Over the average 40-year work life span, approximately 16,000 workers in the United States are hurt on the job every day. On a global scale, almost 1000 workers are killed every day on the job (Smith, 2001). Falls are the second leading cause of occupational deaths after motor vehicle crashes according to the Bureau of Labor Statistics (Department of Labor, 2010). In 2009, falls accounted for 617 deaths among workers. The most prevalent form of injury resulted from workers falling to a lower level from ladders, scaffolds, buildings, or other elevations.

Industries that experienced the greatest number of fall-related deaths and injuries were farming, forestry, fishing occupations, construction laborers, carpenters, roofers, structural metal workers and construction supervisors. The construction industry accounts for as much as 50% of fall-related deaths or injury due to the fact that most firms are self-employed, may hire seasonal workers, work under adverse conditions, and are usually fast moving and involve many employees working at elevation. Mining and agriculture/forestry/fishing are second to construction in fall-related injuries.

Many causes of falls include inexperienced workers, deviation from standard operating procedure, inability to recognize hazards when they exist, deviation from procedures, unfamiliar environments and tasks.

There are many different types of fall related injuries that can occur in a working environment. The more common injuries include:

• Falls from ladders


• Falls from one level to another



From roof




Down the stairs or steps




Building girders or structural steel




Falls from trees



• Falls from scaffolding, staging


• On same level


• From nonmoving vehicle


Ladders: Construction workers are more likely than other occupations to be injured by falling from ladders. Reaching overhead or overextending oneself beyond the rail of the ladder is the most common cause of ladder falls. Ladders may include extension, fixed, rope or step. To avoid injury, it is recommend that workers inspect the ladder to ensure that it is in good condition, select the proper ladder for the task, have a second person to assist with carrying the ladder, stabilizing the ladder and also to transport equipment up the ladder. Ladders may be fixed or portable and can vary in length and type. They can be folding or include an extension. Safety features include stabilizers, non-skid surfaces and a guard rail. Factors that contribute to falls may include overreaching, overbalancing, slipping on rungs, defective equipment and using the wrong ladder for the task. For more information: 10. Ladder Safety - The Right Steps to Take

Falls from one level to another: There are numerous ways that an individual worker may fall from one level to another. A fall of more than six feet is considered a fall from one level to another. Falls may vary from standing on a ladder changing a light bulb, to connecting bolts on steel girders hundreds of feet above the ground. Safety features would include the use of a guardrail system, safety net system, or personal fall-arrest system to protect workers.

Scaffolding: Scaffolds are temporary structures that are used for workers to gain elevation while working on a project. Scaffolding comes in an array of sizes, shapes and materials such as steel, wood or even bamboo. Workers employed in construction, carpentry, or as brick or stone masons were most likely to be injured. Safety features include guard rails, safety line and non-skid surfaces. Attributing factors to falls include the use of broken equipment, improper maintenance or assembly, too much weight for the type of scaffolding, lack of guard rails or improperly getting on or off of the scaffolding.

On Same Level: Slipping or tripping occurs when there is not enough friction between the foot of the person and the surface they are walking on or if the person's foot encounters an unexpected object in their path. Some factors that may contribute to slipping and tripping may include being personally distracted, poor lighting, or wearing inappropriate footwear for the surface on which the individual is walking. Prevention measures include keeping work areas well lit, clean and sanitary, the permanent marking of aisles and passageways, non-skid surfaces and requiring that employees wear proper footwear. Additional research needs to be conducted regarding the types of surfaces on which falls are occurring 03. Falls in the Banking Industry! (Lipscomb et al., 2004).

Nonmoving Vehicle: Vehicles are used in a variety of industries and occupations. Vehicles may include automobiles, buses, trucks, vans, construction machinery used as transport vehicles on public highways, farm and industrial machinery, fire engines, motorcycles, motorized bicycles or scooters, and trolley buses not operating on rails and forklifts. Injuries from this type of fall often occurs from falling off the vehicle while doing maintenance, securing loads, cleaning the vehicle, or loading and unloading cargo. The greatest number of falls occurs in manufacturing and transportation/communications/public utilities (TCPU). Safety features include the use of seat belts, proper footwear and the use of a safety harness.

Falls are not just limited to the construction industry or to those who perform manual labor. In the Financial Activities industry, marble floors contributed to 600 cases in Minnesota in which workers missed one or more days from work in both 2008 and 2009. Here are some interesting facts provided by Brian Zaidman, Senior Research Analyst, for the Minnesota Department of Labor and Industry:

• Only 24 percent of the injured workers were younger than 45 years, compared with 55 percent of all private-sector injured workers.


• 47 percent of the injuries were due to falls, compared with just 21 percent among all injuries to private-sector workers.


• Consistent with the high proportion of falls, 37 percent of the injuries involved multiple traumas or bruises and contusions, compared with only 11 percent among all private-sector workers.

According to the Bureau of Labor Statistics, falls account for 14% of fatal work related fatalities, of which 12% of falls are from workers falling to a lower level.

Hispanic construction workers are most likely to experience fatal falls. The risk of fatal falls is even higher for immigrant young and inexperienced Hispanic workers than Hispanic workers born in the U.S.

The number of fall fatalities over the last 17 years have not changed dramatically. In 1992, the death rate from falls was 600 deaths per year. In 2007, the rate increased to a peak of 847 annual deaths, but over the last two years has decreased to 617. Still, far too many preventable occupationally related deaths.

The inflation adjusted direct costs of workplace injuries that are considered disabling between 1998 to 2008 increased over 2%. Falls on the same level increased by 41.9% and falls to a lower level increased by 9.7%

• Falls on the same were the second leading cost to of disabling injury in 2008


• Cost to employers was $8.37 billion and accounted for over 15% of the injury burden


• Falls to a lower level were the fifth leading cost to of disabling injury in 2008


• Cost to employers was $5.29 billion and accounted for almost 10% of the injury burden


• The mean total work comp benefits for indemnity claims due to falls and trips was $40,043, which includes case reserves for claims that are still open(2007 - 2008).

• Average indemnity benefit: $17,100


• Estimated mean medical benefit: $21,500


• Total estimate work comp benefits: $38,500


• Fall injury indemnity benefits accounted for 20% of all indemnity benefits paid for claims closed between Jan. and Sept. 2010 (Zaidman, 2011).

Dr. William Haddon is a pioneer in the field of injury prevention. In the 1970's he created a useful rubric for identifying and preventing potential injuries and mitigating injuries that have occurred. The first of these guidelines are Haddon's 10 Strategies. The second part is a matrix for injury influences in the pre-injury phase, occurrence aspects in the event phase, and post event factors that can affect the injury. The Haddon Matrix is an excellent basis for today's hierarchy of controls for injury prevention. The hierarchy consists of engineering controls, administrative and personal protective equipment. According to Ellenbecker (1996), engineering controls are a necessity for reducing injuries in the workplace.

1. Prevent the creation of the hazard in the first place

• Example: Identify potential slip, trip or fall hazards on the worksite by doing an initial visual worksite assessment or survey


• Fall protection training


• Job hazard analysis for each task that the worker is going to do


• Fall protection inspection (scheduled or unscheduled) by supervisors

2. Reduce the amount of the hazard brought into being

• Example: Reduce the ladder height required by replacing with scaffolding.


• Install passive systems such as guard rails, railing or safety nets.


• Personal fall arrest systems limiting the distance a person can fall

3. Prevent the release of the hazard that already exists

• Example: Fall protection equipment


• Ensuring that ladders or scaffolding are on a stable surface

4. Modify the rate or partial distribution of release of the hazard from it's source

• Implement the use of rope grabs, shock absorbing lanyards, lifelines, and anchor points on the ladder or scaffolding.

5. Separate, in time or space, the hazard and that which is protected

• Ensure that workers do not go near the edge of an unprotected or unguarded opening.

6. Separate the hazard and that which is to be protected by interposition of a material barrier

• Example: Provide guardrails, scaffolding or ladder railings, or safety nets

7. Modify basic relevant qualities of the hazard

• Example: Ensure that he ladder is strong enough for the worker and equipment. Ensure that all work surfaces have are skid or slip resistant

8. Make what is to be protected more resistant to damage from the hazard

• Example: hardhat or helmet use in order to prevent head injuries. Safety harness use. Slip resistant footwear. Fall harnesses can also be used to protect the worker.

9. Begin to counter the damage already done by the environmental hazard

• Example: Ensuring all workers know Basic Life Support measures, and are aware of how to contact emergency services


• Safety monitoring system or inspection follow-up

10. Stabilize, repair, and rehabilitate the object of the damage

• Example: Repair broken equipment. Ensure the injured worker receives adequate medical treatment and facilitate the process for possible Worker's Compensation claims.

Quantifying the impact of preventative measures is a very difficult task that confounds almost every area of the public health arena. It is difficult to say exactly how much money was saved by something NOT happening. One of the only ways to do this is to identify the cost of an injury or event, or incident that has already occurred (time lost, wages lost, Worker's Compensation increases, pain and suffering) and try to compare that with the potential savings should future similar events be prevented. There are numerous databases available for almost every industry and many government sites that quantify the data from past events. Some helpful websites that are available are as follow:

The Web-based Injury Statistics Query and Reporting System) is a database that allows you to enter information based on specific criteria to produce a customized injury-related report.

http://www.cdc.gov/injury/wisqars/

The Bureau of Labor Statistics is another very useful site that had copious amounts of data, allowing the user to obtain statistics regarding injuries and fatalities industry, gender, race/ethnicity, age, and many other exposures. This website can be found at the following address:

http://www.bls.gov/data/

The United States Department of Labor Occupational Safety and Health Administration has industry specific information including rules and regulations that businesses must adhere to. Everything from ladder safety to explosives can be found on this site!

http://www.osha.gov/

The 2011 National Safety Council Injury fact sheet lists a total Worker's Compensation costs for fall-related injuries in excess of 13.8 billion dollars! Although we do not know exactly how much money could be saved if injuries were prevented, we can infer that the sum would be similar for the same type of injuries.

Every year thousands of men, women and children are seriously injured or killed falling from ladders. According to the U.S. Bureau of Labor and Statistics falls from ladders accounted for 20% of all fatal falls alone in 2009 . Many if not all of these injuries or deaths could have been avoided if proper ladder safety procedures were followed.

The ladder is one of the simplest tools that a person can use, and it can be used safely given proper instruction. The U.S. Department of Labor, Occupational Safety & Health Administration (OSHA) mandates in their "Safety and Health Regulations" that all personnel who are going to use a ladder be properly trained. "The employer shall provide a training program for each employee using ladders and stairways, as necessary. The program shall enable each employee to recognize hazards related to ladders and stairways, and shall train each employee in the procedures to be followed to minimize these hazards" is written specifically into the regulations .

There are many simple steps that can be taken to ensure that all personnel using a ladder do so in a safe and efficient manner, protecting not only themselves but those around them.

CHECK THE SITE Look around you and ask yourself these questions: Is it safe to get on the ladder today? Is it windy? Is there water or ice that could make the ground or the ladder slippery? Is the ground solid under the area where the ladder will be placed? Are there any power lines that could be an electrical hazard? Will my ladder be a hazard to anyone else? Are there any other hazards near the work area? These are all simple questions that can save a lot of grief!

CORRECT LADDER Ladders are rated for specific uses. The American National Standards Institute (ANSI) rating sticker should be on every ladder stating the ladder use and weight restrictions. Ensure that the ladder will hold not only your weight, but that of your equipment too.

INSPECT THE LADDER Is my ladder in good condition? Are there any areas that are cracked or broken? Are there any missing screws or bolts? Are there any loose pieces? Never use a damaged ladder! Ensure that it is properly marked and put aside for proper repair, or destroyed. NEVER leave a broken ladder in an area where someone else may use it!

GET A HELPER Two people can carry a ladder easier than one. A second person also makes it a lot easier to set up a ladder safely! It can save unnecessary back strain or injury and it is safer! Your helper can also play a second role as a ladder "stabilizer" when the ladder has been set up.

SETTING UP THE LADDER Ensure that nothing has changed since you originally looked at the work area. Make sure that the ladder is not placed in a doorway where someone could accidentally knock it over, or a door could push the ladder down. Have your helper hold and guard the base. The Center to Protect Workers' Rights recommends that "The base of the ladder should be 1 foot from the building (or top support, such as an eave) for every 4 feet of ladder length up to the resting position." If a stepladder is used, ensure the braces are locked.

CLIMBING When climbing a ladder, there are many things to keep in mind. Do not climb a ladder carrying tools or equipment. Hands (and feet) should be free of impediments. This will also allow you to keep "three point contact" (one hand and two feet, or two hands and one foot) while climbing. If you need to carry something to the area where you are working (such as a tool) put the tool in your tool belt, or if the tool or equipment is too large, use a rope and haul it up to you. Another good reason to have a helper with you!

GET TO WORK! When you are on the ladder, there are a few more things to keep in mind. First of all, don't over reach! Many people fall off of ladders because they are reaching for something and get off balance. A good rule to ensure that you are not over reaching is to keep your belt buckle between the rungs of the ladder .

CLEAN-UP Once the job is finished it is time to safely lower tools and equipment down to your helper. Ensure you are free of anything that could make you slip or fall (like a power cord wrapped around your leg) and climb back down the ladder using the same controlled three point contact movements that you used to ascend. Keep the belt buckle between the rungs and your face forward as you slowly and safely climb back to earth.

FINAL INSPECTION Once your ladder has been removed from the work area, inspect it once more to ensure that nothing was broken during use, and also ensure that you ladder is clean and ready for the next time you will need it. Take care of your tools and they will take care of you!

There are many good resources available online regarding ladder use and safety. These are just a few of the numerous sites available:
OSHA Safety and Health Regulations for Construction: Ladders
American Ladder Institute http://www.laddersafety.org/ls/Content.aspx?pageid=81
Electronic Library of Construction Occupational Safety and Health http://www.elcosh.org/en/sitemap.html
Occupational Safety and Health Administration - eTool http://www.osha.gov/SLTC/etools/construction/falls/4ladders.html
The Center for Construction - Research and Training http://www.cpwr.com/search.php
U.S. Consumer Product Safety Commission http://www.cpsc.gov/library/neiss.html

Road Construction: Lipscomb et al. (2004) identified the need for further research for workers who are employed in the concrete, street and road construction industries. These industries incurred an increased number of injuries related to falls and high worker's compensation payout rates. Although the authors looked specifically at worker injuries during the construction of the Denver International Airport, these finding may be translated to the general construction industry.

General Construction: It is suggested by Howell et al. (2002) that using a ladder fall simulator in the construction industry could be used to recognize dangerous situations and also as a tool for training personal on how to prevent injuries.

General Research: Studies that are statistical in nature, according to Kines (2003), fail to identify the underlying cause of injuries. Fall victims should be interviewed in order to fully understand the factors that contributed to the injury in order to identify the cognitive, motivational, behavioral and other aspects that may have contributed to the fall.

Bondy, J., Lipscomb, H., Guarini, K., & Glazner, J. E. (2005). Methods for using narrative text from injury reports to identify factors contributing to construction injury. American Journal of Industrial Medicine, 48(5), 373-380.

CDC. (2009, October 27). Falls from Elevations. Retrieved February 6, 2011, from Centers for Disease Control & Prevention: http://www.cdc.gov/niosh/topics/falls/default.html

CDC. (2000). Worker Deaths by Falls. Cincinnati: NIOSH.
Ellenbecker, M. J. (1996). Engineering controls as an intervention to reduce worker exposure. American Journal of Industrial Medicine, 29(4), 303-307.

Dong, X.S., Fujimoto, A., Ringen, K., Men, Y. (2009). Fatal falls among Hispanic construction workers, Accident Analysis & Prevention, 41(5), 1047-1052.

Howell, G. A., Ballard, G., Abdelhamid, T., & Mitropoulos, P. (2002). Working near the edge: A new approach to construction safety. Paper presented at the ANNUAL CONFERENCE ON LEAN CONSTRUCTION, 10 49-60.

Janicak, C. A., (1998). Fall-Related Deaths in the Construction Industry, Journal of Safety Research, 29(1), 35-42.

Kemmlert, K., & Lundholm, L. (2001). Slips, trips and falls in different work groups--with reference to age and from a preventive perspective. Applied Ergonomics, 32(2), 149-153.

Kines, Pete (2003). Case studies of occupational falls from heights; cognition and behavior in context. Journal of Safety Research, 34, 263-271.

Liberty Mutual. (2009). 2010 Liberty Mutual Research Institute for Safety. Retrieved March 25, 2011, from Liberty Mutual Research Institute for Safety: http://www.libertymutualgroup.com/reserachinstitute

Lipscomb, H. J., Glazner, J., Bondy, J., Lezotte, D., & Guarini, K. (2004). Analysis of text from injury reports improves understanding of construction falls. Journal of Occupational and Environmental Medicine, 46(11), 1166.

Maynard, W. S. (2002). Tribology: Preventing slips and falls in the workplace. Occupational Health & Safety, 71(9), 134-140.

NHS Health Scotland. (2008, July 1). Slips, Trips and Falls. Retrieved March 15, 2011, from Healthy Working Lives: http://www.healthyworkinglives.com/advice/workplace-hazards/falls.aspx#reducing

Robertson, L. S. (2007). Injury epidemiology: Research and control strategies Oxford University Press, USA.

Robertson, L. S. (2007). Injury epidemiology: Research and control strategies (3rd ed.). New York, New York: Oxford University Press, USA.

Smith, G. (2001). Public health approaches to occupational injury prevention: Do they work? Injury Prevention, 7(suppl 1), i3.

U.S. Bureau of Labor Statics. (8, 19 2010). 2009 Census of Fatal Occupational Injuries (CFOI) Charts. Retrieved March 15, 2010, from Bureau of Labor Statistics: http://www.bls.gov/iif/oshwc/cfoi/cfch0008.pdf

Webster, T. (2000). Workplace falls. Compensation and Working Conditions, 5(1), 28-38. Retrieved from http://www.bls.gov/opub/cwc/archive/spring2000art4.pdf

Zaidman, B. (2011). In Balint M. M. (Ed.), Marble floors are slippery and hard: A quick look at injuries and illnesses in the financial activities industry.