Session No.

542

Implementing a National Falls Campaign: Lessons

R. Ronald Sokol, BS, CSP

CEO/President
Safety Council Texas City
Texas City, Texas

Introduction: A Time to Act

When U.S. Congressional Leaders finally passed the Williams-Steiger Act of 1970 (the Act) after a
bitter three-year legislative struggle, politicians, labor, management and the American people
envisioned a better future for the safety of the American worker. The basic provision of the Act
required, each employer shall furnish to each of his employees employment and a place of
employment which are free from recognized hazards that are causing or are likely to cause death or
serious physical harm to his employees. This provision known as the General Duty Clause was the
principal tenant of the Act. The Act further required that each employer shall comply with the
occupational safety and health standards promulgated under this Act and that each employee shall
comply with the occupational safety and health standards and all rules, regulations, and orders issued
pursuant to this Act which are applicable to his own actions and conduct. In concert, the Act created
a shared responsibility between government, labor and management to protect the American worker
from on the job injuries and fatalities. Simply stated, the Act created the Occupational Safety and
Health Administration (OSHA) that had a threefold responsibility to promulgate the safety and health
rules, educate workers and employers on those rules and actively enforce those rules. Negotiations
between Congressional Leaders also sparked the idea that a separate research organization, separate
from OSHA, should be created to conduct safety and health research and advise OSHA on solutions
to occupational safety and health issues in the American workplace. This idea was central to the
passage of the Act, and the National Institute of Occupational Safety and Health (NIOSH) was born.
Congressional leaders believed NIOSH should be an independent research organization but should
work closely with OSHA to create solutions to protect the American worker. Congressional Leaders
decided to place NIOSH under the control of the Center for Disease Control (CDC). NIOSH was set
up as a prevention-oriented research institute responsible for identifying occupational hazards,
conducting research and field studies, and conveying the results to OSHA, the Mine Safety Health
Administration (MSHA), other federal agencies, and professionals working in the field. A second
objective was to provide training programs based on the results of research and study for Safety,
Health and Environmental (SHE) professionals. Congressional leaders envisioned a close working
relationship between the two agencies. The success of this relationship has been debated in the halls
of Congress, in the SHE community and most importantly in the American workplace where U.S.
fatality and injury rates continue to lag rates achieved in the European Union (EU) and other civilized
industrial countries.
Progress: Cooperative Efforts Yield Results
Despite the challenges that exist between OSHA and NIOSH housed in different governmental
departments (CDC and Department of Labor) with specific goals and agenda to fulfill and the
pressure of labor, business and the public to steer the agencies in multiple directions, successes are
being achieved through a cooperative effort that demonstrates that NIOSH and OSHA can team up in
a manner that allows safety and health research to actually impact the American worker. This
cooperative spirit begins with effective leadership at the top of each organization demonstrated by Dr.
John Howard of NIOSH and Dr. David Michaels of OSHA and their teams. The fact that each agency
has experienced stable leadership over a sustained period of time has driven a constancy of purpose
that ultimately has benefitted the American workers. Outside of the National Fall Prevention a.k.a.
Safety Pays, Falls Cost Campaign (the Campaign), the research conducted by NIOSH on nail gun
injuries and the development and distribution of the Nail Gun Safety literature by OSHA and NIOSH
has shown the impact that cooperative efforts can have on the American workplace.

Strategic Planning: The Foundation for Success

Achieving sustainable results and success requires more than just effective leadership. It requires the
development of an effective strategic plan with measureable outcomes that drive results. NIOSH
began to lay this foundation with the introduction of the National Occupational Research Agenda
(NORA). The history and goals of NORA are highlighted on the NIOSH webpage and described as
follows:

NORA is a partnership program to stimulate innovative research and improved workplace

practices. Unveiled in 1996, NORA has become a research framework for NIOSH and the nation.
Diverse parties collaborate to identify the most critical issues in workplace safety and health. Partners
work together to develop goals and objectives for addressing these needs. The following types of
information help inform the programs priority setting process:

The numbers of workers at risk for a particular injury or illness

The seriousness of the hazard or issue
The probability that new information and approaches will make a difference

Participation in NORA is broad, including stakeholders from universities, large and small
businesses, professional societies, government agencies, and worker organizations. Involvement
ranges from providing input electronically to volunteering for a sector Council.

The program entered its second decade in 2006 with a new sector based structure to better
move research to practice within workplaces. The national agenda is developed and implemented
through the NORA Sector Councils. Each Council develops and maintains an agenda for its sector.

It is within this framework that the NORA Construction sector began the work of establishing
the Campaign that was an outgrowth of the Strategic Planning Sessions conducted by Construction
sector members. The ideas for this Campaign are rooted in the Program objectives listed on the
NIOSH Construction sector webpage and published below.
 Construction: Program Description
The mission of the NIOSH research program for the Construction sector is to eliminate occupational
diseases, injuries, and fatalities among individuals working in these industries through a focused
program of research and prevention. The program strives to fulfill its mission through:

High Quality Research: NIOSH will continually strive for high quality research and prevention
activities that will lead to reductions in occupational injuries and illnesses among workers in the
Construction industries.
Practical Solutions: The NIOSH program for the Construction sector is committed to the
development of practical solutions to the complex problems that cause occupational diseases,
injuries, and fatalities among workers in construction. We want to tailor these solutions to fit
unique Construction sector attributes.
Partnerships: We recognize that collaborative efforts in partnership with labor, industry,
government, and other stakeholders are usually the best means of achieving successful outcomes.
Partners are important for identifying the most relevant problems, for developing and participating
in research projects, and as intermediate customers transforming research outputs into products for
use by construction employers and workers. Fostering these partnerships is a cornerstone of the
NIOSH program for the Construction sector.
Research to Practice (r2p): We believe that our research only realizes its true value when put into
practice. Every research project within the NIOSH program for the Construction Sector formulates
a strategy to promote the transfer and translation of research findings into prevention practices and
products that will be adopted in the workplace.

Over the years, NIOSH and its partners have completed numerous research projects to address
construction safety and health issues. NIOSH supports targeted surveillance activities involving a
number of state health departments on important construction topics such as lead exposure. Support is
also provided for extramural construction research projects conducted by academic and other
researchers through grants and cooperative agreements.

Projects cut across a number of important construction issues. For example, past projects have
addressed important causes of injuries and fatalities such as falls and electrical hazards. Projects have
addressed musculoskeletal disorders associated with construction work, and health hazards such as
noise, asphalt fumes, silica, and welding fumes. Research has also been conducted to address unique
aspects associated with the construction setting - such as the lack of permanent work stations and
continuously changing environments. NIOSH-funded researchers have developed tools and
approaches such as task-based sampling to address these issues. Projects have transitioned from
identifying problems to developing effective interventions, and finally to providing solutions to the
construction community.

Defining Success: From Macro to Micro

Once the greater framework of NORA was established by NIOSH, the work of the Construction
Sector Council began with the focus on the Strategic goals identified in the following literature posted
on the NIOSH website:

Inputs: NIOSH Strategic Goals

The NIOSH Construction Program uses strategic goals to guide research and partnership efforts over
the next decade. Goals identify specific outcomes that NIOSH wants to target, performance measures
for evaluating progress in meeting the outcome goals, and intermediate goals to describe the
necessary steps that need to be performed to accomplish the goal. Setting goals is challenging for the
following reasons:

It forces the focus on a subgroup of issues where NIOSH can make an impact - a long list would
spread our resources too thin to accomplish the goals. Not every worthwhile topic can be
included.
It is difficult to develop performance measures. Available injury statistics have limitations, and
exposure and health outcome measures are typically not available.
It is ambitious for NIOSH to set goals to achieve outcomes such as reductions in a national
fatality rate. NIOSH is a research agency and doesnt directly influence outcomes; they must
partner well and influence other groups to show results.

Inputs: NORA Construction Sector Goals

NIOSH developed draft strategic goals for the Construction Program in 2004-2005 prior to initiation
of the NORA sectors. The goals were provided as NIOSH input to the NORA Construction Sector
Council effort to develop NORA goals. During the 2006 -2008 timeframe, the NORA Construction
Sector Council developed fifteen strategic goals which make up a National Construction Agenda.
These NORA goals are intended for the industry and the nation. NIOSH chose goals to target
intramural and extramural construction research efforts.

Construction Program Goals for Intramural Research

Strategic Goal 1: Reduce Construction Worker fatalities and serious injuries caused by falls to a
lower level.
Strategic Goal 3: Reduce fatal and serious injuries associated with struck-by incidents associated
with objects, vehicles, and collapsing materials and structures.
Strategic Goal 4: Reduce hearing loss among construction workers by increased use of noise
reduction solutions, practices, and hearing conservation programs by the construction community.
Strategic Goal 5: Reduce silica exposures and future silica-related health risks among
construction workers by increasing the availability and use of silica dust controls and practices for
tasks associated with important exposures.
Strategic Goal 6: Reduce welding fume exposures and future related health risks among
construction workers by increasing the availability and use of welding fume controls and
practices for welding tasks.
Strategic Goal 7: Reduce the incidence and severity of work-related musculoskeletal disorders
among construction workers in the U.S.
Strategic Goal 8: Increase understanding of factors that comprise both positive and negative
construction safety and health cultures; and, expand the availability and use of effective
interventions to maintain safe work practices 100% of the time in the construction industry.
Strategic Goal 9: Improve the effectiveness of safety and health management programs in
construction and increase their use in the industry.
Strategic Goal 11: Develop and build recognition and awareness of construction hazards and the
means for controlling them by strengthening and extending the reach of quality training and
education in the construction industry, including non-English speaking workers.
Strategic Goal 12: Reduce injury and illness among groups of construction workers through
improved understanding of why groups of workers experience disproportionate risks in
construction work and expanding the availability and use of effective interventions.
Strategic Goal 13: Increase the use of prevention through design (PtD) approaches to prevent or
reduce safety and health hazards in construction.
 Strategic Goal 14: Improve surveillance at the Federal, State, and private level to support the
identification of hazards and associated illnesses and injuries; the evaluation of intervention and
organizational program effectiveness; and the identification of emerging health and safety
priorities in construction.
Strategic Goal 15: Engage the media more effectively to raise awareness and improve safety and
health in construction.

Construction Program Priority Goals for Extramural Research

The Construction Program selected the following priority goals as particularly suited for extramural
research during fiscal years 2014-16:
Strategic Goal 1: Reduce Construction Worker fatalities and serious injuries caused by falls to a
lower level.
Strategic Goal 3: Reduce fatal and serious injuries associated with struck-by incidents associated
with objects, vehicles, and collapsing materials and structures.
Strategic Goal 5: Reduce silica exposures and future silica-related health risks among
construction workers by increasing the availability and use of silica dust controls and practices for
tasks associated with important exposures.
Strategic Goal 8: Increase understanding of factors that comprise both positive and negative
construction safety and health cultures; and, expand the availability and use of effective
interventions to maintain safe work practices 100% of the time in the construction industry.
Strategic Goal 12: Reduce injury and illness among groups of construction workers through
improved understanding of why groups of workers experience disproportionate risks in
construction work and expanding the availability and use of effective interventions.
Strategic Goal 13: Increase the use of PtD approaches to prevent or reduce safety and health
hazards in construction.

Implementation Strategy: Zeroing in on the Target

Each year, there are no surprises when the Bureau of Labor Statistics releases its reports on workplace
fatalities and injuries. Construction workers are more likely to die on the job than workers in any
other industry, and falls from heights take the heaviest toll. The sobering fact is that each day on
average, one construction worker dies in a fall from heights.

In 2011, falls to a lower level accounted for 264 out of 774 deaths in the construction industry,
and the majority of these fatalities occurred when workers fell from roofs, ladders and scaffolds.
Studies also show that small construction companies, those with 10 or fewer workers, had the highest
percentage of fatal falls in construction. Inexperienced workers with less than a year in the industry
accounted for more than half of fatalities from falls.

The risks are high for Hispanic workers, who comprise more than a quarter of all workers in the
construction industry. They are more likely to experience fatal falls than their non-Hispanic
counterparts, and immigrant Hispanic workers as well as those who are young and inexperienced are
at high risk for fatal falls.

Falls shatter lives, families and communities. Even when construction workers survive, many have
traumatic injuries, including to the pelvis, head and neurological system that place enormous
emotional, medical and financial burdens on their families. Falls result in significant costs to
employers as well, including lost productivity, regulatory inspection costs, and hefty increases in
workers compensation premiums.
 Falls from heights in construction, however, need not happen. Improved fall prevention
systems and equipment are now widely available in the industryand easier than ever to use. These
systems save lives as dramatically demonstrated when three construction workers were rescued on
April 13, 2013 from outside the 17th floor window of a New York City building after their scaffolding
suddenly collapsed. These men survived because they were wearing their safety harnesses.

In todays highly competitive construction industry, many contractors face pressures to work
faster with increased productivity, which may lead to overlooking important on-site planning for
safety procedures and failure to use proper equipment.

More needs to be done to prevent these tragic events. We know how to prevent falls with proper
equipment, training and on-site planning. Recognizing that it is time to take action that will prevent
falls from heights, in 2012 NIOSH and a broad group of partners launched Safety Pays, Falls Cost,
a nationwide information and media Campaign to prevent construction falls from heights. The
Campaign was re-launched in 2013 with plans for a third year launch in 2014.

Campaign Strategy: A Winning Formula

The Campaign was designed to initially reach residential construction contractors, especially those
with fewer than 10 employees, with a three-part message about fall prevention:

1. PLAN ahead to get the job done safely

2. PROVIDE the right equipment; and
3. TRAIN everyone to use the equipment safely.

The NIOSH and OSHA partnership has increased the outreach efforts of the Campaign. A
Materials Development Group subcommittee was established to keep materials relevant, current and
focused on the target audience. Falls from elevation were determined to pose the greatest risk for the
target audience with the Construction Sector workgroups focusing on falls from roofs, ladders, and
scaffolds. The Campaign created an emphasis on hazard recognition with the development of spot
the hazard cards to increase employee recognition of fall hazards in the workplace. NIOSH
Researchers provided solution driven materials that allowed contractors to implement safety strategies
focused on the cornerstones of Plan, Provide and Train.

These messages are emphasized in posters, fact sheets, videos and other materials, in multiple
languages. The Campaign poster features a worker who had a fall that ruined his life. The Campaign
website (www.stopconstructionfalls.com) maintained by the staff of the Center to Protect Worker
Rights (CPWR) contains downloadable materials that contractors can use to train their workers, as
well as tips for ladder safety, scaffold safety and safety when working on roofs. Each section is
divided into sections on Campaign Literature, Toolbox Talks, Spot the Hazard Cards and
Construction Safety Solutions. The Campaign Materials subcommittee and CPWR staff have worked
diligently to maintain a consistent look and approach for dissemination of materials and resources for
Campaign partners to utilize. Campaign literature is currently translated in English, Spanish, Polish
and Russian. The NIOSH website (www.cdc.gov/niosh/construction/stopfalls.html) and OSHA
website (www.osha.gov/stopfalls/index.html) has additional materials on the fall prevention
Campaign as well.

The broad array of partners involved in the Campaign reflects the firm commitment of
government, industry, labor, trade groups and professional stakeholder organizations to put an
end to falls from heights. Partners include OSHA, the CPWR, the Laborers Health and Safety
 Fund of North America, the National Association of Home Builders, the National Roofing
Contractors Association, and state departments of health, among other groups. Over 70
associations and organizations have joined the Campaign by the end of 2013. The Campaign is
based on solid research analysis, organized by NIOSH and conducted by the NORAs
Construction Sector Council, an industry-labor-government group, which identified preventing
falls as a top priority, especially among small residential construction companies. This
Campaign is designed to speak first to construction contractors, since they bear the primary
responsibility to provide the training and equipment that will keep their employees safe in the
workplace.

Campaign Growth: How Do I Join and Make A Difference

The American Society of Safety Engineers (ASSE) has been an active participant in the Campaign.
The NIOSH Construction Sector Council has active representation by many ASSE members who
actively work on the Campaign. ASSE provided a press release highlighting their involvement in the
Campaign which provides additional resources for fall prevention at the following link:
(www.asse.org/newsroom/fall-protection.php).

Preventing falls in construction requires constant vigilance and a culture shift on the part of
companies, no matter how small, and their workers. When working from heights, the risk of falling is
always presentbut falls can be prevented. With the Campaign, we aim to make fall protection a
habit in the construction industry so that no family needs to be informed that their loved one has been
killed or hurt from a fall at a construction site.

Campaign News: Top Ten Tips for Developing a Local Fall

Protection Campaign
CPWR created an e-newsletter for the Campaign partners, supporters and stakeholders. In Volume
1.10, dated August 28, 2013 the newsletter listed the Top Ten Tips for Developing a Local Fall
Prevention campaign as shown below:

1. Brainstorm possibilities. Work with colleagues to brainstorm what strategies and tactics
you will use in your campaign. In one instance, it might be feasible for a local campaign to include
the distribution of campaign fact sheets to small residential contractors at local home improvement
stores across the region. In another instance, a campaign might leverage access to other partners to
hold free 15-minute fall prevention safety events at locations throughout the state. The key is to pick
strategies that suit the available resources and access to contractors.

2. Identify measurable objectives. Identify at the front end what you are trying to achieve
with your campaign. Measurable objectives include who you will try to reach, how you will try to
reach them and when. Example: The campaign will distribute campaign fact sheets, posters, stickers
and t-shirts to small residential contractors working in the Los Angeles metro area from September 1,
2013 to September 1, 2014.

3. Enlist a senior-level champion. A senior-level champion is someone who is well-known in

the safety and/or construction industries and is a credible source of information among contractors.
The champion can serve as a spokesperson at special events and to support media outreach.
 4. Build on existing local efforts. You can extend campaign messages by joining a company,
union, association or other group that has a safety campaign or a core mission that provides a context
for fall prevention messages and products.

5. Work with established and committed partners. You can leverage relationships with other
campaign partners who may have fall prevention events in your geographic area that you could
promote to your contractor constituents and also where you can work with partners to distribute you
fall prevent materials.

6. Bring ideas to partners. Your brainstorming events may produce several great strategies
and ideas that for various reasons, you cannot implement. There may be other partners who have the
funding and resources to accomplish those efforts. Share the ideas to explore the possibilities.

7. Obtain funding and resources. As you develop annual budgets, allot the funding to support
your local campaign. In addition, the campaign will require other resources such as a staff person who
will coordinate the campaign either on a full-time or part-time status.

8. Identify a partner with an active outreach list. You can extend your campaign promotion
by asking other partners if they could send emails to their constituents, contractors and related
audiences such as safety trainers to promote your events or available campaign safety products.

9. Piggy-back on partner media. You can promote your campaign fall prevention messages,
products and/or events by writing campaign articles about them and requesting that your partners
publish the articles in their media such as a monthly magazine, e-newsletter, Facebook page,
YouTube channel, etc.

10. Secure safety experts. A person who is a safety expert and knows fall prevention methods
will be critical to support your campaign. The expert can review your fall prevention messages and
products for accuracy as well as be a spokesperson at events such as toolbox talks, seminar and
exhibits.

Campaign Progress: Staying the Course

The Campaign was launched on April 26, 2012. It is a nationwide information and media Campaign
to prevent construction-related falls. The Campaign is designed to get contractors, particularly small
residential contractors, to provide their workers with fall protection training and equipment.

To date, over 70 associations, businesses, government offices, organizations and unions have
joined the Campaign as partners, and they play a critical role in distributing Campaign safety
messages, and products and holding safety training and special events. A complete list of partners is
listed on the official Campaign website (www.stopconstructionfalls.com.) If you are interested in
having your organization join, get involved, and support the Campaign, please visit the website. Find
out how you can help lead the fight against injuries and fatalities on construction sites due to falls
from heights.

Your participation in our Campaign can make a difference. Thanks for supporting the Campaign.

Its never too late to: Plan, Provide and Train. Remember: Safety Pays, Falls Cost.
Bibliography
American Society of Safety Engineers (ASSE). http://www.asse.org/newsroom/fall-protection.php
Centers for Disease Control and Prevention. 2003. NIOSH Program Portfolio: Construction:
Strategic Goals. http://www.cdc.gov/niosh/programs/const/goals.html
CPWR website. http://www.stopconstructionfalls.com
National Institute for Occupational Health and Safety
(NIOSH). http://www.cdc.gov/niosh/construction/stopfalls.html.
Occupational Safety and Health Administration (OSHA). 2010. 29.CFR1926 Construction Industry
Regulations. Fall Protection, Part 1926.500.
_____. http://www.osha.gov/stopfalls/index.html.