Strengthening Jobsite Safety Climate: Eight Worksheets to Help You Use and Improve Leading Indicators

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Linda Goldenhar
CPWR - The Center for Construction Research and Training

Summary Statement

This CPWR booklet is designed to help management, safety professionals, and hourly craft workers learn more about important leading safety indicators and ideas for strengthening jobsite safety climate. The booklet includes a worksheet for each of the following indicators: 1. Demonstrating management commitment 2. Aligning and integrating safety as a value 3. Ensuring accountability at all levels 4. Improving site safety leadership 5. Empowering and involving workers 6. Improving communication 7. Training at all levels 8. Encouraging owner/client involvement If you would like one or more printed copies of the workbook please email Sherri Wilson at swilson@cpwr.com with your request and shipping address. The booklets are free and we will be pleased to ship them to you.
August 2014

Contents

Construction companies in partnership with workers are responsible for ensuring that jobsite hazards are eliminated, or at least minimized. These partnerships are most effective when they exist within a positive safety climate.

The safety climate on a specific construction project refers to managements’ and workers’ shared perceptions of the adequacy of the safety and health programs and the consistency between the organization’s espoused safety policies/procedures and the actual conditions at the jobsite. It is the combination of safety climates from multiple organizations including the project owner, construction manager/general contractor, and subcontractors and it may be influenced by local conditions such as project delivery, scheduling, planning methods and existing norms amongst involved trades.

Construction companies remain overly dependent on lagging safety indicators, such as injury and illness rates, to identify needed safety improvements. However, lagging indicators do not help companies learn how to prevent injuries and illnesses before they occur. Companies, and the construction industry as a whole, need to shift the focus from lagging to leading indicators. A leading indicator is a measure that precedes injuries or illnesses and is used to drive activities that, when properly implemented, prevent and control injuries and illnesses and fosters a strong positive jobsite safety climate.

How to Use the Worksheets

  1. First, review the 5-level scoring scale to assess if your company’s safety culture maturity level for that indicator is: Uninformed; Reactive; Compliant; Proactive; or Exemplary.
  2. Timeframe checklistNext, review all of the ideas presented below the scale. For each idea, select one of the four options shown to the right to realistically prioritize actions you or your company can take to become more exemplary with respect to that indicator and improve jobsite safety climate and organizational safety culture.

 

Congratulations, if you’ve already adopted some of the ideas! Your company is on its way to having an exemplary safety culture.

Demonstrating Management Commitment

Management includes those who have the power and responsibility to make decisions and oversee an organization. Their role is to organize, coordinate, and oversee activities to achieve clearly defined objectives in accordance with policies and procedures. In construction, management commitment to keeping workers safe (demonstrated through both words and actions) is critical for establishing and maintaining a positive safety climate. Just saying “safety is #1” does not automatically translate into a positive safety climate. In fact, just saying it can have the opposite effect. There are many ways management can demonstrate its commitment to jobsite safety. Which of the following best describes your company?

UNINFORMED REACTIVE COMPLIANT PROACTIVE EXEMPLARY
Representation from management rarely comes to the actual jobsite. When they are present, they often act as poor safety role models by breaking organizational safety policies and procedures. Management does not participate in safety audits. If employees bring concerns to any level of management they are not acted upon. Management gets involved only after an injury occurs. They often blame workers for injuries, leading to suspension or even termination. Safety rules are enforced only after an incident or when audit results are negative. Management conforms strictly to OSHA regulations, never more or less. Safety compliance is based on owner or regulatory directives. Managers participate in safety audits. Management initiates and actively participates in safety audits. Managers meet with workers to ask for advice and feedback regarding hazard reduction. Management conducts spontaneous site visits and recognizes workers for identifying hazards, working safely, and keeping co-workers safe. Leaders participate in safety program development and provide adequate resources to ensure a positive safety climate. The safety management system is reviewed annually to ensure effectiveness and relevance. Management integrates safety into every meeting and engages in continuous improvement regarding safety conditions and hazard reduction. External audits are conducted to evaluate top management’s involvement in safety. Managers are held accountable for safety expectations through annual performance evaluations. Safety trends are analyzed. There is a formalized process for corrective actions.

How to become exemplary

Review the ideas below and check the short-term (1-2 months), mid-term (6-12 months), or long-term (1-2 years) circle to indicate which you will commit to adopt and by when. Congratulations, if you’ve already adopted the idea!

Idea 1—Develop safety policies, procedures, and guidelines to ensure they are aligned with other organizational priorities

Timeframe checklistSafety is relevant to many organizational policies and procedures. By incorporating and integrating appropriate safety language into applicable policies and procedures, organizational members will trust that the company really does value safety and more importantly values their employees.

Idea 2—Management should be visible to workers and reflect good safety practices

Timeframe checklistOn some sites workers never see senior management. Messages about the company’s commitment to safety are sent down the “chain of command” rather than being delivered face-to-face. Workers are more likely to appreciate, value, and internalize the safety messages if they are occasionally delivered by higher-level management. Also, when senior management is on the jobsite, it is important that they act as ideal safety role models by wearing the proper PPE (e.g., gloves, glasses, boots, hearing protection, etc.).

Idea 3—Allocate adequate resources to effectively implement safety activities

Timeframe checklistWhile written safety policies and procedures are necessary, it is critical that management make available sufficient resources for effective implementation and maintenance of safety-related activities. Financial resources should be allocated for ongoing education, including leadership/communication training for supervisors, OSHA 10 and 30 training for everyone in the organization, and also purchasing and providing appropriate PPE for everyone onsite. Investing in systems for collecting information on incidents and close calls, safety climate, and effectiveness evaluation of any changes made also clearly demonstrates management commitment to continuously improving jobsite safety climate.

Idea 4—Management should actively participate in all meetings at all levels

Timeframe checklistManagement should actively participate in meetings where hazards are reviewed. If it’s a meeting where safety is not typically discussed, management should take the initiative to start the discussion. These types of behaviors provide a direct line of communication between workers and management and help demonstrate to all employees that the organization values safety.

Idea 5—Management should strive for Zero Hazard as well as Zero Injury worksites

Timeframe checklistIn pursuit of achieving zero injuries, companies should periodically conduct (or have an outside party conduct) job hazard analyses using audits or other tools. Data from these audits provide guidance on where changes to processes and products might be needed to help ensure zero injuries on current and future jobsites. Reward structures should be designed to encourage workers to proactively identify hazards, and report close calls as well as injuries. Management might also consider measuring jobsite safety climate throughout the organization during a project or activities to gauge safety-related perceptions that may negatively (or positively) affect incident prevention.

Idea 6—Establish formalized process for corrective action

Timeframe checklistWhen a safety situation arises, management must take the employee’s concern seriously, and address it visibly and promptly. When workers’ concerns are ignored, or if management retaliates, workers quickly lose trust in the system and are discouraged from reporting potential hazards in the future. Establishing a formalized process to respond to safety concerns and to conduct blame-free investigations of close calls and incidents reflects strong commitment to safety. Management should review all serious incident reports, determine contributing factors, and communicate findings throughout the organization. Consider implementing an on-line incident reporting system that notifies management when a hazardous condition is identified or a close call occurs. In addition, consider creating an “action list” to show how issues raised by workers are being addressed. Place the list in a prominent place for all to see. This reinforces the message that workers’ contributions to creating a positive safety climate are valued and will help keep them involved.

Aligning and Integrating Safety as a Value

For an organization to develop and maintain an effective and stable safety climate, management and owners need to align and integrate safety throughout its activities to ensure that safety is not treated as less important than any other function of business practices. This is done by embedding and integrating safety-related language and responsibilities into policies and procedures, including performance evaluations, and clearly and consistently communicating safety as an expectation. Commitment to safety is also demonstrated by never compromising it for the sake of productivity. Employees of companies that do this perceive safety as a core company value rather than an additional burden or diversion from “normal” operations. The perception that safety will not be compromised is integral to achieving a positive project or organizational safety climate. Which of the following best describes your company?

UNINFORMED REACTIVE COMPLIANT PROACTIVE EXEMPLARY
Safety is considered to be a cost; a necessary evil. It is not integrated within policies/procedures. Primary focus is on productivity. There is an inadequate budget for implementing safety activities. Belief is that construction is inherently dangerous and nothing can be done to change it. Bids include a budget for OSHA fines. Accidents are viewed as human error and are punished. Safety is inconsistently communicated as a priority. When a project falls behind schedule, production becomes valued more than safety. Safety is not valued or enforced when work is conducted on varying shifts or on Saturdays based on the theory that no one is looking (e.g., management, safety professionals, or OSHA). Safety policies are not reviewed routinely for consistency or relevancy. Minimum OSHA requirements are set as the company standard. Safety indicators focus solely on lagging indicators. Safety meetings are conducted when required. Company includes safety and health in bids. Subcontractor selection is based on safety and health performance – as well as bid. Safety is not compromised for the sake of productivity. Company uses principles of Prevention through Design (PtD) to reduce hazard exposures and injuries. Routine inspections are completed with items tracked to abatement. Safety is integrated into policies and procedures, formally and informally, and communicated vertically and horizontally throughout the company. All meetings include, and preferably start with safety. Safety is never compromised for productivity. Regular company-wide safety communications reinforce the culture of safety as a value (newsletters, alerts, leadership messages, safety topics, etc.). Company measures and uses leading indicators to improve safety climate on worksites. Prevention through Design (PtD) is seamless

How to become exemplary

Review the ideas below and check the short-term (1-2 months), mid-term (6-12 months), or long-term (1-2 years) circle to indicate which you will commit to adopt and by when. Congratulations, if you’ve already adopted the idea!

Idea 1—Integrate safety expectations into policies, procedures, and guidelines to ensure they are aligned with other organizational priorities

Timeframe checklistIt may be that safety is not relevant to all policies and procedures, but it probably is to most of them. By incorporating and integrating appropriate safety language into those that are, organizational members will trust that the company really does value safety, and more importantly values their employees. Of course just writing it down does not make it happen. Adequate training and resources need to be made available to those responsible for implementing safety policies, and ensuring that worker safety is really the primary value.

Idea 2—Bring together people from different departments and groups to discuss project related safety strategies

Timeframe checklistA positive safety climate thrives when employees in different departments or groups within an organization (or across different organizations) are given the opportunity to communicate about project-specific safety issues. For example, architects, engineers, construction workers, subcontractor managers, and even human resource employees have different perspectives on project-related safety implications and likely have different strategies for managing them. By bringing all parties to the table to discuss safety during project planning and execution, relationships are built, mutual trust is established, and safety becomes integrated and valued.

Idea 3—Reinforce safety through on-going training

Timeframe checklistSupervisors and workers play an important role in identifying and addressing potential hazards. Ensuring that supervisors and workers receive training to effectively implement safety based on their roles helps everyone better understand their responsibilities for creating safe jobsite conditions. It also indicates that the organization values safety as part of productivity. Supervisor training should emphasize that safety cannot be compromised. It should focus on hazard identification, leadership, and communication skills needed to create and sustain a positive safety climate on the jobsite. Training for workers should equip them to be proactive agents in identifying and reporting potential safety hazards. Workers should also be aware of their right to stop work in cases of serious or imminent danger.

Idea 4—Ensure safety is discussed at all regularly scheduled meetings

Timeframe checklistIncorporate safety issues into production and design meetings, weekly supervisory meetings, and other regularly scheduled management meetings. Start all meetings with a “safety minute”. Safety should be the focal point at all on-site, weekly, and daily planning meetings. Train supervisors to carry out safety-focused discussions with workers throughout the day about potential hazards and any close calls/good catches they may have experienced or witnessed. Whenever hazards are identified in any of these meetings they should be promptly addressed and all employees should be informed of how the issue has been or will be mitigated.

Idea 5—Periodically assess if the company’s espoused safety-related values are aligned with other values such as productivity, reducing cost, etc.

Timeframe checklistGathering both quantitative (surveys, audits) or qualitative (informal interviews, focus groups) safety climate data from workers and managers can help determine if there is a gap between what a company says about its safety values and its employees’ perceptions. The information can be used to reveal where changes may be needed. Data should also be collected after changes are made to determine if safety climate has improved. Questions can assess the degree to which:

  • employees share a proactive vision of safety;
  • organizational safety goals are understood;
  • accountability is equal and applied evenly at all levels;
  • management demonstrates commitment to worker safety and health;
  • the roles and responsibilities for implementing safety are clearly defined and understood;
  • employees are a part of the safety process;
  • safety is valued equal to or greater than production;
  • workers feel empowered to stop work if they identify a hazardous situation;
  • the principles of prevention through design (PtD) are embraced; and
  • safety is integrated into planning and part of everything the organization does.

Ensuring Accountability at All Levels

A positive and effective safety climate cannot exist without accountability throughout an organization. Everyone involved in a construction project should be held accountable for safety, including owners, management, safety personnel, supervisors, and workers. Specific responsibilities for implementing safety need to be clearly defined at all levels by role, and communicated and reinforced throughout the organization regularly. Which of the following best describes your company?

UNINFORMED REACTIVE COMPLIANT PROACTIVE EXEMPLARY
There is no formal safety training provided to workers, supervisors, or managers. Expectations are not clearly articulated. Workers are the only ones held accountable for safety performance. Management performance reviews do not include safety metrics. Bonuses are based on the number of reported injuries, which discourages reporting. Investigations into incidents or close calls result in punitive action toward employees. There are no written safety or health policies. Workers are automatically punished (e.g., fined or fired) for poor safety performance. Poor project safety performance carries few consequences for supervisors. Safety goals are not established and metrics are not gathered prospectively or used to evaluate performance. Established safety goals are based only on OSHA guidelines. Company collects injury and illness data, but they are not shared with supervisors or workers. Incident investigations are conducted but not in a “blame free” manner. Safety goals go above and beyond OSHA guidelines to structure supervisor performance evaluations and ensure continuous improvement. All employees are recognized and sometimes rewarded for identifying hazards, reporting close calls, creating safety solutions and for superior safety performance. Incident investigations result in positive outcomes driving improvement. Safety commitment and expectations are consistently communicated across the company, and to all business partners. Everyone is recognized and included in safety awards based on leading vs. lagging indicators. Supervisor and worker performance evaluations are based on leading and lagging safety indicators. Safety metrics are benchmarked against other companies and used for internal continuous quality improvement. Safety performance is a primary factor in hiring managers and subcontractors, and for promotions. All members of a project team are responsible for safety activities. Incident investigations result in positive outcomes driving improvement. Lessons learned are shared.

How to become exemplary

Review the ideas below and check the short-term (1-2 months), mid-term (6-12 months), or long-term (1-2 years) circle to indicate which you will commit to adopt and by when. Congratulations, if you’ve already adopted the idea!

Idea 1—Create an incentive structure that promotes and rewards safety processes not just outcomes

Timeframe checklistCompanies may create a disincentive to report incidents if workers, supervisors and crews are rewarded for achieving a low recordable injury rate. This can send mixed messages about the degree to which safety really is valued compared to productivity and other organizational requirements. These types of mixed messages can lead to confusion and damage the mutual trust between workers and management necessary to achieve a positive safety climate. A better approach is to recognize and reward employees for identifying, reporting, and even mitigating hazards. Management could implement an on-line incident reporting system so they can be notified when an incident or close call is reported. Make sure all on-site personnel can access it so barriers aren’t created. An “action list” could be created and placed in a prominent place showing how issues raised by workers are being addressed, and who was rewarded for identifying the hazard. This creates a climate that reinforces the notion that workers’ contributions for implementing safety are valued.

Idea 2—Develop, distribute, and implement written safety policies to form the foundation of a strong safety climate

Timeframe checklistWritten safety policies should clearly describe expectations, roles, and responsibilities for establishing and maintaining a positive jobsite safety climate. The policies should come from and be signed by the CEO. The policies should be disseminated to and reviewed with all employees, incorporated into the organization’s safety manual, and be reinforced verbally on a day-to-day basis through various task planning discussions.

Idea 3—Conduct blame-free incident investigations

Timeframe checklistCursory investigations of incident occurrences that seek to blame rather than learn, hamper the development of a positive safety climate and the free flow of information. Such investigations can generate a climate of fear among workers that often leads to under- or non-reporting of potential hazards, close calls, and injuries. While underreporting may improve a company’s safety record, it does not lead to a stronger safety climate and indeed might weaken it. Front-line supervisors need training on how to conduct blame-free incident and close call investigations. Investigations should use root-cause analyses to examine the environmental, organizational, and human factors contributing to these incidents, and mechanisms must be put in place to share findings throughout the organization.

Idea 4—Incorporate safety leadership into supervisor evaluations

Timeframe checklistA supervisor’s annual performance evaluation should emphasize his/her leadership skills with respect to safety. A competency rubric (like the one above) could be developed that lays out the expectations for poor to superior performance. The rubric would contain leadership behaviors such as the supervisor’s ability to empower workers to identify hazards and stop work if necessary, report incidents, and participate in blame-free incident investigations. The rubric-based evaluation data can be gathered by asking workers directly about on-site safety leadership and by observational methods. Strengths and shortcomings identified in the evaluation are discussed with supervisors and improvement goals are established.

Idea 5—Owners should also be accountable for safety

Timeframe checklistOne method for making owners accountable for safety is by having them adopt Owner-Controlled Insurance Programs (OCIPs). An OCIP is a self-insurance program where owners pay out-of-pocket for health care and lost-time costs, giving them a visible financial stake in maintaining safety on their sites. Rather than each contractor and subcontractor purchasing insurance (including Workers’ Compensation) separately and charging the owner, in an OCIP the owner purchases the insurance for all parties on the site and thus has a financial incentive to proactively address hazards before an incident occurs.

Improving Supervisory Leadership

Supervisors have the authority and ability to make changes and correct hazards on the jobsite. Therefore, how they lead, act as role models, and communicate are probably the most important factors in determining the degree to which a strong positive project safety climate is achieved. The organization’s expectations are key to shaping supervisors’ safety-related attitudes and behaviors. Which of the following best describes your company?

UNINFORMED REACTIVE COMPLIANT PROACTIVE EXEMPLARY
There is no safety-related vision or leadership. Supervisors have no supervisory training and have little understanding or knowledge of regulatory requirements. Supervisors manage and punish using intimidation and the focus is only on individual behavior without taking the process into account. Supervisors play the blame game when an incident occurs instead of performing root-cause analysis. There is no system of accountability or it is not applied evenly. The focus is on production. Supervisors ignore crew input regarding potential hazards and close calls. They focus on individual behaviors as a foundation for safety, and do not consider underlying factors that can impact safety conditions. The organization becomes concerned with safety and the supervisor’s leadership skills only after an incident occurs or regulatory action is taken. Supervisors follow OSHA regulations. The organization provides or requires training to meet regulatory guidelines. Supervisors participate in and initiate safety program activities that are focused on continuous improvement. Supervisors seek advice from and use worker input to improve site safety. Supervisors are provided with and required to take training in safety communication, motivation, and preplanning. Supervisors are required to attain a Safety Trained Supervisor (STS) credential. As a result, supervisors display a personal vision for, and a deep commitment to, creating a strong, positive project safety climate. They inspire and motivate workers to share that same commitment. They establish clear safety-related roles and responsibilities, make safety a major component of all meetings and instill a sense of safety ownership at all levels. Supervisors are effective communicators, excellent role models for safety, and are able to coach and teach safety to their crew.

How to become exemplary

Review the ideas below and check the short-term (1-2 months), mid-term (6-12 months), or long-term (1-2 years) circle to indicate which you will commit to adopt and by when. Congratulations, if you’ve already adopted the idea!

Idea 1—Supervisors are well-trained, not just on hazards, but also on leadership skills

For most people, leadership skills are not innate; they must be learned through education, training, and experience. Below are 4 aspects of a true leader. While one wouldn’t necessarily be trained separately on each of these, you can use the scale to evaluate where your supervisors are currently and prioritize areas that need more work.

1a. Leads by Example – Is a role model for safety - “Walks the Talk”

Timeframe checklistCrews are constantly observing the supervisor’s safety-related attitudes and behaviors to learn what the safety-related expectations are on the jobsite. Supervisors who learn the skills to lead by example are able to demonstrate through their words and actions that safety is valued. Consistency is key. Supervisors who are inconsistent with their message that safety is never compromised will reinforce worker’s perceptions that productivity trumps safety, and that it’s ok to cut corners, to wear PPE only 80% of the time, ok not to report a close call, or ok to not stop work when they identify a hazard. Supervisors who consistently send and demonstrate pro-safety messages can expect more positive outcomes.

1b. Encourages Innovation

Timeframe checklistExemplary companies expect their supervisors to communicate with their crew members, not only about work but also about hazard identification. This can be done during daily pre-task planning meetings where the supervisor and crew talk about the work to be done that day and cooperatively identify the potential safety problems, along with ideas on how to control them. This creates a climate where workers, who are exposed to the risk more than anybody else and probably have thought of good practical solutions, don’t feel foolish coming forward with their ideas. Depending on the complexity of the solution, the company can reward the worker(s) with a cash bonus for their solution.

1c. Is a Coach

Timeframe checklistA supervisor with good coaching skills creates safety goals in partnership with the crew members, and helps them achieve those goals by removing barriers and providing feedback when things are going well, but also when things need to be improved. The ability to provide constructive feedback is essential. It may not come naturally, but it is a skill that can be learned. There are 3 steps for providing constructive feedback. First, provide context by telling workers exactly what was observed. Then, explain why it was healthy or risky and what outcome might result if the activity continues. Finally, end the conversation with a goal and a plan for making changes (if needed) using worker input and suggestions. Feedback should be given frequently and in a timely manner. Remember that goals should be in line with the overall expectations of the safety management system and should drive the continuous improvement process.

1d. Motivates Others

Timeframe checklistSupervisory leaders motivate their crew by empowering them to participate in their own and each other’s safety. Supervisors must ensure everyone understands there are certain expectations, obligations, and opportunities for everyone. These include: attending and providing input at daily pre-task planning meetings, taking all required safety training, using information learned, stopping work and notifying leads or supervisor when hazards are identified, and reporting all close calls and incidents. Trust is gained when supervisors listen and take seriously input from their crew and involve them in implementing suggestions. It is also critical that when an incident occurs, supervisors and crew members work as partners to conduct a blame-free root-cause analysis. Together they can identify lessons learned and make plans to reduce the risk that the incident will occur again.

Idea 2—Performance evaluations focus primarily on being a good safety leader

Timeframe checklistA supervisor’s annual performance evaluation should emphasize his/her leadership skills with respect to safety in addition to their contribution toward safety goals that were established at the beginning of the year. A competency rubric like the one above could be developed that lays out the expectations for poor to superior performance. The rubric would contain leadership behaviors described above. The rubric-based evaluation information can be gathered by asking the workers for input and also by direct observational methods. Management would discuss the strengths and shortcomings identified by the evaluation with the supervisors and together establish improvement goals, including additional leadership training.

Empowering and Involving Workers

Involving workers in safety-related planning and decision making and empowering them to speak up when they identify hazards will help bridge the communication gap between workers and management, build mutual trust, and promote a shared belief that a positive safety climate is integral to getting the job done. Which of the following best describes your company?

UNINFORMED REACTIVE COMPLIANT PROACTIVE EXEMPLARY
Management isn’t interested in and therefore doesn’t involve workers in safety discussions or empower them to share responsibility for their and their coworkers’ safety. Management passes down safety messages to employees only when there is an incident, injury, or negative event. Workers aren’t engaged in promoting safety. Safety committees meet only when someone is hurt. Inspections are not carried out routinely and items found on inspections are not prioritized or tracked to abatement. There is no accountability at any level with respect to safety and health. Management shares information with workers. Standing safety committees may exist but meetings last only a few minutes, and although workers voice safety concerns, management does not act to address these concerns. Management actively involves workers in identifying hazards and solving safety problems by including them in daily prejob safety and crew task/ hazard analysis. There is a management-worker safety committee that provides suggestions and makes recommendations. Workers participate in all aspects of ensuring a safe jobsite. Safety meetings and walk-arounds focus on solving specific problems identified by workers and others. Problems are promptly addressed and communicated to workers. Workers can observe changes and are empowered to provide additional feedback. Safety as a value is demonstrated across all facets of the organization.

How to become exemplary

Review the ideas below and check the short-term (1-2 months), mid-term (6-12 months), or long-term (1-2 years) circle to indicate which you will commit to adopt and by when. Congratulations, if you’ve already adopted the idea!

Idea 1—Hold site orientations that empower workers to become involved in their own and their co-workers’ safety

Timeframe checklistAn exemplary site orientation helps empower workers right from the start of the project by informing them of potential hazards and setting the expectations regarding workers’ role in identifying and addressing potentially hazardous conditions. Workers ought to be informed of their right (and obligation) to stop work if they perceive or see a hazardous situation AND are ensured that there will be no reprisal for doing so. Site orientations are also used to inform workers of jobsite safety and health plans, who to go to with questions about health and safety procedures on-site, and how to contact that person. By the end of the orientation, workers should understand their safety and health rights. Companies might consider on-going coaching and mentoring to reinforce the knowledge gained and positive behaviors attained.

Idea 2—Conduct participatory daily briefings in which everyone working on-site is involved in pre-task planning and job hazard analysis

Timeframe checklistDaily huddles (also called Tool Box Talks, Tailgate Talks, or Pre-Shift Safety Meetings) provide an excellent opportunity to involve and empower workers on an ongoing basis. Everyone should participate in discussions about the work that will be taking place, the types of hazards that might be associated with the work, and how hazards can be mitigated to avoid injuries and exposures. Workers should be encouraged to actively participate in the huddle by asking questions and sharing their ideas.

Idea 3—Conduct joint walk-arounds throughout the work day

Timeframe checklistSometimes things discussed at the daily site meeting change as the day progresses. Having a joint managementworker team walk around the site and look for potential problems helps keep everyone in the loop. The walk-around activity ensures two-way conversations between management and workers, encourages worker involvement in identifying safety issues and suggestions, and demonstrates that safety is valued by the organization.

Idea 4—Provide and encourage workers to use anonymous suggestion boxes and/or a call-in number

Timeframe checklistSome workers might not feel comfortable making suggestions directly to their foreman, supervisor, or other higher-level manager regarding worksite safety. Nevertheless, they should still be given the opportunity to do so. Providing anonymous suggestion boxes, a call-in number (answered by a non-company person) or some anonymous digital communications channel (e.g., web bulletin board) empowers workers to make suggestions for addressing concerns on jobsites where trust between management and workers is underdeveloped. To reduce barriers, place boxes in multiple locations where anonymity can be maintained and also periodically remind and encourage workers to use them. As suggestions are received, management needs to follow through by demonstrating and communicating to workers how problems were fixed and make sure that good ideas and suggestions are recognized and rewarded.

Idea 5—Obtain feedback from workers by administering periodic surveys and informally touching base during the workday

Timeframe checklistWorkers feel empowered and part of a larger effort when they are asked directly for their opinions about the safety climate on the job site and ways it can be improved. This can be done through surveys or in-person. If surveys are used, it’s important that they be anonymous and may be better if administered by an outside party. Surveys are most effective for identifying program disconnects when supervisors and workers both participate using similar questions and results are compared to identify differences in perceptions and actions. Interviewing workers can be very informative, but obviously face-to-face requests can’t be anonymous. It is critical that the worker be approached and interviewed in a non–threatening manner and by a trusted source. Interviewing workers as they leave employment on the jobsite can be a good source of data for identifying indicators of both safety and non-safety problems that may be contributing to a project’s negative safety climate.

Idea 6—Create joint worker-management committees to address specific safety and health concerns

Timeframe checklistJoint worker-management safety and health committees are often used in larger companies and include management and workers who focus specifically on identifying and addressing worksite safety concerns. Their collaborative nature regarding power and responsibility for safety-related decision making helps to produce mutual trust between management and workers. Where smaller companies are limited in their capacity to establish a standing committee, they should create ad hoc safety action groups or “safety circles” where workers and management come together to address issues raised at weekly and daily meetings. Prompt follow-through on concerns using these groups demonstrates the company takes workers’ suggestions seriously which in turn encourages workers to stay involved and engaged in improving safety. For many companies it may be helpful to integrate safety into regular production meetings so it is not seen as something separate.

Idea 7—Frequently encourage and reward workers for reporting safety concerns and/or injuries. Address problems voiced by workers visibly and promptly, and communicate the impact and results of worker engagement processes.

Timeframe checklistThis helps build trust that safety is valued, and encourages workers to become proactively involved in helping to identify and address safety concerns. Consider developing an “action list” to show which (and how) issues raised by workers are being addressed. Place the list in a prominent place for all to see to ensure accountability for making progress. There should be on-spot recognitions (e.g, “attaboy”, tokens such as Good Catch coins) as well as management recognition. The latter requires implementing a system (e.g., on-line incident report system) that notifies management when a close call is reported and then management can personally call and thank the employee who reported it. All of these activities demonstrate to workers that their contributions to improving project safety climate are valued.

Improving Communication

Clear and consistent communication about the importance of safety and its alignment with production and other organizational goals and objectives is at the core of all other factors. How an organization formally and informally communicates about safety issues through words and actions can have a significant impact on the jobsite safety climate. Effective safety-related communication can create a strong positive climate, while ineffective or poor communications can stifle it. Which of the following best describes your company?

UNINFORMED REACTIVE COMPLIANT PROACTIVE EXEMPLARY
Management discourages (and may even reward) supervisors and workers from reporting injuries and hazards. Supervisors fail to share concerns raised by their crew to management. No system exists for workers to speak directly to management. Employees who take shortcuts in safety are rewarded for meeting production goals. Management responds to employee complaints when raised, although not always promptly. Employees are sporadically provided with informal feedback on hazard reports and incident/injury information, but not with information on how employee concerns were or will be addressed. Issues are not tracked nor are resolutions communicated across the organization. Supervisors pass safety information to their crew as required by management. Injury reports are filed as required. There is no overt reprisal for employees who report injuries or hazards. Employees are encouraged to report safety concerns and issues either to their supervisors or directly to management. Employees participate in incident reviews. Supervisors actively initiate hazard identification in discussions with employees. Employees are actively engaged in communicating about safety. They are rewarded for raising concerns and reporting close calls, and they get timely feedback after action. Employees and supervisors actively plan all tasks including safety. There are formal systems for gathering feedback and sharing incident information.

How to become exemplary

Review the ideas below and check the short-term (1-2 months), mid-term (6-12 months), or long-term (1-2 years) circle to indicate which you will commit to adopt and by when. Congratulations, if you’ve already adopted the idea!

Idea 1—Review company safety materials to ensure a consistent positive safety climate message

Timeframe checklistManagement should evaluate all materials and communication processes to ensure safety is consistently highlighted and equal to other organizational goals and objectives. There are many communication channels within an organization, both formal and informal. Mixed messages about safety and productivity can severely damage the mutual trust between workers and management that is necessary to achieve a positive safety climate. Supervisors should be aware that their actions and behaviors can negatively affect communication or negate the message that safety is a “value”.

Idea 2—Communicate contents of policies and procedures to all employees

Timeframe checklistNot all organizational policies and procedures focus on safety. However, even those that don’t should be reviewed to see if in fact a safety component exists, but had not been included. Ensure policies and procedures are written clearly and are disseminated and understood by all employees. Take steps to make sure non-English speaking employees understand all materials. Take the time to review policies and procedures with all employees at least annually and also when any changes have been made.

Idea 3—Be transparent about how employees’ safety concerns will be addressed

Timeframe checklistEngage workers in reviewing policies as issues arise and as part of an organizational continuous improvement process. Consider implementing an on-line incident reporting system that notifies management when a close call or hazardous condition is reported. Also consider creating an “action list” to show how issues raised by workers are being addressed. Place the list in a prominent place for all to see.

Idea 4—Create opportunities to communicate directly with workers about safety. Some ideas include:

Organizations should use both formal and informal means of communication to facilitate consistent and open dialogue about safety among owners, management, and workers. Open dialogue helps workers believe that management values safety and empowers them to participate in protecting themselves and their co-workers. It is critical that management is sensitive to non-English speaking workers ensuring they are able to meaningfully participate in safety dialogues. Some mechanisms for creating open dialogue both on and off the jobsite include:

4a. Joint worker-management committees or safety action groups

Timeframe checklistThese committees distribute power and responsibility for safety-related decision making, which encourages mutual trust between workers and management.

 

4b. Daily safety discussions

Timeframe checklistDaily safety discussions (or huddles) provide an excellent opportunity to involve and empower workers in identifying and addressing hazards on a daily basis. They typically take no longer than 15 minutes and are part of pre-task planning. Simply consider the hazards involved with the tasks that will be carried out that day.

4c. Joint walk-arounds and informal conversations with workers

Timeframe checklistIssues discussed during daily huddles at the beginning of the day may change as the day progresses. A joint management-worker team site walk-around helps identify and address new concerns as they emerge throughout the day. Informal conversations with workers throughout the day are an effective way to reaffirm that safety is valued and promote ongoing conversations between workers and management about potential safety concerns.

Training at All Levels

All employees need to know and understand where and how they fit into the safety culture and climate. The best way to ensure this happens is to provide ongoing, effective training tailored to the specific roles and responsibilities at each level of the organization. Training should be provided by qualified trainers using adult learning principles; including active and interactive learning techniques. Which best describes your company?

UNINFORMED REACTIVE COMPLIANT PROACTIVE EXEMPLARY
Company does not engage in on-going employee training and education. It assumes workers are trained properly when they come on-site and that supervisors have leadership skills. Fraudulent training cards may even be accepted. Only the OSHA 10-hour certificate is required for both workers and supervisors. The training that exists is aimed exclusively at individual worker behavior. Training is only implemented after an incident, and the commitment to training diminishes over time. Workers are provided OSHA 10 training. An off-the-shelf curriculum is used to meet OSHA and management system training requirements. Majority of training is provided via toolbox talks. Trainers meet minimal qualifications. Training records are kept, but not reviewed. Supervisors are required to obtain OSHA 30-hour certificate. Management provides adequate resources needed to ensure high quality training, and testing for knowledge and skills obtained. Safety curriculum is developed and administered by highly qualified trainers. Training needs may be identified by workers. Supervisors get training on safety skills, as well as OSHA standards. Company implements a Safety Trained Supervisor (STS) certification program. Training programs are ongoing versus one-shot opportunities and trainers use adult learning principles. Supervisor-specific training as well as peer training is implemented. Field personnel are integral to identifying training needs and developing materials rather than simply passive recipients.

How to become exemplary

Review the ideas below and check the short-term (1-2 months), mid-term (6-12 months), or long-term (1-2 years) circle to indicate which you will commit to adopt and by when. Congratulations, if you’ve already adopted the idea!

Idea 1—Supervisors: Front-line supervisors are the linchpin for safety on the jobsite. Therefore, it is critical that they are trained in the skills necessary to foster a good jobsite safety climate. Some ideas include:

1a. OSHA Training

Timeframe checklistSupervisors should have OSHA 30-hour training at the very least. It would be ideal if they received certification as safety-trained supervisors.

 

 

1b. Leadership and Communication Skills

Timeframe checklist For most people, leadership skills are not innate; they must be learned through education and experience. Supervisors should be given the opportunity to participate in leadership training where they would learn how to effectively communicate their vision and expectations, act as a positive role model, and be able to coach workers on how to create a strong jobsite safety climate, and provide constructive feedback. Supervisors should also receive training in the elements of an effective safety management system to better understand processes and expectations.

1c. Team Level Root Cause Analysis

Timeframe checklistProvide supervisor training on how best to work with their crew to conduct root-cause analyses to examine environmental, organizational, and human factors that contribute to jobsite incidents and close calls. Establish a process to easily share findings from these investigations across the whole organization.

1d. Role Modeling

Timeframe checklistEducate supervisors on the importance of being a good safety role model. For example, they should always use proper personal protective equipment (PPE), insist their workers (and managers who come on-site) do so as well, and uphold accountability measures. Training on coaching skills is critical to help supervisors be more effective at motivating their team to participate in creating a strong safety climate. Supervisors need to be aware that their perception of risk may be different than the workers and keep that in mind when evaluating and responding to worker complaints.

Idea 2—Workers: Training should provide workers with the tools they need to identify and report hazards, and the knowledge to protect themselves. Some ideas include:

2a. OSHA Training

Timeframe checklistAll workers should have at least an OSHA 10-hour training certificate and preferably the OSHA 30-hour certificate.

 

2b. Empowerment

Timeframe checklistTraining should include methods for empowering workers to actively participate in recognizing potential hazards on the jobsite and understand their right (and obligation) to stop work when a hazard is identified that is serious or presents an imminent danger to themselves or their co-workers.

2c. Communication Skills

Timeframe checklistWorkers would benefit from training on how to communicate effectively with co-workers and supervisors, including how to listen and how to provide constructive feedback.

 

2d. Proper Use of PPE

Timeframe checklistWorkers should be able to demonstrate their knowledge of, and ability to use, proper PPE. If the worker is unable to do so, the worker should receive training and a skills evaluation prior to going onto the jobsite.

 

Idea 3—Management

Timeframe checklistProvide management with safety leadership training so they understand the critical role they play in leading and maintaining safety implementation efforts. The training would include how best to communicate, provide feedback, and be a good role model for workers, particularly when visiting jobsites. Management should also be educated about and have a comprehensive understanding of how safety fits into and complements quality, production, marketing, and the financial aspects of their organization.

Idea 4—In-house architects and engineers

Timeframe checklistProvide training for in-house architects and engineers on Prevention through Design (PtD) strategies that they could use during the planning and design stages of a project to design out potential hazards from equipment, structures, materials, and processes that might adversely affect workers or end users of the project.

 

Encouraging Owner/Client Involvement

Owners are uniquely positioned to promote safety as an organizational value. They have the authority to develop and issue project policies, shape bidding practices, and ultimately approve budgets – all of which, if done with a focus on safety, can drive a strong project safety climate. Maintaining consistent dialogue with people in the field keeps owners informed of emerging safety concerns, thus providing them with valuable insight into what resources or actions might be needed to eliminate (or reduce) potential hazards. Which of the following best describes your company?

UNINFORMED REACTIVE COMPLIANT PROACTIVE EXEMPLARY
Owner/client does not require safety prequalifications from general contractors or sub-contractors and only make selections based on lowest bids. Executive management does not have an understanding of, or presence in, the safety process. Contractors with poor safety records are excluded from bidding. However, there are no meetings to discuss why the safety record is poor or what they are doing to improve the situation. Data aren’t reviewed for trends. Owner/client relies exclusively on federal, state, and local safety laws (industry average lagging standards) for pre-qualification criteria but still use low bid for selecting general and subcontractors. They depend on conventional methods of insuring the job (e.g., insurance provided by the contractors). Owner/client communicates safety expectations to general contractors and subcontractors, and consistently enforce them on-site. There is a sitespecific safety template for each job that all general and subcontractors are required to follow as per their contract. There are regularly scheduled safety meetings with all contractors and owners. Injury and illness trends are reviewed and used to determine weaknesses. Safety programs are reviewed annually at a minimum. General and subcontractors are selected based on safety practices/climate rather than low bid. Owner participates in employee orientation and may join in daily planning meetings. An owner representative is on-site to monitor and assist with safety program implementation. Owners regularly come on-site to connect with and learn from employees. Prevention through Design (PtD)) and Building Information Modeling (BIM) are used in the design and planning phases which includes workers. Owners provide adequate resources to ensure that safety really is valued equally to productivity.

How to become exemplary

Review the ideas below and check the short-term (1-2 months), mid-term (6-12 months), or long-term (1-2 years) circle to indicate which you will commit to adopt and by when. Congratulations, if you’ve already adopted the idea!

Idea 1—Owner presence on-site demonstrates safety buy-in and provides the foundation for a strong safety climate. Some ideas include:

1a. Participate and perhaps lead employee orientation to reflect commitment to safety

Timeframe checklistSite orientations help familiarize workers with potential hazards at each new jobsite. Orientations also provide an opportunity to establish a foundation for two-way communication between management and workers about safety issues throughout a project. When workers see owners demonstrate that they value safety as a priority, they are more confident that their participation in implementing safety is important.

1b. Devote adequate resources to implementing safety programs and enforcing policies

Timeframe checklistSafety policies and programs are meaningless unless they are effectively implemented, enforced, reviewed, and if necessary, modified. Adequate resources must be made available to those in charge of the program to do this effectively and to show a true commitment to protecting workers.

1c. Create mechanisms for workers to voice safety concerns

Timeframe checklistProvide a climate where crew and supervisor concerns are heard and positively recognized. Suggestion boxes and call-in numbers designated for safety concerns provide workers a way to communicate their safety concerns anonymously and without fear of retaliation. Boxes in multiple locations on the site reduce barriers to using them and protect workers’ anonymity. Surveys and questionnaires focused on jobsite safety are another way to solicit concerns and empower workers to share their views on safety issues anonymously.

1d. Join daily planning meetings and safety walk-arounds and always wear appropriate PPE

Timeframe checklistAs often as possible, owners (or their representative) should participate in daily pre-task planning meetings (or huddles) and joint site safety walk-arounds with general contractors, subcontractors, and workers. Asking field personnel for solutions to safety-related issues clearly demonstrates “walking the talk”; that is, assuming feasible suggestions are considered and acted upon by the owner. Being involved in these types of safety activities helps workers trust management’s espoused safety values.

Idea 2—Incorporate safety throughout the design and planning phases of the project. Some ideas include:

2a. Take safety into account when selecting and evaluating contractors

Timeframe checklistCarefully review safety programs and safety policies as well as safety performance when pre-qualifying and selecting general and subcontractors for a project. Data on lagging indicators (e.g., injuries) may reflect under-reporting rather than a strong commitment to safety. Once selected, responsibilities, expectations, and evaluation metrics based on safety climate indicators should be specified in the contract and selected contractors and subcontractors should be held accountable for meeting those expectations.

2b. Use Prevention through Design (PtD) methods

Timeframe checklistA PtD approach is utilized in the planning and design stages of the project to help ensure jobsite safety. Provide PtD training for in-house and contracted architects and engineers to educate them on strategies they can use to design hazards out of equipment, structures, materials, and processes that may cause hazards for workers.

2c. Use Building Information Modeling (BIM) techniques

Timeframe checklistBIM can be used as a planning tool that can provide valuable simulative information about a jobsite, the sequence of tasks to be performed, and potential hazards that might emerge at different stages of a project. Owners engage contractors and workers in the BIM process and encourage them to help identify potential hazards and solutions to address problems.

Idea 3—Align owner incentives with safety

Timeframe checklistTypically, each general and sub-contractor hired for a job purchases its own insurance (including Workers’ Compensation) and charges the owner for those costs. In an Owner Controlled Insurance Program (OCIP), the owner purchases the insurance for all parties on-site and pays directly for health care and lost time costs. Owners who use OCIPs have a strong financial incentive to address hazards before an incident occurs and may be more likely to implement programs that involve, empower, and reward workers for identifying and mitigating jobsite hazards.

Summary of Ideas for Improving Leading Indicators to Strengthen Jobsite Safety Climate

1. Demonstrating management commitment

Management commitment is critical to improving jobsite safety climate. Managers that “talk the talk” but do not “walk the talk” are poor safety role models and will have difficulty establishing the trust needed for all to participate in keeping everyone on the jobsite injury-free.

  • Safety expectations are clearly defined in policies, procedures, and guidelines, and communicated across the company
  • Adequate resources are available to effectively implement safety activities
  • Safety is a top agenda item at all meetings
  • Management participates in all safety-related meetings
  • Management is visible to workers and observes good on-site safety behaviors
  • Workers receive sufficient safety training, and have proper PPE
  • Management designs reward and incentive structures to encourage workers to actively participate in safety implementation.
  • Safety trends are analyzed
  • External audits are conducted to evaluate safety performance
  • There is a formalized process for corrective action

2. Aligning and integrating safety as a value

Safety is integrated throughout an organization and aligned with productivity and other organizational priorities. Organizational members and subcontractors see safety as a core company value rather than an additional burden or diversion from “normal” operations.

  • Safety expectations are clearly defined in policies, procedures, and guidelines, and communicated across the company
  • Regular company-wide safety communications reinforce the culture of safety as a value (e.g., newsletters, alerts, leadership messages, safety topics, etc.)
  • Employees at all levels are recognized for participation in safety activities
  • Safety as a key value is reinforced through training for supervisors and workers
  • Different departments and groups are able to discuss project-related safety strategies
  • Safety is an agenda item for all production and planning meetings
  • Safety is aligned with productivity as a key value
  • Safety is considered in hiring and promotion decisions
  • Safety performance and engagement in safety activities is factored into compensation
  • Safety is factored into planning and bidding processes
  • Safety performance metrics use leading indicators for evaluations

3. Ensuring accountability at all levels

Policies and procedures that specify roles and responsibilities are needed to ensure everyone involved in a construction project is held accountable for safety: owners, management, safety personnel, supervisors, and workers. Enforcement and fairness are critical for achieving a strong jobsite safety climate.

  • System is perceived as fair
  • Safety expectations are clearly defined in policies, procedures, and guidelines, and communicated consistently across the company (and to all business partners)
  • Owners adopt an Owner Controlled Insurance Program (OCIP)
  • Enforcement of safety policies and procedures is consistent
  • Leading indicator data is benchmarked against other companies and internal continuous quality improvement
  • Incentive structures promote and reward safety processes not (just) outcomes
  • External audits are conducted to evaluate safety performance, and are based on leading as well as lagging indicators
  • Safety performance is a primary factor in hiring managers and subcontractors, and for promotions
  • All members of project team are responsible for safety activities
  • Everyone is recognized and included in safety awards which are based on leading vs. lagging indicators

4. Improving site safety leadership

Front-line supervisors are the linchpin of any safety program. They have the power to address hazards before anyone gets hurt. Their ability to lead and communicate with workers about safety issues is critical to achieving a strong safety climate.

  • Safety is included in the strategic planning process
  • Safety roles and responsibilities are clearly defined at all levels of the organization
  • People at all levels are held accountable for their safety responsibilities
  • Supervisors lead by example
  • Senior leaders are visible on safety issues
  • Leadership promotes a learning environment
  • Supervisors are provided with, and required to take training in safety communication, motivation, and preplanning
  • Supervisors are required to attain a Safety Trained Supervisor (STS) credential

5. Empowering and involving workers

Involving workers in safety-related planning and decision making and empowering them to speak up when they identify hazards helps to bridge the communication gap between workers and management, and creates the positive safety climate integral to getting the job done safely.

  • Site orientations empower workers to actively participate in safety implementation
  • There is a joint worker-management safety committee
  • Workers are involved in job hazard analyses
  • Joint walk-arounds are regularly conducted and focus on addressing specific problems raised by workers and others
  • Workers are frequently solicited to share perceptions about safety implementation
  • Workers are encouraged and unafraid to report potential hazards, close-calls and/or injuries
  • Workers feel empowered with stop-work authority

6. Improving communication

Organizational communication occurs through formal and informal mechanisms and can be transmitted in the form of words and actions. Poor communication about safety issues can significantly impact an organization’s ability to take proactive and preventable actions to address concerns before an incident occurs.

  • Policies and procedures are communicated so all workers understand them
  • Safety is included as an agenda item at every meeting
  • Company materials communicate a consistent positive safety climate message
  • Informal leaders are identified to help communicate safety messages
  • There is a formal system for sharing close call and incident information
  • There is a formal transparent process for how employee safety concerns will be addressed
  • Management and supervisors actively engage in two-way conversation with workers about safety through joint worker-management committees, daily safety briefings, and joint walk-arounds
  • Supervisors and management provide timely feedback on safety reports
  • Safety mentoring is practiced

7. Training at all levels

All organization members need to know and understand where they fit into a project’s safety climate. The best way to ensure this happens is to provide on-going, effective training tailored to the specific roles and responsibilities of individuals at each level of the organization.

  • Safety training is provided at all levels of the company, and is ongoing
  • Company requires supervisors to have STS certification
  • Safety leadership training is available for supervisors and foremen
  • Empowerment and peer training is provided to workers
  • Prevention through Design training is provided to in-house architects and engineers
  • Joint safety committee training is given to all participants
  • All field personnel help to identify training needs, and develop materials

8. Encouraging owner/client involvement

Owners are uniquely positioned to promote safety as an organizational value from the top down. They have the authority to develop and issue company policies, shape bidding practices, and ultimately approve budgets, all of which, if done with safety in mind, can drive a strong project safety climate as well as excellent safety performance.

  • Owners devote adequate resources to safety implementation
  • Owners participate in employee orientation, daily planning meetings, and wear PPE (as appropriate)
  • Owners regularly come on-site to connect with and learn from employees
  • An owner representative is on-site to monitor and assist with safety implementation
  • Owners use Prevention through Design and Building Information Modeling in design and planning phases, and involve workers in planning
  • Owners use safety performance as a prequalification for bids
  • Owners use leading indicators to evaluate bids
  • Owners support safety performance audits
  • Owners solicit anonymous feedback from workers and ensure no retaliation for raising safety concerns
  • Owners participate in Owner Controlled Insurance Programs giving them a financial stake in maintaining safety

We hope you find these worksheets useful for improving safety climate on your jobsites! If you have feedback you would like to share, please contact: Dr. Linda M. Goldenhar at lgoldenhar@cpwr.com.

CPWR Logo Much of the information presented here was provided by stakeholders who participated in a CPWR sponsored Safety Culture/Climate in Construction Workshop held June 2013. To read the full workshop report please go to: http://www.cpwr.com/safety-culture/workshop-safety-culture-and-climate-construction. This information sheet was made possible by cooperative agreement number U60-OH009762 to the CPWR – The Center for Construction Research and Training from the National Institute for Occupational Safety and Health (NIOSH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIOSH.