programs is (37.6, 52.3), and 39.5 percent for behavior-based programs is (32.3, 46.7).
The 95 percent confidence interval for medium manufacturers which had the estimate of
84.9 percent for demerit systems is (79.4, 89.4), 36.5 percent for rate-based programs is
(29.9, 43.1), and 22.3 percent for behavior-based programs is (16.7, 27.9). The 95 percent
confidence interval for small manufacturers which had the estimate of 58.5 percent for
demerit systems is (48.3, 68.7), 12.5 percent for rate-based programs is (7.2, 19.6), and
6.6 percent for behavior-based programs is (3.0, 12.3).
31
  The 95 percent confidence interval for the post-incident drug alcohol testing estimate of
44.2 percent for small manufacturers is (34.3, 54.1).




Page 16                                            GAO-12-329 Workplace Safety and Health
Figure 4: Manufacturers with Safety Incentive Programs and Other Workplace
Safety Policies, by Size, 2010




Companies sometimes request information on manufacturers’ injury and
illness rates before signing a contract with them to manufacture goods.
According to some workplace safety experts, such contractors may feel
pressure to lower injury and illness rates to avoid the risk of losing bids for
contracted work. Manufacturers whose injury and illness rates were
requested by potential contracting companies were more than twice as
likely to have rate-based safety incentive programs than manufacturers
whose rates were not requested. 32 We estimated that 31 percent of U.S.




32
  The 95 percent confidence interval for the 38.3 percent estimate of manufacturing
contractors that had rate-based programs whose injury and illness rates had been
requested of is (24.1, 54.8), and for the 12.6 percent estimate of manufacturing
contractors whose injury and illness rates had not been requested of is (6.5, 23.1).




Page 17                                           GAO-12-329 Workplace Safety and Health
manufacturers performed contractual work in 2010. 33 Contracting
companies requested injury and illness rate data from nearly a third of
these manufacturers prior to signing a contract with them. 34 Thirty-eight
percent of these manufacturers that had their injury and illness rates
requested reported having rate-based programs in 2010. In contrast, 13
percent of the manufacturers that had did not have their injury and illness
data requested by potential contracting companies prior to signing a
contract reported having rate-based programs in 2010.

U.S. manufacturers provided incentives to workers for a variety of safety
goals and behaviors. Nearly three-quarters of manufacturers with rate-
based programs, according to our estimates, rewarded workers for having
no reported injuries and illnesses. 35 Forty percent rewarded workers for
having a low number or rate of injuries and illnesses during a specific time
period, and 23 percent of them rewarded workers for reducing the
number or rate of reported injuries and illnesses. 36 Nearly 70 percent of
manufacturers with behavior-based programs rewarded workers for
recommending workplace safety improvements and 37 percent rewarded
them for wearing protective gear. 37

The criteria for providing rewards differed between rate-based and behavior-
based programs, but the types of rewards manufacturers provided and the
types of workers targeted by both of these safety incentive programs were
similar. For both types of programs, monetary awards, meals, and other non-
monetary awards, such as gift cards, were more commonly offered than time




33
 The 95 percent confidence interval for the estimate of 30.8 percent is (24.6, 37.0).
34
 The 95 percent confidence interval for the estimate of 33.2 percent is (22.7, 43.7).
35
 The 95 percent confidence interval for the estimate of 73.7 percent is (62.7, 82.8).
36
  The 95 percent confidence intervals for the estimates of 39.5 percent is (28.8, 50.2), and
23.0 percent is (13.6, 34.9).
37
  The 95 percent confidence intervals for the estimates of 68.8 percent is (56.0, 79.8), and
36.6 percent is (24.6, 48.5).




Page 18                                            GAO-12-329 Workplace Safety and Health
                               off work or a token of recognition, such as a plaque.38 Manufacturers used
                               safety incentive programs to target various levels of workers and worker
                               groups, including entire workplaces, work teams such as department or
                               shifts, supervisors, and frontline workers. However, the percentage of
                               manufacturers that rewarded individual frontline workers through either rate-
                               based or behavior-based safety incentive programs was twice as high as
                               those that rewarded supervisors. 39



OSHA Has Taken
Limited Actions to
Address Safety
Incentive Programs
and Other Workplace
Safety Policies

OSHA’s Enforcement             OSHA can use its enforcement authority to address certain aspects of
Efforts Address Safety         safety incentive programs and other workplace safety policies, but the
Incentive Programs and         effectiveness of these activities is limited. Although the OSH Act does not
                               mandate that OSHA regulate safety incentive programs, OSHA officials
Other Workplace Safety         told us the agency could potentially issue a regulation to address safety
Policies to a Limited Extent   incentive programs and other workplace safety policies. However, OSHA



                               38
                                 The 95 percent confidence interval for the rate-based program monetary rewards
                               estimate of 53.2 percent is (42.7, 63.7), the behavior-based program monetary rewards
                               estimate of 43.6 percent is (30.8, 56.3), the rate-based program meals reward estimate of
                               56.8 percent is (46.2,67.3), the behavior-based program meals rewards estimate of 46.6
                               percent is (33.9, 59.3), the rate-based program non-monetary rewards estimate of 40.5
                               percent is (30.5, 50.5), the behavior-based program non-monetary rewards estimate of
                               44.5 percent is (32.3, 56.6), the rate-based program time off work rewards estimate of 4.5
                               percent is (2.1, 8.3), the behavior-based program time off work rewards estimate of 5.5
                               percent is (0.8, 17.5), the rate-based program token of recognition rewards estimate of
                               24.8 percent is (15.3, 36.5), and the behavior-based program token of recognition rewards
                               estimate of 21.4 percent is (13.8, 30.7).
                               39
                                 The 95 percent confidence interval for the rate-based program individual frontline worker
                               estimate of 43.1 percent is (32.7, 53.5), the behavior-based program individual frontline
                               worker estimate of 52.8 percent is (40.0, 65.5), the rate-based program supervisor
                               estimate of 20.0 percent is (12.3, 29.8), and the behavior-based program supervisor
                               estimate of 26.4 percent is (15.0, 40.7).




                               Page 19                                           GAO-12-329 Workplace Safety and Health
has not done so because, according to OSHA officials, it has focused its
regulatory resources on other priorities such as projects that address
exposure to serious safety and health hazards. 40 Some of OSHA’s
enforcement tools can be used to address certain aspects of safety
incentive programs and other workplace safety policies, but these tools
are not designed to systematically address these programs. For example,
a worker may file a whistleblower protection complaint if the worker
reports an injury and, under the rules of the employer’s safety incentive
program, is subsequently excluded from receiving a reward, such as a
bonus. However, such claims may only address the adverse action
experienced by an individual worker and not address the potential overall
negative impact a safety incentive program may have on the workplace. 41

Under its recordkeeping regulations, OSHA can address recordkeeping
violations that occur as a result of safety incentive programs and other
workplace safety policies, but it cannot address potential disincentives to
injury and illness reporting associated with the policies. For example,
OSHA can cite employers for failing to properly record injuries or illnesses
under its recordkeeping regulations, 42 but the relationship between a
safety incentive program and potential underreporting of injuries and
illnesses is not directly addressed in these requirements. To find evidence
of underreporting, inspectors must interview workers, review their medical
records, and compare these records to employers’ injury and illness logs
to determine whether an injury or illness occurred but was not reflected
on the log.

OSHA has explored the potential effect of safety incentive programs and
other workplace safety policies on injury and illness reporting through its
recordkeeping enforcement initiative, which was established to determine



40
  One provision of OSHA’s ergonomics standard from 2000 required employers to ensure
that their policies and practices did not discourage reporting of ergonomics injuries.
However, the ergonomics standard was invalidated by Congress in 2001 under the
Congressional Review Act. Pub. L. No. 107-5, 115 Stat. 7 (2001).
41
  The whistleblower protection provision is limited because affected employees must file a
complaint within 30 days of the adverse action, see 29 U.S.C. § 660(c)(2) and, according
to OSHA officials, they are not guaranteed anonymity during OSHA’s investigation. In
addition, in some cases OSHA may decide pursuing a claim in court is not an appropriate
use of resources, particularly when the monetary value of the reward is relatively small.
42
  29 U.S.C. §§ 657(c), 658(a). For OSHA’s recordkeeping regulations, see generally 29
C.F.R. part 1904.




Page 20                                           GAO-12-329 Workplace Safety and Health
the accuracy of employers’ injury and illness logs and identify and correct
any mistakes or omissions. OSHA began this program in September
2009, and in February 2010 established a goal of auditing injury and
illness records at approximately 350 worksites nationwide over a 2-year
period. Inspectors compared employers’ injury and illness logs to workers’
medical records, and interviewed workers, managers, recordkeepers, and
first-aid providers. As part of these audits, OSHA directed inspectors to
consider the effect of safety incentive programs or other workplace safety
policies on injury and illness reporting, and when recordkeeping violations
were found, in assessing the severity of the violation. For example,
according to OSHA officials, if inspectors found underreporting of injuries
and illnesses and concluded that a safety incentive program was a
contributing factor, the inspector could classify the violation as willful,
which carries an increased penalty. 43 However, the guidance provided to
inspectors did not specify how this assessment should be done and, in
our interviews with OSHA area office officials we found that OSHA
inspectors inconsistently considered safety incentive programs when
reviewing employers’ injury and illness records. For example, one area
office official said that the penalty assessment for a recordkeeping
violation would be the same regardless of the existence of a safety
incentive program. In addition, because OSHA did not select a nationally
representative sample of worksites for these inspections, OSHA cannot
use the results to determine the effect of safety incentive programs and
other workplace safety policies on injury and illness reporting
nationwide. 44




43
  29 U.S.C. § 666(a).
44
  We analyzed the preliminary results of OSHA’s recordkeeping enforcement initiative as
of October 21, 2011, and found that 75 percent of inspected worksites had some type of
safety incentive program, disciplinary workplace policy, or post-injury drug or alcohol
testing. Of the 264 worksites inspected as of then, almost half of the worksites inspected
had recordkeeping errors that would have affected the injury and illness rate used by
OSHA to target worksites for inspection. However, the most common mistakes were
relatively minor. For example, many worksites listed an employee’s injury or illness on the
log but made a mistake in the number of days the employee was not at work or on
restricted duty. The recordkeeping enforcement initiative yielded a total of 882 violations of
OSHA’s recordkeeping requirements as of October 21, 2011.




Page 21                                             GAO-12-329 Workplace Safety and Health
OSHA Has Guidance on         OSHA has developed policy guidance on safety incentive programs for
Safety Incentive Programs    the VPP, but the guidance for its other cooperative programs and for its
for One of Its Cooperative   enforcement efforts does not address safety incentive programs or other
                             workplace safety policies. For example, OSHA’s guidance on its SHARP
Programs but Has Not         program, a voluntary cooperative program that focuses on smaller
Adopted Similar Guidance     employers, does not address safety incentive programs. Similarly,
for Other Efforts            OSHA’s field operations manual does not provide guidance to its
                             inspectors for addressing safety incentive programs during inspections.

                             In June 2011, OSHA issued a policy memorandum for the VPP program
                             that contains specific criteria for safety incentive programs, including the
                             types of programs that are encouraged for VPP sites and those that are
                             prohibited. Programs that promote accurate injury and illness reporting
                             are encouraged, while participants in the VPP are now prohibited from
                             having safety incentive programs that focus on the number of injuries and
                             illnesses, such as rate-based programs that reward workers for achieving
                             low injury and illness rates. This policy memorandum does not address
                             other workplace safety policies that might impact injury and illness
                             reporting. OSHA officials are required to ensure current VPP participants
                             are in compliance with this policy when participants are reevaluated to
                             determine whether they will be allowed to continue to participate in the
                             program, but the new policy is not included in the VPP manual. Officials
                             from one regional office estimated that almost 20 percent of its VPP
                             participants have safety incentive programs that are not in compliance
                             with this new policy.

                             In addition to providing guidance on its voluntary cooperative programs,
                             OSHA often provides safety information to employers during its on-site
                             inspections. In its guidance on conducting inspections, OSHA’s field
                             operations manual outlines the educational duties that inspectors have as
                             part of the inspection process. For example, inspectors are expected to
                             discuss the strengths and weaknesses of the employers’ safety and
                             health management system and advise the employer of the benefits of
                             effective systems during the closing conference of the inspection.
                             However, the field operations manual does not make any references to
                             safety incentive programs or other workplace safety policies.

                             Other OSHA resources lack guidance about safety incentive programs
                             and other workplace safety policies. Outreach specialists and materials
                             available on OSHA’s website are additional sources of information that
                             can educate employers and workers about how safety incentive programs
                             and other workplace safety policies may affect a workplace’s safety and
                             health management system. Although outreach specialists each develop


                             Page 22                                   GAO-12-329 Workplace Safety and Health
              materials and approaches for addressing the needs of employers in their
              particular geographic area, each has an opportunity to discuss the
              potential risks and benefits of safety incentive programs and the potential
              impact of workplace safety policies on injury and illness reporting during
              discussions about recordkeeping, safety and health management
              systems, and OSHA’s cooperative programs, among other topics. In
              addition, many resources are available to employers through OSHA’s
              website, including fact sheets about recordkeeping and best practices,
              such as the Effective Workplace Safety and Health Management Systems
              fact sheet. This fact sheet and several others do not discuss safety
              incentive programs or other workplace safety policies, although some do
              address aspects of a positive safety culture.


              Safety incentive programs exist in the context of a workplace’s safety
Conclusions   culture. Some types of programs, particularly those that are tied to low
              injury and illness rates, may discourage injury or illness reporting.
              However, the same programs in workplaces with positive safety cultures
              may have no effect with regard to reporting. Similarly, some workplace
              safety policies, such as those that punish workers in some way for
              reporting injuries or illnesses, may discourage workers from reporting
              injuries and illnesses, especially when implemented in a workplace with a
              negative safety culture.

              Because OSHA relies heavily on accurate injury and illness reporting in
              tailoring its programs and allocating its finite enforcement resources, it is
              important for the agency to assess the impact of safety incentive
              programs and certain workplace safety policies on injury and illness
              reporting, particularly given their prevalence. Without accurate data,
              employers engaged in hazardous activities can avoid inspections and
              may be allowed to participate in voluntary programs that reward
              employers with exemplary safety and health management systems by
              exempting them from routine inspections.

              OSHA can encourage employers to create positive safety cultures and
              avoid safety incentive programs and workplace safety policies that may
              have a negative effect on injury and illness reporting. However, because
              safety incentive programs and certain workplace safety policies are not
              addressed in OSHA guidance, including its field operations manual,
              OSHA inspectors may not consider these programs and policies during
              worksite inspections, even as they observe key aspects of the
              workplace’s safety culture. As a result, inspectors may miss opportunities
              to educate employers about the benefits of promoting a positive safety


              Page 23                                    GAO-12-329 Workplace Safety and Health
                      culture and avoiding prevalent programs and policies that can discourage
                      accurate reporting of injuries and illnesses. In addition, in the absence of
                      consistent guidance on the potential benefits and risks of some safety
                      incentive programs and workplace safety policies, OSHA may recognize
                      some employers as having exemplary safety and health management
                      systems without considering the potentially negative effects of some of
                      their programs and policies.


                      To increase consistency across OSHA’s cooperative programs, the
Recommendations for   Secretary of Labor should direct the Assistant Secretary of OSHA to
Executive Action      implement criteria on safety incentive programs and other workplace
                      safety policies across all of its cooperative programs such as VPP and
                      SHARP. The criteria should be consistent with the most recent VPP
                      guidance memorandum that prohibits employers with safety incentive
                      programs that focus on injury and illness rates from participating in the
                      program.

                      To help OSHA inspectors consistently educate employers about the
                      importance of safety culture, the Secretary of Labor should direct the
                      Assistant Secretary of OSHA to add language about key elements of a
                      positive safety culture—and the potential effect of different types of safety
                      incentive programs and other workplace safety policies—to its field
                      operations manual.


                      We provided a draft of this report to Labor for review and comment.
Agency Comments       Labor’s Assistant Secretary for OSHA provided written comments, which
                      are reproduced in appendix IV. OSHA agreed with our recommendations
                      and emphasized the agency’s concern about workplace programs that
                      appear to encourage safe work practices but actually discourage workers
                      from reporting injuries. OSHA also provided technical comments, which
                      we incorporated as appropriate.

                      In response to our recommendation that OSHA implement criteria on
                      safety incentive programs and other workplace safety policies across all
                      of its cooperative programs such as VPP and SHARP, OSHA stated that
                      it will provide policy guidance about safety incentive programs across the
                      agency’s cooperative programs. According to OSHA, this guidance will be
                      similar to the VPP policy prohibiting participants from using safety
                      incentive programs that have the potential to discourage workers from
                      reporting injuries. Establishing such criteria across all of its cooperative



                      Page 24                                    GAO-12-329 Workplace Safety and Health
programs will help OSHA accurately recognize employers with exemplary
safety and health management systems.

In response to our recommendation that OSHA add language about key
elements of a positive safety culture—and the potential effect of different
types of safety incentive programs and other workplace safety policies—
to its field operations manual, OSHA stated that it has issued guidance for
its inspectors about safety incentive programs that underscores the
agency’s position that programs that discourage workers from reporting
injuries may violate whistleblower protection statutes and OSHA’s
recordkeeping regulations. OSHA issued this guidance to regional and
whistleblower program officials in March 2012 and published it on the
agency’s website, but it has not yet been incorporated into the agency’s
field operations manual.


As agreed with your offices, unless you publically announce the contents
of this report earlier, we plan no further distribution until 30 days from the
report date. At that time, we will send copies of this report to the
Secretary of Labor, relevant congressional committees, and other
interested parties. In addition, the report will also be available at no
charge on GAO’s website at http://www.gao.gov.

If you or your staff have questions about this report, please contact me at
(202) 512-7215 or moranr@gao.gov. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last page
of this report. Key contributors to this report are listed in appendix V.




Revae E. Moran
Director, Education, Workforce, and Income Security Issues




Page 25                                     GAO-12-329 Workplace Safety and Health
List of Congressional Requesters

The Honorable Tom Harkin
Chairman
Committee on Health, Education,
  Labor and Pensions
United States Senate

The Honorable Patty Murray
Chairman
Subcommittee on Employment
  and Workplace Safety
Committee on Health, Education,
  Labor and Pensions
United States Senate

The Honorable George Miller
Ranking Member
Committee on Education and the Workforce
House of Representatives

The Honorable Lynn Woolsey
Ranking Member
Subcommittee on Workforce Protections
Committee on Education and the Workforce
House of Representatives




Page 26                              GAO-12-329 Workplace Safety and Health
Appendix I: Scope and Methodology
                           Appendix I: Scope and Methodology




Literature Review and      To determine what is known about the effect of workplace safety incentive
Expert Input on Safety     programs and other workplace safety policies on injury and illness
Incentive Programs and     reporting, we conducted a literature search for relevant studies. We
                           sought studies that analyzed the effect of workplace safety incentive
Other Workplace Safety     programs; other workplace safety policies, such as post-incident drug
Policies That May Affect   testing; or safety culture on workers’ use of safe practices; injury and
Injury and Illness         illness rates; or reporting of injuries and illnesses. To identify the studies,
Reporting                  we searched bibliographic databases covering scientific, safety, medical,
                           and economic literature, including ArticleFirst, CINAHL, EconLit,
                           Electronic Collections Online, EMBASE, MEDLINE, ProQuest, PsycINFO,
                           SciSearch, and Social SciSearch for relevant search terms and citations
                           of studies. We limited the searches to materials published in 2001 or
                           after. We performed these searches from August 2011 to October 2011,
                           and identified over 600 abstracts of studies. Among these studies, we
                           excluded those that did not satisfy our criteria that each study (1) be
                           published in a peer-reviewed journal and (2) contain relevant, primary
                           research conducted in the United States. We also excluded studies that
                           seemed duplicative or did not meet GAO’s methodological standards. To
                           assess the methodological quality of the studies, two GAO research
                           methodologists independently reviewed each study that satisfied our
                           criteria and excluded those that did not contain original research or lacked
                           rigor. Using this approach, we identified 26 methodologically sound
                           studies (see app. II for a list of the 26 studies).

                           To supplement our understanding of what is known about the effect of
                           safety incentive programs and other workplace safety policies on injury
                           and illness reporting, we interviewed experts and industry officials from
                           academia, employer associations, a law firm, a consulting firm, unions,
                           and state and federal occupational safety and health agencies. We spoke
                           with individuals from the University of Connecticut, Boston University,
                           Institute for Work and Health, United Steel Workers, United Mine Workers
                           of America, American Federation of Labor and Congress of Industrial
                           Organizations, National Association of Manufacturers, Mercer, Voluntary
                           Protection Programs Participants’ Association, Gibson, Dunn & Crutcher,
                           Occupational Safety and Health Administration (OSHA), Bureau of Labor
                           Statistics (BLS), National Institute for Occupational Safety and Health,
                           Chemical Safety Board, and state occupational safety and health
                           agencies in California, North Carolina, South Carolina, and Vermont. To
                           identify these experts and industry officials, we reviewed relevant trade
                           press and congressional transcripts and sought referrals from
                           interviewees. To ensure balance, we spoke with an array of experts and
                           industry officials with varying backgrounds and perspectives.



                           Page 27                                    GAO-12-329 Workplace Safety and Health
                          Appendix I: Scope and Methodology




Survey of Manufacturing   To study the prevalence of workplace safety incentive programs as well
Worksites                 as other workplace safety policies that may affect injury and illness
                          reporting, we surveyed a nationally representative sample of
                          manufacturing worksites. We selected a systematic random sample of
                          1,000 manufacturers from a total of 26,552 included in our sample frame
                          of data. Our sample frame consisted of the set of manufacturers with 11
                          or more employees contained in a nationally representative BLS
                          establishment survey fielded in 2010. This list was a relatively complete,
                          current source of business names and addresses that had undergone a
                          strict refinement process to remove establishments that were out of
                          business, duplicates, or miscoded. We sorted the manufacturers by the
                          sample weight for the BLS survey prior to the systematic random
                          selection in order to ensure that a range of manufacturers was obtained.

                          We designed and implemented a dual mode survey (mail and web-based)
                          to obtain information from manufacturers on the types and characteristics
                          of safety incentive programs and policies used at their workplaces, and
                          the extent to which they performed contractual work for other companies.
                          To develop our survey questions, we drew on information we gathered
                          from interviews with occupational safety and health stakeholders and
                          from scholarly studies on occupational safety and health. We pretested
                          the survey with nine manufacturers that represented the three size
                          populations of manufacturers studied (small, medium, and large) and
                          submitted the questionnaire for an additional independent review by two
                          survey specialists within GAO and experts in OSHA and BLS. We then
                          made revisions based on their feedback prior to finalizing the survey. We
                          conducted the survey using a self-administered questionnaire, and
                          offered prospective respondents the option of completing and mailing a
                          hard copy questionnaire or completing the questionnaire online (see app.
                          III for a copy of the survey). To encourage participation, we mailed a
                          reminder postcard, a second questionnaire, and made follow-up phone
                          calls to all those who had not yet responded in regular intervals prior to
                          closing the survey. A total of 663 manufacturers responded, resulting in a
                          final weighted response rate of 62.4 percent.

                          Because we surveyed a sample of manufacturers, the survey results are
                          weighted estimates for a population of manufacturers and thus are
                          subject to sampling errors associated with samples of this size and type.
                          Our sample is only one of a large number of samples we might have
                          drawn. As each sample could have provided different estimates, we
                          expressed our confidence in the precision of our particular sample’s
                          results as a 95 percent confidence interval (e.g., plus or minus 10
                          percentage points). We excluded 29 of the sampled manufacturers


                          Page 28                                   GAO-12-329 Workplace Safety and Health
Appendix I: Scope and Methodology




because we were able to determine that they were out of business at the
time of our survey or they indicated that they did not engage in
manufacturing. Therefore, all 29 of the manufacturers we excluded were
considered out of scope. All estimates produced from the sample and
presented in this report are representative of the in-scope population.

The practical difficulties of conducting any survey may introduce errors
resulting from the data collection procedures, commonly referred to as
nonsampling errors, which can introduce unwanted variability into the
survey results. There are four primary sources of nonsampling error:

1. Measurement—error in responses recorded on the survey
   instruments resulting from poorly worded, biased, or sensitive
   questions; ambiguous instructions; or lack of information available to
   respondents.

2.    Nonresponse—bias from failing to get responses from
     establishments whose answers would have differed significantly from
     those that did participate.

3. Coverage—bias from failing to include all eligible establishments or
   from including ineligible establishments in the list from which we
   sampled.

4. Data processing—error arising from faulty handling or processing of
   the data.

We took extensive steps in developing the questionnaire, collecting the
data and analyzing the results to address the potential sources of
nonsampling error. To minimize measurement error, GAO staff with
subject-matter expertise collaborated with a survey design specialist to
develop the questionnaire. We pretested the instrument using cognitive
interviewing techniques and interviewed the pretest respondents to
ensure that (1) the questions and instructions were clear, unambiguous,
and in the correct order; (2) the terms we used were precise; (3) the
survey did not place an undue burden on the respondents completing it;
and (4) the survey was unbiased. To assess the risk of nonresponse bias,
we obtained answers over the phone to three survey questions from 19
nonrespondents. We statistically compared the answers from the
nonrespondents with those of our respondents on these three questions
and found no statistically significant differences. Our sample frame
minimized the risk of coverage error by drawing on a nationally
representative list of manufacturers that was thoroughly reviewed and



Page 29                                  GAO-12-329 Workplace Safety and Health
                            Appendix I: Scope and Methodology




                            cleaned to remove ineligible establishments. Finally, we took several
                            steps to reduce processing errors: (1) Quality control measures were
                            implemented during preparation and mailout of survey packages to
                            ensure that the respondents would receive the package with the proper
                            login identification number and that the packages contained the correct
                            contents. (2) We contracted with an outside company to enter the data
                            from the paper questionnaires into a database, and we checked a 10
                            percent sample of the database as a quality control measure. (3)
                            Respondents who completed questionnaires online entered their answers
                            directly which eliminated the errors associated with a manual data entry
                            process. (4) After we analyzed the data, a second independent data
                            analyst checked all of the computer programs for accuracy.


Examination of OSHA’s       To examine OSHA’s efforts to address safety incentive programs, we
Efforts to Address Safety   reviewed relevant federal laws and regulations, OSHA’s policies and
Incentive Programs and      procedures, and interviewed OSHA officials regarding the agency’s
                            activities. We interviewed selected OSHA officials from the agency’s
Workplace Policies          national office as well as several regional and area offices to learn about
                            (1) their efforts to address the potential impact of safety incentive
                            programs and workplace policies on injury and illness reporting, (2) the
                            recordkeeping enforcement initiative, and (3) their views on safety
                            incentive programs and the potential relationship between these
                            programs and injury and illness reporting. We interviewed officials from
                            three regional offices and five area offices representing 5 of the 10
                            different OSHA regions. In all of these interviews we attempted to meet
                            with regional and area office officials with experience in the recordkeeping
                            enforcement initiative and those that oversee cooperative programs and
                            other outreach and training efforts. We visited five OSHA offices and
                            spoke with officials from four state occupational safety and health
                            agencies. We selected these offices based on their geographic dispersal
                            and representation of OSHA regions.

                            To assess the results of OSHA’s recordkeeping enforcement initiative, we
                            analyzed data from the OSHA Recordkeeping Inspection Assistant
                            database, which contains records of the inspections OSHA conducted in
                            2009, 2010, and 2011. Prior to our analysis, we assessed the reliability of
                            the OSHA Recordkeeping Inspection Assistant database by reviewing
                            information obtained from OSHA about the database, and interviewing a
                            knowledgeable agency official. Where there were discrepancies in the
                            data, we worked with this official to clarify and, in some cases, correct the
                            data. For example, we found two records that were missing key
                            identifying information about the OSHA region in which the inspections


                            Page 30                                   GAO-12-329 Workplace Safety and Health
Appendix I: Scope and Methodology




occurred. On the basis of our assessment, we concluded that the updated
data were sufficiently reliable for our reporting purposes.

We conducted this performance audit from September 2010 to April 2012
in accordance with generally accepted government auditing standards.
These standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.




Page 31                                GAO-12-329 Workplace Safety and Health
Appendix II: Studies on the Effect of Safety
               Appendix II: Studies on the Effect of Safety
               Incentive Programs, Workplace Safety
               Policies, and Safety Culture on Workplace

Incentive Programs, Workplace Safety Policies,
               Safety




and Safety Culture on Workplace Safety
               Alavosius, Mark, Jim Getting, Joseph Dagen, William Newsome, and Bill
               Hopkins. “Use of a Cooperative to Interlock Contingencies and Balance
               the Commonwealth.” Journal of Organizational Behavior Management,
               vol. 29, no. 2 (2009): 193-211.

               Brown, Jean Geiger, Alison Trinkoff, Kenneth Rempher, Kathleen
               McPhaul, Barbara Brady, Jane Lipscomb, and Charles Muntaner. “Nurses
               Inclination to Report Work-Related Injuries: Organizational, Work-Group,
               and Individual Factors Associated with Reporting.” AAOHN Journal,
               vol. 53, no. 5 (2005): 213-217.

               Chowdhury, Sanjib K., and Megan Lee Endres. “The Impact of Client
               Variability on Nurses’ Occupational Strain and Injury: Cross-Level
               Moderation by Safety Climate.” Academy of Management Journal,
               vol. 53, no. 1 (2010): 182-198.

               DeJoy, David M., Lindsay J. Della, Robert J. Vandenberg, Mark G.
               Wilson. “Making Work Safer: Testing a Model of Social Exchange and
               Safety Management.” Journal of Safety Research, vol. 41, no.2 (2010):
               163-171.

               Evans, Demetrice D., Judd H. Michael, Janice K. Wiedenbeck, and
               Charles D. Ray. “Relationships Between Organizational Climates and
               Safety-Related Events at Four Wood Manufacturers.” Forest Products
               Journal, vol. 55, no. 6 (2005): 23-28.

               Fugas, Carla S., José L. Meliá, and Silvia A. Silva. “The “Is” and the
               “Ought”: How Do Perceived Social Norms Influence Safety Behaviors at
               Work?” Journal of Occupational Health Psychology, vol. 16, no. 1 (2011):
               67-79.

               Gangwar, Manish, and Paul M. Goodrum. “The Effect of Time on Safety
               Incentive Programs in the US Construction Industry.” Construction
               Management and Economics, vol. 23, no. 8 (2005): 851-859.

               Hinze, Jimmie. “Safety Incentives: Do They Reduce Injuries?” Practice
               Periodical on Structural Design and Construction, vol. 7, no. 2 (2002):
               81-84.

               Hofmann, David A., and Barbara Mark. “An Investigation of the
               Relationship Between Safety Climate and Medication Errors As Well As
               Other Nurse and Patient Outcomes.” Personnel Psychology, vol. 59, no. 4
               (2006): 847-869.


               Page 32                                        GAO-12-329 Workplace Safety and Health
Appendix II: Studies on the Effect of Safety
Incentive Programs, Workplace Safety
Policies, and Safety Culture on Workplace
Safety




Hoonakker, Peter, Todd Loushine, Pascale Carayon, James Kallman,
Andrew Kapp, and Michael J. Smith. “The Effect of Safety Initiatives on
Safety Performance: A Longitudinal Study.” Applied Ergonomics, vol. 36,
no. 4 (2005): 461-469.

Huang,Yueng-Hsiang, Michael Ho, Gordon S. Smith, and Peter Y. Chen.
“Safety Climate and Self-Reported Injury: Assessing the Mediating Role
of Employee Safety Control.” Accident Analysis and Prevention, vol. 38,
no. 3 (2006): 425-433.

Lauver, Kristy J., Chris Quinn Trank, and Huy Le. “Information by Design:
How Employee Perceptions of Organizational Design Relate to Injury
Reporting.” Journal of Leadership and Organizational Studies, vol. 18,
no. 3 (2011): 344-352.

Lauver, Kristy J., and Scott W. Lester. “Get Safety Problems to the
Surface: Using Human Resource Practices to Improve Injury Reporting.”
Journal of Leadership and Organizational Studies, vol. 14, no. 2 (2007):
168-179.

Leiss, Jack K. “Management Practices and Risk of Occupational Blood
Exposure in U.S. Paramedics: Needlesticks.” American Journal of
Industrial Medicine, vol. 53, no. 9 (2010): 866-874.

Ludwig,Timothy D., Jay Biggs, Sandra Wagner, and E. Scott Geller.
“Using Public Feedback and Competitive Rewards to Increase the Safe
Driving of Pizza Deliverers.” Journal of Organizational Behavior
Management, vol. 21, no. 4 (2001): 75-104.

Mark, Barbara A., Linda C. Hughes, Michael Belyea, Yunkyung Chang,
David Hofmann, Cheryl B. Jones, and Cynthia T. Bacon. “Does Safety
Climate Moderate the Influence of Staffing Adequacy and Work
Conditions on Nurse Injuries?” Journal of Safety Research, vol. 38, no. 4
(2007): 431-446.

Michael, Judd H., Zhen George Guo, Janice K. Wiedenbeck, Charles D.
Ray. “Production Supervisor Impacts on Subordinates’ Safety Outcomes:
An Investigation of Leader-Member Exchange and Safety
Communication.” Journal of Safety Research, vol. 37, no. 5 (2006):
469-477.




Page 33                                        GAO-12-329 Workplace Safety and Health
Appendix II: Studies on the Effect of Safety
Incentive Programs, Workplace Safety
Policies, and Safety Culture on Workplace
Safety




Morantz, Alison D., and Alexandre Mas. “Does Post-Accident Drug
Testing Reduce Injuries? Evidence from a Large Retail Chain.” American
Law and Economics Review, vol. 10, no. 2 (2008): 246-302.

Morrow, Stephanie L., Alyssa K. McGonagle, Megan L. Dove-Steinkamp,
Curtis T. Walker Jr., Matthew Marmet, and Janet L. Barnes-Farrell.
“Relationships Between Psychological Safety Climate Facets and Safety
Behavior in the Rail Industry: A Dominance Analysis.” Accident Analysis
and Prevention, vol. 42, no. 5 (2010): 1460-1467.

Probst, Tahira M., and Armando X. Estrada. “Accident Under-Reporting
Among Employees: Testing the Moderating Influence of Psychological
Safety Climate and Supervisor Enforcement of Safety Practices.”
Accident Analysis and Prevention, vol. 42, no. 5 (2010): 1438-1444.

Probst, Tahira M., Ty L. Brubaker, and Anthony Barsotti. “Organizational
Injury Rate Underreporting: The Moderating Effect of Organizational
Safety Climate.” Journal of Applied Psychology, vol. 93, no. 5 (2008):
1147-1154.

Seo, Dong-Chul. “An Explicative Model of Unsafe Work Behavior.” Safety
Science, vol. 43, no. 3 (2005): 187-211.

Smith, Gordon S., Yueng-Hsiang Huang, Michael Ho, and Peter Y. Chen.
“The Relationship Between Safety Climate and Injury Rates Across
Industries: The Need to Adjust for Injury Hazards.” Accident Analysis and
Prevention, vol. 38, no. 3 (2006): 556-562.

Vredenburgh, Alison G. “Organizational Safety: Which Management
Practices are Most Effective in Reducing Employee Injury Rates?”
Journal of Safety Research, vol. 33, no. 2 (2002): 259-276.

Wallace, Craig, and Gilad Chen. “A Multilevel Integration of Personality,
Climate, Self-Regulation, and Performance.” Personnel Psychology,
vol. 59, no. 3 (2006): 529-557.

Zohar, Dov, and Gil Luria. “The Use of Supervisory Practices as Leverage
to Improve Safety Behavior: A Cross-Level Intervention Model.” Journal of
Safety Research, vol. 34, no. 5 (2003): 567-577.




Page 34                                        GAO-12-329 Workplace Safety and Health
Appendix III: Questionnaire Used for GAO’s
              Appendix III: Questionnaire Used for GAO’s
              Survey of Manufacturing Worksites



Survey of Manufacturing Worksites




              Page 35                                      GAO-12-329 Workplace Safety and Health
Appendix III: Questionnaire Used for GAO’s
Survey of Manufacturing Worksites




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Appendix III: Questionnaire Used for GAO’s
Survey of Manufacturing Worksites




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Appendix III: Questionnaire Used for GAO’s
Survey of Manufacturing Worksites




Page 38                                      GAO-12-329 Workplace Safety and Health
Appendix III: Questionnaire Used for GAO’s
Survey of Manufacturing Worksites




Page 39                                      GAO-12-329 Workplace Safety and Health
Appendix III: Questionnaire Used for GAO’s
Survey of Manufacturing Worksites




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Appendix III: Questionnaire Used for GAO’s
Survey of Manufacturing Worksites




Page 41                                      GAO-12-329 Workplace Safety and Health
Appendix III: Questionnaire Used for GAO’s
Survey of Manufacturing Worksites




Page 42                                      GAO-12-329 Workplace Safety and Health
Appendix IV: Comments from the
             Appendix IV: Comments from the Department
             of Labor



Department of Labor




             Page 43                                     GAO-12-329 Workplace Safety and Health
Appendix IV: Comments from the Department
of Labor




Page 44                                     GAO-12-329 Workplace Safety and Health
Appendix V: GAO Contact and Staff
                  Appendix V: GAO Contact and Staff
                  Acknowledgments



Acknowledgments

                  Revae Moran, (202) 512-7215 or moranr@gao.gov
GAO Contact
                  In addition to the contact named above, Gretta L. Goodwin, Assistant
Staff             Director, and Joel Green, Analyst-in-Charge, managed all aspects of this
Acknowledgments   assignment; James E. Lloyd III and Michelle Loutoo Wilson made
                  significant contributions to all phases of the work; Grace Cho made
                  substantial contributions to data analysis and message and report
                  development; Carl Barden and Pamela Davidson provided assistance in
                  designing the study, conducting data analysis, and developing the report;
                  Lorraine Ettaro, Stuart Kaufman, and Carl Ramirez helped with survey
                  administration; Delores Hemsley assisted in data collection; Catherine
                  Hurley assisted in data analysis; Ashley McCall provided literature search
                  assistance; Barbara Chapman, Cynthia Saunders, and Elizabeth Wood
                  assisted in the methodological review of studies; Susannah Compton
                  assisted in message and report development; James Bennett created the
                  report’s graphics; Sarah Cornetto provided legal advice; and Amber
                  Yancey-Carroll and Anna Bonelli reviewed the report to check the facts
                  presented.




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                  Page 45                                  GAO-12-329 Workplace Safety and Health
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