ANSI nee eee einer This standard is one of more than 4000 approved as either 2 USA Standard or as Revision of an Amorican Standard. I became an American National Standard in October 1969 2161-1954 when the Instituto changed its name te American National Standards Istit (R1959) ANSI, 1430 Brosdway, New York, N.Y, 10018 American National Standard Method of Recording and Measuring Work Injury Experience Secretariat National Safety Council American Insurance Association Approved December 27, 1967 ‘American National Standards Institute, IncUSA Standard ‘A USA Standard implies @ consensus of those substantially concerned with its scope and provistons. A USA Standard is intended as a guide to aid the manufacturer. the consumer, and the general public. The existence of 8 USA Standard does not in any respect preclude anyone, whether he has approved the standard or not, from manufacturing, marketing, purchasing, or using products, processes, or procedures not conforming to the standard. USA Standards are subject to periodic review and users are cautioned to obtain the latest editions. Producers of goods made in conformity with a USA Standard are encouraged to state on their own responsibility in ad- vertising. promotion material, or on tags or labels. that the goods are produced in conformity with particular USA Standards. Published by United States of America Standards Institute 10 East 40th S treet, New York. N. Y. 10016 Copyright 1968 by the United States of America Standards Institute ‘Universal Decimal Classification 313.1:931 822.6148 ‘No portion af this publication may be quoted a reproduced in any form without the written permission of the United States of Americe Stenderds, Institute, HsiMs7a/4Foreword (This Foreword is not a part of the USA Standard Method of Recording and Messuring Work Injury Experience, 216.1-1967.) ‘This is a revision of the 1954 USA Standard Method of Recording and Measuring Work Injury Experience. The work on this standard dates back to Bulletin 276 of the U.S. Bureau of Labor Statistics, published in 1920. Although developed by a body representing governmental statistical agencies, the rate provisions of this Bulletin were widely followed in whole or in part by private agencies. At a national conference on Industrial Accident Prevention, called by the U.S. Secretary of Labor in Washington in 1926, a resolution was adopted in favor of a revision of Bulletin 276 by a committee set up under the procedures of the American Standards Association*. As a result of the work of this committee, the first edition of this standard was completed and approved in 1937. Work was started in 1942 on a revision of this standard, which after completion was approved in 1945. Shortly after the 1945 revision the International Association of Industrial Accident Boards and Commissions and the National Council on Compensation Insurance withdrew as sponsors of this project, and the Accident Prevention Department of the Association of Casualty and Surety Companies (now the American Insurance Association) assumed joint sponsorship for this project with the National Safety Council ‘This standard was revised in 1945 and in 1954: it was reaffirmed without change in 1959: this edition is the latest revision and was approved December 27, 1967, Realizing that questions may arise from time to time concerning interpretations of this standard, provisions have again been made for an Interpretations Committee in order that uniform handling of questionable cases may be provided. It is recommended that anyone using this standard and desiring an interpretation of a questionable case communicate with the USA Standards Institute in accordance with the instructions in the Introduction. Suggestions for improvement gained in the use of this standard will be welcome. They should be sent to the United States of America Standards Institute, 10 East 40th Street, New York, N.Y. 10016, ‘The USA Standards Committee, Accident Statistic 7.16, on Standardization of Methods of Recording and Compiling which processed and approved this standard, had the following personnel: Frank S. McElroy, Chairman Gene Miller, Secretary Organization Represented Name of Representative Aerospace Industries Association of America M. L. Williams Harold Hemphill (Aly) American Association of State Compensation Insurance Funds Ralph Langley ‘American Conference of Governmental Industrial Hygienists Victoria M. Trasko ‘Ameriean Couneil on Education Donald Dedrick ‘American Federation of Labor Representation Vacant ‘American Gas Association Robert E. Coleman, American Hospital Association ‘American Hotel & Motel Association ‘American Industrial Hygiene Association George J. Butler (Ate) American Insurance Association David Curley WS. Biermann (Alt) ‘American Iron and Steel Institute Warren Saunders Leo Teplow (Alt) ‘American Merchant Marine Institute William L, Rich Frank K. Riley (Ale) Peter J. Finnerty (Alt) American Mutual Insurance Alliance W. Hagerup Fred H. Deeg (Alt) American Paper Institute Date Howard Charles W. Hoffman (Alt) “The American Standards Association was reconstituted the United States of America Standards Institute in August, 1966.Organisation Represented American Petroleum Institute American Society of Safety Engineers American Transit Association ‘American Water Works Association Associated General Contractors of America ‘Association of American Railroads Association of Schoo! Business Officials ‘Automobile Menufacturers Association Blectric Light & Power Group Blectronie Industries Association Forging Industry Association Industrial Medical Association International Association of Governmental Labor Officials Interstate Commerce Commission Manufacturing Chemists’ Association, Ine Milk Industry Foundation National Education Association National Electrical Manufacturers Associ National Restaurant Association National Safety Council Portland Cement Association ‘The Telephone Group Department of Agriculture Department of the Army Department of Health, Education & Welfare (Liaison) Department of the Interior, Bureau of Mines, Department of Labor, Bureau of Employees’ Compensation Department of Labor, Bureau of Labor Standards Department of Labor, Bureau of Labor Statistics Department of the Navy Department of Education fs ¢ ¢s sece Western Wood Products Association Individual Member Name of Representative 0.C. Haier J.P. MeKenna (Alt) ‘Arthur H, Christian JL. Ridinger (Ale) F. W. Wischmeyer (Ale) M. 1. Gershenson Jules Quint (Att) John J. Moran John T. Cappio David B. Preston (Alt) Arthur L. Sehmubl E.H. Blewer D. P. Russell (Alt) H, Spilman Burns, K. 8. Hedges Timothy C. Mather (Att) JE, McMaster ‘A. T. Higgins (Ale) George Re Orth ‘Thomas H. MeBrien (Alt) William S, Work Robert W. Atkinson (Ale) KS.Lane NN, Eckelberry (ity M. L. Gershenson Charles A. Pearce James Gribbon (Att) William H, MeCarthy J. A. Musselwhite (Ale) RH, Albisser 48. Queener (Alt) NE. Thiel S.A. Abercrombie 3. F. Van Namee ©. V. Culbertson Gene Miller Grant Seward (Alt) Howard Riefenstahl J. Langwig W. H. Homoyer (ale) E.J. Dymek (Att) BG. Metcalf ‘Albert F. Abraham Representation Vacant Forrest T. Moyer Harry F. Weaver (Alt) Donald Kress George J. Yatsko Ralph W. Netterstrom (Alt) Maurice F. Bresnahan William E. Tarrants (Alt) Alen Turnbull RN. Finchum William W. Chase (Alt) J. R. Grady LB. Hoolscher (Ale) Frank S. McElroyContents SECTION Introduction 1. Definitions Work Injury Classification of Work Injury 3. Employment 4 Regularly Established Job 5 Total Days Charged .6 Employee 7 8 9 1 1 Exposure Employee Hours Disabling Injury Frequency Rate 0 Disabling Injury Severity Rate 1 Average Days Charged per Disabling Injury 2, Evaluation of Severity 2.1 Death 2.2 Permanent Total Disability 2.3 Permanent Partial Disability. 24 Temporary Total Disability 3, Exposure 3.1 Measurement of Exposure to Industrial Injuries 3.2 Determination of Employee-Hours of Exposure 4, Measures of Injury Experience. 4.1 Disabling Injury Frequency Rate 4.2. Disabling Injury Severity Rate 4.3 Average Days Charged per Disabling Injury 4.4 Special Injury Rates 4.5 Closing Dates 4.6 Injuries Charged to Date of Occurrence 5. Classification of Special Cases I Inguinal Hernia 5.2. Hernia Other Than Inguinal 5.3. Back Injury 5.4 Aggravation of an Existing Physical Deficiency 5.6 57 Disability Arising Solely Out of Physical Deficiency Purposely Inflicted Injuries Horseplay 5.8 Animal and Insect Bites and Stings 5.9 Skin Irritations and Infections 5.10 Muscular and Skeletal Disabilities 5.11 Exposure to Temperature Extremes 5.12 Athletic Activities 5.13 External Events 14 Hospitalization for Observation 5.15 Reaction to Medication PAGE weowoveaaywss 3 wooe 12 12 2 12 13 13 1B 13 13 uMSECTION PAGE 5.16 Aggravation of Minor Injury 15 5.17 Degree of Disability 15 ‘Table 1 Tabulation of Scheduled Charges 10 Fig. 1 Chart of Scheduled Charges for Hand and Foot un Appendix Guiding Interpretations and Examples 7American National Standard Method of Recording and Measuring Work Injury Experience Introduction The purpose of this standard is to provide a practical and uniform method for recording and measuring work injury experience. Injury rates compiled in accordance with this stan. dard may be used to evaluate: (1) The relative need for accident prevention activities in different departments of an estab- lishment (2) The seriousness of the accident problem in an establishment or industry. (3) The effectiveness of safety activities in establishments with comparable hazards. (4) The progress made in accident preven: tion within an establishment or industry The methods outlined in this standard for classifying work injuries are independent of workmen's compensation laws and rulings of workmen's compensation agencies. ‘The fact that the employee or employer did not have control over the cause of a work in- jury shall not be a criterion for excluding the work injury from being recorded under this standard. ‘Thorough investigation of all factors relating to the occurrence of each reported injury is essential. Determination as to whether or not the injury should be considered a work injury under the provisions of this standard shall be based upon the evidence developed in such investigations. Unless there is a preponderance of evidence that the injury did not result from the work activity or environment of employ ment, the injury shall be considered a work injury. (See the Appendix for suggestions as to factors to be considered.) When the proper classification of, or the correct time charge for, any injury is in doubt, nine copies of a full report of the circumstances of the injury or alleged injury, including all pertinent medical information, may be submit- ted to the United States of America Standards Institute, 10 Fast 40th Street, New York, New York 10016, for a decision by a Committee on Interpretations, 1. Definitions 1.1 Work Injury. Any injury or occupational disease suffered by a person which arises out of and in the course of his employment, ie., resulting from work activity or environment of employment. (See Appendix A1.1.) 1.1.1 Occupational Disease. A disease caused by exposure to environmental factors associ- ated with employment. (See Appendix A1.1.1.) 1.2 Classification of Work Injury. 1.2.1 Death. Any fatality resilting from a work injury regardless of the time intervening between injury and death. 1.2.2 Permanent Total Disability. The clas- sification for any injury other than death which permanently and totally incapacitates an employee from following any gainful occu- pation or which results in the loss, or the com- plete loss of use, of any of the following in one accident (1) Both eyes (2) One eye and one hand, or arm, or leg, or foot (3) Any two of the following not on the same limb: hand, arm, foot. or leg 1.2.3 Permanent Partial Disability. The clas: sification for any injury other than death or permanent total disability which results in the oss, or complete loss of use, of any member or part of a member of the body, or any perma nent impairment of functions of the body or part thercof, regardless of any preexisting disability of the injured member or impaired body function. These cases are included in the injury rates whether or not time is lost ‘The following work injuries are not classified as permanent partial disability, but should be considered under the provisions of 1.24 or 12.6: (1) Inguinal hernia, if it is repaired. NOTE: An unrepaired inguinal hernia shall be classi ed as a permanent partial disability with a time charge of 50 day's, but when repaired should be reclassified as a temporary total disability and the time charged replaced by the actual days of disability.216.1 (2) Loss of fingernails or toenai (3) Loss of tip of finger or tip of toe without bone involverent NOTE: For the purpose of this standard, the loss or removal of the tuft of the bone in the distal phalange of {finger of toe shall be considered bone involvement Provided it shows in xrays (4) Loss of teeth. (5) Disfigurement. (G) Strains or sprains which do not cause permanent limitation of motion. (7) Fractures that do not result in perma: nent total or permanent partial disability or the permanent restriction of normal function of the injured member. (See Appendix A1.2.3.) 1.2.4 Temporary Total Disability. The clas sification for any injury which does not result in death, permanent total, or permanent par: tial disability, but which does result in one or days of disability as defined in 1.5.1. 5 Disabling Injury (Sometimes Referred to as Lost-Time Injury). A work injury which results in death, permanent total disabilit permanent partial disability, or tempor total disability as defined herein. These are the injuries used in calculating the disabling injury frequeney and severity rates. 1.2.6 Medical Treatment Injury. The clas. sification for any injury which does not result in death, permanent total, permanent partial, or temporary total disability, but which re- quires first aid or medical attention of any kind. 1.3 Employment. Defined as the following: U1) All work or activity performed in carry ing out an assignment or request of the em: ployer including incidental and related activi ties not specifically covered by the assignment or request (2) Any voluntary work or activity under: taken while on duty for the purpose of bene- fiting the employer. (3) Any other activities undertaken while on duty with the consent or approval of the em: ployer 1.4 Regularly Established Job. One which has not been established especially to accommo date an injured employee. either for thera peutic reasons or to avoid counting the case as a temporary total disability 1.5 Total Days Charged. The combined total, for all injuries, of (1) All days of disability resulting from temporary total injuries and (2) All scheduled charges assigned to fatal, permanent total, and permanent partial in- juries. 1.5.1 Day of Disability. A day of disability is any day on which an employee is unable, because of injury. to perform effectively throughout a full shift, the essential functions of a regularly established job which is open and available to him. 1.1 The day of injury and the day on which the employee was able to return to full- time employment shall not be counted as days of disability: but all intervening calendar days, or calendar days subsequent to the day of in- jury (including week-ends, holidays, other days off, and other days on which the plant may be shut down), shall be counted as days of dis ability provided they meet the criteria of the preceding paragraph. 1.2 Time lost on a workday, or on a nonworkday. subsequent to the day of injury, ascribed solely to the unavailability of medical attention or of necessary diagnostic aids shall be considered disability time, unless in the opinion of the physician authorized by the employer to treat the case the person was able to work on all days subsequent to the day of injury 1.5.1.3 If the physician authorized by the employer to treat the case is of the opinion that the injured employee is actually capable of working a full normal shift at a regularly established job (as defined in 1.4), but has pre- scribed certain therapentic treatments, the employee may be excused from work for those treatments without counting the excused time as disability time, provided: (1) the time re- quired to obtain the treatments does not, on any workday, prevent him from performing effectively the essential functions of his job assignment on that day, and (2) the treatments are professionally administered and constitute more than simple rest 1.5.14 If the physician authorized by the employer to treat the case is of the opinion that the injured employee was actually capable of working a full normal shift at a regularly established job (as defined in 1.4), but because of transportation problems, associated withhis injury, the employee is forced to arrive at his place of work late. or to leave the work- place before the established quitting time, such lost time may be excused and not counted as disability time, provided: (1) that the ex cused time does not materially reduce his working time, and (2) that it is clearly evident that this failure to work the full shift hours is the result of a bona fide transportation prob- lem and not a deviation from the “regularly established job” definition as expressed in 1.4 1.5.1.5 If the injured employee receives medical treatment for his injury. the determi- nation of his ability to work shall rest with the physician authorized by the employer to treat the case. as specified in 5.17. If the employee rejects medical attention offered by the em: ployer, the determination may be made by the employer based upon the best information available to him. If the employer fails to pro vide medical attention, the employee's decision shall be controlling. 1.5.2 Scheduled Charge. The specitic charge (in days} assigned to a permanent partial, permanent total, or fatal injury, For these charges, see 2.3 through 2.3.1.5 and Table 1 Tabulation of Scheduled Charges. 1.6 Employee. For the purpose of counting injuries or calculating exposure under this standard. an employee is any person engaged in activities for an employer from whom he receives direct payment for his services. In- cluded are working owners and officers. (See Appendix AL.6.) 1.7 Exposure (See Section 3). The total num ber of employee-hours worked by all employees including those in operating, production maintenance, transportation, clerical, admin- istrative, sales, and other activities. 1.8 Employee Hours. The same as exposure as defined in 1.7. 1.9 Disabling Injury Frequency Rate. ‘The number of disabling injuries per 1,000,000 employee-hours of exposure. 1.10 Disabling Injury Severity Rate. The total days charged (as defined in 1.5) per 1,000,000 employee-hours of exposure. NOTE: It is recommended that this rate be rounded to the nearest whole number 216. 1.11 Average Days Charged per Disabling Injury. The total days charged (as defined in 1.5) divided by the number of disabling. in juries (as defined in 1 2. Evaluation of Severity 2.1 Death. Each death resulting from work injury shall be assigned a time charge of 6,000 days 2.2 Permanent Total Disability. Permanent total disabilities resulting from work injuries shall be assigned a time charge of 6,000 days each. 2.3 Permanent Partial Disability. Permanent partial disabilities, either traumatic or surgi cal, resulting from work injuries shall be as: signed charges as provided in Table 1, Tabula. tion of Scheduled Charges. These charges shall be used whether the actual number of days lost is greater or less than the scheduled charges. or even if no days are lost at all, ex: cept as noted in 2.3.14 2.3.1 Scheduled Charges. See Table | and Fig, 1. Chart of Scheduled Charges for Hand and Foot, 2.3.1.1 Charges for Finger and Toe Ampu- tations. For cach finger (or toc) use only onc charge—the charge shown in the table or on. the chart—for the highest valued bone in. volved. For amputations of more than one finger (or toc}, total the separate charges for each finger (or toe} EXAMPLE: Amputation of the little finger with part of the metacarpal would be charged 400 days. Amputation of the ring finger. in. volving the proximal phalange would be charged 240 days. If both of these occurred in one accident, the charge would be 400 + 240, or 640 days. 2.8.1.2 Charges due to Permanent Im- pairment of Function. The charge due to per- manent impairment of function shall be a percentage of the scheduled charge, corre: sponding to the percentage of permanent re duction of function of the member or part of member involved as determined by the physi cian authorized by the employer to treat the case. (See special rules relating to permanent impairment of hearing and vision in ?.3.1.2.1 and 2.3.1.2.2 below.) EXAMPLE: An injury to the index finger r sulted in permanent stiffness at the middle216.1 Table 1 Tabulation of Scheduled Charges (See 2.3.1) A. For Loss of Member—Traumatic or Surgical (For Loss of Use of Member, see 2.3.1.2) Fingers, Thumb, and Hand (also see Fig. 1) Amputation Involving All or Part of Bone"+ Thumb Fingers Index Middle Ring Little Distal phatange 300 | 10075 «0 —« Middle phalange == | 200 150 120100 Proximal phalange 600 | 400 300 © 240-200 Metacarpal 900 | 600 500 450400 Hand at wrist, 3000 ‘Toe, Foot, and Ankle (also see Fig. 1) Amputation Involving All or Part of Bone"? Great, Each of Toe Other Toes, Distal phalange 150 35 Middle phalange B Proximal phalange 150 Metatarsal 600 360 Foot at ankle, 2400 Arm ‘Any point aboved elbow, including shoulder joint 4500 ‘Any point above wrist and at or Below elbow 53600 Leg [Any point aboved knee 4900 ‘Any point above ankle and at or below knee 3000 B. Impairment of Function ‘ne Bye (loss of sight), whether or not there is sight in the other eye 1400 Both Eyes (lose of sight). in one accident 6000 ‘One Ear (complete industrial loss of hearing), whether or not there is hearing. in the other ear 600 Both Ears (complete industrial loss of hearing! in one accident 3000 Unrepaired Hernia [for repaired hernia, see 1.2.9(1)1 50 “Ifthe bone is not involved, use actual days lost, and classify as temporary total disability. ‘The tuft of the distal bone of a finger or toe ia considered bone if it shows in x-rays. [Seo 1.2.313).1 ‘fFor loss of use, without amputation, see 2.9.1.2 The term “above” when applied to the arm means toward the shoulder, and when applied to the leg means toward the hip. 10261 Fig. 1 Chart of Scheduled Charges for Hand and Foot (See 2.3.1) HAND 9 2 18 izle 5 Bg i 2 Bia ,e2; 3 En eon de FOOT TARSUS \ 2400 Fi { PHALANGES NOTES, (1) Numbers on the bones are the charges for loss involving part or all of the bone. (2) ‘The tuft of the distal bone in a finger or toe is considered bone if it shows in x-rays, [See 1.2.9(3).] (3) For additional information on use of the chart, see 2.3.1.1 through 2.9.1.5. u216.1 phalange which the physician, authorized by the employer to treat the case, estimated at 25 percent permanent impairment of function. ‘The charge would be 25 percent of 200 days, or 50 days. 2.3.1.2.1 Permanent Impairment of Hear- ing. Loss of hearing is considered a permanent partial disability only in the event of complete industrial impairment of hearing from trau- matic injury or industrial noise exposure, in which case the full time charges shown in Table 1, Tabulation of Scheduled Charges, shall apply. 2.3.1.2.2 Permanent Impairment of Vi- sion. The charge due to permanent impairment of vision shall be a percentage of the scheduled charge for total loss of vision corresponding to the percentage of permanent impairment of vision as determined by the physician author- ized by the employer to treat the case. The determination of this percentage shall be on the basis of uncorrected loss. 2.3.1.3 Impairments Affecting More Than One Part of the Body. For permanent impair: ment affecting more than one part of the body, the total charge shall be the sum of the sched: uled charges for the individual body parts impaired. If the sum exceeds 6,000 days, the total charge shall be 6,000 days. 2.3.1.4 Permanent and Temporary In Juries in the Same Accident. In those cases where an employee suffers a permanent partial injury to one part of the body and a temporary total injury to another part in one accident, the greater charge shall be used and shall determine the injury classification. 2.3.1.5 Charges for Injuries Not Identified in Table 1. The charge for any permanent in jury other than those identified in the schedule of charges (such as damage to internal organs, loss of speech, damage to lungs, back, etc.) shall be a percentage of 6,000 days, correspond: ing to the percentage of permanent total disa bility which results from the injury. as deter: mined by the physician authorized by the employer to treat the case 2.4 Temporary Total Disability. The charge for a temporary total disability shall be the total number of calendar days of disability (as defined in 1.5.1) resulting from the injury 3. Exposure 3.1 Measurement of Exposure to Industrial Injuries. Exposure to industrial injuries shall 2 be measured by the total number of hours of employment of all employees in each estab- lishment, including employees of operating, production, maintenance, transportation, cler- ical, administrative, sales, and other depart ments. If any departments are excluded from the announced injury experience of an estab- lishment or industry, this fact shall be stated. (See Appendix A3.1.) 3.1.1 Exposure of Central Office. The ex perience of a central administrative office or central sales office of a multiestablishment concern shall not be included in the experience of any one establishment, nor shall it be pro- rated among the establishments, but it shall be included in the overall experience of the concern or the industry. (See Appendix A3.1.1.) 3.2 Determination of Employee-Hours of Ex- posure. Employee-hours of exposure for cal- culating work injury rates are intended to be actual hours worked. When actual hours are not available estimated hours may be used. Employee-hours should be calculated as fol lows: (1) Actual Exposure Hours. Employee-hours of exposure shall be, if possible, taken from payroll or time-clock records and include only actual straight time hours worked and actual overtime hours worked, (2) Estimated Exposure Hours. When actual employee-hours of exposure are not available, estimated hours may be used. Such estimated hours should be obtained by multiplying the total employee-days worked for the period by the average number of hours worked per day. If the hours worked per day vary among de- partments. a separate estimate should be made for each department and these estimates added to obtain the total hours. Estimates of over: time hours should be included. If employee-hours are estimated, indicate basis on which estimates are made. (3) Hours Not Worked. Employee-hours paid for but not worked (either actual or estimated) such as time taken for vacation, sickness, jury duty, holidays. funerals, etc., should not be included in the total hours worked. The final figures should represent, as nearly as possible, hours actually worked, ie.. hours of accident exposure. 3.2.1 Employees Living on Company Prop- erty. In calculating hours of exposure for em:ployees who live on company property, onty those hours during which employees were actually on duty shall be counted. 3.2.2 Employees with Undefined Hours of Work. For traveling salesmen, executives, and others whose working hours are not defined, an average of eight hours per day shall be as- sumed in computing exposure hours. 3.2.3 Standby Employees. For standby em- ployees, including seamen aboard vessels, who are restricted to the confines of the employer's premises all standby hours shall be counted, as well as all work injuries, as defined in 1.1, occurring during such hours. 4. Measures of Injury Experience 4.1 Disabling Injury Frequency Rate. The disabling injury frequency rate is based upon the total number of deaths, permanent total, permanent partial, and temporary total dis: abilities which occur during the period covered by the rate (see 4.6). The rate relates these injuries to the employee-hours worked during the period and expresses the number of such injuries in terms of a million-hour unit by use of the following formula disabling injury frequency rate number of disabling injuries X 1,0 employee hours of exposure (See Appendix A4.1 for example of disabling injury frequency rate computation.) 42 Disabling Injury Severity Rate. The dis- abling injury severity rate is based on the total of all scheduled charges for all deaths, Permanent total, and permanent partial dis- abilities, plus the total days of disability from all temporary total injuries which occur during the period covered by the rate. The rate relates these days charged for death and permanent disability and those counted for temporary total disability to the employee hours worked during the period and expresses the loss in terms of a million-hour unit, by use of the following formula: disabling injury severity rate total days charged X 1,000,000 ‘employee hours of exposure (See Appendix A4.2 for example of disabling injury severity rate computation.) 4.3 Average Days Charged per Disabling In- jury. This measure expresses the relationship 1B 216.1 between the total days charged, as defined in 1.5, and the total number of disabling injuries, as defined in 1.2.5. The average may be calcu- lated by use of the following formula: average days charged per disabli total days charged total of disabling injuries ‘The following alternate formula may also be used to compute this measure: average days charged per disabling injury injury severity rate injury frequency rate 4.3.1 Average Days Charged for Different Classes of Injuries. Average days charged may be calculated for all disabling injuries, for permanent partial disability injuries only, and for temporary total disability injuries only. To compute the average for permanent partial disability injuries, divide the number of such injuries into the total of scheduled charges resulting from them. To compute the average for temporary total disability injuries, divide the number of such injuries into the total num- ber of days of disability resulting from them, 4.4 Special Injury Rates. Any establishment, organization, or industry may, for analysis or other special purposes, compute frequency or ‘ates on the basis of any one or more of the injury classifications defined in 1.2. or. for any one type of injury within one or more of the classifications. However, the kinds of injuries included in the computation of such subsidiary rates should be clearly stated to distinguish them from the basic disabling in. jury frequency rate and the disabling injury severity rate as defined in 4.1 and 4.2 4.4.1, Nonstandard Measures. See Appendix Ad.4.1 for a discussion of the serious injury frequency rate and the disabling injury index ‘These nonstandard measures, if used, should be supplementary to, and not replacements for, the standard disabling injury frequency rate or the standard disabling injury severity rate as defined in 4.1 and 4.2. (See Appendix AMAL) 4.5 Closing Dates. Injury rates shall be com piled in accordance with the following rules (1) Injury rates shall be based on all injuries known to have occurred in the period covered by the rate, These shall include all cases rezea ported within 20 days after the close of the period (month, quarter, year. etc.), When an injury is reported as having occurred in the period, but has not become disabling by the closing date it shall, nevertheless. be counted as disabling if it is clearly evident on the clos: ing date that it will become disabling at some later time. (2) For known cases in which disability con: tinues beyond, or from which it is clearly evident that disability will result after, the closing dates stated in (I), time charges shall be estimated on the basis of medical opinion as to probable ultimate disability (3) Cases reported and time charges de- termined after the closing dates stated in (1) need not be included in injury rates for that period or for any similar subsequent period However, the rates for longer periods of which that period is a part shouid include the addi tional cases and adjusted time charge U1) Revisions of injury rates, if made, should include all cases occurring within the period and known at the date of revision, and time charges should be made according to the dis: ability as then determined or estimated. 4.6 Injuries Charged to Date of Occurrence. An injury, and all time charges or days of disability resulting from it, shall be charged to the date on which the injury occurred, ex: cept as noted in 4.6.1 4.6.1 Injuries Not Identified with Specific Accidents. Injuries, such as tenosynov' bursitis, silicosis, ete., which are determined to have arisen out of the employment, but can- not be attributed to a specific accident, shall be charged to the date on which the injury is first reported, 5. Classification of Special Cases 5.1 Inguinal Hernia. An inguinal hernia shall be considered a work injury only if it is pre- cipitated by an impact, sudden effort, or severe strain and meets all of the following conditions: (1) There is a clear record of an accident or an incident such as a slip, trip or fall, sudden effort, or overexertion. (2) There is actual pain in the hernial region at the time of the accident or incident (3) The immediate pain was so severe that the injured employee was forced to stop work 4 Jong enough to draw the attention of his fore- man or fellow employee to his condition or the attention of a physician was secured within 2 hours, except as provided in 1.5.1.2 in re- spect to the unavailability of a physician. (See Appendix A3.1.) 5.2 Hernia Other Than Inguinal. This shall not be considered under the conditions of 5.1 but shall be considered in the same way as any other injury. 5.3. Back Injury. A back injury shall be consid ered a work injury if: (1) There is a clear record of an accident such as a slip, trip, fall. sudden effort, or blow on the back or (2) The employee was engaged in work ac: tivity which. in the opinion of the physician authorized by the employer to treat the case, produced a physical condition resulting from overexertion. (See Appendix A5.3.) 5.4 Aggravation of an Existing Physical De- ficiency. If aggravation of an existing physical deficiency arises out of and in the course of employment, any resulting disability shall be considered a work injury and classified ac. cording to the ultimate extent of the disability as provided in 1.2. (See Appendix Ad.4.) 5.5 Disability Arising Solely Out of Physical Deficiency. If an accident or incident such as aslip, trip, or fall arises solely out of an exist ing physical deficiency, and if a worker without such physical deficiency would not have suf. fered such an accident or incident, any result ing injury shall not be considered a work injury. However, an injury which results from the work activity or the environment of the employment shall be considered a work in- jury even though the employee had an existing physical deficiency. (See Appendix A5.5.) 5.6 Purposely Inflicted Injuries. An injury purposely inflicted by another person shall be considered a work injury if it arises out of and in the course of employment. (See Appen- dix A5.6.) 5.7 Horseplay. An injury inflicted by, or aris- ing out of, horseplay during employment shall be considered a work injury: (See Appendix AT.) 5.8 Animal and Insect Bites and Stings. Ani: mal and insect bites and stings are work in-juries if they arise out of and in the course of ‘employment. (See Appendix 5.8.) 5.9 Skin Irritations and Infections. Skin ir- ritations and infections such as dermatitis and poison ivy are work injuries if they arise out of and in the course of employment. (See Ap: pendix Ad.) 5.10 Muscular and Skeletal Disabilities. Mus: cular disability, bursitis, tenosynovitis. ete.. are work injuries if they arise out of and in the course of employment. (See Appendix A5.10.) 5.11 Exposure to Temperature Extremes. An injury which results from exposure to tem perature extremes (heat or cold) is a work injury if it arises out of and in the course of employment. 5.12 Athletic Activities. An injury to an em: ployee resulting from participation in athletic activities, whether or not they are employer sponsored, shall be considered a work injury only if the participant was paid by the em- ployer for these activities. 3. External Events. An injury which results directly from an external event of catastrophic proportions such as tornadoes, twisters, hur- ricanes, earthquakes, flood, conflagration, or explosion originating outside of employment, or from an immediate secondary event, such as a fire, boiler explosion, falling electric wire, shall be classified as a work injury only if the victim was a policeman, fireman, member of a disaster or emergency squad, utility work: man, or other employee who is engaged in duties in connection with such events. (See Appendix A5.13.) 5.13.1 Lightning. An injury resulting from lightning shall be classified as a work injury if the conditions of employment are such as 216.1 to anticipate exposure to such hazards as a matter of duty. 5.14 Hospitalization for Observation. If after observation in a hospital for a period not to exceed 48 hours from the time of an injury or suspected injury known to have a delayed ef- fect, i... from accidents such as a blow on the head, a blow to the abdomen, or the inhalation of harmful gases, the physician authorized by the employer to treat the case determines that, the injury was in reality slight and that the injured person could have returned to work without any permanent impairment or tempo- rary total disability, the injury shall be clas sified as a medical treatment case. In cases of exposure to ionizing radiation the period of observation may be extended to 10 days. How. ever, if any. treatment or medication at all is given for the confining injury or the suspected injury after the first 24 hours of observation, the injury shall be classified as disabling. (See Appendix A5.14.) 5.15 Reaction to Medication. Illness resulting solely from reaction to medication such as antitoxin, vaccines, or drugs used in the treat- ment of a nondisabling injury shall not cause the injury to be classified as disabling. (See Appendix A5.15.) 5.16 Aggravation of Minor Injury. If a minor work injury is aggravated because of improper diagnosis or improper treatment, either pro- fessional or nonprofessional, or if infection develops later, either on the job or off the job, the injury shall be classified according to the ultimate extent of the disability. (See Appendix 5.16.) 5.17 Degree of Disability. The degree of dis- ability of an injury shall be based on the deci- sion of the physician authorized by the em- ployer to treat the case.Appendix Guiding Interpretations and Examples (This Appendix is not a part of the USA Standard Method of Recording and Measuring Work Injury Experience, 216.1-1967. Its purpose is to provide guides for the interpretation and application of certain specifie provisions of the ‘standard. The numbers in this Appendix refer to the pertinent items of the standard) Introduction Thorough investigation of all factors relating to the occurrence of each reported injury is essential. Determination as to whether or not the injury should be considered a work injury under the provisions of this standard shall be based upon the evidence developed in such investigations. Unless there is a preponderance of evidence that the injury did not result from the work activity or environment of employ. ment the injury shall be considered a work injury. Preponderance of Evidence. The evidence to be considered in determining whether or not the reported injury should be considered a work injury should include, but not necessarily be limited to: (1) Facts resulting from investigation of the injured employee's work activities and working environment to which the injury might be related (2) Statements (written, if possible) of the injured employee, fellow employees. witnesses, and supervisors, (3) Medical reports acceptable to authority classifying the work injury. (4) Facts concerning the injured employee's work activity for other employers, and other off-the-job activities, injuries, and illness ALL Work Injury. Any injury or occupational disease suffered by a person which arises out of and in the course of his employment, i.e, resulting from work activity or environment of employment Al.l(a) Radiation. Work injury also includes radiation injury which is any injury charac terized by clinically evident biological damage resulting from exposure to radiations includ- ing ionizing radiation arising out of and in the course of employment. AL.1(b) Going to and from Regular Place of Work. An injury would not be considered as arising out of and in the course of employment if it occurred during normal routine travel from the employee's home to the employer's regular place of business, and return, except as noted in Al.1(c). Normal or routine travel would include travel at irregular hours due to late shifts. overtime, special, or emergency work. [For personnel who travel in connection with their work, see Al.L(e).| AL.L(c) Regular Place of Work Inaccessible. If a regular place of work is inaccessible to ordi- nary transportation and the employer fur- nishes special transportation from designated meeting places, an injury would be considered as arising out of and in the course of employ- ment if it occurred between the time the em- ployee was picked up at such a meeting place and the time he was returned to that place. If an employee drove his own car or a company: furnished car to such a place of work, or if he rode with another person in that person’s car or a company-furnished car, AL.I(b) would apply. A1.1(d) Employees Not Having Regular Place of Employment. An injury to an employee who does not have a regular place of employment, such as a member of a public utility line crew, would be considered as arising out of and in the course of employment if it occurred be- tween the time he reached a designated meeting place for the crew and the time he was dis- missed from duty at the point where the crew disbands. AL.L(e) Employees Who Travel in Connection With Their Work. An injury to any employee (salesman, engineer, consultant, ete.), who may travel in the interest of his employer, either locally or long distances, would be considered as arising out of and in the course of employ- ment if it occurred between the time his travel started (either from his home or from his place of work) and the time his travel ended (either at his place of work or at his home). However,z16.1 the injury would not be considered a work injury if it occurred (1) during normal living activities such as eating, sleeping, recreation, ete. 12) during deviations from a reasonably direct route of travel such as a side trip for personal reasons; or (3) during other activities neither necessitated by the travel nor in the interest of the employer. EXAMPLE 1: A city salesman (could also be a routeman, television repairman, etc.) contacted his office and received instructions for his first call, then proceeded there direct from his home. He was injured in an automobile acci: dent before reaching the designated place. The injury would be considered as arising out of and in the course of employment. EXAMPLE 2: A consulting engineer received instructions from his office not to report there the next morning, but instead to go to Plant X in a neighboring town. An injury suffered during this travel would be considered as aris. ing out of and in the course of employment. EXAMPLE 3: An employee was instructed to go to a town some 300 miles from his home office to attend a meeting early on the follow: ing day. His route took him within a mile of a scenic view which he had not seen and he de- cided to turn off the through road to see it. On his way back to the main highway after viewing the site he was involved in a collision with another car. His resulting injury would not be considered a work injury since it occurred during a deviation made for purely personal reasons from his direct route of travel, EXAMPLE 4: As in example 3, an employee was driving to another town as instructed by his employer. His brother happened to live on the direct road to the other town and he de- cided to stop for a short visit with his brother's family. While in his brother's home he tripped and fell. The resulting injury would not be considered a work injury since his visit to his brother's home was neither necessitated by his travel nor in the interest of his employer. AL.A(f) Entertainment By, or As, a Customer or Client. An injury to an employee which occurs while he is entertaining a customer or client, or while he is being entertained as a customer or client, for the purpose of transact: ing, discussing, or promoting business, would be considered as arising out of and in the course of employment. 18 APPENDIX AL.(g) Movement Within Confines of Em- ployer's Premises. An injury, which occurred before, during, or after working hours, would be considered a work injury if it occurred (1) while the employee was going from the entrance to the employer's premises to his place of work, or from his place of work to the exit from the employer's premises; or (2) while the employee was going from one part of the employer's premises to another for any pur. pose associated with his employment as de- fined in 1.3 The entrance to, or the exit from, the em: ployer’s premises should be deemed to be that point beyond which only employees and per. sons having business with the employer are expected to pass. In most instances this would be the perimeter of the property owned or leased by the employer on which his place of business is located, including access driveways or walks. However, areas such as the following should not be considered as within the entrance to the employer's premises: (1) roadways or walkways passing through property owned by the employer but open to unrestricted use by the gencral public; (2) property adjacent to the employer's buildings or work place which is open to the general public for unrestricted use as park land; (3) entrance lobbies, corri- dors, elevators, and stairways serving other tenants in buildings where the employer occu- ies only a part of the building: and (4) access roads, walkways, and parking lots serving both the employer and ather employers as in industrial parks and retail shopping centers. AL.1(h) Absence from the Employer's Prem- ises. An injury to an employee outside of the employer's premises would be considered as arising out of and in the course of employment if the absence from the premises was author- ized by the employer or his agent and was in the interest of the employer or his agent. EXAMPLE: An injury to an employee who is off the employer's premises, during working hours, with permission of the employer, for the purpose of seeking housing accommoda: tions for himself, his family, or his friends, would not be considered as arising out of em- ployment. An injury to an employee who is sent by his supervisor on a personal errand for that supervisor would be considered as arising out of and in the course of employment.APPENDIX ALA(i) Lunch Period Injuries. An injury to an employee which occurs during his specifi cally defined lunch period or other specifically defined off-duty period except as provided in AL.1§) would not be considered as arising out of and in the course of employment unless it arose out of the hazards of the work area. EXAMPLE I: If while eating in the work area during his specifically defined lunch period, an employee is injured when struck by a piece of moving equipment, boxes, or materials which he or another worker caused to fall on him, or he is injured by a slip or fall. or by any other situation peculiar to the work area, the injury would be considered as arising out of and in the course of employment EXAMPLE 2: If while eating in the same loca tion as described in Example I, an employee chokes on his food. or becomes ill from his food, the case would not be considered as aris ing out of and in the course of employment. EXAMPLE 3: An injury occurring in a cafe- teria or lunchroom, whether on or off the em ployer's premises, would not be considered as arising out of and in the course of employment but injuries which occur on the employer's premises while going to or from such eating places would be considered as arising out of and in the course of employment EXAMPLE 4: Food poisoning which results from a meal furnished free by the employer on the employer's premises would be considered as arising out of and in the course of employ: ment AL.1G) Injuries During Rest Breaks. An in jury which occurs during a coffee break or other rest break would be considered as arising out of and in the course of employment unless it occurred under circumstances which are specifically excluded by other provisions of this standard. AL.1(k) Shower Room, Wash Room, or Toilet Room Injuries. An injury to an employee which occurs while he is going to or from a shower. toilet, or wash room, or which occurs while he is taking a shower or otherwise using wash room or toilet facilities, before, during, or after working hours on the employer's prem. ises, would be considered as arising out of and in the course of employment, if use of the facili ties was occasioned by the employee's work. 216. ALL) Parking Lot Injuries. An injury occur. ring on a parking lot established on the em- ployer’s premises for the convenience of em: ployees would not be considered as arising out of and in the course of employment unless it occurred while the employee was performing the duties of his employment or was under the direction of a supervisor, ALL1 Occupational Disease. A disease caused by exposure to environmental factors associated with employment GUIDE: Since some of the environmental fac tors that affect an employee on the job may also affect him off the job, occupational disease is limited to those diseases that, as determined by the physician authorized by the employer to treat the case, result from factors related to an employce’s trade or occupation, for exam: ple: a particular process to which he is exposed. when ai work. It does not include cases of discase resulting from conditions to which he is exposed only when not at work. Examples of diseases that may have both job and off-job origins are: benzene poisoning, carbon tetra: chloride poisoning, heat prostration, poison ivy, loss of hearing. athlete's foot, and tubercu: losis AL.2.3 Permanent Partial Disability. The classification for any injury other than death or permanent total disability which results in the loss, or complete loss of use, of any member or part of a member of the body, or any perma- nent impairment of functions of the body or part thereof, regardless of any preexisting disability of the injured member or impaired body function. These cases are included in the injury rates whether or not time is lost. GUIDE: As used here the phrases loss, com: plete loss of use, and permanent impairment of functions refer strictly to the effect on the injured person without consideration of the effect upon his working ability. Specifically, if awork injury produces one of the stated physi- cal conditions, the injury shall be classified as a permanent partial disability even though the injured person’s working ability is not reduced in any degree. AL6 Employee. For the purpose of counting injuries or calculating exposure under this standard, an employee is any person engaged in activities for an employer from whom he receives direct payment for his services. In cluded are working owners and office!216.1 GUIDE: It is the intent of the standard that hours of exposure and injuries of workers furnished and paid by a contractor shall be recorded by the contractor rather than by the establishment in or for which the workers may be assigned to work. However, there are certain industries (such as logging, agriculture, and construction) where much of the regular employment is on a contract basis and it is known that some of the contractors do not maintain work injury records. In such stances establishments utilizing contract work: ers in their regular operations may desire to ecord the experience of these workers in order to have a complete injury record for their operations. When such combined records ar prepared the experience of contract. workers should be recorded separately from that of the company’s own employees and the record should contain a clear statement as to what workers have been included. A3.1 Measurement of Exposure to Industrial Injuries. Exposure to industrial injuries shall be measured by the total number of hours of employment of all employees in each estab: lishment, including employees of operating. production, maintenance, transportation, cle) ical, administrative, sales, and other depart- ments. If any departments are excluded from the announced injury experience of an estab: lishment or industry, this fact shall be stated. A3.L.1 Exposure of Central Office. The ex- perience of a central administrative office or central sales office of a multiestablishment concern shall not be included in the experience of any one establishment, nor shall it be pro- rated among the establishments, but it shall be included in the overall experience of the concern or the industry. GUIDE: The term establishment, as used in 3.1 and 3.1.1, means an operating unit that is autonomous in the sense that it is concentrated at a single location and maintains its own pay roll and inventory records. A single-establishment concern is one which has all of its operations at one location even though those operations may be departmental ized with separate subordinant managers for each department. In such a concern the basic establishment injury record would include the injury and exposure records of all employees of the company. A single-establishment may (and this practice is recommended) elect to APPENDIX maintain separate injury experience records for any of its departments, divisions, or iden: tifiable operating units within the establish: ment, but when this is done those records should be clearly labeled to identify the specific operations covered and to distinguish them from the basic establishment injury record A multiestablishment concern is one which conducts operations at more than one location and maintains separate payroll and inventory records for some or all of those locations. Each operating location for which such records are maintained constitutes an establishment. When the payroll and inventory records of several small operating units are maintained on a combined basis, those units as a group consti: tute an establishment even though the units may be at different locations. As used here, the term different locations does not mean that two establishments of the same concern must be physically separated by any specified distance. They may in fact be side by side or even in the same building, The essential characteristics which identify them as separate establishments are: (1) they must constitute separate operating units in the company’s organizational structure; and (2) they must maintain separate payroll and inventory records, Most multiestablishment concerns maintain a central headquarters or administrative unit which directs and services all sub-units of the organization. ‘These central administrative units may be located entirely apart from all of the concern's operating establishments, or they may share the premises of one of the operating establishments. However, they usually are separately identified and maintain their own separate payroll. In such instances they con: stitute an establishment in themselves. There. fore, their injury experience should be re: corded separately and not combined with the experience of any other single establishment, nor should it be prorated among the various other establishments, The experience of the central administrative establishment, however, must be included in the computation of com: pany-wide injury rat. Some multiestablishment concerns are or- ganized into divisions. each of which is com: posed of several establishments, and maintain separate divisional headquarters or adminis- trative units for one or more of the divisions Such divisional administrative units shouldAPPENDIX be considered establishments in themselves and their injury experience recorded sepa rately. Their experience should be included, however, in the computation of division-wide injury rates. In assigning industry clas statistical summary purposes each operating establishment. should be classified separate on the basis of its principal product (in terms of dollar value), or its principal function when it does not produce a specific product. Central administrative units take the industry clas sification of the primary end product or func: tion of the group of establishments which they service. fications for Ad4.1 Disabling Injury Frequency Rate. The disabling injury frequency rate is based upon the total number of deaths, permanent total, permanent partial, and temporary total disa- bilities which occur during the period covered by the rate (see 4.6). The rate relates these injuries to the employee-hours worked during the period and expresses the number of such injuries in terms of a million-hour unit by use of the following formula. disabling injury frequency rate = number of disubling injuries X 1,000,000 employee hours of exposure EXAMPLE: In a month, which included 21 scheduled workdays of eight hours each, the injury records of Establishment A showed that one employee experienced a disabling work injury during the period ‘The payroll records for the period showed the following: (1) 182 employees worked full time every day and accumulated 21 X 8 hours or 168 hours apiece: the total exposure hours for these employees therefore, was 182. 168 (2) 7 employees worked 6 hours of overtime apiece; the total of overtime hours, therefore, was 7X 6 = (3) 1 employee resigned after work ing 12 days: his exposure hours, there fore, were 12 X 8 = (4) I new employee was hired and worked 6 days: his exposure hours therefore, were 6 X 8 = (5) L employee was off work for 5 days for personal reasons, but worked 30.576 96 48 24 z16.1 full time on 16 days; his exposure hours, therefore, were 16 X 8 (6) The injured employee was dis. abled for 6 calendar days, but two of these days were not scheduled work days; he was away from work, there: fore, on 4 scheduled work days and actually worked full time on 17 days. NOTE: In computing days lost or charged for the computation of the severity rate all 6 days of disability would be included, In the computation of exposure hours, however, con- sideration is given only to the actual time worked. 128 His exposure hours, therefore, were Xe (7) The total exposure hours for all employees in the month, therefore, were (8) Inserting these figures in the formula given above, the disabling injury frequency rate would be: 1 (no. disabling injuries) X 1.000.000 31,026 (employee hours of exposure) 136 31,026 Computation of disabling injury frequency rate: (1) 1 (disabling 1,000,000 (2) 1,000,000 (product of step 1) divided by 31,026 (total exposure hours} = or 32.23, NOTE: The disabling: injury frequency rate should not normally be computed to more than two places beyond the decimal point A4.2 Disabling Injury Severity Rate. The dis abling injury severity rate is based on the total of all scheduled charges for all deaths, permanent total, and permanent partial dis: abilities, plus the total days of disability for all temporary total injuries which occur dur- ing the period overed by the rate. The rate relates these days charged for death and permanent disability and those counted for temporary total disability to. the employee hours worked during the period and ex- presses the loss in terms of a million-hour unit, by use of the following formula x injury) X 1,000,000 disabling injury severity rate total days charged X 1,000,000 employee hours of exposure EXAMPLE; In the course of a year the em, ployees of a large establishment accumulated a total of 2.189.243 employee hours of exposurez16. (computed as illustrated in the Example shown in A4.1). During the year the employees experienced the following disabling work injuries: lays. (1) 1 death, for which the scheduled me charge i 6,000 (2) 1 complete loss of vision in one eye, for which the scheduled time charge is: 1,800 (3) 10 cases of temporary total dis: ability, for which the combined total of days of disability was. 2 (4) Total of scheduled days charged and of actual days of disability from temporary total disability, therefore, was: (5) Inserting these figures in the formula given above, the disabling injury severity rate would be 7,872 7,872 (total days charged) X 1,000,000 189,243 employee hours of exposure} Computation of disabling injury rate: (1) 7,872 (total days charged) X 1,000,000 = 7,872,000,000 (2) 7,872,000,000 (product of step 1) divided by 2,189,243 (total employee hours of exposure} 595.7, or 3596. NOTE: It is recommended that the disabling injury severity rate be rounded to the nearest whole number severity 4.4.1 Nonstandard Measures. See Appen- dix 44.1 fora discussion of the serious injury frequency rate and the disabling injury index. These nonstandard measures, if used, should be supplementary to and not replacements for the standard disabling injury frequency rate or the standard disabling injury severity rate as defined in 4.1 and 4.2. A4A.1(a} Serious Injury Frequency Rate. Some organizations, particularly those in which the number of disabling injuries is small during the usual reporting period, may wish to supplement the disabling injury frequency rate by maintaining an additional injury frequency measure of somewhat broader scope. For in- ternal purposes such a rate may measure safety program effectiveness more adequately than the disabling injury frequency rate. The serious injury frequency rate is sug- gested for such purpose with the understand- ing that it is not considered a “standard” rate APPENDIX and that it constitutes only a supplement to and not a replacement for the “standard” disabling injury frequency rate. When used, it should be clearly identified to distinguish it from the disabling injury frequency rate. For the purpose of uniformity it is recom: mended that the following definitions and pro- cedures be followed in computing the serious injury frequency rate: (1) Definition of Serious Injury. Serious in- juries include the following work injuries: {a) All disabling work injuries (as defined in 1.2.5), (b) Nondisabling injuries in the following categories: 1) eye injuries from work-produced ob: jects, corrosive materials, radiation, burns, etc., requiring treatment by a physician ) fractures 3) any work injury that requires hospi. talization for observation 4) loss of consciousness (work related) 5) any other work injury (such as abra- sion, physical or chemical bura, contusion, laceration, or puncture wound) which re: quires: aj treatment by a medical doctor, or b) restriction of work or motion, or signment to another regularly established job. (2) Computation of Serious Injury Fre. quency Rate. The serious injury frequency rate is based upon the total number of serious in- juries, as defined above which occur during the period covered by the rate. The rate relates these injuries to the employee-hours worked during the period and expresses the number of such injuries in terms of a million-hour unit by use of the following formula serious injury frequency rate = number of serious injuries X 1,000,000 employee hours of exposure NOTE: No severity measure can be computed for the serious injury classification A4.4.1(b) Disabling Injury Index. Numerous formulas have been used through the years by many companies to combine disabling injury frequency and severity rates into a single meas. ure. Other companies have expressed a desire for such a combined measure. The “Disabling Injury Index" described below is suggested for this purpose. This measure is not a part of the standard. It is included here only as an aid toAPPENDIX those companies which want a measure of their combined frequency and severity experience. The disabling injury index.is computed by multiplying the disabling injury frequency rate by the disabling injury severity rate and di- viding the product by 1,000 as in the following formula: disabling injury index = disabling injury frequency rate X disabling injury severity rate 000 —_ This measure reflects both frequency and severity, yielding a combined index of total disabling injury. It may be used primarily for ranking different establishments, organiza tions, or industries. In its raw form it can be correctly applied only for ranking total experience from “best” to “worst.” If the measure is to be used to deter: mine percentage of improvement or for com paring the degree of difference between two units, the square root of the index must be taken before such comparisons are made. A5.1 Inguinal Hernia, An inguinal hernia shall be considered a work injury only if it is precipitated by an impact, sudden effort, or severe strain, and meets all of the following conditions. (1) There is a clear record of an accident or an incident such as a slip, trip or fall, sudden effort, or overexertion. (2) There is actual pain in the hernial region at the time of the accident or incident. (3) The immediate pain was so severe that the injured employee was forced to stop work long enough to draw the attention of his fore man or fellow employee to his condition or the attention of a physician was secured within 12 hours, except as provided in 1.5.1.2 in respect to the unavailability of a physician. EXAMPLE 1: A plant operator, during stren- uous overexertion in turning a large valve which had been stuck, experienced sharp pain in his left groin. In rubbing the spot he felt a lump. He immediately reported to the plant physician who determined that a left indirect hernia was present. The physician was satis fied from the employee's medical history that the pain and lump in the left groin had not oc curred previous to the above incident. This, would be considered as arising out of and in the course of employment. 23 26.1 EXAMPLE 2: A receiving clerk was perform: ing his normal work of opening boxes of metal parts and placing the parts in storage racks. This work, which he had performed repeatedly without harm, involved lifting and moving the boxes, weighing about 50 to 75 pounds, position for opening. Near the end of his shift a box slipped out of his hands and in catching ithe felt a sharp pain in the hernial region. He immediately sat down and told his supervisor what had happened. By the end of the shift the pain had subsided and he did not see a physi cian. During the night the pain returned and persisted. He reported this by phone to his supervisor who told him to see a doctor. The doctor found a hernia. This would be consid- ered a work injury. EXAMPLE 3: A machinist, complaining of a lump in the left groin, was seen by the plant physician at 2:00 p.m. and was found to have a left indirect inguinal hernia. He stated “I was walking from one lathe to the next one thi morning when I felt pain in the left groin and a large lump appeared. I was busy and didn’t get to tell my foreman about it until some hours later. He told me to report to the medical of fice. I had not had pain or noticed a lump in this region before.” This would not be consid- ered a work injury since there is no record of an accident or a work incident associated with the occurrence of the pain. A5.3 Back Injury. A back injury shall be con: sidered a work injury if: (1) There is a clear record of an accident such as a slip, trip, fall, sudden effort, or blow on the back or (2) The employee was engaged in work activ- ity which, in the opinion of the physician au- thorized by the employer to treat the case, pro- duced a physical condition resulting from overexertion. EXAMPLE 1: A serviceman was installing a window air-conditioning unit on a customer's premises. As he was sliding it into place it tilted and started to fall. As he caught it and forced it into place he felt a sharp pain in hi back. This would be considered a work injury resulting from “sudden effort.” EXAMPLE 2: A woodsman’s foot slipped while he was swinging an axe and back pain developed immediately. This would be con: sidered a work injury since the onset of symp: toms was directly associated with an accident216.1 (slip) which occurred in the course of and arose out of employment. EXAMPLE 3: A computer-room employee lifted a tray of punch cards and turned to place the tray in a file. As he turned, the end of the tray struck the file cabinet and he felt a sharp pain in his back. This would be considered a work injury because of its direct association with a work accident of such nature as to im ose a strain upon his back. EXAMPLE 4: A clerical employee, at the re quest of a secretary, carried an electric type- writer from her desk to an adjacent table. As he set the typewriter down he experienced a severe back pain. The physician authorized by the employer to treat the case indicated that in his opinion moving the typewriter constituted overexertion for this individual and that the back strain resulted from this action. The in jury, therefore, would be considered a work injury. EXAMPLE 5: An employee stooped to pick up a small object from the floor and developed a “catch” in his back which resulted in disability. Since there was no “accident” and the physi cian authorized by the employer to treat th case did not consider an isolated stooping inci dent as constituting overexertion, this would not be considered a work injury EXAMPLE 6: An employee reported severe back pain which gradually developed toward the end of each work day, but could not attrib- ute the condition to any specific event or activ- ity. After reviewing the employee's work as signments the physician authorized by the em ployer to treat the case concluded that the con dition did not result from overexertion in the performance of his duties. The case, theref would not be considered a work injury EXAMPLE7: A warehouseman, while operat: ing a forklift, backed his machine into a stack of heavy cartons. This dislodged the top carton on the stack which fell, striking the forklift operator in his back. His back was perma nently injured by the blow. This would be con sidered a work injury covered by provision (1) of 5.3. No opinion of a doctor would be re quired to establish that the back injury arose out of and in the course of employment. A5.4 Aggravation of an Existing Physical De- ficiency. If aggravation of an existing physical deficiency arises out of and in the course of employment, any resulting disability shall be APPENDIX considered a work injury and classified accord- ing to the ultimate extent of the disability as provided in 1.2, EXAMPLE 1: An employee with a known chronic “trick knee” wrenched it climbing down a ladder when the bottom rung gave way. ‘This aggravation required surgery for correc. tion. The injury, therefore, would be consid- ered disabling. EXAMPLE 2: An employee with a nonwork- connected blister knocked the top off the blister in the course of his work activity, The broken blister became infected and resulted in lost time. This would be considered a disabling work injury. A5.5 Disability Arising Solely Out of Physical Deficiency. If an accident or an incitlent such as a slip, trip, or fall arises solely out of an existing physical deficiency, and if a worker without such physical deficiency would not have suffered such an accident or incident, any resulting injury shall not be considered a work injury. However, an injury which results from the work activity or the environment of the employment shall be considered a work injury even though the employee had an existing phys- ical deficiency. EXAMPLE I: A worker with arthritis fell in a clear open walkway and suffered a broken arm when his impairment caused him to lose his balance while walking. The accident arose solely out of his existing physical disability and the fracture would: not be considered a work injury, EXAMPLE 2: A worker with a “trick knee” suffered a recurrence of this condition while simply walking up steps. The incident arose solely out of his preexisting physical deficiency and the resulting knee disability would not be considered a work injury. EXAMPLE 3: The same physical deficiency exists as did in Example 2, but the condition recurred when the worker slipped on a spot of oil. The accident did not arise solely out of the preexisting physical deficiency and the dis- abling condition would be considered a work injury EXAMPLE 4: If an employee falls or has some other accident caused by an illness which is not associated with or aggravated by his work, or the work environment (fainting, epilepsy, etc.), any resulting injury would not be a work injuryAPPENDIX A5.6 Purposely Inflicted Injuries. An injury purposely inflicted by another person shall be considered a work injury if it arises out of and in the course of employment. EXAMPLE |: An employee who had lent money to a coworker lost his temper and as: saulted the borrower when he failed to repay the loan as promised. The resulting injury to the borrower would not be considered a work injury even though it occurred on company premises during working hours. EXAMPLE 2: A worker was called into his foreman’s office and was told he was dis. charged. He reacted by knocking the foreman out and then returned to his workplace where he attacked a coworker whom he accused of making unfavorable reports about him. Since both assaults were associated with the em: ployment the injuries to both the foreman and the coworker would be considered work in- juries. EXAMPLE 3: A newspaper photographer while trying to take pictures at the scene of a riot was assaulted by the rioters. His injuries would be considered work injuries. EXAMPLE 4: A delivery man, making a de- livery, was assaulted by a group of unidentified persons. His injuries would be considered work injuries, EXAMPLE 5: A night watchman was shot by a burglar attempting to enter the premises. The injury arose out of and in the course of employment and would be a work injury EXAMPLE 6: A bus driver was slugged and robbed by a passenger. The injury arose out of and in the course of employment and would be a work injury. EXAMPLE 7: An attendant in a mental hos. pital was assaulted by a patient. His injuries arose out of and in the course of employment and would be considered work injuries. EXAMPLE 8: An employee was seriously in- jured during a fight in a shop which arose from a dispute over an umpire's decision in a base. ball game broadcast the preceding evening. ‘This injury did not arise out of employment and would not be a work injury. A5.7 Horseplay. An injury inflicted by, or arising out of, horseplay during employment shall be considered a work injury. EXAMPLE: An employee was showing off by operating a forklift, which he was not familiar with nor authorized to use, in the loading dock 216.1 area. He lost control and the lift struck a pile of boxes, one of which fell on another employee, and then ran off the edge of the dock. Although the employee was engaged in a prohibited ac- tivity. his action was showing off or horseplay and his injury as well as that of his fellow em- ployee would be considered work injuries. A5.8 Animal and Insect Bites and Stings. Animal and insect bites and stings are work injuries if they arise out of and in the course of employment. EXAMPLE: A lineman was engaged in routine work on a pole when a wasp stung him on the neck and on the thumb. Investigation revealed ‘no wasp nest in the vicinity and none could be found on the pole or any of its attachments. However, the injury qualifies as a work injury since it arose out of and in the course of em ployment. Insects are part of the outdoor environment in which his cmployment required him to work. (See also 1.1 and LLL.) A5.9 Skin Irritation and Infections. Skin ir: ritations and infections such as dermatitis and poison ivy are work injuries if they arise out of and in the course of employment. EXAMPLE I: A member of a land survey party, while cutting a path through under- brush, developed a dermatitis from contact with poison ivy. Poison ivy is a part of the en- vironment in which he was required to work and his contact with the plant arose out of and in the course of employment. The dermatitis, therefore, would be considered a work injury. (See also 1.1 and 1.1.1.) EXAMPLE 2: An employee in a citrus fruit processing plant developed a severe rash on her hands. The physician authorized by the employer to treat the case diagnosed it as a dermatitis resulting from contact with the fruit juices. This would be considered a work injury. EXAMPLE 3: An employee, whose work in- volved handling an epoxy resin, developed a severe rash on his hands. ‘The physician au- thorised'by the employer to treat the case diag: nosed it as a dermatitis resulting from contact, with a chemical. This would be considered a work injury 5.10 Muscular and Skeletal Disabilities. Muscular disability, bursitis, tenosynovitis, ete., are work injuries if they arise out of and in the course of employment.zie EXAMPLE 1: A female employee was as signed to a job which required her to use a hammer continuously to knock carton blanks from perforated cardboard sheets. After sev eral days, wrist motion and hand grasp be came so impaired she could no longer swing the hammer. The medical diagnosis was teno- synovitis at wrist. This would be considered a work injury EXAMPLE 2: An employee reported to the medical department because of pain in his posterior chest wall every time he performed his task of picking up a case of produets. There were no objective findings. but patient gave a history of a recent sore throat. Diagnosis was fibrositis of the chest wall unrelated to his work. This would not be considered a work injury even though the symptoms first became apparent in the course of employment. A5.13 External Events. An injury which re sults directly from an external event of cat- astrophic proportions such as tornadoes, twisters, hurricanes, earthquakes, flood, con- flagration, or explosion originating outside of employment, or from an immediate secondary event, such as a fire, boiler explosion, falling electric wire, shall be classified as a work in jury only if the victim was a policeman, fire. ‘man, member of a disaster or emergency squad, utility workman, or other employee who is engaged in duties in connection with such events. EXAMPLE 1; A truck carrying a heavy load of explosive material on a public highway ex- perienced an accident as it was passing a fac- tory and its load exploded. The driver and helper on the truck were killed and several workers in the factory were injured by flying glass and other debris thrown by the explosion Later an employee of the factory who was as. signed to help clean up the debris in the plant was seriously cut while attempting to remove a broken piece of glass from a window frame, (1) The deaths of the truck driver and his helper would be considered as work injuries since the event originated from a hazard within their employment. (2) The injuries to the factory workers, in flicted by the blast or by debris thrown by the explosion, would not be considered work in. juries since the explosion originated entirely outside of their employment. APPENDIX (3) The injury to the plant employee while cleaning up after the explosion would be con: sidered a work injury since the hazard he en. countered was a part of the environment in which he was assigned to work. EXAMPLE 2: An independent construction contractor was erecting a new building on the premises of a manufacturing company. His men were overcome by toxic gas when a high: pressure line of the plant on whose premises they were working ruptured. These would be considered work injuries since they arose out of the environment in which the construction men were assigned to work. EXAMPLE 3: Company A occupied one floor of a multiple-oceupaney building. A fire, which quickly became out of control and ultimately consumed the entire building, started in the area occupied by Company B on another floor. Several employees of Company A were injured in their attempt to escape from the fire, These injuries would be considered work injuries even though the fire started outside Company A\’s particular area for the following reasons: (1) A fire confined to one building would not qualify as an event of catastrophic propor: tions in the sense intended by 5.13 of the stan: dard. (2) Even though Company A’s occupancy of the building was limited to one floor the possi bility of a fire originating in any part of the building was an inherent hazard of that occu pancy. Such a fire, therefore, was not entirely an external event originating outside the em ployment, but rather was an event arising out of the environment of employment. A5.L4 Hospitalization for Observation. If after observation in a hospital for a period not to exceed 48 hours from the time of an injury or suspected injury known to have a delayed ef- fect, i., from accidents such as a blow on the head, a blow to the abdomen, or the inhalation of harmful gases, the physician authorized by the employer to treat the case determines that the injury was in reality slight and that the injured person could have returned to work without any permanent impairment or tempo- rary total disability, the injury shall be classi- fied as a medical treatment case. In cases of exposure to ionizing radiation the period of ob- servation may be extended to 10 days. How- ever, if any treatment or medication at all isAPPENDIX given for the confining injury or the suspected injury after the first 24 hours of observation, the injury shall be classified as disabling. EXAMPLE I: A worker received a blow on the head when an electric drill stuck, causing the handle of the drill to swing around and hit him. The accident was seen by another worker and he mentioned it to his foreman, but he did not seck medical attention until two days later when he experienced a headache. He was hos pitalized by the doctor for the following 36 hours to determine if there might be some after effect from the mild head injury. Nothing de- veloped and he returned to work without fur. ther difficulty. This injury would be classified as a temporary total disability since the al lowed 48 hours of observation is limited to a period starting with the time of the injury EXAMPLE 2: A worker experienced an in: jury similar to that described in Example 1, but reported to the doctor at once. The doctor gave him no treatment, but ordered him to go home and stay quiet for two days with instruc tions to contact the medical oftice immediately if he experienced headaches or other discom- fort. Nothing developed and. after examination at the end of the 48 hours. the doctor reported that there had been no disability and that he could have continued working. For record pur. pose, however, this injury would be classified as a temporary total disability since the ex empted period for observation must be spent in a hospital where the patient is under constant professional observation and facilities ay available for immediate treatment if unfavor. able symptoms oceur. EXAMPLE 3: Four employees were exposed to radiation as a result of a nuclear excursion fission) in a chemical process and were hos- pitalized for observation and medical research No medication was given after the first 24 hours and it was ascertained within 48 hours by the physician authorized by the employer to treat the cases that the employees were neither physically injured nor in need of any treatment pertaining to radiation injury. However angements were made to have the men avail: able for medical research tests which were deemed essential to further medical science in this aspect. All cmployces were released from the hospital on or before the L0th day after the accident. These injuries would be classified as medical treatment eases. Z16.1 A5.15 Reaction to Medication. Illness result: ing solely from reaction to medication such as antitoxin, vaccines, or drugs used in the treat- ment of a nondisabling injury shall not cause the injury to be classified as disabling. EXAMPLE |: An employee reported to the medical department with an abrasion of the elbow 48 hours after injury. Because the area was inflamed, an antibiotic was given as in- surance against infection. The patient devel- oped a severe reaction to the medication with vomiting, diarrhea. weakness. and skin rash and was unable to work for 3 days. The elbow wound healed without causing any disability The injury would not be considered as dis. abling since the disability resulted solely from the drug used in treating the minor injury EXAMPLE 2: An employee experienced a minor cut which was treated in the medical office and covered with a dressing held in place with adhesive tape. The next day the employee developed a dermatitis which prevented his working for several days although the cut healed promptly. ‘Tests indicated that the dermatitis was an allergic reaction to the ad. hesive on the tape used to hold the bandage. This injury would not be considered disabling, A5.16 Aggravation of Minor Injury. If a minor work injury is aggravated because of improper diagnosis or improper treatment, either pro- fessional or nonprofessional, or if infection develops later. either on the job or off the job, the injury shall be classified according to the ultimate extent of the disability EXAMPLE 1: An employee, pulling on a pipe wrench, slipped and fell to the floor on his wrist. The company doctor said the injury was a minor sprain and the man continued to do his, regular work, During the next several weeks a knot appeared on his wrist and, on the basis of a specialist's diagnosis of the knot as a ganglion cyst unrelated to the fall, an operation was performed. The operation established the trouble as contusions and lacerations to the fibrous tissues. The surgeon reported that if the injury had been properly diagnosed, sur- gery would not have been necessary nor would the employee have lost time from work. Here the minor injury was aggravated by the operation resulting from improper diag- nosis and the injury would be considered dis- ablingZ16.1 EXAMPLE 2: An employee reported to his foreman that a sharp tool glanced off and struck his foot, but that the injury was too minor to warrant a trip to the doctor. Despite urging then and on several occasions by his foreman and fellow employces he did not see a Bhemearmans ALA ANSO1/0107 BIBLIOTECA CENTRAL 28 APPENDIX doctor until over a week later when his foot became very sore and he developed a backache. He died of tetanus in the hospital. This injury was aggravated by infection and should be classified according to the ultimate extent of disability—a fatality.