1. Preventing Falls from Ladders in Construction

2. 2009 Study
In Fall 2007, as part of the baseline assessment for the Ladder Safety Study, we visited eight construction companies in Massachusetts. Each company had two or three worksites; we observed a total of 18 sites. A handheld worksite audit tool was used to collect information on ladder use; the diagram on the next slide illustrates the design of the tool. Overall, there
were 1,151 pieces of equipment: 771 step ladders, 50 extension ladders, 28 job-made ladders, and 302 ladder alternatives. Among the ladder alternatives were portable scaffolds, scissor lifts, aerial buckets, scaffoldings, and ladder jacks. These tables give a condensed version of the baseline data, showing only the main hazards present for step ladders.

3. Parent Form Inspect/ID Setup Moving Working Rater Company Site (code)
Step
Extension
Job
Ladder Alternative
Step
Extension
This slide shows how the PDA checklist tool worked. Parent Form: a file was made for each site visited. The four bottom boxes (I.e. inspect/ID, setup, etc.) show the four categories that were scored. Each category has its own checklist criteria. The superintendents can tell what criteria were scored by looking at their individualized analyses (previously handed out).

4. Emergency Room Study 65 US Hospitals 254 Ladder fall victims surveyed
97 were construction workers
Reasons for the fall
Identifying reoccurring risk factors
We conducted a study that surveyed workers that were treated at emergency rooms for injuries sustained from ladder use. Of the 254 ladder fall victims surveyed, 97 were construction workers. We sought to identify key risk factors for falls from ladders.
Brennan M, Lombardi D, Smith GS, Courtney T, Young J, Dennerlein J, Perry MJ [2008]. Falls from Ladders: Preliminary Results from a Case-crossover Study of Emergency Room Cases. 18th Annual Construction Safety and Health Conference and Expo, Rosemont, Illinois, February.

5. Injury Characteristics: Main Diagnosis
For the 97 participants who work in the Construction Industry in the Emergency Room Study, these are the types of injuries sustained due to a ladder fall.

6. Injury Characteristics: Body Parts
Emergency room study: ladder fall injury results continued…Body part-specific

7. Mechanism of Ladder Fall
When we examine the mechanism of the fall itself across all subjects, we find that movement of the ladder is very important - occurring 40% of the time.
Loss of balance comes in second at 18% and
foot miss is third at 24%.
Ladder failure or breakage occurs in very small numbers - 4%.
Since ladder movement is such a large percentage - We further broke this out to see that the ladder slipped out
at the bottom 25% of the time, followed by a sideways slip 9% of the time…..
This slide is important when it comes to the intervention phase of our project. Proper ladder set-up is critical. You can’t expect to climb a ladder, put torque on a tool or maneuver a box and stay on a wobbly ladder if it hasn’t been set up properly to begin with.

8. Injury Situation
In 2006, there were over 5,700 occupational deaths in the US. 14% of these deaths were due to falls. 1,126 of the 5,703 fatalities were specific to construction. 38% of construction deaths were due to falls. Now specifically to ladders, 24% of the over 36,000 nonfatal falls were due to ladders in 2004.
BLS Workplace Injuries and Illnesses in 2007.

9. An extreme example of improper ladder use.

10. Salary of Injured Worker
This graph is from Professor Boden at Boston University. The Y-axis is the difference in quarterly earnings of a worker. The X-axis is the number of quarters from injury. His work on injuries, workers compensation, and workers’ salaries shows that after an injury (x=0) a worker does not get back to the pay they would have been receiving if they were not injured. This assumption is based on the injured worker’s peers. So, after an injury (x=0), a worker loses about 22% of his or her earnings in the first 3 months. He or she then begins to earn more income as they are likely to be back at work. It is important to note that it takes women considerable longer than men to regain their earnings. Even though it changes, the difference in the two lines (i.e. earnings) is around 3%.
Boden LI, Galizzi M. Income Losses of Women and Men Injured at Work.
J Hum Resour 2003; 38(3):

11. Salary of Injured Worker-2
An example of Les Boden’s work from slide 10 in table form. This example uses an average male pre-injury annual salary of $50,000. The injury results in a 22.9% decrease in male salaries. Over time, the salary rate increases, but even after 3.5 years, the salary is 7.3% less than their pre-injury salary.

12. The total costs of fatal and nonfatal injuries in the construction industry were estimated at $11.5 billion in 2002, 15% of the costs for all private industry. The average cost per case of fatal or nonfatal injury is $27,000 in construction, almost double the per-case cost of $15,000 for all industry in 2002.
The costs of morbidity and mortality in construction is significant to the company as well as to the individual.
Waehrer GM, Dong XS, Miller T, Haile E, Men Y. Costs of occupational injuries in construction in the United States. Accid Anal Prev 2007; 39(6):

13. Behind schedule and over budget Injuries have plagued the worksite
New construction
Behind schedule and over budget
Injuries have plagued the worksite
A foreman is on the top step of a 14' stepladder screwing in a light bulb 20' above the ground
The foreman is in charge of a key group of workers and is vital for the completion of the project.
The foreman is a hothead and has consistently given you problems, but does good work, and his journeymen and apprentices are loyal to him.
All his workers are overworked and stressed. They are busy doing their work, so he is forced to use leftover supplies (i.e. the ladder) to do this simple task unsafely.
CASE VIGNETTE
Greencom Construction Company is working on the new construction of a major medical research building in Boston. The site is behind schedule and over budget. At the same time, injuries have plagued the worksite since the start of the project. You, the superintendent, are on a daily walk-through of a floor when you notice a foreman on the top step of a 14’ step ladder screwing in a light bulb 20’ above the ground. The foreman is in charge of a key group of workers and is vital for the completion of the project. If the foreman is injured, the site will be further delayed. The foreman is a hothead and has consistently given you problems, but he does good work and his journeymen and apprentices are loyal to him. All his workers are overworked and stressed. They are busy doing their work, so he is forced to use leftover supplies (i.e., the ladder) to do this simple task unsafely.
Superintendents will be split into groups of two. One person will play the role of the foreman; the other will be the superintendent.
For the group:
One participant is the foreman who just wants to be left alone so he can get his work done.
The other participant is the site superintendent on the walk-through.
You are to act out your part assuming the superintendent confronts the foreman.
Some potential considerations:
Everyone is stressed and hurried.
The foreman is needed on site to work and run his crew.
There are no site safety personnel.

14. What is wrong in this picture. What can be done to fix it
What is wrong in this picture? What can be done to fix it? Any alternatives better?
Ladder is placed incorrectly. Ladder should be extended out with its spreaders locked. If the work area is too small, an alternative should be used.
Photo courtesy of the Harvard Construction Group

15. Unsafe posture. Worker should be facing the ladder and on a lower rung
Unsafe posture. Worker should be facing the ladder and on a lower rung. A taller ladder facing the opposite direction may be necessary.
Photo courtesy of the Harvard Construction Group

16. Unsafe posture. Worker should be on a lower rung; a taller ladder is needed.
Photo courtesy of the Harvard Construction Group

17. Extension ladder should extend past the roof by at least three feet
Extension ladder should extend past the roof by at least three feet. Worker is in an unsafe posture. He should be standing on a rung and should be wearing fall protection.
Photo courtesy of Jack T. Dennerlein

18. Considerations… Planning Alternatives Communication
During construction build planning, consider the safety of the workers, incorporate safer alternatives when able, and clearly communicate risks, expectations, and be open to feedback to promote a safe working environment and strong safety culture.

19. Adjusts for 14’ to 17’ landings
Gang ladder (left) are being replaced by reusable stairs (right) on several projects.
The portable stairs on the right are able to be reused on several projects while allowing the workers a safer angle for ascent and descent compared to the gang-ladder on the left.
Photos courtesy of TJ Lyons, Turner Construction Company

20. The lift on the right allows a worker to reach heights while providing a safe working platform and small footprint in the hallway compared to the very tall step ladders on the left that are still not tall enough for the workers to safely reach their job tasks.
Photos courtesy of TJ Lyons, Turner Construction Company