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Thousands of workers are injured on the job every year.  That is why there are places such as Minnesota Occupational Health. They can provide many services that will help get employees back to work safely, while working with employers. We pride ourselves on providing the best in customer service, communication, and also clinical expertise.

There is no end to the type of injuries that our services providers treat on a regular basis. These can include strains and sprains, dislocations, bone fractures, chemical exposure, burns, and much more.

We believe in providing injury care to workers in the same way we would to professional athletes. Just like the goal is to get them back on the field, the goal for our injured employee clients is to get them back to work safely, or to help keep them mobile so they can continue working safely. If you are injured, visit one of our walk-in clinics for help.

We believe that injury recovery and returning to work should be done in collaboration between healthcare provider, employer, and employee. We will communicate with all parties involved so that everyone understands the situation and what is appropriate for the worker. This means consulting on return-to-work plans, such as light duty accommodations. We have therapists and specialists who will know what the employer is able to do, and what they should avoid to protect their health.

Our service providers have a wealth of knowledge and experience in treating work-related injuries and the recovery it takes to return to work. Every facility provides X-ray services, and we can provide referrals for MRI and other tests.

Whether you are an employer or an employee, working with Minnesota Occupational Health means you will be provided with complete information every step of the way. We will work with everyone involved so that an injured worker can return to work safely and productively.

The winter is the perfect time to consider the dangerous effects of radon. Radon accumulates naturally and it can be dangerous to humans. When we’re outside more often in the summer months, it does not pose as big of a threat. However, if it accumulates inside of a building it is extremely harmful to human health. Here are some things to know about radon.

What Is Radon And Why Is It Dangerous?

Radon is a gas that occurs naturally from the deterioration of uranium in soil, water, and rock. It is radioactive, which means it is dangerous in large enough doses. It is invisible, scentless, and tasteless, so you will not even know you are inhaling it. Often, a home will get inundated with uranium from the soil under the basement. Other than cigarettes, there is nothing that causes more lung cancer, and kills 20,000 people every year.

The EPA says that any exposure carries with it the risk of lung cancer, so it’s vital to keep the radon level in your home as low as possible. A person will get more radiation from radon than from any other source, assuming they do not work with radioactive materials on a regular basis.

What To Do?

Since radon is most certainly a major health risk, it is a good idea to purchase a kit at your local hardware store to test the levels in your home. Place the tester on the lowest floor of your home to get the best readings. You can also hire a professional to check your levels. If your level is higher than 4 pCi/l, then it is elevated.

If you have high levels of radon, then you should call a professional immediately to deal with the problem. They will use a process called Active Soil Depressurization (ASD). This process will remove the radon from your home and prevent it from recurring. It involves using a pipe that runs through the floor of the basement and up through the roof. Strategically placed fans will push the radon out into the atmosphere where it will not cause any harm.

Radon is not something to be taken lightly, as it can kill you or your family. Make sure to have your home tested and if necessary, treated, to keep your family safe.

If you are a Minnesota worker who has been injured on the job, do not hesitate to contact Minnesota Occupational Health online, by phone or by visiting one of our Twin Cities locations. Our staff of physicians, many of whom are board certified in occupational medicine, offer years of experience and understanding in addressing work injuries.

A spirometry test is a lung function or Pulmonary Function Test (PFT) that may be ordered when clearing an individual to wear a respirator for work.

The Importance of Respirators

Several industries mandate that workers wear a respirator while other employers make respirators available in certain circumstances, even if not required. Respirators can range from a standard dust mask, half or full-face filter mask all the way to an entirely enclosed Self Contained Breathing Apparatus (SCBA), such as those worn by firefighters and people who work in confined spaces. Medical requirements to meet OSHA standards are determined by the reason for respirator use, the type of respirator, the duration and frequency that a respirator is worn and the age and respiratory health of a worker.

Whether your respirator protection program is an OSHA requirement or a voluntary offering, forming an effective respiratory surveillance program helps to keep your employees protected, reducing potential medical expenses and lost time.

The Spirometry Test

During a test, the patient is asked to take a deep breath and then secure his or her lips around the spirometer. Once the spirometer is in place, the patient breathes out as quickly and with as much force as possible, maintaining the exhale as long as possible. The device determines if the test is valid. Three valid tests are captured and compared. Measurements on the spirometer are read by a medical provider who determines if a worker can wear a respirator on anywhere from a daily to emergency-only basis. The frequency of retesting is determined by the medical provider based upon respirator types, how often and for how long respirators are worn, and the respiratory health of a worker.

MN Occupational Health performs spirometry tests – or pulmonary function tests – on behalf of employers in the Twin Cities. Contact us online or by calling 651-968-5740 to learn more.

Employers with positions that require specific physical abilities will often create a functional job description in addition to required duties, responsibilities, and the education, skill level, and experience that would enable a person to perform the job successfully. A person offered a job contingent upon things like passing a drug test or a physical exam may also be required to demonstrate an ability to execute the essential physical demands of the position. Pre-hire HPE’s/POET’s/Work Simulations can help identify pre-existing conditions that would prevent a candidate from performing the job without accommodation.

How Does a HPE/POET/Work Simulation Work?

Job Task Analysis

In order to accurately assess the essential functional demands required of a job, an employer along with MOH will observe, measure and document the required tasks, equipment and environment the worker functions within. In determining the physical requirements for the job, detailed weights, distances, static postures and awkward positions, tools, etc., will be assessed and later incorporated into the Job Task Analysis and the HPE/POET/Work Sim.

Determining the Exact Requirements

If the job requires lifting material in a warehouse, it is important to find out exactly how much weight one would be expected to move and both the starting and ending heights and distances. This can be done with scales or other measuring devices. Understanding a suitable weight limit will ensure you do not exclude any qualified applicants. By setting an arbitrary weight limit that is much higher than generally required, you may lose potential workers who are perfectly capable of performing the job. Try to estimate the amount of time an employee will be performing physical activities like bending, standing, sitting, and lifting; and whether they will need stamina and balance for tasks like climbing ladders, working in a confined space, or being exposed to extreme weather.

Avoid Discrimination

Employers have a right but not a requirement to accommodate a candidate who has some limitations.  For example, to find an experienced construction worker who does not have certain limitations can be difficult in certain specialties, but if a candidate’s skill-sets offset their ability to lift x pounds to shoulder level, the employer can still choose to hire the individual.

Before conducting a HPE/POET/Work Simulation, make sure the potential employee has been offered the job contingent upon medical evaluation, drug testing, etc. Administering a human performance evaluation prior to offering employment or only to some people applying for the same job will likely be seen as discriminatory.

Related Information:

• Learn about our pre-placement exam services.
• Learn about our work performance center.

Background and Health Impacts

What is crystalline silica?

Crystalline silica is a mineral used for many industrial applications and products. It is widely used at construction sites. It is used to make materials such as sand, stone, concrete and mortar, which in turn are used to produce products like glass and ceramic. Silica exposure occurs from industrial operations like foundry work or fracking.

How can exposure impact your workers’ health?

Crystalline silica is linked to several diseases. These include silicosis (an incurable lung disease), kidney disease, chronic obstructive pulmonary disorder (COPD) and lung cancer. Inhaling even a small amount of crystalline silica particles drastically increases the risk of developing serious health issues.

Who is at risk from exposure?

About 2.3 million workers are exposed to crystalline silica while on the job. Just being around sand, or other silica-laced materials however, is not dangerous. Inhalation occurs with specific job applications that release breathable dust into the air. These “respirable” crystalline silica particles are 100x smaller than than ordinary grains of sand found on playgrounds or beaches and are made from high-energy applications like sawing, cutting, grinding, crushing, or drilling on substrates like stone, concrete, mortar, or brick.

What is the connection between crystalline silica and lung cancer?

Scientific data has linked crystalline silica and lung cancer. Both the World Health Organization (WHO) and the National Institute of Health’s (NIH) Toxicology Program have classified crystalline silica as a ‘known human carcinogen’. OSHA has reviewed more than 50 studies providing evidence of this link. It has found evidence between the two in at least ten different industries, prompting the American Cancer Society (ACS) to use the same classification as WHO and NIH.

How will the new rule protect workers’ health?

Employers are now required to utilize engineering controls like ventilation and wet methods for sawing and/or cutting crystalline silica-containing materials. OSHA expects these measures to prevent up to 600 deaths per year from silica-related diseases like lung cancer, silicosis and kidney disease. The measures are meant to prevent more than 900 new cases of silicosis every year.

Why is a new crystalline silica rule being issued?

The current permissible exposure limit (PELs) for crystalline silica was established 45 years ago and has not been updated to reflect recent scientific research regarding exposure to crystalline silica and diseases like lung cancer and silicosis. Crystalline silica is classified as a ‘human carcinogen’ by groups like the National Institute for Occupational Safety and Health (NIOSH), the U.S. National Toxicology Program and the International Agency for Research on Cancer. Previous PELs were measured with methods that are no longer in use and that failed to measure the true impact of crystalline silica on workers’ health.

With evidence of a decline in silicosis cases in the United States, is this new rule necessary for preventing industrial exposure to crystalline silica?

More workers in 2014 died from silicosis than from fires or industrial accidents like structural or trench collapses. Most deaths from silicosis are never diagnosed or even reported and those numbers reported between 2005 and 2014 do not include deaths from silica-related ailments like lung disease, kidney disease or COPD. This has prompted lawmakers to take action by implementing this new rule across industries, including newer industries like hydraulic fracking.

What is the new permissible exposure limit (PEL)?

The new PEL limits worker exposure to breathable crystalline silica to 50micrograms/cubic meter of air (μg/m3) over a span of eight hours. OSHA determined the new PEL of 50 μg/m3 was enough to significantly reduce the risk of developing crystalline silica-related diseases in workplace environments, although the American Conference of Governmental Industrial Hygienists recommends a lower exposure limit of 25 μg/m3 over an eight-hour day.

Impact on Industry

A number of major industries will be affected by this new change. These include, but are not limited to:

• Construction
• Ready-Mix Concrete
• Glass Manufacturing
• Concrete products
• Stone products
• Pottery products
• Abrasive blasting for general industry, construction and maritime work
• Structural clay products
• Foundries
• Dental laboratories
• Refractory furnace installation/repair
• Paintings/coatings
• Jewelry production
• Railroads
• Hydraulic fracturing for gas/oil
• Landscaping
• Asphalt products manufacturing

How many workplaces will be affected?

There are approximately 676,000 workplaces in general industry, construction and maritime applications that will be affected by the new rule.

How many workers will be impacted?

An estimated 2.3 million workers are exposed to breathable crystalline silica every year. About 2 million of those cases are within the construction industry. At least a million of these exposure cases are expected to be resolved with the new mandates.

What will be the economic impact?

The total annual cost of implementing the new rule is $1 billion. The rule is expected to provide an average annual net benefit of $3.8 million over the next 60 years. This should result in annual costs of roughly $1,524 for the average workplace. However, OSHA’s research indicates that the economic impact on small businesses will be minor, with only a $560 average for businesses with less than 20 employees.

Why does the total compliance cost appear to be so high?

OSHA’s standards for general industry and construction are extremely broad. As many as 2.3 million workers and 676,000 establishments maybe affected. According to a recent economic analysis conducted by OSHA, the new rule will not have a substantial economic impact on large firms. Instead, the aggregate costs will be sufficiently offset by benefits like reduced costs associated with treating and preventing silica-related deaths or illnesses.

How will jobs be impacted?

Inforum, a renowned macroeconomics modeling firm based at the University of Maryland, recently conducted a study that showed the new rule will have a negligible, yet positive net effect on the overall employment rate in the United States.

How have small businesses been included in the new rule?

A Small Business Advocacy Review Panel was convened before the silica rule was proposed. Following the proposal, small business owners and members of the general public were given the chance to voice concerns about writing the new rule. Suggestions were submitted by testimony at a public hearing, written comments and submission of data and briefs following the hearing. OSHA then utilized all of the information to decide upon the final rule and began evaluating its impact on small businesses.

Rule Requirements

How can silica exposure be controlled in order to abide by the PEL?

Engineering controls such as ventilation must be used by employers to keep exposure to breathable crystalline silica at, or below the PEL. Wetting down surface dust before sweeping, or using the water flow rate the manufacturer recommends for a tool with water control features are other effective ways to minimize the risk of exposure to crystalline silica. Process isolation has been known to work well. Respirators are effective but they are only allowed when workplace and engineering practice controls cannot keep exposure levels at or below the PEL.

Why can’t workers just wear respirators at all times?

Respirators are neither practical or effective in providing enough protection against breathable crystalline silica. Unless they are individually fitted and regularly maintained for each worker, there will still be a much higher risk of exposure compared with facilities utilizing vents or other control methods. Respirators are less reliable simply because it is up to the individual workers to ensure their devices are being properly fitted and maintained and are worn consistently and correctly, despite the potential for discomfort, particularly in hot weather.

Are air sampling methods used to detect and measure silica reliable?

Yes and to improve on the reliability of these measurements, employers must have their silica samples analyzed by qualified laboratories that utilize methods specified in Appendix A of the standard. These methods that have been published by OSHA, NIOSH and MSHA are incredibly precise.

Why must construction employers implement engineering and work practice controls a year before laboratories are required to meet specifications for air sample analysis?

Construction companies will not be required to conduct regular assessments for exposure. Those that do not use specific guidelines will, however, have sufficient measurements available from the one of the 40 laboratories in the United States.

What is the purpose of medical surveillance?

Identify negative health effects that are linked with crystalline silica exposure.
Determine if any employees are suffering from conditions including lung disease that may make them more sensitive to breathable crystalline silica exposure.
Determine the employee’s unique fit for a respirator.

Why are medical surveillance results given only to the workers and not their employers?

Employers are not provided with such information, a) because of patient confidentiality and b) because they are supposed to provide protection for employees based on silica exposure levels and how well the current controls are working. Employee physicians or licensed health care professionals instead provide recommendations to the employer based on the health of the patient(s).

Compliance Dates

When must employers comply with the standard for general industry and
maritime?

Aside from hydraulic fracturing operations in the gas and oil industry, employers must:

• Comply with all obligations of the standard (excluding the action level trigger for medical surveillance) by June 23, 2018.
• Offer medical exams for employees exposed at or above PEL for 30 days or more a year by June 23, 2018.
• Offer medical exams to employees exposed at or above the action level for 30 days or more a year beginning on June 23, 2018.

For hydraulic fracturing operations in oil and gas, employers must:

• Comply with all obligations of the standard, except for engineering controls and the action level trigger for medical surveillance, by June 23, 2018.
• Comply with requirements for engineering controls to limit exposures to the new PEL by June 23, 2021; employers can continue to have employees wear respirators if their exposures exceed the PEL between June 23, 2018 through June 23, 2021.
• Offer medical examinations to employees exposed above the PEL for 30 or more days beginning on June 23, 2018.
• Offer medical examinations to employees exposed at or above the action level for 30 or more days a year beginning on June 23, 2020.

Why is there a difference in these compliance dates?

The new rule allows hydraulic fracturing employers additional time to have these changes implemented and to take advantage of emerging technologies because the controls for breathable crystalline silica in this industry are still in development. These employers do not have to implement engineering controls until June 2021. Hydraulic fracturing employers may continue to provide individual respirators for their employees between June 2018 and June 2021 when exposures exceed the PEL.

When must employers comply with the construction standard?

Employers must comply with all of the obligations of the standard by June 23, 2017, with the exception of methods of sample analysis, which must be in compliance by June 23, 2018.

State Plans and Compliance Assistance

Will states with OSHA-approved programs adopt the standard?

States with OSHA-approved state plans will have six months to adopt and comply with the standards that are as effective as Federal OSHA standards. Some state plans may have more stringent requirements.

What resources are available for small businesses and other employers to help them comply with the standards?

OSHA offers extensive compliance assistance with Compliance Assistance Specialists, as well as on its website, in publications, webinars and through training programs. Many of these are designed to help small- to mid-sized employers. OSHA will develop a Small Entity Compliance Guide for crystalline silica to provide more information and assistance with the process.

Minnesota’s summer brings with it a myriad of work-related health risks including sun exposer, heat, and even Lyme disease. As an employer, you should be made aware of the potential dangers that this season presents to your employees. Measures should be put in place to protect both you and the people who occupy your workplace.

How to cope with ultraviolet (UV) radiation

Overexposure to the sun has been linked to premature aging of the skin, cataracts, and skin cancer. Workers who spend hours outside exposed to the sun may develop skin irritation or worse. To cope with this, it is recommended that your workers take the following preventative measures:

• Wear clothes that cover most of the body to minimize the amount of harmful rays penetrating the skin.
• Wear a brim hat to cover the face and neck.
• If possible, wear UV-absorbent sunglasses. 
• Apply sunscreen to areas of skin that experienced sun exposure.
• Minimize sun exposure to only a few hours. Bear in mind the most harmful rays appear between 10am and 4pm.

How to cope with excess heat

Individuals who work in a kitchen or outdoors may have a difficult time adjusting to the heat. Following these tips will help your employees feel more comfortable:

• Stay hydrated. Drink plenty of fluids.
• When it gets too hot, take a break in a cool shade.
• Wear light, loose fitting clothes to allow the body to cool.
• Avoid alcohol, caffeine, and minimize sugar intake.
• Eat smaller meal portions, especially before grueling labor.
• When wearing work suits or respirators, avoid working directly under the sun if possible.

How to cope with ticks

Staff working outdoors risk receiving tick bites and catching Lyme disease. If you work outdoors (especially near wildlife), how can you avoid tick bites?

• Use a strong repellent on clothing and wear long pants, long sleeves and socks.
• When working outdoors, avoid bushy areas or moist and humid environments.
• Perform a physical check after spending time in a tick-infested environment.
• Shower immediately when you get to the house. Take precautions to ensure you do not take any ticks into your home.

A fitness-for-duty exam is designed to assess an individual’s capacity to return to work, normally following an absence. The absence may be the result of surgery or other medical or psychological conditions. Because these workers have likely been under the care of one or more general or specialty medical providers, Minnesota Occupational Health normally requires the worker to release their relevant medical files to our physicians so they can be reviewed in the context of determining fitness for duty.

Following a thorough review of the treating provider’s records, a targeted examination seeks to answer the question, “Is this person fit for duty?” and / or “Would accommodations by the employer likely be necessary?”

Minnesota Occupational Health offers a detailed, considerate fitness-for-duty examination process that abides by stipulated regulations such as the Family Medical Leave Act (FMLA), the Americans with Disabilities Act (ADA) and the Equal Employment Opportunity Commission (EEOC).

Many employers have adopted policies and implemented programs for drug and alcohol testing after an employee is involved in a workplace accident. This testing is referred to as “post-accident” or “post-incident” drug testing. The result of the test will be used to determine if drug use was a contributing factor to the accident. When an employer opts to use post-accident drug testing, certain criteria must be established to maintain objectivity and determine what circumstances warrant a drug test.

Many employers require a drug test to be performed if their employee’s action resulted in property damage, a citation from the police, a fatality, or a serious injury. Post-accident drug tests can determine whether the person involved used drugs and is also important in establishing that drugs or alcohol were not involved.

Positivity Rates

Data compiled from the Quest Diagnostics Drug Testing Index (DTI) – based on the results of drug tests administered under the circumstances mentioned above – reveal that positive results occurred in 6.5 percent of post-accident urine drug tests administered to the general workforce.

Specimen Types

Urine-based drug testing is the best method suited for post-accident drug testing and can include the following categories of drugs:

Typical 10-panel Non-Federal urine drug test **** Federal 5-panel Drug Test

• Amphetamines	• Barbiturates	• Benzodiazepines
• Cocaine	• Creatinine	• Marijuana
• Methadone	• Methaqualone	• Opiates
• PCP	• Propoxyphene

Breath Alcohol tests are performed for all Federal (DOT, FAA, Pipeline, Coast Guard, FTA, etc.) testing. Non-Federal alcohol testing within Minnesota, because of case law is normally initiated using Breath Alcohol as a screen or indicator. The level at which alcohol is considered positive must be defined in a drug and alcohol policy, may be as low as 0.04 or even 0.02. If that level is reached, a Blood Alcohol test is normally performed. Minnesota case law allows a worker who tests positive to a drug or alcohol test to pay for a retest of the same specimen. Since non-Federal breath tests do not result in a physical, retestable specimen, blood is collected and sent to a lab, much like urine drug screens.

Conclusion

Drug tests can have many different purposes for an employer. Pre-screening applicants with a drug test can reduce the chance that your organization hires an active drug user. Random screening during employment can discourage current employees from using drugs. Post-accident drug testing is different. Its purpose is to determine whether drug and/or alcohol use played a role in a workplace accident. Post-accident drug and alcohol testing is a useful policy that can lead to improvement in safety practices and a reduction in risk and costs for the employer.

A functional capacity evaluation (FCE) is designed to document both the medical and functional ability of a worker to perform occupational tasks following an injury in order to determine return-to-work readiness and the need for more permanent employer accommodations. FCE’s are typically ordered by an insurer or Qualified Rehabilitation Consultant (QRC).

How does a functional capacity evaluation work?

When MOH Occupational Therapists under the direction of MOH physicians perform an FCE we will typically conduct the assessments:

• Intake review. We will acquire information related to your medical history, general health, job description, the state / condition of your injury and your work-related goals. We will also examine your perception of pain, its impact on your day-to-day activities and the psychological impact it has had on you.
• Musculoskeletal evaluation. We will evaluate your strength, range of motion, sensation and volumetric measurements.
• Physical demand testing. We use standardized and non-standardized tests to observe you using both specific parts and your whole body in work-related tasks.
• Material testing is used to determine your ability to exert force for the purpose of moving items. This test includes lifting, carrying, pulling and pushing. EPIC lift stations are generally used to test lifting capabilities at various heights, while pushing and pulling tests are conducted with a sled.
• Non-material handling evaluates tasks involving bending, kneeling, squatting, crawling and climbing ladders; no significant amount of weight or force is involved.
• General conditioning. This step measures your overall aerobic capacity. The test may involve stair climbing and walking.
• Specific job simulation. Various evaluations may be performed. Simulations include clerical, patient care, law enforcement and housekeeping.
• Psychological factors. Several tests may be conducted to measure behavior. The Spinal Functional Sort test is used to compare your perceived level of capability with your actual level of capability.

The FCE includes a summary of your strengths and limitations regarding work-related tasks. It will contain recommendations for safety, rehabilitation and case resolution. A physical capacities form may also accompany the finished report with information on your general material- and non-material handling abilities.