Toolbox Talks: Insights for Improvement

Tool box talks (TBTs) have the potential to improve communication, empower workers, reduce injuries and improve safety; however, they can also be “missed opportunities” for providing important safety messages in construction. The goal of this paper is to share the results from two research projects designed to improve the frequency, delivery, participation, and outcomes of TBTs. The results of these projects provide suggestions for planning and delivering TBTs in construction. METHODS: In the first project, 86 residential carpentry foremen from 8 different residential contractors in the St. Louis region participated in training for delivering TBTs as part of an 8-hour fall prevention and safety communication intervention. We compared baseline measures of safety behavior and fall prevention knowledge items to follow-up between participating foremen and their crewmembers. Concurrently, surveys of 300 apprentice carpenters were collected to describe the frequency and delivery methods of TBT and to serve as a comparison group for the TBT intervention. In the second project, we evaluated the utility of ergonomics TBTs delivered by a safety representative to 36 carpenters and laborers. Workers rated their perceptions of topic relevance, delivery method, similarities to traditional TBTs, and intent to change behaviors. The safety representative provided feedback regarding the TBTs and reported their observations of improved worker use of ergonomics in work tasks post-training. DISCUSSION / CONCLUSIONS: Both interventions described in this paper improved workplace safety. The interventions demonstrate how to simply shift from non-collaborative TBTs to participatory, context-driven TBTs by using a pre-printed TBT template, modified to address the hazards present at the worksite. Delivery suggestions relate the information to the workers, and include workers in the identification of problems and safety-related solutions. These participatory methods for preparing and delivering TBTs have the potential to improve construction workplace safety practices

Using job-title-based physical exposures from O*NET in an epidemiological study of carpal tunnel syndrome

OBJECTIVE: We studied associations between job title based measures of force and repetition and incident carpal tunnel syndrome (CTS). BACKGROUND: Job exposure matrices (JEMs) are not commonly used in studies of work-related upper extremity disorders. METHODS: We enrolled newly-hired workers into a prospective cohort study. We assigned a Standard Occupational Classification (SOC) code to each job held and extracted physical work exposure variables from the Occupational Information Network (O*NET). CTS case definition required both characteristic symptoms and abnormal median nerve conduction. RESULTS: 751 (67.8%) of 1107 workers completed follow-up evaluations. 31 subjects (4.4%) developed CTS during an average of 3.3 years of follow-up. Repetitive Motion, Static Strength, and Dynamic Strength from the most recent job held were all significant predictors of CTS when included individually as physical exposures in models adjusting for age, gender, and BMI. Similar results were found using time-weighted exposure across all jobs held during the study. Repetitive Motion, Static Strength, and Dynamic Strength were correlated, precluding meaningful analysis of their independent effects. CONCLUSION: This study found strong relationships between workplace physical exposures assessed via a JEM and CTS, after adjusting for age, gender, and BMI. Though job title based exposures are likely to result in significant exposure misclassification, they can be useful for large population studies where more precise exposure data are not available. APPLICATION: JEMs can be used as a measure of workplace physical exposures for some studies of musculoskeletal disorders

Postoffer Pre-Placement Screening for Carpal Tunnel Syndrome in Newly Hired Manufacturing Workers

OBJECTIVE: We determined the predictive validity of a post-offer pre-placement (POPP) screen using nerve conduction velocity studies (NCV) to identify future cases of carpal tunnel syndrome (CTS). METHODS: A cohort of 1648 newly hired manufacturing production workers underwent baseline NCS, and were followed for 5 years. RESULTS: There was no association between abnormal POPP NCV results and incident CTS. Varying NCV diagnostic cut-offs did not improve predictive validity. Workers in jobs with high hand/wrist exposure showed greater risk of CTS than those in low exposed jobs (Relative Risk 2.82; 95% CI 1.52, 5.22). CONCLUSIONS: POPP screening seems ineffective as a preventive strategy for CTS