Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings

Published date27 October 2021
Citation86 FR 59309
Record Number2021-23250
SectionProposed rules
CourtOccupational Safety And Health Administration
Federal Register, Volume 86 Issue 205 (Wednesday, October 27, 2021)
[Federal Register Volume 86, Number 205 (Wednesday, October 27, 2021)]
                [Proposed Rules]
                [Pages 59309-59326]
                From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
                [FR Doc No: 2021-23250]
                =======================================================================
                -----------------------------------------------------------------------
                DEPARTMENT OF LABOR
                Occupational Safety and Health Administration
                29 CFR Parts 1910, 1915, 1917, 1918, 1926, and 1928
                [Docket No. OSHA-2021-0009]
                RIN 1218-AD39
                Heat Injury and Illness Prevention in Outdoor and Indoor Work
                Settings
                AGENCY: Occupational Safety and Health Administration (OSHA), Labor.
                ACTION: Advance notice of proposed rulemaking (ANPRM).
                -----------------------------------------------------------------------
                SUMMARY: OSHA is initiating rulemaking to protect indoor and outdoor
                workers from hazardous heat and is interested in obtaining additional
                information about the extent and nature of hazardous heat in the
                workplace and the nature and effectiveness of interventions and
                controls used to prevent heat-related injury and illness. This ANPRM
                provides an overview of the problem of heat stress in the workplace and
                of measures that have been taken to prevent it. This ANPRM also seeks
                information on issues that OSHA can consider in developing the
                standard, including the scope of the standard and the types of controls
                that might be required.
                DATES: Submit comments on or before December 27, 2021.
                ADDRESSES: You may submit comments and attachments, identified by
                Docket No. OSHA-2021-0009, electronically at www.regulations.gov, which
                is the Federal e-Rulemaking Portal. Follow the instructions online for
                making electronic submissions.
                 Instructions: All submissions must include the agency's name and
                the docket number for this ANPRM (Docket No. OSHA-2021-0009). When
                submitting comments or recommendations on the issues that are raised in
                this ANPRM, commenters should explain their rationale and, if possible,
                provide data and information to support their comments or
                recommendations. Wherever possible, please indicate the title of the
                person providing the information and the type and number of employees
                at your worksite.
                 All comments, including any personal information you provide, will
                be placed in the public docket without change and will be publicly
                available online at www.regulations.gov. Therefore, OSHA cautions
                commenters about submitting information they do not want to be made
                available to the public or submitting materials that contain personal
                information (either about themselves or others) such as Social Security
                Numbers and birthdates.
                 Docket: To read or download comments or other material in the
                docket, go to Docket No. OSHA-2021-0009 at www.regulations.gov. All
                comments and submissions are listed in the www.regulations.gov index;
                however, some information (e.g., copyrighted material) is not publicly
                available to read or download through that website. All submissions,
                including copyrighted material, are available for inspection at the
                OSHA Docket Office. Documents submitted to the docket by OSHA or
                stakeholders are assigned document identification numbers (Document ID)
                for easy identification and retrieval. The full Document ID is the
                docket number plus a unique four-digit code. OSHA is identifying
                supporting information in this ANPRM by author name and publication
                year, when appropriate. This information can be used to search for a
                supporting document in the docket at www.regulations.gov. Contact the
                OSHA Docket Office at 202-693-2350 (TTY number: 877-889-5627) for
                assistance in locating docket submissions.
                FOR FURTHER INFORMATION CONTACT:
                 Press Inquiries: Contact Frank Meilinger, Director, Office of
                Communications, U.S. Department of Labor; telephone (202) 693-1999;
                email [email protected].
                 General and technical information: Contact Andrew Levinson, Acting
                Director, Directorate of Standards and Guidance, U.S. Department of
                Labor; telephone (202) 693-1950.
                SUPPLEMENTARY INFORMATION: This ANPRM on Heat Injury and Illness
                Prevention in Outdoor and Indoor Work Settings follows this outline:
                Table of Contents
                I. Background
                 A. Occupational Illnesses, Injuries, and Fatalities Due to
                Hazardous Heat
                 B. Under Reporting of Occupational Illnesses, Injuries, and
                Fatalities Due to Hazardous Heat
                 C. Scope
                 1. Industries, Occupations, and Job Tasks
                 2. Structure of Work and Work Arrangements
                 3. Business Size
                 D. Geographic Region
                 E. Inequality in Exposures and Outcomes
                 F. Climate Change
                II. Existing Heat Illness Prevention Efforts
                 A. OSHA Efforts
                 1. OSHA's Heat Illness Prevention Campaign and Other Guidance
                Efforts
                 2. Stakeholder Engagement--NACOSH Work Group
                 3. General Duty Clause
                 4. Other Enforcement Efforts
                 5. Applicable OSHA Standards
                 B. Petitions for Rulemaking
                 C. NIOSH Criteria Documents
                 D. History and Requirements of State Standards
                 E. Other Standards
                 F. Employer Efforts
                III. Key Issues in Occupational Heat-Related Illness
                 A. Determinants of Occupational Heat Exposure
                 1. Heat Exposure
                 2. Contributions to Heat Stress in the Workplace
                 B. Strategies To Reduce Occupational Heat-Related Injury and
                Illness
                 1. Heat Injury and Illness Prevention Programs
                 2. Engineering Controls, Administrative Controls, and Personal
                Protective Equipment
                 3. Acclimatization
                 4. Monitoring
                 5. Planning and Responding to Heat-Related Illness Emergencies
                 6. Worker Training and Engagement
                IV. Costs, Economic Impacts, and Benefits
                 A. Overview
                 B. Impacts on Small Entities
                V. References
                I. Background
                 Heat is the leading cause of death among all weather-related
                phenomena (NWS, September 8, 2021a; NWS,
                [[Page 59310]]
                September 8, 2021b). Excessive heat exacerbates existing health
                problems like asthma, kidney failure, and heart disease, and can cause
                heat stroke and even death if not treated properly and promptly.
                Workers in both outdoor and indoor work settings without adequate
                climate-controlled environments are at risk of hazardous heat exposure.
                In an evaluation of 66 heat-related illness enforcement investigations
                from 2011-2016, 80% of heat-related fatalities occurred in outdoor work
                environments. However, 61% of non-fatal heat-related illness cases
                occurred during or after work in an indoor work environment (Tustin et
                al., August 2018). Pregnant workers (NIOSH, April 20, 2017) and workers
                of color are disproportionately exposed to hazardous levels of heat in
                essential jobs across these work settings (Gubernot et al., February
                2015). In addition, climate change is increasing the frequency and
                intensity of extreme heat events, as well as increasing daily average
                daytime and nighttime temperatures. OSHA is initiating a rulemaking to
                protect both indoor and outdoor workers from hazardous heat, and as a
                first step is seeking additional information about the extent and
                nature of hazardous heat in the workplace and the nature and
                effectiveness of interventions and controls used to prevent heat-
                related illness. This ANPRM provides an overview of the problem of heat
                stress in the workplace and the measures that have been taken to
                prevent it. This ANPRM also seeks information on issues that may be
                considered in developing a standard, including the scope of the
                standard and the types of controls that might be required.
                 OSHA uses several terms related to excessive heat exposure
                throughout this document. Heat stress means the load of heat that a
                person experiences due to sources of heat or heat retention, or the
                presence of heat in a work setting. Heat strain means the physiological
                response to heat exposure (ACGIH, 2017). Heat-related illness means
                adverse clinical health outcomes that occur due to exposure to
                hazardous heat. Heat-related injury means an injury linked to heat
                exposure that is not considered one of the typical symptoms of heat-
                related illness, such as a fall or cut. The document also uses the
                combined terms of heat injury and illness when talking about prevention
                or programming to demonstrate that both injury and illness should be
                considered, with the exception of the names of existing programs.
                A. Occupational Illness, Injuries, and Fatalities Due to Hazardous Heat
                 According to the Bureau of Labor Statistics (BLS) Census of Fatal
                Occupational Injuries, exposure to excessive environmental heat stress
                has killed 907 U.S. workers from 1992-2019, with an average of 32
                fatalities per year during that time period (BLS, September 10, 2021a).
                In 2019, there were 43 work-related deaths due to environmental heat
                exposure (BLS, September 1, 2021). A recent analysis of BLS data by
                National Public Radio and Columbia Journalism Investigations found that
                the three-year average of heat-related fatalities among U.S. workers
                has doubled since the early 1990s (Shipley et al., August 17, 2021).
                The BLS Annual Survey of Occupational Injuries and Illnesses estimates
                that 31,560 work-related heat injuries and illnesses involving days
                away from work have occurred from 2011-2019, with an average of 3,507
                injuries and illnesses of this severity occurring per year during this
                period (BLS, September 10, 2021b). However, the estimates provided here
                on occupational heat-related illnesses, injuries, and fatalities are
                likely vast underestimates, as discussed further in Underreporting of
                occupational illnesses, injuries, and fatalities due to hazardous heat
                (Section I.B. of this ANPRM).
                 In a warm environment, the human body maintains a healthy internal
                body temperature by getting rid of excess heat through mechanisms like
                sweating and increasing blood flow to the skin. This is especially true
                during physical activity or exertion. Briefly, if the body is not able
                to dissipate heat, the body temperature may rise, and symptoms of heat-
                related injury and illness can result. These can include heat rashes,
                heat syncope (fainting), heat cramps, heat exhaustion, rhabdomyolysis
                (a complex medical condition involving muscle breakdown), kidney
                injury, and even heat stroke (the inability of the body to cool which
                can lead to death) if the thermoregulatory capacity of the body is
                exceeded (Ebi et al., August 21, 2021; NIOSH, February 2016). A multi-
                country meta-analysis of dozens of studies involving thousands of
                workers globally found that of those exposed to hazardous heat during a
                single work shift, 35% experienced heat strain while 15% of those who
                frequently worked in hazardous heat experienced kidney disease or acute
                kidney injury (Flouris et al., December 2018).
                 Exposure to hazardous heat can also result in the exacerbation of
                pre-existing medical conditions, such as diabetes or cardiovascular
                disease. A study of U.S. Army personnel demonstrated that those who
                have been hospitalized in U.S. hospitals for heat-related illness may
                experience organ damage that can persist for years afterward, even
                resulting in an increased risk of death from cardiovascular disease and
                ischemic heart disease compared to those previously hospitalized for
                other reasons (Wallace et al., 2007). Recurrent exposure to hazardous
                heat, and resulting dehydration, has also been found to be associated
                with acute and chronic kidney disease and injury in agricultural
                workers and others performing manual labor in outdoor work settings,
                particularly in South America, central America and certain South Asian
                countries. These illnesses appear to be unrelated to traditional causes
                of the disease (Glaser et al., August 8, 2016; Johnson et al., May 9,
                2019; Sorensen and Garcia-Trabanino, August 22, 2019). Although much of
                this research has focused on international populations, there is
                emerging evidence of this health hazard in occupational populations
                within the U.S. (Mix et al., 2019; Glaser et al., August 8, 2016).
                 The following questions are intended to solicit information on the
                topics related to assessing the nature and magnitude of occupational
                illness, injuries, and fatalities occurring due to hazardous heat.
                 (1) What are the occupational health or safety impacts of hazardous
                heat exposure?
                 (2) What sources of data are important to consider when evaluating
                occupational heat-related illnesses, injuries, and fatalities?
                 (3) Beyond the studies discussed in this ANPRM, are there other
                data that provide more information about the scope and magnitude of
                injuries, illnesses, and fatalities related to occupational heat
                exposure?
                B. Underreporting of Occupational Illnesses, Injuries, and Fatalities
                Due to Hazardous Heat
                 Heat-related illnesses, injuries, and fatalites are underreported
                (EPA, April 2021; Popovich and Choi-Schagrin, August 11, 2021).
                Occupational heat-related illnesses, injuries, and fatalities may be
                underestimated for several reasons. First, the full extent of heat-
                related health outcomes is underreported generally because heat is not
                always recognized as a contributing factor and the criteria for
                defining a heat-related death or illness may vary by state, and among
                physicians, medical examiners, and coroners. (Gubernot et al., October
                2014). Due to the varying
                [[Page 59311]]
                nature of heat-related illness symptoms, some of which (e.g., headache,
                fatigue) may have other causes, not all cases of illness or injury are
                reported. Further, if the illness or injury does not require medical
                treatment beyond first aid, or result in restrictions or days away from
                work, loss of consciousness, diagnosis by a healthcare professional as
                a significant injury, or death, an employer is not required to report
                the incident under OSHA's existing injury reporting requirements (see
                29 CFR 1904.7(a)). There may also be situations where an illness,
                injury, or fatality is deemed to be unrelated to work, but heat
                exposure at work may have contributed to that incident (Gubernot et
                al., October 2014; Shipley et al., August 17, 2021).
                 Second, hazardous heat can impair job tasks related to complex
                cognitive function (Ebi et al., August 21, 2021), and also reduce
                decision-making abilities and productivity. A recent global meta-
                analysis showed that 30% of workers who experienced hazardous heat
                during a single shift reported productivity losses (Flouris et al.,
                December 2018). Additionally, a growing body of evidence has
                demonstrated that these heat-induced impairments may result in
                significant occupational injuries that are not currently factored into
                assessments of the health hazards resulting from occupational heat
                exposure (Park et al., July 2021). In California, the likelihood of
                same-day workplace injury risk significantly increased by approximately
                5-7% when comparing a day that was 60-65 degrees Fahrenheit to a day
                that was 85-90 degrees Fahrenheit. Same-day workplace injury risk
                increased 10-15% when comparing a day that was 60-65 degrees Fahrenheit
                to a day that was above 100-degrees Fahrenheit. These increased risks
                were demonstrated in certain indoor and outdoor work environments,
                contributing to approximately 360,000 additional workplace injuries in
                California alone from 2001-2018 (Park et al., July 2021).
                 Third, self-reporting of health outcomes can result in bias which
                can lead to over- or under-estimates of health outcomes (Althubaiti,
                May 4, 2016). In 2009, the Government Accountability Office (GAO)
                reported that the BLS Survey of Occupational Injuries and Illnesses,
                which relies heavily on employer self-report of non-fatal injuries and
                illnesses, may underreport employer-reported injury and illness data
                (GAO, October 2009). This underreporting of non-fatal illnesses and
                injuries may be particularly present in some industries, like
                agriculture, where some employers (e.g., employers with 10 or fewer
                employees) are excluded from reporting requirements (Leigh et al.,
                April 2014). While there may be multiple factors influencing
                underreporting, BLS investigations of this issue have found that
                employers and employees may face disincentives for reporting injuries
                and illnesses (BLS, December 8, 2020). By reporting injuries and
                illness, employers may increase their workers' compensation costs and
                jeopardize their reputation. Employees may also face disincentives for
                reporting if they are reluctant to report for fear of retaliation or
                may not realize an illness or injury is heat-related. Employees may
                decide to continue working for economic incentives and to avoid losing
                wages. Employee fear of retaliation, including the potential loss of
                employment, may be of particular concern with heat-related illness and
                injuries given the disproportionate number of undocumented, migrant,
                low-wage, or other vulnerable workers that make up sectors that are at
                high risk of hazardous heat exposure such as agriculture and
                construction. These workers may lack the awareness of their right to,
                and perceived ability to, speak out about workplace conditions.
                Additional concerns related to the inequalities in hazardous heat
                exposure and resulting health outcomes are discussed below in more
                detail. Despite potential underreporting, these datasets are important
                indicators of occupational safety and health, and through the questions
                below, OSHA seeks additional information and data to better assess the
                fullest extent of occupational illnesses, injuries, and fatalities due
                to hazardous heat exposure in the workplace.
                 Finally, there are some health conditions associated with
                occupational heat exposure that may take many years to manifest in
                workers previously exposed to hazardous heat due to the latency period
                between exposure and symptom onset (Gubernot et al., October 2014). For
                these illnesses that develop over time, it is unlikely that the current
                national datasets of occupational illnesses and injuries associate
                those outcomes with hazardous heat exposure.
                 The following questions are intended to solicit information on the
                topics related to assessing and addressing underreporting of
                occupational illness, injuries, and fatalities occurring due to
                hazardous heat.
                 (4) Are there quantitative estimates of the magnitude of
                occupational illnesses, injuries, and fatalities related to hazardous
                heat, beyond what is described in this ANPRM?
                 (5) Are there quantitative estimates or other quantitative or non-
                quantitative examinations of the magnitude of underreporting of
                occupational illnesses, injuries, and fatalities related to hazardous
                heat?
                 (6) What factors lead to the underreporting of occupational heat-
                related illness, injuries, and fatalities of which OSHA should be
                aware?
                 (7) What datasets are available to address some of the limitations
                associated with the underreporting of occupational heat-related
                illnesses, injuries, and fatalities?
                C. Scope
                1. Industries, Occupations, and Job Tasks
                 Workers across hundreds of industries are at risk for hazardous
                heat exposure and resulting health impacts. Since 2018, 789 heat-
                related hospitalizations and 54 heat-related fatalities across nearly
                275 unique industries have been documented by OSHA through workplace
                inspections and violations . During this time, hospitalizations
                occurred most frequently in postal and delivery service, landscaping,
                and commercial building, as well as highway, street, and bridge
                construction workers. Fatalities were reported in landscaping, masonry,
                and highway, street, and bridge construction workers (OSHA, August 20,
                2021).
                 Also since 2018, over 230 unique industries (as identified by 6-
                digit NAICS codes) across indoor and outdoor work settings have had at
                least one heat-related inspection by OSHA. During 2019, for example,
                OSHA heat-related inspections occurred most often in industries and
                workplaces such as roofing, postal and delivery service, construction
                and contracting, masonry, landscaping, restaurants, and warehousing and
                storage (OSHA, August 20, 2021).
                 Further, multiple analyses of OSHA enforcement investigations and
                the Census of Fatal Occupational Injuries have found that Agriculture
                (NAICS code 11), Construction (NAICS code 23), Transportation and
                Warehousing (NAICS codes 48-49), and Administrative and Support and
                Waste Management and Remediation Services (NAICS code 56) experience
                the highest rates of heat-related mortality (Gubernot et al., February
                2015; Tustin et al., August 2018). Compared to the average annual heat-
                related workplace fatality rate in all other industries of 0.09 deaths
                per 1 million workers, Agriculture, Forestry, Fishing, and Hunting was
                found to have 35 (95% confidence interval, 26.3-47.0) times the risk of
                [[Page 59312]]
                heat-related deaths with 3.06 deaths per 1 million workers from 2000-
                2010. Construction had 13 (95% confidence interval, 10.1-16.7) times
                the risk of heat-related deaths with 1.13 deaths per 1 million workers
                during that time period (Gubernot et al., February 2015).
                 Many job tasks, regardless of the industry in which they are
                performed, may also result in the risk of exertional heat stress in
                workers. The American Conference of Governmental Industrial Hygienists
                (ACGIH) has developed categories of work intensity based on their
                estimated metabolic rate, with the metabolic rate increasing across
                categories: rest (e.g., sitting), light (e.g., sitting, standing, light
                arm/handwork, occasional walking), moderate (e.g., normal walking,
                moderate lifting), heavy (e.g., heavy material handling, walking at a
                fast pace), very heavy (e.g., pick and shovel work) (ACGIH, 2017; OSHA,
                September 15, 2017). In an evaluation of 14 heat-related workplace
                fatalities that occurred from 2011-2016, the workload was moderate,
                heavy, or very heavy in 13 of the incidents (Tustin et al., July 6,
                2018). Of 20 enforcement cases from 2012-2013 that resulted in heat-
                related citations under the Occupational Safety and Health Act's
                General Duty Clause, all fatalities and non-fatal heat-related
                illnesses occurred under moderate or heavy workloads (Arbury et al.,
                April 2016).
                 The following questions are intended to solicit information about
                how hazardous heat exposure and risk varies across industries,
                occupations, and job tasks.
                 (8) Are there industries, occupations, or job tasks that should be
                considered when evaluating the health and safety impacts of hazardous
                heat exposure in indoor and outdoor work environments? Please provide
                examples and data.
                 (9) Are there any industries, occupations, or job tasks that are
                facing changes in the rate or frequency of occupational heat-related
                illness? Please provide examples and data.
                2. Structure of Work and Work Arrangements
                 The structure of work and various work arrangements, such as the
                use of temporary, gig, or contingent workers, has been found in some
                studies, including of non-US workers, to be associated with increased
                health and safety risks to workers (Caban-Martinez et al., April 2018;
                Virtanen et al., 2005). This may be due to a variety of reasons,
                including workers in these work arrangements being assigned more
                hazardous work tasks, being less aware of their ability to report
                unsafe work conditions, being less acclimatized to the heat conditions
                of the work environment, or not receiving adequate personal protective
                equipment (PPE) or training for the job duties they are conducting.
                These work arrangements are present in a variety of industries where
                workers face hazardous heat exposure, such as construction,
                agriculture, and landscaping, in part due to outdoor work settings and
                seasonality of work.
                 Additionally, multi-employer contexts may impact the health and
                safety of workers due to the need for and challenges associated with
                close coordination across employers on health and safety issues such as
                training and monitoring safe work practices (OSHA, October 6, 2021a;
                OSHA and NIOSH, October 6, 2021). OSHA recognizes that any rulemaking
                will need to consider the challenges for employers and employees
                related to protecting those in non-traditional, variable, and multi-
                employer work arrangements.
                 The following questions are intended to solicit information about
                how unique and non-traditional work arrangements contribute to workers'
                risk of heat-related injuries and illnesses, as well as the best
                practices and challenges for reducing those risks in these work
                settings.
                 (10) In addition to traditional work arrangements, are there
                specific types of work arrangements or multi-employer work arrangements
                that should be considered when evaluating the health and safety impacts
                of hazardous heat exposure in indoor and outdoor work environments?
                 (11) What are current and best practices for protecting workers in
                various types of work arrangements, including temporary and multi-
                employer work arrangements, from hazardous heat exposure?
                 (12) What are current challenges in and limitations of protecting
                workers in various types of work arrangements, including temporary and
                multi-employer work arrangements, from hazardous heat exposure?
                3. Business Size
                 Heat-related illnesses can occur in businesses of all sizes. An
                evaluation of 38 enforcement investigations involving 66 incidents of
                fatal and non-fatal heat-related illness from 2011-2016 found that 92%
                of workplaces investigated had less than 250 employees (Tustin et al.,
                August 2018). In a different assessment of workplace heat-related
                fatalities from 2000-2010, almost half of all fatalities where
                establishment size was known (244 cases out of 359 fatalities) occurred
                in what the authors termed ``very small establishments,'' or those with
                fewer than 10 employees (Gubernot et al., February 2015). However,
                approximately a quarter of fatalities during that time period occurred
                in ``very large establishments'' with more than 100 employees (Gubernot
                et al., February 2015).
                 The following questions are intended to solicit information about
                how business size may influence the practices and interventions
                implemented to prevent heat-related injuries and illnesses and the
                challenges experienced by businesses of varying sizes when implementing
                these prevention strategies. There are additional questions on the
                economic considerations for small entities included in Impacts on Small
                Entities (Section IV.B. of this ANPRM).
                 (13) How are employers in businesses of various sizes currently
                preventing heat-related injury and illness in workers?
                 (14) Are there limitations or concerns in preventing heat-related
                injury and illness in workers that vary among businesses of various
                sizes?
                D. Geographic Region
                 Heat-related injury and illness among workers can occur anywhere in
                the United States. In 2015, Texas and California had the highest number
                of nonfatal injuries and illnesses with days away from work (BLS,
                August 30, 2017). Texas and California also accounted for a quarter of
                all heat-related workplace fatalities from 2000-2010 (Gubernot et al.,
                February 2015).
                 However, when the size of the worker populations are taken into
                account, states across the southern United States, including
                Mississippi, Arkansas, Nevada, West Virginia, and South Carolina, have
                been found to have the highest rates of heat-related workplace
                fatalities from 2000-2010 (Gubernot et al., February 2015). In 2015,
                Kansas and South Carolina had the highest rates of heat-related
                nonfatal injuries and illnesses with days away from work, at 1.3 and
                1.0 per 10,000 workers, respectively (BLS, August 30, 2017). Recent
                evidence also shows that the Southeast United States accounts for the
                most cases officially reported to OSHA.
                 As discussed in Under-reporting of Occupational Illnesses,
                Injuries, and Fatalities due to Hazardous Heat (Section I.B. of this
                ANPRM), significant underreporting of workplace heat-related injury and
                illness limits the understanding of the full geographic scope of
                outcomes. Additionally, populations that are less accustomed to
                hazardous heat, such as those in the Northeast or Midwest U.S., may be
                at increased risk of health impacts from
                [[Page 59313]]
                extreme heat, particularly during early season high heat events
                (Anderson and Bell, February 2011).
                 The following questions are intended to solicit information,
                relevant data sources, and considerations related to occupational heat
                exposure and outcomes based on geographic region.
                 (15) How does geographic region contribute to occupational heat
                hazards and the outcomes experienced by workers? Please provide
                examples and data.
                 (16) Are there regions with improving or worsening occupational
                heat hazards and associated outcomes? Please provide examples and data.
                 (17) Do regions with traditional and pervasive heat hazards address
                the hazard differently than regions with more episodic exposures (e.g.,
                heat waves in a normally temperate region)?
                 (18) What regional differences should be considered or accounted
                for when determining the appropriate interventions and practices to
                prevent heat-related injuries and illnesses among workers?
                E. Inequality in Exposures and Outcomes
                 Disproportionate exposure to hazardous working conditions and their
                resulting health and safety impacts on workers exacerbates
                socioeconomic and racial inequalities in the U.S. In assessments of
                national work-related injuries, illnesses, and fatalities, employment
                in high-risk occupations has been disproportionately held by those who
                are Black, foreign-born, or low wage-earners, after adjusting for other
                demographic characteristics like sex and education (Steege et al.,
                2014). Non-Hispanic Black workers and foreign-born Hispanic workers
                tend to work in jobs with the highest injury risks even after adjusting
                for sex and education (Seabury et al., February 2017). Sociodemographic
                disparities in hazardous occupational exposures to dust and chemicals,
                noise, musculoskeletal hazards, and strain have been found to persist
                even after accounting for industry and job (Quinn et al., 2007).
                 These disparities are also present when focusing on health and
                safety outcomes that result from hazardous heat exposure. Black and
                Hispanic workers had higher relative risks of heat-related fatalities
                compared to white workers from 2000-2010 (Gubernot et al., February
                2015), and one-third of workplace heat-related fatalities since 2010
                have occurred in Hispanic workers (Shipley et al., August 17, 2021).
                From 1992-2006, agricultural crop workers were estimated to be 20 times
                more likely to suffer a heat-related fatality at work when compared to
                all other civilian occupations, with the majority of fatalities
                occurring among immigrant workers (CDC, June 20, 2008), and from 2000-
                2010, agricultural workers had 35 (95% confidence interval, 26.3-47.0)
                times the risk of dying from heat-related causes compared to all other
                industries (Gubernot et al., February 2015). Lower-wage workers are
                more likely to live and work in areas facing greater exposure to
                hazardous heat, to work in dangerous occupations, and to have limited
                access to air conditioning at home or other housing which may limit the
                ability to recover from occupational and non-occupational heat
                exposures. In California, lower-wage workers experienced five times as
                many heat-related injuries compared to the highest-wage workers between
                2001 and 2018 (Park et al., July 2021). As climate change increases
                extreme heat events, Hispanic and Latino individuals, as well as
                American Indian and Alaska Native individuals, individuals with low
                income, and individuals lacking a high school diploma are more likely
                to live in areas with the highest projected labor hour losses (EPA,
                September 2, 2021).
                 The following questions are intended to solicit information,
                relevant data sources, and considerations related to inequalities in
                occupational heat exposure and disproportionate outcomes experienced by
                vulnerable occupational populations.
                 (19) Are there specific populations facing disproportionate
                exposure to or outcomes from hazardous heat in indoor or outdoor work
                settings? Please provide examples and data.
                 (20) Are there data sources available to assess inequalities in
                exposure to or outcomes from hazardous heat in indoor or outdoor work
                settings?
                 (21) Are there industries or employers who are addressing
                occupational heat-related illness with an environmental justice
                approach (i.e., with a focus on fair treatment and meaningful
                involvement of all people regardless of race, color, national origin,
                or income) to appropriately address the disproportionate exposures and
                outcomes faced by workers of color, low-wage workers, immigrant
                workers, or pregnant workers (NIOSH, April 20, 2017)? Please provide
                examples and data.
                F. Climate Change
                 Climate change is increasing the frequency and intensity of extreme
                heat events, as well as increasing daily average daytime and nighttime
                temperatures. The National Climate Assessment, the United States'
                quadrennial report assessing climate change science and impacts and
                published by the U.S. Global Change Research Program, states that high
                summer temperatures are linked to increased illness and death, that hot
                days are associated with increased heat-related illnesses, that health
                risks may be higher earlier in warmer seasons before people have had
                time to acclimatize, and that workers will face an increased risk of
                heat-related illness due to heat exposure. This will be especially true
                in rural areas, particular sectors and occupations such as agriculture,
                forestry, construction, utilities, warehousing, manufacturing, and
                indoor workplaces producing additional heat or lacking adequate
                cooling, such as steel mills, dry cleaning, and others, and for workers
                of color, those who are older, and of lower socioeconomic status
                (USGCRP, 2016; USGCRP, 2018). It is estimated that under a high
                emissions scenario, climate change will result in the annual loss of
                almost 2 billion labor hours with an annual cost of an estimated $160
                billion in lost wages (in 2015 dollars) due to extreme temperatures
                alone, the vast majority of which is due to heat (EPA, May 2017;
                USGCRP, 2018). As the number of days above 90 degrees Fahrenheit
                increases due to climate change, so do lost hours of work. Nationally,
                the average losses are projected to be 14 to 34 hours annually per
                ``weather-exposed'' worker due to high temperature days. Weather-
                exposed workers in parts of the Southwest and Southern Great Plains
                could lose up to 84 hours per worker annually, depending on the level
                of temperature increases (EPA, September 1, 2021).
                 The following questions are intended to solicit information,
                relevant data sources, and considerations to further assess the impact
                of climate change on occupational heat exposure and outcomes.
                 (22) Are there data sources available to assess how climate change
                is altering hazardous heat exposure in outdoor and indoor work
                environments?
                 (23) How will climate change affect existing inequities in
                occupational heat exposure and related health outcomes? Please provide
                relevant data.
                 (24) How will climate change affect the risk of occupational heat-
                related illness and mortality in the different regions of the United
                States?
                 (25) How should climate change be factored into an OSHA heat
                illness and injury prevention standard?
                 (26) What efforts are employers currently taking to prepare for and
                respond to the ways that climate change
                [[Page 59314]]
                is altering hazardous heat exposure in their workplaces?
                II. Existing Heat Injury and Illness Prevention Efforts
                A. OSHA Efforts
                 OSHA has taken a multi-pronged approach to address hazardous heat
                among both indoor and outdoor workers. This includes efforts ranging
                from education and awareness building, guidance, compliance assistance,
                stakeholder engagement, and enforcement.
                1. OSHA's Heat Illness Prevention Campaign and Other Guidance Efforts
                 OSHA has a long-running Heat Illness Prevention Campaign (https://www.osha.gov/heat), which was initiated in 2011 to build awareness of
                prevention strategies and tools for employers and workers to reduce
                occupational heat-related illness. Historically, the Campaign has
                utilized the slogan ``Water. Rest. Shade.'' The agency updated Campaign
                materials in 2021 to recognize both indoor and outdoor heat hazards, as
                well as the importance of protecting new and returning workers from
                hazardous heat. These efforts, which are ongoing, incorporate
                stakeholder feedback and feature materials available in an increasing
                number of languages. Despite the strengths and reach of the Campaign,
                these guidance and communication materials are not legally enforceable
                requirements.
                 In addition to the Heat Illness Prevention Campaign materials, OSHA
                publishes a heat specific Safety and Health Topics page (https://www.osha.gov/heat-exposure), which provides additional information and
                resources on heat topics. The page provides information on planning and
                supervision in hot environments, identification of heat-related illness
                and first aid, information on prevention such as training, calculating
                heat stress and controls, personal risk factors, descriptions of other
                heat standards and case study examples of situations where workers
                developed heat-related illness. OSHA and the National Institute for
                Occupational Safety and Health (NIOSH) also co-developed a Heat Safety
                Tool Smartphone App for both Android and iPhone devices. The app
                provides outdoor location sensitive temperature, humidity, and heat
                index readings, as well as provides a corresponding risk level for
                ranges of heat index. The app is not for indoor use if using
                automatically downloaded data for the heat index calculation. Each risk
                level provides relevant information on identifying signs and symptoms
                of heat-related illness and steps that should be taken at that risk
                level to prevent heat-related illness.
                2. Stakeholder Engagement--NACOSH Work Group
                 On June 22, 2021, at a meeting of the National Advisory Committee
                for Occupational Safety and Health (NACOSH), the agency announced its
                intention to form a NACOSH work group to engage stakeholders and better
                understand current best practices and challenges in occupational heat-
                related illness prevention across a variety of industries to inform
                OSHA's response to this important hazard. This NACOSH Heat Illness
                Prevention Work Group (WG) will consist of experts who have extensive
                knowledge and experience in causes of, identification of, and factors
                that affect heat-related illness hazards in the workplace, as well as
                best practices and interventions for mitigating occupational heat-
                related illness. OSHA intends to initially convene the work group in
                late fall 2021.
                3. General Duty Clause
                 Although OSHA does not have a specific standard governing hazardous
                heat conditions at workplaces, the agency currently enforces Section
                5(a)(1) (General Duty Clause) of the OSH Act against employers that
                expose their workers to this recognized hazard. Section 5(a)(1) states
                that employers have a general duty to furnish to each of their
                employees employment and a place of employment free from recognized
                hazards that cause or are likely to cause death or serious physical
                harm to employees (29 U.S.C. 654(a)(1)). To prove a violation of the
                General Duty Clause, OSHA needs to establish--in each individual case--
                that: (1) The employer failed to keep the workplace free of a hazard to
                which its employees were exposed; (2) the hazard was recognized; (3)
                the hazard was causing or likely to cause death or serious injury; and
                (4) a feasible means to eliminate or materially reduce the hazard
                existed. (See, e.g., A.H. Sturgill Roofing, Inc., 2019 O.S.H. Dec.
                (CCH) ] 33712, 2019 WL 1099857, (No. 13-0224, 2019)).
                 OSHA has relied on the General Duty Clause to cite employers for
                heat-related hazards for decades. Additionally, OSHA has issued various
                forms of guidance for employers and employees whose work occurs in
                indoor and outdoor heat environments and has addressed heat-related
                illness in Regional Emphasis Programs in an attempt to protect workers
                from heat-related injury. (Please see OSHA Heat Illness Prevention
                Campaign and Guidance Efforts and Other Enforcement Efforts, Sections
                II.A.1 and II.A.4 of this ANPRM, respectively.) However, the General
                Duty Clause does not specifically prescribe hazardous heat exposure
                thresholds or provide specifics on how employers are to eliminate or
                reduce their employees' exposure to hazardous heat. A standard specific
                to heat-related injury and illness prevention would more clearly set
                forth employer obligations and help employers to identify the measures
                necessary to more effectively protect employees from hazardous heat.
                 OSHA's enforcement efforts to protect employees from hazardous heat
                conditions using the General Duty Clause, although important, have been
                met with significant legal challenges, leaving many workers vulnerable
                to heat-related hazards. Because there are no specific, authoritative
                exposure thresholds for OSHA to rely on, it has been challenging for
                the agency to prove the existence of a recognized hazard, even in cases
                in which a heat-related fatality has occurred. (See, e.g., A.H.
                Sturgill Roofing, Inc., 2019 O.S.H. Dec. (CCH) ] 33712, 2019 WL
                1099857, (No. 13-0224, 2019); Aldridge Elec., Inc., 26 BNA OSHC 1449,
                2016 WL 8581709, (No. 13-2119, 2016)).
                 Moreover, in litigated cases OSHA has been largely unsuccessful in
                relying on third-party scientific documents--such as ACGIH exposure
                thresholds and NIOSH criteria--to prove the existence of a recognized
                hazard. (See Aldridge Elec., Inc., 2016 WL 8581709 at *14 (noting that
                ``none of these documents is a mandatory document that [employers] must
                follow akin to an OSHA regulation.''); Industrial Glass, 15 BNA OSHC
                1594, 1992 WL 88787, at *12 n. 10, (No. 88-348, 1992) (noting that the
                NIOSH criteria ``[do] not have the force or effect of law.'')).
                Additionally, because the available scientific information is not
                currently defined in terms of a workplace hazard standard, adjudicators
                have found that crucial terms and methods for determining the severity
                of risk for heat-related illness are too vague or insufficiently
                defined to effectively determine the existence of a recognized hazard
                in the context of a particular case. (See, e.g., A.H. Sturgill Roofing,
                Inc., 2019 WL 1099857 at *4 (noting that the National Oceanic and
                Atmospheric Administration's (NOAA) National Weather Service Heat Index
                chart does not define ``prolonged exposure'' or explain what factors
                must be considered to increase heat index values; only stating that
                ``exposure to full sunshine
                [[Page 59315]]
                can increase heat index values by up to 15 [deg]F.'')).
                 Under the General Duty Clause, OSHA cannot require abatement before
                proving in an enforcement proceeding that specific workplace conditions
                are hazardous; whereas a standard would establish the existence of the
                hazard at the rulemaking stage, thus allowing OSHA to identify and
                require specific abatement measures without having to prove the
                existence of a hazard in each case. Given OSHA's burden under the
                General Duty Clause, it is currently difficult for OSHA to ensure
                necessary abatement before employee lives and health are unnecessarily
                endangered. Moreover, under the General Duty Clause OSHA must largely
                rely on expert witness testimony to prove both the existence of a
                hazard and the availability of feasible abatement measures that will
                materially reduce or eliminate the hazard in each individual case.
                (See, e.g., Industrial Glass, 1992 WL 88787 at *4-7).
                4. Other Enforcement Efforts
                 In 2019, OSHA conducted 289 heat-related inspections (OSHA, August
                20, 2021). More than 110 of these were initiated by complaints and 20
                were due to the occurrence of a fatality or catastrophe. As a result of
                these inspections, OSHA issued 155 Hazard Alert Letters (HALs), which
                provide employers with information to mitigate hazards and resources to
                assist in this process when OSHA determines a formal citation cannot be
                issued. OSHA issued only 31 General Duty Clause citations during the
                same period (OSHA, August 20, 2021). Thus, HALs were issued at five
                times the rate of 5(a)(1) citations in 2019.
                 On September 1, 2021, OSHA's Directorate of Enforcement Programs
                issued an Inspection Guidance for Heat-Related Hazards, which
                establishes a new enforcement initiative to prevent heat-related
                illnesses and fatalities while working in hazardous hot indoor and
                outdoor environments (OSHA, September 1, 2021). The guidance provides
                that days when the heat index exceeds 80 degrees Fahrenheit will be
                considered heat priority days. Enforcement efforts will be increased on
                heat priority days for a variety of indoor and outdoor industries, with
                the aim of identifying and mitigating potential hazards and preventing
                heat-illnesses before they occur.
                 OSHA's Region VI regional office, located in Dallas, TX, has a
                heat-related special Regional Emphasis Program (REP) (OSHA, October 1,
                2019). This region covers Texas, New Mexico, Oklahoma, Arkansas, and
                Louisiana, which have a high number of heat-related injuries,
                illnesses, and fatalities. This REP allows field staff to conduct heat
                illness inspections of outdoor work activities on days when the high
                temperature is forecast to be above 80 degrees Fahrenheit. This REP
                includes employers with fewer than 11 employees. Under the authority of
                this REP, Region VI conducted 78 inspections on heat-related illness,
                which identified 89 violations, in 2019 alone.
                 Heat-related inspections are also initiated by heat-related
                complaints, hospitalizations or fatalities, and during an unrelated
                programmed or unprogrammed inspection where a heat hazard is
                identified. In addition, OSHA Area Offices can initiate heat
                interventions or inspections based on local knowledge of
                establishments, referrals from the local health department, or from
                other Federal agencies with joint jurisdictions, such as U.S.
                Department of Agriculture (USDA), Environmental Protection Agency
                (EPA), media referrals or previous OSHA inspection history.
                5. Applicable OSHA Standards
                 OSHA currently has other existing standards that, while applicable
                to some issues related to hazardous heat, have not proven to be
                adequate in fully protecting workers. OSHA's Recordkeeping standard (29
                CFR 1904.7) requires employers to record and report injuries and
                illnesses that meet recording criteria. If an injury or illness does
                not require medical treatment beyond the provision of first aid, it
                does not need to be reported. Some actions that a worker may be
                recommended to take when experiencing heat-related illness, such as
                hydration, are considered to be first aid, and therefore are not
                recordable.
                 The agency's Sanitation standards (29 CFR 1910.141, 29 CFR 1915.88,
                29 CFR 1917.127, 29 CFR 1926.51, and 29 CFR 1928.110) require employers
                to provide potable water readily accessible to workers. While these
                standards require that drinking water be made available in ``sufficient
                amounts,'' it does not specify what those amounts are, and employers
                are only mandated to encourage workers to frequently hydrate on hot
                days.
                 OSHA's Safety Training and Education standard (29 CFR 1926.21)
                requires employers in the construction industry to train employees in
                the recognition, avoidance, and prevention of unsafe conditions in
                their workplaces. OSHA's PPE standards (29 CFR 1910.132, 29 CFR
                1915.152, 29 CFR 1917.95, and 29 CFR 1926.28) require employers to
                conduct a hazard assessment to determine the appropriate PPE to be used
                to protect employees from the hazards identified in the assessment.
                However, hazardous heat is not specifically identified as a hazard for
                which workers need training or PPE, complicating the application of
                these requirements to hazardous heat.
                 The following questions are intended to solicit information related
                to the existing efforts OSHA has undertaken to prevent occupational
                heat-related illness, injuries, and fatalities.
                 (27) Are OSHA's existing efforts and authorities adequate or
                effective in protecting workers from hazardous heat in indoor and
                outdoor work settings?
                 (28) What additional efforts or improvements should be undertaken
                by OSHA to protect workers from hazardous heat in indoor and outdoor
                work settings?
                 (29) What are the gaps and limitations of existing applicable OSHA
                standards, as well as existing campaign, guidance, enforcement, and
                other efforts for preventing occupational heat-related illness in
                indoor and outdoor work settings?
                B. Petitions for Rulemaking
                 OSHA has received three petitions from Public Citizen and
                supporting organizations, in 2011, 2018, and 2021, to implement a heat
                standard. The petitions presented data on the impacts of heat on
                workers' morbidity and mortality. The 2011 petition was for an
                Emergency Temporary Standard under section 6(c) of the OSH Act and was
                denied for failing to meet the grave danger requirement of the Act. The
                2018 petition asked for an OSHA heat standard under section 6(b) of the
                OSH Act and was co-signed by over 130 organizations and nearly 100
                individuals. The 2021 petition again requested that OSHA issue an
                Emergency Temporary Standard. The agency has not yet responded to the
                2018 and 2021 petitions.
                 Over the last several years, many members of Congress have also
                urged OSHA to initiate rulemaking for a Federal heat standard. In 2019,
                OSHA received a request for rulemaking from members of the Senate
                (Brown et al., November 18, 2019). In August 2021, OSHA received a
                request for rulemaking from members of both the Senate and the House of
                Representatives (Padilla et al., August 3, 2021; Chu et al., August 6,
                2021). Both chambers of Congress also have pending legislation in the
                2021-2022 legislative session that would order OSHA to develop and
                implement a Federal heat standard (U.S. Senate, 117th Congress, April
                12, 2021; U.S. House of Representatives, 117th
                [[Page 59316]]
                Congress, March 26, 2021). This legislation has also been considered in
                past legislative sessions.
                C. NIOSH Criteria Documents
                 NIOSH first proposed details of a potential Federal heat standard
                in 1972 in its Criteria for a Recommended Standard (NIOSH, 1972).
                Criteria documents, issued under the authority of section 20(a) of the
                Occupational Safety and Health Act of 1970, recommend occupational
                safety and health standards based on exposure limits and work intensity
                that are safe for various periods of employment as established by a
                critical review of scientific and technical information. NIOSH's
                criteria for a recommended standard have since been updated in 1986
                (NIOSH, April 1986) and again in 2016 (NIOSH, February 2016). The 2016
                criteria recommend that a Federal heat standard include provisions for
                medical screening and physiological monitoring, heat stress thresholds,
                rest breaks, hydration, shade, acclimatization plans, engineering
                controls (e.g., air conditioners, fans, tents), administrative controls
                (e.g., rest breaks and altered work schedules), PPE and auxiliary body
                cooling (e.g., cooled or iced vests, jackets, or other wearable
                garments), exposure and medical monitoring, hazard notification alerts,
                worker training and education, medical surveillance, and recordkeeping
                (NIOSH, February 2016).
                 The 2016 criteria document recommends occupational exposure limits
                for heat stress, such that no worker be ``exposed to combinations of
                metabolic and environmental heat greater than'' the recommended alert
                limit (RAL, for unacclimatized workers) or the recommended exposure
                limit (REL, for acclimatized workers). The NIOSH criteria recommend
                that environmental heat should be assessed with hourly measurements of
                Wet Bulb Globe Temperature (WBGT) (NIOSH, February 2016), and metabolic
                heat should be assessed using the metabolic-work-rates set by ACGIH
                (ACGIH, 2017). There are lower recommended exposure limits for
                unacclimatized workers, workers who are wearing work clothing that
                minimizes heat dissipation from the body, and those who have underlying
                personal risk factors. These exposure limits were highly sensitive,
                meaning the exposure limits were met or exceeded, in an investigation
                of a subset of 14 cases of fatal (100% sensitivity) and 11 nonfatal
                (72% sensitivity) heat-related illness in workers that occurred during
                outdoor work (Tustin et al., July 6, 2018).
                D. History and Requirements of State Standards
                 As of October 2021, four states have promulgated hazardous heat
                standards requiring employers in various industries and workplace
                settings to provide protections and abatement measures to reduce the
                risk of heat-related illness for their employees: California,
                Minnesota, Oregon, and Washington. Oregon issued a temporary rule in
                July of 2021 after experiencing temperatures well above 100 [deg]F for
                an extended period. Washington State also issued emergency heat rules
                during the summer of 2021 that provide additional worker protections to
                its previously promulgated heat rule. Additionally, since 2020, three
                more states, Colorado, Maryland, and Nevada, have passed laws requiring
                state health and safety administrators to promulgate rules related to
                hazardous heat in the workplace. Virginia's Safety and Health Codes
                Board is also considering a standard on this topic.
                 State standards differ in the scope of coverage. For example,
                Minnesota's standard covers only indoor workplaces. California and
                Washington standards cover only outdoor workplaces, although California
                is engaged in rulemaking for a potential indoor heat standard. Oregon's
                emergency rule covers both indoor and outdoor workplaces. California,
                Washington, and Oregon all have additional protections that are
                triggered by high heat, however, they differ as to the trigger for
                these additional protections: In California it is at a temperature
                reading of 95 [deg]F (and only includes certain industries), in
                Washington it is at a temperature reading of 100 [deg]F, and in Oregon
                it is at a heat index of 90 [deg]F. State rules also differ in the
                methods used for triggering the heightened protections against
                hazardous heat. Minnesota's standard considers the type of work being
                performed (light, moderate, or heavy) and has calculated a threshold
                WBGT for each work activity. California's heat-illness prevention
                protections go into effect at 80 [deg]F, ambient temperature.
                Washington's rule also relies on ambient temperature readings combined
                with considerations for the weight and breathability of workers'
                clothing. Oregon's emergency rule relies on the heat index as
                calculated by NOAA's National Weather Service.
                 All of the state standards require training for employees and
                supervisors. All of the state standards except for Minnesota require
                employers to provide at least 1 quart of water per hour for each
                employee, require some form of emergency response plan, mention the
                importance of acclimatization for workers, and require access to shaded
                break areas. Washington and Oregon require that employers provide
                training in a language that the workers understand. Similarly,
                California's standard requires that employers create a written heat-
                illness prevention plan in English as well as in whatever other
                language is understood by the majority of workers at a given workplace.
                California has the most robust acclimatization program, which requires
                close monitoring of new employees for up to fourteen days and
                monitoring of all employees during a heat wave. Table II.D.1, below,
                highlights these and additional similarities and differences between
                the existing state standards on hazardous heat.
                 Table II.D.1--State Rules on Hazardous Heat as of August 2021
                ----------------------------------------------------------------------------------------------------------------
                 WA **** (emergency
                 Standard requirements CA * MN ** OR *** rule additions in
                 italics)
                ----------------------------------------------------------------------------------------------------------------
                Worksite coverage............... Outdoor, year- Indoor, year-round Indoor and Outdoor, May 1-
                 round. outdoor, Sept. 30.
                 emergency rule.
                Thresholds triggering protection 80 [deg]F (ambient Between 77 [deg]F- 80 [deg]F (NOAA 89 [deg]F (ambient
                 requirements. temp.). 86 [deg]F (WBGT) NWS Heat Index). temp.); lower if
                 based on workload. wearing heavy
                 clothing/PPE.
                Add'l high heat protections..... At 95 [deg]F No................ At 90 [deg]F...... At 100 [deg]F.
                 (certain
                 industries only).
                Water/Hydration................. 1 qt./hr./worker.. No................ 1 qt./hr./worker, 1 qt./hr./worker
                 cool or cold. Suitably cool.
                Shade........................... Yes............... N/A............... Yes............... Yes.
                [[Page 59317]]
                
                Training........................ Yes (new hire).... Yes (new hire and Yes............... Yes (new hire and
                 annual). annual).
                Breaks.......................... Yes (Encouraged Yes (After two Yes (Mandatory if Yes. (Encouraged
                 generally, hours exposure at symptoms at any preventative and
                 mandatory if threshold). temp. every 2 must be paid;
                 symptoms). hours for all at Mandatory if
                 90 [deg]F). symptoms;
                 Mandatory at 100
                 [deg]F).
                Acclimatization Plan............ Yes............... No................ Yes (in practice No (only included
                 at 90 [deg]F). in training).
                Heat Illness Prevention Plan.... Yes............... No................ No................ Yes (as part of
                 accident
                 prevention plan).
                Emergency Medical Response Plan. Yes............... No................ Yes............... Yes.
                Medical Monitoring.............. Reactive, Reactive.......... Reactive.......... Reactive.
                 Proactive when
                 above 95 [deg]F.
                Record-keeping requirements..... Yes............... Yes............... No................ Yes.
                ----------------------------------------------------------------------------------------------------------------
                * CAL/OSHA, Title 8, section 3395. Heat Illness Prevention. https://www.dir.ca.gov/Title8/3395.html.
                ** Minnesota Administrative Rules. Section 5205.0110 Indoor ventilation and temperature in places of employment.
                 https://www.revisor.mn.gov/rules/5205.0110/.
                *** Oregon Administrative Rules. 437-002-0155 Temporary Rule Heat Illness Prevention. https://osha.oregon.gov/OSHARules/div2/437-002-0155-temp.pdf.
                **** Washington Administrative Code (WAC) Title 296, General Occupational Health Standards. Sections 296-62-095
                 through 296-62-09560. Outdoor Heat Exposure. https://app.leg.wa.gov/WAC/default.aspx?cite=296-62&full=true#296-62-095; Emergency Rule 2125 CR103E. https://lni.wa.gov/rulemaking-activity/AO21-25/2125CR103EAdoption.pdf.
                 The following questions are intended to solicit information related
                to the existing efforts at the state level to prevent occupational
                heat-related illness, injuries, and fatalities.
                 (30) What are the most effective aspects of existing state
                standards aimed at preventing occupational heat-related illness?
                 (31) What are the challenges with the implementation of existing
                state standards aimed at preventing occupational heat-related illness?
                 (32) Of the existing state standards, have any been more effective
                or challenging in their implementation than others? Why?
                 (33) What components of a state standard or program should be
                included in Federal guidance or regulatory efforts on heat-related
                illness prevention?
                 (34) Would any of the elements of the state standards not be
                feasible to include at the Federal level?
                E. Other Standards
                 Various other organizations have also either identified the need
                for standards to prevent heat-related injury and illness or published
                their own standards. In 2019, the American National Standards
                Institute/American Society of Safety Professionals A10 Committee (ANSI/
                ASSP) announced a proposed consensus standard on heat stress
                management. The International Organization for Standardization has a
                standard estimating heat stress: ISO 7243: Hot Environments--Estimation
                of Heat Stress on Working Man, Based on the WBGT-Index (ISO, 2017).
                Additional standards address predicting sweat rate and core temperature
                (ISO 7933), methods for determining metabolic rate (ISO 8996),
                physiological strain (ISO 9886), and thermal characteristics for
                clothing (ISO 9920) (NIOSH, February 2016). The ISO heat stress
                standard uses WBGT values to assess hot environments and assumes
                workforces to which thresholds are applied are healthy, physically fit,
                and are wearing standard clothing.
                 ACGIH has identified Threshold Limit Values or TLVs for heat stress
                and heat strain (ACGIH, 2017). The TLVs utilize WBGT and take into
                consideration metabolic rate or work load categories: Light (sitting,
                standing, light arm/handwork, occasional walking), moderate (normal
                walking, moderate lifting), heavy (heavy material handling, walking at
                a fast pace), very heavy (pick and shovel work). Additionally, ACGIH
                provides clothing adjustment factors in degrees Celsius that should be
                added to the assessed WBGT for certain types of work clothing. The TLVs
                range from WBGTs of approximately 24.5 degrees Celsius at the highest
                level of work to just under 34 degrees Celsius at light work and low
                metabolic rates (ACGIH, 2017). ACGIH emphasizes that the TLVs are
                appropriate for healthy, acclimatized workers and they encourage
                screening of workers for potential sensitivities to heat and provide
                guidelines for physiological monitoring for heat strain. An action
                limit that is below the level of the TLV is identified for
                unacclimatized workers.
                 The U.S. Armed Forces has developed extensive heat-related illness
                prevention and management strategies. The Warrior Heat and Exertion
                Related Events Collaborative is a tri-service group of military leaders
                focused on clinical, educational, and research efforts related to
                exercise and exertional heat-related illnesses and medical emergencies
                (HPRC, October 6, 2021). The U.S. Army has a Heat Center at Fort
                Benning which focuses on management, research, and prevention of heat-
                related illness and death (Galer, April 8, 2019). In 2016, the U.S.
                Army updated its Training and Doctrine Command (TRADOC) Regulation 350-
                29 addressessing heat and cold casualties. The regulation includes
                requirements for rest and water consumption according to specific WBGT
                levels and work intensity (Department of the Army, July 18, 2016). The
                U.S. Navy has developed Physiological Heat Exposure Limit curves based
                on metabolic and environmental heat load and represent the maximum
                allowable heat exposure limits, which were most recently updated in
                2009. The Navy monitors WBGT, with physical training diminishing as
                WBGTs increase and all nonessential outdoor activity stopped when WBGTs
                exceed 90 degrees Fahrenheit (Department of the Navy, February 12,
                2009). The U.S. Marine Corps follows the Navy's guidelines for
                implementation of the Marine Corps Heat Injury Prevention Program
                (Commandant of the Marine Corps, June 6, 2002). The U.S. Army and U.S.
                Air
                [[Page 59318]]
                Force issued a technical heat stress bulletin in 2003 with measures to
                prevent indoor and outdoor heat-related illness in soldiers, with
                recommended limitations of continuous work at ``moderate'' or ``hard''
                intensities, acclimatization planning, work-rest cycles, and fluid and
                electrolyte replacement (Department of the Army and Air Force, March 7,
                2003).
                 The following questions are intended to solicit information related
                to the existing efforts undertaken to prevent occupational heat-related
                illness, injuries, and fatalities by other entities.
                 (35) Do any of these existing standards contain elements that
                should be considered for a Federal standard?
                 (36) Are there other industry standards that contain elements that
                should be considered for a Federal standard?
                 (37) Are there elements of these standards that would not be
                appropriate or feasible for a Federal heat standard?
                F. Employer Efforts
                 While this section has primarily detailed efforts undertaken by
                OSHA, other Federal agencies, states, and industry trade associations,
                OSHA also recognizes that some employers may be engaged on this topic
                and implementing their own heat-related illness prevention efforts.
                 The following questions are intended to solicit information,
                relevant data sources, and considerations to further assess the current
                employer efforts to prevent heat-related illness and their efficacy in
                preventing heat-related illnesses.
                 (38) What efforts are employers currently taking to prevent
                occupational heat-related illness in their workplace? Please provide
                examples and data.
                 (39) How effective have employers been in preventing occupational
                heat-related illness in their workplaces, and how are employer-driven
                heat injury and illness prevention programs being evaluated?
                III. Key Issues in Occupational Heat-Related Illness
                A. Determinants of Occupational Heat Exposure
                1. Heat Exposure
                 Workers in both indoor and outdoor occupations in a variety of
                sectors are exposed to heat at work through process, exertional, and/or
                environmental heat. Hazardous heat exposure can reduce the body's
                ability to regulate physiological processes and can result in heat-
                related injury or illness, heat stroke, or death. Determining when heat
                becomes hazardous is complex. Heat exposure and its resultant health
                effects depend on multiple factors, such as heat-generating practices
                within a workplace, level of exertion during work, air temperature,
                humidity, whether work is occurring in direct sunlight or shade, wind,
                and cloud cover (OSHA, September 2, 2021). Individual-level factors
                such as age, pharmaceutical use, underlying health conditions (such as
                cardiovascular diseases), and the ability to cool at night (during heat
                waves or access to night time air conditioning, for example) also play
                a role (Kilbourne, 1997; Quandt et al., 2013; OSHA, October 6, 2021b).
                 Multiple metrics and thresholds exist for measuring heat and
                identifying when it may become hazardous to a population. Ambient
                temperature, heat index, and WBGT are available metrics for measuring
                environmental heat and identifying conditions that may lead to heat-
                related injury or illness. Ambient temperature, which can be calculated
                using a common thermometer, is the most accessible and understandable
                metric that most people are familiar with. However, ambient temperature
                measurements alone do not take into consideration humidity, which is an
                important factor that influences the body's ability to cool. Heat index
                combines air temperature and humidity and is a widely reported weather
                statistic that many people are familiar with and is often referred to
                as the ``feels like'' or ``apparent'' temperature. Heat index is used
                for setting heat advisories (NWS, September 2, 2021) but does not take
                into consideration radiant heat or wind speed, which the more health-
                relevant WBGT does. WBGT is a health-relevant measurement that
                incorporates air temperature, wind, radiant heat, and humidity (Budd,
                2008; OSHA, September 15, 2017; Oliveira et al., 2019). Measuring WBGT
                requires specialized thermometers or equipment, and may not always be
                available as a forecast through the National Weather Service.
                Additionally, WBGT may require guidance and training to avoid confusion
                with more well-known scales like temperature or heat index.
                 Another challenge with each of these metrics is identifying
                appropriate thresholds for each metric that will prevent adverse health
                impacts due to hazardous heat exposure. There is no universally
                accepted threshold for ambient temperature, heat index, or WBGT at
                which heat is considered hazardous. Determining thresholds is
                complicated by differences in regional climatology, where one region's
                population may become vulnerable to heat-related illness at lower heat
                levels (Grundstein et al., January 2015; NWS, August 25, 2021). NOAA,
                NIOSH, OSHA, the U.S. Military, and other organizations currently offer
                differing thresholds and metrics for the identification of hazardous
                heat (Department of the Army and Air Force, March 2007; NIOSH, 2016;
                NWS, August 25, 2021; OSHA, September 2021; NWS, September 1, 2021).
                Existing state standards also apply different thresholds and metrics.
                Further, existing thresholds for various metrics may not be protective
                in the occupational setting because injuries and illnesses have been
                reported below these existing thresholds (Morris et al., January 28,
                2019; Park et al. July 2021), and many of the thresholds indicating the
                potential for heat-related injury or illness are based on older data or
                studies that included populations that may not be most appropriate for
                evaluating heat stress or strain in the occupational setting, such as
                military populations (Steadman, April 11, 1979; Rothfusz, July 1, 1990;
                Budd, 2008).
                 The following questions are intended to solicit information,
                relevant data sources, and considerations to further assess the
                application of various heat metrics and the identification and
                definition of hazardous heat using metric thresholds.
                 (40) What metrics are currently being used to monitor and assess
                hazardous heat exposure in the workplace (e.g., heat index, ambient
                temperature, WBGT)?
                 (41) What are the advantages and disadvantages of using each of
                these metrics (e.g., heat index, ambient temperature, WBGT) in indoor
                and outdoor work settings? Are there any challenges associated with
                training employers and employees on these different metrics?
                 (42) Are there other metrics used to assess hazardous heat exposure
                in the workplace that are not discussed here?
                 (43) What are current and best practices in defining hazardous heat
                exposure in outdoor and indoor workplaces, and what are the limitations
                or challenges associated with those practices?
                 (44) Are there industries implementing exposure monitoring for
                heat? Please provide examples and data.
                 (45) What thresholds are utilized for various metrics implemented
                in existing occupational heat prevention plans or activities? Are these
                thresholds effective for preventing heat-related illness and
                fatalities?
                 (46) Which metrics and accompanying thresholds are both feasible
                and health-protective in both
                [[Page 59319]]
                indoor and outdoor occupational settings?
                 (47) Does application of certain heat metrics require more training
                than the use of other heat metrics?
                2. Contributions to Heat Stress in the Workplace
                 Air temperature, humidity, wind, and whether work occurs in direct
                sunlight all contribute to the potential for heat stress for outdoor
                workers. Additionally, physical exertion contributes to heat stress by
                increasing metabolic heat production. Exertion is an important
                consideration for the development of heat stress especially since
                physical activities may take place over prolonged periods of time in a
                work setting and in environmental conditions that limit the body's
                ability to cool, such as working in direct sunlight or under warm and
                humid conditions. These factors that contribute to heat stress can lead
                to heat strain and heat-related illness when the body fails to lose
                heat. Some surfaces, such as asphalt, absorb heat and can add to heat
                exposure. The urban heat island effect is a well-studied phenomenon
                that can elevate temperatures in areas concentrated with heat absorbent
                surfaces. For example, dense urban areas may experience afternoon
                temperatures 15-20 degrees higher than surrounding areas with more
                natural land cover and vegetation (NIHHIS, August 25, 2021). PPE can
                also contribute to heat stress by interfering with the body's ability
                to cool. PPE intended to protect workers from chemical, physical, or
                biological hazards can reduce sweat evaporation and subsequent cooling
                (i.e., limit the body's ability to sweat), can trap heat and moisture
                next to the skin, and can increase the level of exertion required to
                complete a task (NIOSH, February 2016).
                 The factors that contribute to heat stress in outdoor settings
                contribute to heat stress in indoor settings as well, especially in
                buildings that lack adequate climate control. Additionally, heat-
                producing processes and equipment such as those that generate steam,
                generate heat, or use certain tools and combustion, can increase
                ambient temperature and contribute to heat stress in indoor work
                settings. Lack of adequate climate control in indoor work settings can
                also contribute to occupational heat stress since indoor settings can
                increase in temperature and humidity as outdoor temperatures increase,
                and there is no relief for process or task-related heat production.
                Additionally, buildings with windows may be further heated by sunlight
                that enters windows and warms the workspace.
                 The vulnerability of the energy grid is another variable that may
                place many workers at risk of experiencing heat-related illness. In
                many areas of the country, energy grids are vulnerable to brownouts and
                blackouts in conditions of high heat due to the increased demand and
                stress placed on the energy infrastructure (Stone, Jr., et al., 2021).
                Because of this vulnerability of a key cooling mechanism, more workers
                in more industries may be at risk for experiencing heat stress, strain,
                and heat-related illness than is currently realized, especially during
                heat waves or during other natural disasters that impact the
                functionality of energy grids.
                 In both indoor and outdoor settings, individual risk factors
                contribute to the risk of heat-related illness as some individuals are
                more susceptible to the detrimental effects of heat. Occupational heat-
                related fatalities have been found to occur more frequently in men than
                in women, in those with preexisting conditions (e.g., obesity,
                diabetes, hypertension, cardiac disease), and in those with a
                preexisting use of certain medications or illicit drugs that predispose
                individuals to heat-related illness (Gubernot et al., February 2015;
                Tustin et al., July 6, 2018; Tustin et al., August 2018). Other
                factors, such as age, fitness level, alcohol consumption, prior heat-
                related illness, and lack of access to air conditioning in housing,
                also reduce the body's ability to regulate heat and can increase
                individual risk of heat-related illness. Workplace controls should
                focus on making indoor and outdoor work safe for all employees, while
                also complying with the Americans with Disabilities Act and the Age
                Discrimination in Employment Act.
                 The following questions are intended to solicit information,
                relevant data sources, and considerations to further assess
                contributions to heat stress in indoor and outdoor work settings as
                well as individual risk factors that may contribute to heat-related
                illness in occupational settings.
                 (48) What factors, beyond those discussed above, contribute to heat
                stress in outdoor and/or indoor occupational settings?
                 (49) Is air conditioning provided in employer-provided or sponsored
                housing?
                 (50) Are there existing employer efforts or programs to ensure that
                employees have the ability to adequately cool at night in order to
                recover from occupational heat exposure?
                 (51) What factors are the most important contributors to heat-
                related illness risk?
                 (52) Are there other individual risk factors that contribute to the
                risk of heat-related illness?
                 (53) What individual risk factors are the most important
                contributors to heat-related illness risk?
                 (54) Are there existing employer-led heat prevention programs that
                consider individual-level risk factors in their prevention guidance? If
                so, how are they implemented? What are the challenges associated with
                this?
                B. Strategies To Reduce Occupational Heat-Related Injury and Illness
                 Workplace heat-related injury and illness is preventable, and many
                effective controls can be implemented. The following sections provide a
                brief overview and targeted questions about controls that would be
                important to consider as part of an effective heat injury and illness
                prevention program.
                1. Heat Injury and Illness Prevention Programs
                 Safety and health programs aim to prevent workplace injuries,
                illnesses, and fatalities by using a proactive approach to managing
                workplace safety and health. An effective heat injury and illness
                prevention program would include elements on: Assessing heat hazards
                that may occur at the workplace, acclimatizing new and returning
                workers, evaluating how and when heat will be measured, and determining
                what controls will be put into place and what training will be provided
                to workers and supervisors. Evaluations of heat-related enforcement
                cases have shown that in investigations of heat-related fatalities or
                heat-related illness that resulted in 5(a)(1) violations from 2012-
                2013, no employer had a complete heat illness prevention program that
                addressed all of the recommended components, and 12 of the 20 cases
                evaluated had no heat illness prevention program at all (Arbury et al.,
                April 2016). In one study, the implementation of a heat illness
                prevention program was found to decrease workers' compensation costs
                associated with heat-related illness incidents and reduce the total
                number of heat-related illnesses experienced by outdoor municipal
                workers in Texas (McCarthy et al., September 2019).
                 The following questions are intended to solicit information and
                relevant data sources that OSHA should consider when evaluating the
                need for and elements of a heat injury and illness prevention program
                for indoor and outdoor work environments.
                [[Page 59320]]
                 (55) What are the elements of a successful employer-led heat injury
                and illness prevention program? How are these programs implemented?
                What are the challenges associated with them? Please provide examples
                and data.
                 (56) Are there other elements of a heat injury and illness
                prevention program that are important to consider?
                 (57) Are there limitations associated with implementing a heat
                injury and illness prevention program across indoor or outdoor work
                settings, or across businesses of various sizes? If so, what are they?
                 (58) Are there demonstrated evaluations on the successes or
                limitations of various components of any existing state or employer
                heat injury and illness prevention program, including quantitative or
                qualitative evaluations?
                2. Engineering Controls, Administrative Controls, and Personal
                Protective Equipment
                 Engineering controls, such as air conditioning or increased
                ventilation, increase evaporative cooling and can keep body
                temperatures at safe levels. Other examples of engineering controls
                that may reduce the amount of hazardous heat present could include the
                use of local exhaust ventilation at points of high heat production,
                insulating hot surfaces or equipment (e.g., furnaces), and providing
                shade tents, or other building modifications where appropriate.
                 Administrative controls, such as making changes to workloads or
                work schedules, can be useful in keeping workers cool during hazardous
                heat exposure. For example, work schedules may shift from the hottest
                parts of the day to cooler times of the day, like overnight or early in
                the morning. Employers may implement work-rest cycles by adding
                additional rest breaks in the shade or air conditioning away from heat
                sources as environmental and exertional heat increases. Some employers
                have implemented self-pacing for workers as an alternative to work-rest
                cycles, allowing employers to pace themselves throughout the work shift
                when heat is hazardous. Other examples of administrative controls could
                include reducing physical demands during the hottest times of the day
                or implementing buddy systems to ensure workers are watching out for
                signs and symptoms of heat-related illness in each other.
                 OSHA's Heat Illness Prevention Campaign has historically
                recommended the implementation of ``Water. Rest. Shade.,'' which is a
                combination of engineering and administrative controls to provide
                workers with adequate amounts of water, rest, and shade. As discussed
                above in more detail, because the Campaign is not mandatory, these
                controls are not always implemented in workplaces. An evaluation of 38
                enforcement investigations from 2011-2016 found that while nearly 85%
                of the inspected employers provided accessible water, none of them
                enforced or required rest breaks during periods of hazardous heat
                (Tustin et al., August 2018). In some work settings, such as in
                agricultural workplaces, workers may be paid piecemeal or receive wages
                based on their productivity or output. These payment schemes can result
                in workers making tradeoffs between reduced productivity and lost wages
                versus taking breaks to rest or drink water (Wadsworth et al., 2019).
                However, without breaks, overall productivity can decline during
                hazardous heat due to workers being less able to work efficiently, as
                well as from higher rates of accidents and heat-related illnesses (Ebi
                et al., August 21, 2021).
                 In some situations, PPE and auxiliary body cooling methods (e.g.,
                cooled or iced vests, jackets, or other wearable garments) may further
                reduce the risk of heat strain in those working in hazardous heat
                conditions. For example, reflective and breathable clothing, cooling
                neck wraps, and cooling vests or jackets may provide enhanced
                protection to some workers.
                 The following questions seek to solicit additional information,
                data sources, and considerations for engineering and administrative
                controls, as well as PPE, and their use in preventing heat-related
                illness in indoor and outdoor work settings.
                 (59) What engineering controls, administrative controls, or PPE can
                be used to prevent heat-related illness in indoor and outdoor work
                settings? Have the qualitative or quantitative effectiveness of these
                controls been evaluated?
                 (60) Are there data that demonstrate the role of facility energy
                efficiency in maintaining optimal thermal conditions, optimizing worker
                performance, and cost-effectiveness of cooling strategies?
                 (61) Are certain controls that are more effective or more feasible
                than others? If so, which ones? Do effectiveness and feasibility of
                controls differ due to setting (indoor/outdoor, business size,
                arrangement of work, etc.)?
                 (62) What are the limitations associated with implementing water,
                rest, and shade effectively in indoor and outdoor work settings?
                 (63) How are work-rest cycles currently implemented in indoor and
                outdoor work settings? What are the limitations for implementation?
                 (64) Are there additional sources of data or evidence that describe
                the quantitative or qualitative impacts of work-rest cycles on
                productivity?
                 (65) How do productivity or output based payment schemes affect the
                ability of workers to follow heat illness and injury prevention
                training, guidance or requirements?
                 (66) How do productivity or output based payment schemes affect
                employer implementation of heat illness and injury prevention training,
                guidance or requirements?
                 (67) Are there additional sources of data or evidence that describe
                the quantitative or qualitative impacts of self-pacing as an
                alternative to work-rest cycles to prevent occupational heat-related
                illness?
                3. Acclimatization
                 Acclimatization refers to the process of the human body becoming
                accustomed to new environmental conditions by gradually adapting to the
                conditions over time. Gradual exposure to the condition of concern
                (e.g., heat) allows the body to develop more robust physiological
                responses, such as a greater sweat response, to adapt to heat more
                efficiently. Workers who are new to working in warm environments may
                not be acclimatized to heat, and their bodies need time to gradually
                adapt to working in hot environments. Evaluations of workplace
                fatalities have shown that approximately 70% of deaths occur within the
                first few days of work, and upwards of 50% occur on the first day of
                work (Arbury et al., August 8, 2014; Tustin et al., August 2018),
                highlighting the consequences of workers not becoming acclimatized to
                the environmental conditions of the workplace. Acclimatization is also
                important for those who may have been previously acclimatized but were
                out of the workforce or hot environment of the workplace for more than
                2 weeks (e.g., due to vacation or sick leave). All outdoor workers may
                need time to acclimatize to heat during early season hazardous heat, or
                during particularly severe or long-lasting heat events, which are
                associated with higher mortality in the general population (Anderson
                and Bell, February 2011). During a heat wave, environmental conditions
                may become extremely hazardous, even to workers who may have been
                previously acclimatized.
                 OSHA and NIOSH have historically recommended the ``Rule of 20
                Percent'' for acclimatizing workers. Under this regimen, workers would
                only work 20 percent of the normal duration of work
                [[Page 59321]]
                on their first day in hazardous heat conditions performing job tasks
                similar in intensity to their expected work, increasing the work
                duration by 20 percent on each subsequent day until performing a normal
                work schedule. For example, if the normal workday lasts 8 hours, then
                new workers should work no more than 1 hour and approximately 40
                minutes (20 percent of 8 hours) on their first day in the heat, and
                spend the remainder of the workday doing work tasks without heat stress
                (OSHA, October 7, 2021). They should be given at least one rest break
                during the period when they are working. Workers with underlying
                medical conditions may need more time to fully adapt to the heat.
                 The following questions aim to solicit additional information,
                relevant data sources, and considerations on the design and
                implementation of acclimatization plans for workers in indoor and
                outdoor work settings.
                 (68) What are current and best practices for implementing
                acclimatization in various industries and across businesses of various
                sizes?
                 (69) What are the challenges with acclimatizing workers, including
                workers in non-traditional/multi-employer work arrangements (e.g.,
                temporary workers)?
                 (70) Are there different challenges and best practices for
                acclimatization in indoor work settings versus outdoor work settings?
                 (71) Are there unique concerns or approaches for implementing
                acclimatization for a small versus large business?
                 (72) Are there additional sources of data or evidence that describe
                the quantitative or qualitative impacts of acclimatization schedules on
                productivity?
                4. Monitoring
                 Physiological, medical, and exposure monitoring of workers exposed
                to heat hazards can prevent heat strain from progressing to heat-
                related illness or death. Monitoring can alert both employees and
                employers when workers have been exposed to hazardous heat and are
                experiencing heat strain and should seek water, rest, shade, cooling,
                or medical attention. Monitoring activities may include monitoring
                environmental conditions regularly, self-monitoring of urine color, and
                monitoring of heart rate and core body temperature. Individual-level
                biomonitoring with wearable technologies may be an option in some
                occupational settings. Monitoring activities may also include buddy
                systems where workers are educated in signs and symptoms of heat-
                related illness and proactively look for signs and symptoms in fellow
                workers and encourage them to rest, hydrate, and find shade or seek
                emergency medical attention if the worker is experiencing signs of
                heat-related illness.
                 The following questions are intended to solicit information,
                relevant data sources, and considerations to further assess heat
                monitoring activities or programs in occupational settings.
                 (73) Are there industries or individual employers implementing
                exposure, medical, and/or physiological monitoring to assess workers'
                health and safety during hazardous heat events?
                 (74) What are the best practices for implementing a monitoring
                program? How effective are the monitoring activities in preventing
                heat-related illness in workers?
                 (75) If physiological and medical monitoring programs are used, who
                implements these programs? Does that individual(s) have specialized
                training or experience?
                 (76) If physiological and medical monitoring programs are used, are
                data protected by confidentiality or privacy requirements? Please
                describe how data are maintained to ensure employee privacy and to meet
                any confidentiality or privacy requirements.
                 (77) How is exposure, medical, or physiological monitoring
                currently implemented or tracked across various time scales (e.g.,
                hourly, daily) in an occupational setting?
                 (78) What are the risks or challenges with this type of medical or
                physiological monitoring in a workplace?
                 (79) Do you use physiological or medical monitoring to assist in
                identifying high risk employees?
                 (80) How do you use physiological monitoring data (e.g., as a short
                term response to heat stress conditions, to address long term
                examination in protecting employees, to identify high risk categories
                of workers)?
                 (81) Do you require that notification of monitoring results be
                provided to employees?
                 (82) Do you use physiological monitoring to validate the
                effectiveness of recommended controls?
                 (83) Are there unique concerns or approaches in developing a
                monitoring program for small versus large businesses?
                5. Planning and Responding to Heat-Illness Emergencies
                 A heat-illness emergency occurs when a worker is experiencing a
                health crisis due to over-exposure to hazardous heat. Workers and
                employers need to be able to identify a heat-illness emergency, know
                how to respond to an emergency to protect the health of the affected
                worker, to have materials on-site to respond to an emergency, and know
                how to contact emergency medical care when needed. Emergency response
                plans can ensure that workers understand how to respond in an emergency
                and can help prevent heat-related illness from progressing to heat
                stroke or death.
                 The following questions are intended to solicit information,
                relevant data sources, and considerations to further assess the role of
                heat-illness emergency planning and response in indoor and outdoor work
                settings in responding to heat stress in the workplace and preventing
                heat-related injury and illness from progressing to heat stroke or
                death.
                 (84) How do organizations in both indoor and outdoor work
                environments currently deal with heat-illness emergencies if they
                arise?
                 (85) What are current best practices in workplace response to
                occupational heat-illness emergencies?
                 (86) What are the challenges with responding to a heat-illness
                emergency in various work environments (e.g., indoor settings, outdoor
                settings, remote locations)?
                 (87) What should be included in an employer's heat emergency
                response plan?
                 (88) What materials or supplies should employers have on-site to
                respond to a heat emergency?
                 (89) When should employers refer employees for medical treatment or
                seek medical treatment for an employee who is experiencing a heat-
                illness emergency?
                 (90) When and how do employers refer employees for medical
                treatment or seek medical treatment for them when experiencing a heat-
                illness emergency?
                6. Worker Training and Engagement
                 Employers informing employees of the hazards to which employees may
                be exposed while working is a cornerstone of occupational health and
                safety (OSHA, 2017). Training is an effective tool to reduce injury and
                illness (Burke et al., February 2006). Employees must know what
                protective measures are being utilized and be trained in their use so
                that those measures can be effectively implemented. Training and
                education provide employees and managers an increased understanding of
                existing safety and health programs. Training provides managers,
                supervisors, and employees with the knowledge and skills needed to do
                their
                [[Page 59322]]
                work safely, as well as awareness and understanding of workplace
                hazards and how to identify, report, and control them.
                 Because OSHA has long recognized the importance of training in
                ensuring employee safety and health, many OSHA standards require
                employers to train employees (e.g., the Bloodborne Pathogen standard at
                29 CFR 1910.1030(g)(2)). When required as a part of OSHA standards,
                training helps to ensure that employees can conduct work safely and
                healthfully (OSHA, April 28, 2010). Training is essential to ensure
                that both employers and employees understand the sources of potential
                exposure to hazardous heat, control measures to reduce exposure to the
                hazard, signs and symptoms of heat-related illness, and how to respond
                in the event of an emergency. A 2018 analysis of OSHA enforcement
                investigations of 66 heat-related illnesses showed that nearly two-
                thirds of the employers did not provide employees with training on
                occupational heat-related illness (Tustin et al., August 2018).
                 The following questions are intended to solicit information,
                relevant data sources, and considerations to further assess existing
                worker training and engagement programs and their effectiveness for
                preventing occupational heat injury and illness.
                 (91) How do employers currently involve workers in heat injury and
                illness prevention?
                 (92) What types of occupational heat injury and illness prevention
                training programs have been implemented and how effective are they?
                What is the scope and format of these training programs? Are workers in
                non-traditional/multi-employer work arrangements included in these
                training programs?
                 (93) What are best practices in worker training and engagement in
                heat injury and illness prevention?
                 (94) How do employers involve workers in the design and
                implementation of heat injury and illness prevention activities?
                 (95) What challenges are there with worker training and engagement
                for heat injury and illness prevention?
                IV. Costs, Economic Impacts, and Benefits
                A. Overview
                 OSHA also seeks information on the costs, economic impacts, and
                benefits of heat injury and illness prevention practices. In addition
                to information regarding the costs and economic impacts of heat injury
                and illness prevention practices, OSHA is interested in the benefits of
                such practices in terms of reduced injuries, illnesses, deaths, and
                compromised operations (i.e., emotional distress, staffing turnover,
                and unexpected reallocation of resources), as well as any other
                productivity effects. As discussed above in Part I of this ANPRM,
                millions of workers across hundreds of occupations are likely to be
                exposed to conditions that could lead to heat-related injury, illness,
                and death.
                 The effects of heat-related injury and illness can be significant
                to employers and workers alike. They harm workers financially,
                physically, and mentally, and employers also bear several costs and
                reduced revenue. A single serious injury or illness can lead to
                workers' compensation losses of thousands of dollars, along with
                thousands of dollars in additional costs for overtime, temporary
                staffing, or recruiting and training a replacement. Even if a worker
                does not have to miss work, heat stress can still lead to higher
                turnover and deterioration of productivity and morale.Globally, the
                International Labour Organization (ILO) has estimated that increased
                heat stress could result in a productivity decline by the equivalent of
                80 million full-time jobs by the year 2030 (ILO, 2019).
                 According to BLS, as shown below in Table IV.A.1, exposure to
                environmental heat results in thousands of injury and illness cases and
                dozens of deaths per year (BLS, December 22, 2020 and BLS, January 28,
                2021). Note that these data do not provide a comprehensive account of
                the number of heat-related injuries and fatalities, for a variety of
                reasons, such as employee reluctance to report and lack of awareness of
                the contributing effects of heat to symptoms.
                 Table IV.A.1--Reported Occupational Injuries (Involving Days Away From
                 Work) and Fatalities as a Result of Exposure to Environmental Heat
                ------------------------------------------------------------------------
                 Annual Annual
                 Year injuries fatalities
                ------------------------------------------------------------------------
                2011.................................... 4,420 61
                2012.................................... 4,170 31
                2013.................................... 3,160 34
                2014.................................... 2,660 18
                2015.................................... 2,830 37
                2016.................................... 4,110 39
                2017.................................... 3,180 32
                2018.................................... 3,950 49
                2019.................................... 3,080 43
                ------------------------------------------------------------------------
                Source: U.S. Bureau of Labor Statistics: Injuries, Illnesses, and
                 Fatalities, (BLS, December 22, 2020 and BLS, January 28, 2021)
                 (Accessed August 30, 2021).
                 The following questions are intended to solicit information on the
                topics covered in this section.
                 (96) OSHA requests any workers' compensation data related to heat-
                related injury and illness. Any other information on your workplace's
                experience would also be appreciated.
                 (97) Are there additional data (other than workers' compensation
                data) from published or unpublished sources that describe or inform
                about the incidence or prevalence of heat-related injuries, illness, or
                fatalities in particular occupations and industries?
                 (98) What are the potential economic impacts associated with the
                promulgation of a standard specific to the risk of heat-related injury
                and illness? Describe these impacts in terms of benefits, including
                reduction of incidents; effects on costs, revenue, and profit; and any
                other relevant impact measurements.
                 (99) If you utilize the WBGT method when making your work
                determinations, what were the costs of any associated equipment and/or
                training to implement this measurement method?
                 (100) If you utilize a temperature metric other than WBGT when
                making work determinations, what were the costs associated with
                measurement and/or training to implement this measurement method?
                 (101) Have you instituted programs or policies directed at
                mitigating heat-related injury and illness at your worksite? If so,
                what were the resulting benefits?
                 (102) If you have implemented a heat injury and illness program or
                policy, what was the cost of implementing the program or policy, in
                terms of both time and expenditures for supplies and equipment? Please
                describe in detail the resource requirements and associated costs
                expended to initiate the program(s) and to conduct the program(s)
                annually. If you have any other estimates of the costs of preventing or
                mitigating heat-related injury and illness, please provide them. It
                would be helpful to OSHA to learn both overall totals and specific
                components of the program (e.g., cost of equipment, equipment
                installation, equipment maintenance, training programs, staff time,
                facility redesign).
                 a. What are the ongoing operating and maintenance costs for the
                program?
                 b. Has your program reduced incidents of heat-related injury and
                illness and by how much? Can you identify which elements of your
                program most reduced incidents? Which elements did not seem effective?
                [[Page 59323]]
                 c. Has your program reduced direct costs for your facility (e.g.,
                workers' compensation costs, fewer lost workdays)? Please quantify
                these reductions, if applicable.
                 d. Has your program reduced indirect costs for your facility (e.g.,
                reductions in absenteeism and worker turnover; increases in reported
                productivity, satisfaction, and level of safety in the workplace)?
                 (103) Do you provide wearable devices (specific to heat) to
                workers? Does each worker get a device or only specific members of the
                crew?
                 a. If wearables are provided, what were the associated upfront
                costs of the equipment and how often do they need to be replaced?
                 b. Which specific wearable did you choose? What were your deciding
                factors (i.e., price, ease of use)?
                 (104) If you are in a state with standards requiring programs and/
                or policies to reduce heat stress, how did implementing the program
                and/or policy affect the facility's budget and finances?
                 (105) What changes, if any, in market conditions would reasonably
                be expected to result from issuing a standard on heat stress
                prevention? Describe any changes in market structure or concentration,
                and any effects on the prices of products and services to consumers,
                that would reasonably be expected from issuing such a standard.
                 (106) If you have implemented acclimatization practices in your
                workplace, were there any associated costs?
                 (107) How does your workplace address the costs of any rest breaks
                necessary to prevent heat-related injury and illness?
                B. Impacts on Small Entities
                 As part of the agency's consideration of a heat stress standard,
                OSHA is concerned about whether its actions will have a significant
                economic impact on a substantial number of small entities. Small
                entities included small businesses, small non-profit organizations, and
                small governmental jurisdictions with a population of less than 50,000.
                These other small employer organizations may experience heat stress
                issues in much the same manner as small businesses. Injury and illness
                incidence rates are known to vary by establishment size. In the
                construction industry, for example, across all nonfatal occupational
                injuries and illnesses, establishments between 11 and 49 employees had
                an average incidence rate of 3.3 per 100 Full Time Equivalent (FTE)
                workers, whereas establishments with 1,000 or more employees had an
                average incidence rate of 0.9 per 100 FTE workers. (BLS, August 31,
                2021). If the agency pursues the development of a standard that would
                have such impacts on small businesses, OSHA is required to develop a
                regulatory flexibility analysis and convene a Small Business Advocacy
                Review panel under the Small Business Regulatory Enforcement Fairness
                Act (before publishing a proposed rule (see Regulatory Flexibility Act,
                5 U.S.C. 601 et seq.)). Regardless of the significance of the impacts,
                OSHA seeks ways of minimizing the burdens on small businesses
                consistent with OSHA's statutory and regulatory requirements and
                objectives.
                 The following questions are intended to solicit information on the
                topics covered in this section.
                 (108) How many, and what type of small firms, or other small
                entities, have heat-related injury and illness training, or a heat
                injury and illness program, and what percentage of their industry
                (NAICS code) do these entities comprise? Please specify the types of
                heat stress risks employees in these firms face.
                 (109) How, and to what extent, would small entities in your
                industry be affected by a potential OSHA standard to prevent heat
                stress? Do special circumstances exist that make preventing heat stress
                more difficult or more costly for small entities than for large
                entities? Please describe these circumstances.
                 (110) How many, and in what type of small entities, is heat-related
                injury and illness a threat, and what percentage of their industry (by
                NAICS codes) do these entities comprise?
                 (111) Are there alternative regulatory or non-regulatory approaches
                OSHA could use to mitigate possible impacts on small entities?
                 (112) For very small entities (historically defined by OSHA as
                those with fewer than 20 employees), what types of heat-related injury
                and illness threats are faced by workers? Does your experience with
                heat-related injury and illness reflect the lower rates reported by
                BLS?
                 (113) For very small entities, what are the unique challenges
                establishments face in addressing heat-related injury and illness?
                 (114) If you are in a jurisdiction with standards requiring
                programs and/or policies to reduce heat stress, how did implementing
                the program and/or policy affect your small entity or other small
                entities in your jurisdiction?
                V. References
                Althubaiti A. (2016, May 4). Information bias in health research:
                definition, pitfalls, and adjustment methods. Journal of
                Multidisciplinary Healthcare, 9, 211-217. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862344/pdf/jmdh-9-211.pdf.
                (Althubaiti, May 4, 2016)
                American Conference of Governmental Industrial Hygienists (ACGIH).
                (2017). Heat Stress and Strain: TLV[supreg] Physical Agents 7th
                Edition Documentation. http://mhssn.igc.org/2017%20ACGIH%20-%20Heat%20Stress%20TLV.pdf. (ACGIH, 2017)
                Anderson GB and ML Bell. (2011, February). Heat waves in the United
                States: mortality risk during heat waves and effect modification by
                heat wave characteristics in 43 U.S. communities. Environmental
                Health Perspectives, 119, 210-218. doi:10.1289/ehp.1002313.
                (Anderson and Bell, February 2011)
                Arbury S et al. (2014, August 8). Heat illness and death among
                workers--United States, 2012-2013. Centers for Disease Control and
                Prevention, Morbidity and Mortality Weekly Report, 63(31). (Arbury
                et al., August 8, 2014)
                Arbury S et al. (2016, April). A critical review of OSHA heat
                enforcement cases: lessons learned. Journal of Occupational and
                Environmental Medicine, 58(4). doi:10.1097/JOM.0000000000000640.
                (Arbury et al., April 2016)
                Brown S, Baldwin T, Murray P, Whitehouse S, Warren E, Schatz B, Wood
                Hassan M, Blumenthal R, Casey, Jr. RP, Rosen J, Hirono MK, Reed J.
                (2019, November 18). Correspondence from members of the U.S. Senate
                to the Honorable Eugene Scalia, Secretary, United States Department
                of Labor. (Brown et al., November 18, 2019)
                Budd G. (2008). Wet-bulb globe temperature (WBGT)--its history and
                limitations. Journal of Science and Medicine and Sport, 11, 20-32.
                2008. doi:10.1016/j.jsams.2007.07.003. (Budd, 2008)
                Bureau of Labor Statistics (BLS). (2017, August 30). Work injuries
                in the heat in 2015. The Economics Daily. https://www.bls.gov/opub/ted/2017/work-injuries-in-the-heat-in-2015.htm. (BLS, August 30,
                2017)
                Bureau of Labor Statistics (BLS). (2020, December 8). Survey of
                Occupational Injuries and Illnesses Data Quality Research. https://www.bls.gov/iif/data-quality.htm. (BLS, December 8, 2020)
                Bureau of Labor Statistics (BLS). (2020, December 22). Census of
                Fatal Occupational Injuries. https://www.bls.gov/iif/oshcfoi1.htm.
                (BLS, December 22, 2020)
                Bureau of Labor Statistics (BLS). (2021, January 28). Survey of
                Occupational Injuries and Illnesses Data. https://www.bls.gov/iif/soii-data.htm. (BLS, January 28, 2021)
                Bureau of Labor Statistics (BLS). (2021, August 31). Injuries,
                Illnesses, and Fatalities. Table Q1. Incidence rates of total
                recordable cases of nonfatal occupational injuries and illnesses by
                quartile distribution and employment
                [[Page 59324]]
                size, 2019. Accessed August 31, 2021. (BLS, August 31, 2021)
                Bureau of Labor Statistics (BLS). (2021, September 1). 43 work-
                related deaths due to environmental heat exposure in 2019. The
                Economics Daily. https://www.bls.gov/opub/ted/2021/43-work-related-deaths-due-to-environmental-heat-exposure-in-2019.htm. (BLS,
                September 1, 2021)
                Bureau of Labor Statistics (BLS). (2021a, September 10). Fatal
                occupational injuries by selected worker characteristics and
                selected event or exposure, All U.S., all ownerships, 1992-2019.
                https://data.bls.gov/gqt/InitialPage. Accessed September 10, 2021.
                (BLS, September 10, 2021a)
                Bureau of Labor Statistics (BLS). (2021b, September 10). Databases,
                Tables & Calculators by Subject. Nonfatal cases involving days away
                from work: selected characteristics (2011 forward). https://data.bls.gov/PDQWeb/cs. Accessed September 10, 2021. (BLS, September
                10, 2021b)
                Burke MJ et al. (2006, February). Relative effectiveness of worker
                safety and health training methods. American Journal of Public
                Health, 96, 315-324. (Burke et al., February 2006)
                Caban-Martinez AJ et al. (2018, April). Physical exposures, work
                tasks, and OSHA-10 training among temporary and payroll construction
                workers. Journal of Occupational and Environmental Medicine, 60(4),
                e159-e165. doi:10.1097/JOM.0000000000001267. (Caban-Martinez et al.,
                April 2018)
                CAL/OSHA, Title 8, Section 3395. Heat Illness Prevention. https://www.dir.ca.gov/Title8/3395.html. (CAL/OSHA)
                Centers for Disease Control and Prevention (CDC). (2008, June 20).
                Heat-related deaths among crop workers--United States, 1992-2006.
                Centers for Disease Control and Prevention, Morbidity and Mortality
                Weekly Report, 57(24), 649-653. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5724a1.htm. (CDC, June 20, 2008)
                Chu J, Grijalva RM, Levin A, Schakowsky J, Takano M, Hayes J, Pocan
                M, Bonamici S, Lowenthal A, Davis DK, Adams AS, Scott RC, Lee B,
                Blumenauer E, Jaypal P, Moore G, McGovern JP, Panetta J, Carson A,
                Dingell D, Carbajal S, Pressley A, Watson Colman B, Sanchez L.
                (2021, August 6). Correspondence from members of the U.S. House of
                Representatives to The Honorable Martin J. Walsh, Secretary, U.S.
                Department of Labor. (Chu et al., August 6, 2021)
                Commandant of the Marine Corps. (2002, June 6). Marine Corps Order
                6200.1E W/CH1: Marine Corps heat injury prevention program. https://www.imef.marines.mil/Portals/68/Docs/IMEF/Surgeon/MCO_6200.1E_W_CH_1_Heat_Injury_Prevention.pdf. (Commandant of the
                Marine Corps, June 6, 2002)
                Department of the Army (2016, July 18). Training Prevention of Heat
                and Cold Casualties. TRADOC Regulation 350-29. https://adminpubs.tradoc.army.mil/regulations/TR350-29.pdf. (Department of
                the Army, July 18, 2016)
                Department of the Army and Air Force. (2003, March 7). Technical
                bulletin: Heat stress control and heat casualty management. https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=46205.
                (Department of the Army and Air Force, March 7, 2003)
                Department of the Navy, Bureau of Medicine and Surgery. (2009,
                February 12). Manual of Naval Preventive Medicine, Chapter 3:
                Prevention of heat and cold stress injuries (ashore, afloat, and
                ground forces). NAVMED P-5010-3 (Rev. 2-2009) 0510-LP-108-2696.
                https://www.med.navy.mil/Portals/62/Documents/BUMED/Directives/All%20Pubs/5010-3.pdf?ver=yohnSL5ixr0E8pzXCJLhCw%3d%3d. (Department
                of the Navy, February 12, 2009)
                Ebi KL et al. (2021, August 21). Hot weather and heat extremes:
                health risks. The Lancet, 398, 698-708. (Ebi et al., August 21,
                2021)
                Environmental Protection Agency (EPA). (2017, May). Multi-Model
                Framework for Quantitative Sectoral Impacts Analysis: A Technical
                Report for the Fourth National Climate Assessment. U.S.
                Environmental Protection Agency, EPA 430-R-17-001. https://cfpub.epa.gov/si/si_public_record_Report.cfm?Lab=OAP&dirEntryId=335095. (EPA, May
                2017)
                Environmental Protection Agency (EPA). (2021, April). Climate Change
                Indicators: Heat-Related Deaths. https://www.epa.gov/climate-indicators/climate-change-indicators-heat-related-deaths. (EPA,
                April 2021)
                Environmental Protection Agency (EPA). (2021, September 2). Climate
                Change and Social Vulnerability in the United States: A Focus on Six
                Impacts. EPA 430-R-21-003. www.epa.gov/cira/social-vulnerability-report. (EPA, September 2, 2021)
                Flouris AD et al. (2018, December). Workers' health and productivity
                under occupational heat strain: a systematic review and meta-
                analysis. Lancet Planetary Health, 2, e521-31. (Flouris et al.,
                December 2018)
                Galer M. (2019, April 8). The heat center initiative: heat illness
                awareness. https://www.army.mil/article/218736/the_heat_center_initiative_heat_illness_awareness. (Galer, April 8,
                2019)
                Glaser J et al. (2016, August 8). Climate change and the emergent
                epidemic of CKD from heat stress in rural communities: the case for
                heat stress nephropathy. Clinical Journal of the American Society of
                Nephrology, 11(8), 1472-1483. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974898/?report=printable. (Glaser et al., August 8,
                2016)
                Government Accountability Office (GAO). (2009, October). Enhancing
                OSHA's records audit process could improve the accuracy of worker
                injury and illness data. https://www.gao.gov/assets/gao-10-10.pdf.
                (GAO, October 2009)
                Grundstein A, et al. (2015, January). Regional heat safety
                thresholds for athletics in the contiguous United States. Applied
                geography, 56 (2015), 55-60. https://doi.org/10.1016/j.apgeog.2014.10.014. (Grundstein et al., January 2015)
                Gubernot DM et al. (2014, October). The epidemiology of occupational
                heat-related morbidity and mortality in the United States: a review
                of the literature and assessment of research needs in a changing
                climate. International Journal of Biometeorology, 58(8), 1779-1788.
                doi:10.1007/s00484-013-0752-x. (Gubernot et al., October 2014)
                Gubernot DM et al. (2015, February). Characterizing occupational
                heat-related mortality in the United States, 2000-2010: An analysis
                using the census of fatal occupational injuries database. American
                Journal of Industrial Medicine, 58(2), 203-211. doi:10.1002/
                ajim.22381. (Gubernot et al., February 2015)
                Human Performance Resources by Consortium for Health and Military
                Performance (HPRC). (2021, October 6). Warrior heat- and exertion-
                related events collaborative. https://www.hprc-online.org/resources-partners/whec. Accessed October 6, 2021. (HPRC, October 6, 2021)
                International Labour Organization (ILO). (2019). Working on a warmer
                planet: The impact of heat stress on labour productivity and decent
                work. 13. (ILO, 2019)
                International Organization for Standardization (ISO). (2017).
                Ergonomics of the thermal environment--Assessment of heat stress
                using the WBGT (wet bulb globe temperature) index. Third Edition.
                ISO 7243:2017(E). 2017. (ISO, 2017)
                Johnson RJ et al. (2019, May 9). Chronic kidney disease of unknown
                cause in agricultural communities. The New England Journal of
                Medicine, 380, 1843-1852. doi:10.1056/NEJMra1813869. (Johnson et
                al., May 9, 2019)
                Kilbourne, EM. (1997). Heat waves and hot environments. The public
                health consequences of disasters. (1997). (Kilbourne, 1997)
                Leigh JP et al. (2014, April). An estimate of the US government's
                undercount of nonfatal occupational injuries and illnesses in
                agriculture. Ann Epidemiology, 24(4). 254-259. doi:10.1016/
                j.annepidem.2014.01.006. (Leigh et al., April 2014)
                McCarthy RB et al. (2019, September). Outcomes of a heat stress
                awareness program on heat-related illness in municipal outdoor
                workers. Journal of Occupational and Environmental Medicine, 61(9),
                724-728. doi:10.1097/JOM.0000000000001639. (McCarthy et al.,
                September 2019)
                Minnesota Administrative Rules. Section 5205.0110 Indoor ventilation
                and temperature in places of employment. https://www.revisor.mn.gov/rules/5205.0110/. (Minnesota Administrative Rules)
                Mix J et al. (2019). Hydration status, kidney function, and kidney
                injury in Florida
                [[Page 59325]]
                agricultural workers. Journal of Occupational and Enviornmental
                Medicine, 60(5), e253-e260. DOI: https://doi.org/10.1097/JOM.000000000000126. (Mix et al., 2019)
                Morris CE et al. (2019, January 28). Actual and simulated weather
                data to evaluate wet bulb globe temperature and heat index as alerts
                for occupational heat-related illness. Journal of Occupational and
                Environmental Hygiene, 16(1), 54-65. https://www.tandfonline.com/doi/full/10.1080/15459624.2018.1532574. (Morris et al., January 28,
                2019)
                National Weather Service (NWS). (2021, August 25). Wet Bulb Globe
                Temperature: Guidelines-Charts. https://www.weather.gov/arx/wbgt#guidelines. Accessed August 25, 2021. (NWS, August 25, 2021)
                National Weather Service (NWS). (2021, September 1). What is the
                heat index?. https://www.weather.gov/ama/heatindex. Accessed
                September 1, 2021. (NWS, September 1, 2021)
                National Weather Service (NWS). (2021, September 2). Heat watch vs.
                warning. https://www.weather.gov/safety/heat-ww. Accessed on
                September 2, 2021. (NWS, September 2, 2021)
                National Weather Service (NWS). (2021a, September 8). 80-year list
                of severe weather fatalities. https://www.weather.gov/media/hazstat/80years_2020.pdf. 2020. Accessed September 8, 2021. (NWS, September
                8, 2021a)
                National Weather Service (NWS). (2021b, September 8). Weather
                related fatality and injury Statistics: weather fatalities 2020.
                https://www.weather.gov/hazstat/2020. Accessed September 8, 2021.
                (NWS, September 8, 2021b)
                National Institute for Occupational Safety and Health (NIOSH).
                (1972). NIOSH criteria for a recommended standard: occupational
                exposure to hot environments. Publication 72-10269. https://www.cdc.gov/niosh/docs/72-10269/default.html. (NIOSH, 1972)
                National Institute for Occupational Safety and Health (NIOSH).
                (1986, April). NIOSH criteria for a recommended standard:
                occupational exposure to hot environments. Publication 86-113.
                https://www.cdc.gov/niosh/docs/86-113/86-113.pdf?id=10.26616/NIOSHPUB86113. (NIOSH, April 1986)
                National Institute for Occupational Safety and Health (NIOSH).
                (2016, February). NIOSH criteria for a recommended standard:
                occupational exposure to heat and hot environments. Publication
                2016-106. https://www.cdc.gov/niosh/docs/2016-106/default.html.
                (NIOSH, February 2016)
                National Institute for Occupational Safety and Health (NIOSH).
                (2017, April 20). Reproductive health and the workplace: Heat.
                https://www.cdc.gov/niosh/topics/repro/heat.html. (NIOSH, April 20,
                2017)
                National Integrated Heat Health Information System (NIHHIS). (2021,
                August 25). Understand Urban Heat Islands. https://nihhis.cpo.noaa.gov/Urban-Heat-Island-Mapping/Understand-Urban-Heat-Islands. Accessed August 25, 2021. (NIHHIS, August 25, 2021)
                Occupational Safety and Health Administration (OSHA). (2010, April
                28).Training standards policy statement.https://www.osha.gov/dep/standards-policy-statement-memo-04-28-10.html.(OSHA, April 28, 2010)
                Occupational Safety and Health Administration (OSHA).
                (2017).Workers' rights.https://www.osha.gov/sites/default/files/publications/osha3021.pdf.(OSHA, 2017)
                Occupational Safety and Health Administration (OSHA). (2017,
                September 15). OSHA Technical Manual. Section III: Chapter 4--Heat
                Stress. https://www.osha.gov/otm/section-3-health-hazards/chapter-4.
                (OSHA, September 15, 2017)
                Occupational Safety and Health Administration (OSHA). (2019, October
                1). Region VI: Regional Emphasis Program for Heat Illnesses. https://www.osha.gov/sites/default/files/enforcement/directives/CPL_2_02-00-027A.pdf. (OSHA, October 1, 2019)
                Occupational Safety and Health Administration (OSHA). (2021, August
                20). Federal OSHA Heat-Related Inspections and Violations, Jan 2018-
                August 19, 2021. (OSHA, August 20, 2021)
                Occupational Safety and Health Administration (OSHA). (2021,
                September). A Selection of Agency Heat Exposure Guidelines Tables.
                (OSHA, September 2021)
                Occupational Safety and Health Administration (OSHA). (2021,
                September 1). Inspection Guidance for Heat-Related Hazards. (OSHA,
                September 1, 2021)
                Occupational Safety and Health Administration (OSHA). (2021,
                September 2). Heat: Prevention>>Hazard Recognition. https://www.osha.gov/heat-exposure/hazards. Accessed September 2, 2021.
                (OSHA, September 2, 2021)
                Occupational Safety and Health Administration (OSHA). (2021, October
                6). Protecting Temporary Workers. https://www.osha.gov/temporaryworkers. Accessed October 6, 2021. (OSHA, October 6, 2021a)
                Occupational Safety and Health Administration (OSHA). (2021, October
                6). Safety and Health Topics>>Heat>>Personal risk factors. https://www.osha.gov/heat-exposure/personal-risk-factors. Accessed October
                6, 2021. (OSHA, October 6, 2021b)
                Occupational Safety and Health Administration (OSHA). (2021, October
                7). Heat: Prevention--Protecting New Workers. https://www.osha.gov/heat-exposure/protecting-new-workers. Accessed October 7, 2021.
                (OSHA, October 7, 2021)
                Occupational Safety and Health Administration (OSHA and National
                Istitute for Occupational Safety and Health (NIOSH). (2021, October
                6). Recommended Practices: Protecting Temporary Workers. https://www.osha.gov/sites/default/files/publications/OSHA3735.pdf. Accessed
                October 6, 2021. (OSHA and NIOSH, October 6, 2021)
                Oliveira AVM et al. (2019, August). Globe temperature and its
                measurement: requirements and limitations. Annals of Work Exposure
                sand Health, 63(7), 743-758. doi:10.1093/annweh/wxz042. (Oliveira et
                al., August 2019)
                Oregon Administrative Rules. 437-002-0155 Temporary Rule Heat
                Illness Prevention. https://osha.oregon.gov/OSHARules/div2/437-002-0155-temp.pdf. (Oregon Administrative Rules)
                Padilla A, Brown S, Warren E, Wyden R, Sanders B, Cortez Masto C,
                Gillibrand K, Geinstein D, Blumenthal R, Baldwin T, Smith T, Markey
                EJ, Booker C. (2021, August 3). Correspondence from members of the
                U.S. Senate to The Honorable Martin Walsh, Secretary, United States
                Department of Labor. (Padilla et al., August 3, 2021)
                Park RJ et al. (2021, July). Temperature, workplace safety, and
                labor market inequality. Institute of Labor Economics, Discussion
                Paper Series. http://ftp.iza.org/dp14560.pdf. (Park et al., July
                2021)
                Popovich N and Choi-Schagrin W. (2021, August 11). Hidden toll of
                the northwest heat wave: hundreds of extra deaths. The New York
                Times. https://www.nytimes.com/interactive/2021/08/11/climate/deaths-pacific-northwest-heat-wave.html. (Popovich and Choi-
                Schagrin, August 11, 2021)
                Quandt SA et al. (2013, August). Heat index in migrant farmworker
                housing: implications for rest and recovery from work-related heat
                stress. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723406/.
                (Quandt et al., August, 2013)
                Quinn MM et al. (2007). Social disparities in the burden of
                occupational exposures: results of a cross-sectional study. American
                Journal of Industrial Medicine, 50, 861-875. doi:10.1002/ajim.20529.
                (Quinn et al., 2007)
                Rothfusz. (1990, July 1). National Weather Service Technical
                Attachment: The heat index ``equation'' (or, more than you ever
                wanted to know about heat index). https://www.weather.gov/media/ffc/ta_htindx.PDF. (Rothfusz, July 1, 1990)
                Seabury AS et al. (2017, February). Racial and ethnic differences in
                the frequency of workplace injuries and prevalence of work-related
                disability. Health Affairs, 36(2), 266-273. doi:10.1377/
                hlthaff.2016.1185. (Seabury et al., February 2017)
                Shipley J et al. (2021, August 17). Heat is killing workers in the
                U.S.--and there are no federal rules to protect them. National
                Public Radio. https://www.npr.org/2021/08/17/1026154042/hundreds-of-workers-have-died-from-heat-in-the-last-decade-and-its-getting-worse. (Shipley et al., August 17, 2021)
                Sorensen C and R Garcia-Trabanino. (2019, August 22). Perspective
                essay: A new era of climate medicine--addressing heat-triggered
                renal disease. The New England Journal of Medicine, 381, 693-
                [[Page 59326]]
                696. https://www.nejm.org/doi/pdf/10.1056/NEJMp1907859?articleTools=true. (Sorensen and Garcia-Trabanino,
                August 22, 2019)
                Steadman. (1979, April 11). The assessment of sultriness. Part 1. A
                temperature-humidity index based on human physiology and clothing
                science. https://journals.ametsoc.org/view/journals/apme/18/7/1520-0450_1979_018_0861_taospi_2_0_co_2.xml?tab_body=pdf. (Steadman,
                April 11, 1979)
                Steege AL et al. (2014). Examining occupational health and safety
                disparities using national data: a cause for continuing concern.
                American Journal of Industrial Medicine, 57, 527-538. doi:10.1002/
                ajim.22297. (Steege et al., 2014)
                Stone, Jr., B et al. (2021). Compound climate and infrastructure
                events: how electrical grid failure alters heat wave risk.
                Environmental Science and Technology, 55, 6957-6964. https://doi.org/10.1021/acs.est.1c00024. (Stone, Jr., et al., 2021)
                Tustin A et al. (2018, July 6). Evaluation of occupational exposure
                limits for heat stress in outdoor workers--United States, 2011-2016.
                Centers for Disease Control and Prevention, Morbidity and Mortality
                Weekly Report, 67(26). (Tustin et al., July 6, 2018)
                Tustin A et al. (2018, August). Risk factors for heat-related
                illness in U.S. workers: an OSHA case series. Journal of
                Occupational and Environmental Medicine, 60(8). (Tustin et al.,
                August 2018)
                U.S. Global Change Research Program (USGCRP). (USGCRP, 2016). The
                Impacts of Climate Change on Human Health in the United States: A
                Scientific Assessment. https://health2016.globalchange.gov/low/ClimateHealth2016_FullReport_small.pdf. (USGCRP, 2016)
                U.S. Global Change Research Program (USGCRP). (USGCRP, 2018).
                USGCRP, 2018: Impacts, Risks, and Adaptation in the United States:
                Fourth National Climate Assessment, Volume II: 1515 pp. https://nca2018.globalchange.gov/downloads/NCA4_2018_FullReport.pdf.
                (USGCRP, 2018)
                U.S. House of Representatives, 117th Congress. (2021, March 26).
                H.R. 2193, Asuncion Valdivia Heat Illness and Fatality Prevention
                Act of 2021. https://www.congress.gov/bill/117th-congress/house-bill/2193?s=1&r=4. (U.S. House of Representatives, March 26, 2021)
                U.S. Senate, 117th Congress. (2021, April 12) S. 1068, Asuncion
                Valdivia Heat Illness and Fatality Prevention Act of 2021. https://www.congress.gov/bill/117th-congress/senate-bill/1068/text?r=5&s=1.
                (U.S. Senate, 117th Congress, April 12, 2021)
                Virtanen M et al. (2005). Temporary employment and health: a review.
                International Journal of Epidemiology, 34, 610-622. doi:10.1093/ije/
                dyi024. (Virtanen et al., 2005)
                Wadsworth G et al. (2019). Pay, power, and health: HRI and the
                agricultural conundrum. Labor Studies Journal, 44(3), 214-235.
                https://doi.org/10.1177/0160449X18767749. (Wadsworth et al., 2019)
                Wallace RF et al. (2007). Prior heat illness hospitalization and
                risk of early death. Environmental Research, 104, 290-295.
                doi:10.1016/j.envres.2007.01.003. (Wallace et al., 2007)
                Washington Administrative Code (WAC) Title 296, General Occupational
                Health Standards. Sections 296-62-095 through 296-62-09560. Outdoor
                Heat Exposure. https://app.leg.wa.gov/WAC/default.aspx?cite=296-62&full=true#296-62-095; Emergency Rule 2125 CR103E. https://lni.wa.gov/rulemaking-activity/AO21-25/2125CR103EAdoption.pdf.
                (Washington Administrative Code)
                Authority and Signature
                 James S. Frederick, Acting Assistant Secretary of Labor for
                Occupational Safety and Health, U.S. Department of Labor, 200
                Constitution Avenue NW, Washington, DC 20210, authorized the
                preparation of this document pursuant to the following authorities: 29
                U.S.C. 653, 655, and 657, Secretary's Order 8-2020 (85 FR 58393; Sept.
                18, 2020), and 29 CFR part 1911.
                James S. Frederick,
                Acting Assistant Secretary of Labor for Occupational Safety and Health.
                [FR Doc. 2021-23250 Filed 10-26-21; 8:45 am]
                BILLING CODE 4510-26-P
                

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT