The construction industry forms 5 to 15% of the national economy of most countries and is usually one of the three industries having the highest rate of work-related injury risks. The following chronic occupational health risks are pervasive (Commission of the European Communities 1993):

• Musculoskeletal disorders, occupational hearing loss, dermatitis and lung disorders are the most common occupational diseases.
• An increased risk of respiratory tract carcinomas and mesothelioma caused by asbestos exposure has been observed in all countries where occupational mortality and morbidity statistics are available.
• Disorders resulting from improper nutrition, smoking or use of alcohol and drugs are associated especially with migrant workers, a substantial portion of construction employment in many countries.

Preventive health services for construction workers should be planned with these risks as priorities.

Types of Occupational Health Services

Occupational health services for construction workers consist of three main models:

1. specialized services for construction workers
2. occupational health care for construction workers rendered by providers of broad-based occupational health services
3. health services provided voluntarily by the employer.

Specialized services are the most effective but also the most expensive in terms of direct costs. Experiences from Sweden indicate that the lowest injury rates on construction sites worldwide and a very low risk for occupational diseases among construction workers are associated with extensive preventive work through specialized service systems. In the Swedish model, called Bygghälsan, technical and medical prevention have been combined. Bygghälsan operates through regional centres and mobile units. During the severe economic recession of the late 1980s, however, Bygghälsan severely cut back its health service activities.

In countries that have occupational health legislation, construction companies usually buy the needed health services from companies serving general industries. In such cases, the training of occupational health personnel is important. Without special knowledge of the circumstances surrounding construction, medical personnel cannot provide effective preventive occupational health programmes for construction companies.

Some large multinational companies have well-developed occupational safety and health programmes that are part of the culture of the enterprise. The cost-benefit calculations have proved these activities economically profitable. Nowadays, occupational safety programmes are included in quality management of most international companies.

Mobile health clinics

Because construction sites are often situated far from any established providers of health services, mobile health service units may be necessary. Practically all countries that have specialized occupational health services for construction workers use mobile units for delivering the services. The mobile unit’s advantage is the saving of work time by bringing the services to worksites. Mobile health centres are contained in a specially equipped bus or trailer and are especially suitable for all types of screening procedures, such as periodic health examinations. Mobile services should be careful to arrange in advance for collaboration with local providers of health services in order to secure follow-up evaluation and treatment for workers whose test results suggest a health problem.

Standard equipment for a mobile unit includes a basic laboratory with a spirometer and an audiometer, an interview room and x-ray equipment, when needed. It is best to design module units as multipurpose spaces so they can be used for different types of projects. The Finnish experience indicates that mobile units are also suitable for epidemiological studies, which can be incorporated into occupational health programmes, if properly planned in advance.

Contents of preventive occupational health services

Identification of risk at construction sites should guide medical activity, although this is secondary to prevention through proper design, engineering and work organization. Risk identification requires a multidisciplinary approach; this requires close collaboration between the occupational health personnel and the enterprise. A systematic workplace survey of risks using standardized checklists is one option.

Preplacement and periodic health examinations are usually conducted according to requirements set by legislation or guidance provided by authorities. The examination’s content depends on the exposure history of each worker. Short work contracts and frequent turnover of the construction workforce can result in “missed” or “inappropriate” health examinations, a failure to follow up on findings or unwarranted duplication of health examinations. Therefore, regular standard periodic examinations are recommended for all workers. A standard health examination should contain: an exposure history; symptom and illness histories with special emphasis on musculoskeletal and allergic diseases; a basic physical examination; and audiometry, vision, spirometry and blood pressure tests. The examinations should also provide health education and information on how to avoid occupational risks known to be common.

Surveillance and Prevention of Key Construction-related Problems

Musculoskeletal disorders and their prevention

Musculoskeletal disorders have multiple origins. Lifestyle, hereditary susceptibility and ageing, combined with improper physical strain and minor injuries, are commonly accepted risk factors for musculoskeletal disorders. The types of musculoskeletal problems have different exposure patterns in different construction professions.

There is no reliable test to predict an individual’s risk for acquiring a musculoskeletal disorder. Medical prevention of musculoskeletal disorders is based on guidance in ergonomic matters and lifestyles. Preplacement and periodic examinations can be used for this purpose. Non-specific strength testing and routine x rays of the skeletal system have no specific value for prevention. Instead, early detection of symptoms and a detailed work history of musculoskeletal symptoms can be used as a basis for medical counselling. A programme that performs periodic symptom surveys to identify work factors that can be changed has been shown to be effective.

Often, workers who have been exposed to heavy physical loads or strain think the work keeps them fit. Several studies have proved that this is not the case. Therefore, it is important that, in the context of health examinations, the examinees be informed about proper ways to maintain their physical fitness. Smoking has also been associated with lumbar disk degeneration and low-back pain. Therefore, anti-smoking information and therapy should be included in the periodic health examinations, too (Workplace Hazard and Tobacco Education Project 1993).

Occupational noise-induced hearing loss

The prevalence of noise-induced hearing loss varies among construction occupations, depending on levels and duration of exposure. In 1974, less than 20% of Swedish construction workers at age 41 had normal hearing in both ears. Implementation of a comprehensive hearing conservation programme increased the proportion in that age group having normal hearing to almost 40% by the late 1980s. Statistics from British Columbia, Canada, show that construction workers generally suffer significant loss of hearing after working more than 15 years in the trades (Schneider et al. 1995). Some factors are thought to increase susceptibility to occupational hearing loss (e.g., diabetic neuropathy, hypercholesterolemia and exposure to certain ototoxic solvents). Whole-body vibration and smoking may have an additive effect.

A large-scale programme for hearing conservation is advisable for the construction industry. This type of programme requires not only collaboration at the worksite level, but also supportive legislation. Hearing conservation programmes should be specific in work contracts.

Occupational hearing loss is reversible in the first 3 or 4 years after initial exposure. Early detection of hearing loss will provide opportunities for prevention. Regular testing is recommended to detect the earliest possible changes and to motivate workers to protect themselves. At the time of testing, the exposed workers should be educated in the principles of personal protection, as well as the maintenance and proper use of protection devices.

Occupational dermatitis

Occupational dermatitis is prevented mainly by hygienic measures. The proper handling of wet cement and skin protection are effective in promoting hygiene. During health examinations, it is important to stress the importance of avoiding skin contact with wet cement.

Occupational lung diseases

Asbestosis, silicosis, occupational asthma and occupational bronchitis can be found among construction workers, depending on their past work exposures (Finnish Institute of Occupational Health 1987).

There is no medical method to prevent the development of carcinomas after someone has been sufficiently exposed to asbestos. Regular chest x rays, every third year, are the most common recommendation for medical surveillance; there is some evidence that x-ray screening improves the outcome in lung cancer (Strauss, Gleanson and Sugarbaker 1995). Spirometry and anti-smoking information are usually included in the periodic health examination. Diagnostic tests for the early diagnosis of asbestos-related malignant tumours are not available.

Malignant tumours and other lung diseases related to asbestos exposure are widely underdiagnosed. Therefore, many construction workers eligible for compensation remain without benefits. In the late 1980s and early 1990s, Finland conducted a nationwide screening of workers exposed to asbestos. The screening revealed that only one-third of the workers with asbestos-related diseases and who had access to occupational health services had been diagnosed earlier (Finnish Institute of Occupational Health 1994).

Special needs of migrant workers

Depending on the construction site, the social context, sanitary conditions and climate may present important risks to construction workers. Migrant workers often suffer from psychosocial problems. They have a higher risk of work-related injuries than native workers. Their risk of carrying infectious diseases, such as HIV/AIDS, tuberculosis, and parasitic diseases must be taken into account. Malaria and other tropical diseases are problems for workers in areas where they are endemic.

In many large construction projects, a foreign workforce is used. A preplacement medical examination should be conducted in the home country. Also, the spreading of contagious diseases must be prevented through proper vaccination programmes. In the host countries, proper vocational training, health and safety education, and housing should be organized. Migrant workers should be provided the same access to health care and social security as native workers (El Batawi 1992).

In addition to preventing construction-related ailments, the health practitioner should work to promote positive changes in lifestyle, which can improve a worker’s health overall. Avoiding alcohol and smoking are the most important and fruitful themes for health promotion for construction workers. It has been estimated that a smoker costs the employer 20 to 30% more than a non-smoking worker. Investments in anti-smoking campaigns pay not only in the short term, with lower accident risks and shorter sick leaves, but also in the long term, with lower risks of cardiovascular pulmonary diseases and cancer. In addition, tobacco smoke has harmful multiplier effects with most dusts, especially with asbestos.

Economic benefits

It is difficult to prove any direct economic benefit of occupational health services to an individual construction company, especially if the company is small. Indirect cost-benefit calculations show, however, that accident prevention and health promotion are economically beneficial. Cost-benefit calculations of investments in preventive programmes are available for companies to use internally. (For a model used extensively in Scandinavia, see Oxenburg 1991.)

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Implementation of the EC directive Minimum Regulations for Health and Safety on Temporary and Mobile Building Sites typifies the legal regulations emanating from the Netherlands and from the European Union. Their aim is to improve working conditions, to combat disability and to reduce sickness absenteeism. In the Netherlands, these regulations for the construction industry are expressed in the Arbouw Resolution, Chapter 2, Section 5.

As is often the case, the legislation seems to be following the social changes that began in 1986, when organizations of employers and employees joined to establish the Arbouw Foundation to provide services for construction companies in civil engineering and utility construction, earth works, roadbuilding and water construction and the completion sectors of the industry. Thus, the new regulations are scarcely a problem for the responsible companies already committed to implement health and safety considerations. The fact that these principles are often very difficult to put into practice, however, has led to non-observance and unfair competition and, consequently, the need for legal regulations.

Legal Regulations

The legal regulations focus on preventive measures before the construction project is started and while it is in progress. This will yield the greatest long-term benefit.

The Health and Safety Act stipulates that evaluations of risks must address not only those arising from materials, preparations, tools, equipment and so on, but also those involving special groups of workers (e.g., pregnant women, young and elderly workers and those with disabilities).

Employers are obliged to have written risk evaluations and inventories produced by certified experts, who may be employees or external contractors. The document must include recommendations for eliminating or limiting the risks and must also stipulate phases of the work when qualified specialists will be required. Some construction companies have developed their own approach to the evaluation, the General Business Investigation and Risk Inventory and Evaluation (ABRIE), which has become the prototype for the industry.

The Health and Safety Act obliges employers to offer a periodic health examination to their employees. The purpose is to identify health problems that may make certain jobs especially hazardous for some workers unless certain precautions are taken. This requirement echoes the various collective labour agreements in the construction industry which for years have required employers to provide employees with comprehensive occupational health care, including periodic medical examinations. The Arbouw Foundation has contracted with the Federation of Occupational Health and Safety Care Centres for the provision of these services. Over the years, a wealth of valuable information has been accumulated which has contributed to enhancement of the quality of the risk inventories and evaluations.

Absenteeism Policy

The Health and Safety Act also requires employers to have an absenteeism policy which includes a stipulation that experts in this field be retained to monitor and counsel disabled employees.

Joint Responsibility

Many health and safety risks can be traced to inadequacies in the building and organization choices or to poor planning of the work when setting up a project. To obviate this, the employers, employees and the government agreed in 1989 on a working conditions covenant. Among other things, it specified cooperation between clients and contractors and between contractors and subcontractors. This has resulted in a code of conduct which serves as a model for the implementation of the European directive on temporary and mobile building sites.

As part of the covenant, Arbouw formulated limits for exposure to hazardous substances and materials, along with guidelines for the application in various construction operations.

Under the leadership of Arbouw, the FNV Building Workers and Wood Workers Union, the FNV Industry Union and the Mineral Wool Association, Benelux, agreed to a contract that called for the development of glass wool and mineral wool products with less dust emission, development of the safest possible production methods for glass wool and mineral wool, formulation and promotion of working methods for the safest use of these products and performance of the research necessary to establish safe exposure limits to them. The exposure limit for respirable fibres was set at 2/cm³ although a limit of 1/cm³ was regarded as feasible. They also agreed to eliminate the use of raw and secondary materials that are health risks, using as criteria the exposure limits formulated by Arbouw. Performance under this agreement will be monitored until it expires on 1 January 1999.

Construction Process Quality

The implementation of the EC directive does not stand in isolation but is an integral part of company health and safety policies, along with quality and environmental policies. Health and safety policy is critical part of the quality policy of the companies. The laws and regulations will be enforceable only if the employers and employees of the construction industry have played a role in their development. The government has dictated the development of a model health and safety plan that is practicable and can be enforced to prevent unfair competition from companies that ignore or subvert it.

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Diversity of Projects and Work Activities

Many people outside the construction industry are unaware of the diversity and degree of specialization of work undertaken by the industry, though they see portions of it every day. In addition to traffic delays caused by encroachments on roads and street excavations, the public is frequently exposed to buildings being erected, subdivisions being constructed and, occasionally, to the demolition of structures. What is hidden away from view, in most cases, is the large amount of specialized work done either as part of a “new” construction project or as part of the ongoing repairs maintenance associated with almost anything constructed in the past.

The list of activities is very diverse, ranging from electrical, plumbing, heating and ventilating, painting, roofing and flooring work to very specialized work such as installing or repairing overhead doors, setting heavy machinery, applying fireproofing, refrigeration work and installing or testing communications systems.

The value of construction can be partially measured by the value of building permits. Table 1 shows the value of construction in Canada in 1993.

Table 1.  Value of construction projects in Canada, 1993 (based on value of building permits issued in 1993).

Source: Statistics Canada 1993.

The health and safety aspects of the work depend in large measure on the nature of the project. Each type of project and each work activity presents different hazards and solutions. Often, the severity, scope or size of the problem is related to the size of the project as well.

Client-Contractor Relationships

Clients are the individuals, partnerships, corporations or public authorities for whom construction is carried out. The vast majority of construction is done under contractual arrangements between clients and contractors. A client may select a contractor based on past performance or through an agent such as an architect or engineer. In other cases, it may decide to offer the project through advertising and tendering. The methods used and the client’s own attitude to health and safety can have a profound effect on the project’s health and safety performance.

For example, if a client chooses to “pre-qualify” contractors to ensure that they meet certain criteria, then this process excludes inexperienced contractors, those who may not have had satisfactory performance and those without qualified personnel required for the project. While health and safety performance has not previously been one of the common qualifications sought or considered by clients, it is gaining in usage, primarily with large industrial clients and with government agencies that purchase construction services.

Some clients promote safety much more than others. In some cases, this is due to the risk of damage to their existing facilities when contractors are brought in to perform maintenance or to expand the client’s facilities. Petrochemical companies in particular make it clear that contractor safety performance is a key condition of the contract.

Conversely, those firms who choose to offer their project through an unqualified open bidding process to obtain the lowest price often end up with contractors that may be unqualified to perform the work or who take short cuts to save on time and materials. This can have an adverse effect on health and safety performance.

Contractor-Contractor Relationships

Many people who are not familiar with the nature of the contractual arrangements common in construction presume that one contractor performs all or at least the major part of most building construction. For example, if a new office tower, sports complex or other high-visibility project is being constructed, the general contractor usually erects signs and often company flags to indicate its presence and to create the impression that this is “its project”. Years ago, this impression may have been relatively accurate, since some general contractors actually undertook to perform substantial parts of the project with their own direct-hire forces. However, since the mid-1970s, many, if not most, general contractors have assumed more of a project management role on large projects, with the vast majority of the work contracted out to a network of subcontractors, each of which has special skills in a particular aspect of the project. (See table 2)

Table 2. Contractors/subcontractors on typical industrial/commercial/institutional projects

The influence that this network of contractors may have on health and safety becomes fairly obvious when it is compared with a fixed worksite such as a factory or a mill. At a typical fixed-industry workplace, there is only one management entity, the employer. The employer has sole responsibility for the workplace, the lines of command and communication are simple and direct, and only one corporate philosophy applies. At a construction project, there may be ten or more employer entities (representing the general contractor and the usual subcontractors), and the lines of communication and authority tend to be more complex, indirect and often confused.

The attention given to health and safety by the person or company in charge can influence the health and safety performance of others. If the general contractor has attached a high degree of importance to health and safety, this can have a positive influence on the health and safety performance of the subcontractors on the project. The converse is also true.

Additionally, the overall health and safety performance of the site can be adversely affected by the performance of one subcontractor (e.g., if one subcontractor has poor housekeeping, leaving a mess behind as his or her forces move through the project, it can create problems for all of the other subcontractors onsite).

Regulatory efforts regarding health and safety are generally more difficult to introduce and administer in these multi-employer workplaces. It may be difficult to determine which employer has responsibility for which hazards or solutions, and any administrative controls which appear to be eminently workable in a single-employer workplace may need significant modification to be workable on a multi-employer construction project. For example, information regarding hazardous materials used on a construction project must be communicated to those who work with or near the materials, and workers must be adequately trained. At a fixed workplace with only one employer, all of the material and the information accompanying it is much more readily obtained, controlled and communicated, whereas on a construction project, any of the various subcontractors may be bringing in hazardous materials of which the general contractor has no knowledge. Additionally, workers employed by one subcontractor using a certain material may have been trained, but the crew working for another subcontractor in the same area but doing something entirely different may know nothing about the material and yet could be as much at risk as those using the material directly.

Another factor which emerges regarding contractor-contractor relationships relates to the bidding process. A subcontractor who bids too low may take short-cuts that compromise health and safety. In these cases, the general contractor must ensure that subcontractors adhere to the standards, specifications and statutes pertaining to health and safety. It is not uncommon on projects where everyone has bid very low to observe continuing health and safety problems coupled with excessive passing of responsibility, until regulatory authorities step in to impose a solution.

A further problem relates to the scheduling of work and the impact this can have on health and safety. With several different subcontractors on the site at one time, competing interests may create problems. Each contractor wants to get his or her work done as quickly as possible. When two or more contractors want to occupy the same space, or when one has to perform work overhead of another, problems can occur. This is typically a much more common problem in construction than in fixed industry, where the main competing interests tend to involve only operations versus maintenance.

Employer-Employee Relationships

The several employers on a particular project may have somewhat different relationships with their employees than those common at most fixed industrial workplaces. For example, unionized workers at a manufacturing facility tend to belong to one union. When the employer needs additional workers, it interviews and hires them and the new employees join the union. Where there are former unionized workers on layoff, they are re-hired generally on a seniority basis.

In the unionized part of the construction industry, a completely different system is used. Employers form collective associations which then enter into agreements with building and construction trade unions. The majority of the non-salaried direct-hire employees in the industry work through their union. When, for example, a contractor needs five additional carpenters at a project, he or she would call the local Carpenters’ Union and place a request for five carpenters to show up for work at the project on a certain day. The union would notify the five members at the top of the employment list that they are to report to the project to work for the particular firm. Depending on the provisions of the collective agreement between the employers and the union, the contractor may be able to “name hire” or select some of these workers. If there are no union members available to fill the employment call, the employer may be able to hire temporary workers who would join the union, or the union may bring in skilled workers from other locals to help fill the demand.

In non-unionized situations, employers use different processes to obtain additional staff. Prior employment lists, local employment centres, word of mouth and advertising in local newspapers are the principal methods used.

It is not uncommon for workers to be employed by several different employers in the course of a year. The employment duration varies with the nature of the project and the amount of work to be done. This places a large administrative load on the construction contractors compared with their fixed-industry counterparts (e.g., recordkeeping for income taxes, workers’ compensation, unemployment insurance, union dues, pensions, licensing and other regulatory or contractual issues).

This situation presents some unique challenges compared to the typical fixed-industry workplace. Training and qualifications must not only be standardized but portable from one job or sector to another. These important issues affect the construction industry much more profoundly than fixed industries. Construction employers expect workers to come to the project with certain skills and capabilities. In most trades, this is accomplished by a comprehensive apprenticeship programme. If a contractor places a call for five carpenters, he or she expects to see five qualified carpenters at the project on the day they are needed. If health and safety regulations require special training, the employer needs to be able to access a pool of workers with this training, since the training may not be readily available at the time the work is scheduled to start. An example of this is the Certified Worker Programme required at larger construction projects in Ontario, Canada, which involves having joint health and safety committees. Since this training is not currently part of the apprenticeship programme, alternative training systems had to be put in place to create a pool of trained workers.

With growing emphasis on specialized training or at least confirmation of skill level, training programmes conducted in conjunction with the building and construction trades unions will likely grow in importance, number and variety.

Inter-union Relationships

The structure of organized labour mirrors the way in which contractors have specialized within the industry. On a typical construction project, five or more trades may be represented onsite at any one time. This involves many of the same problems posed by multiple employers. Not only are there competing interests to deal with, but lines of authority and communication are more complex and sometimes blurred when compared with a single-employer, single-union workplace. This influences many aspects of health and safety. For example, which worker from which union will represent all workers on the project if there is a regulatory requirement for a health and safety representative? Who gets trained in what and by whom?

In the case of rehabilitation and reinstatement of injured workers, the options for skilled construction workers are much more limited than those of their fixed-industry counterparts. For example, an injured worker at a factory may be able to return to some other job at that workplace without crossing important jurisdictional boundaries between one union and another, because there is typically only one union in the factory. In construction, each trade has fairly clearly defined jurisdiction over the types of work its members can perform. This greatly limits the options for injured workers who may not be able to perform their normal pre-injury job functions but could none the less perform some other related work at that workplace.

Occasionally, jurisdictional disputes arise over which union should perform certain types of work which have health and safety implications. Examples include scaffold erection, boom truck operation, asbestos removal and rigging. Regulations in these areas need to consider jurisdictional concerns, especially with respect to licensing and training.

The Dynamic Nature of Construction

Construction workplaces are in many respects quite different from fixed industry. Not only are they different, they tend to be constantly changing. Unlike a factory which operates at a given location day after day, with the same equipment, the same workers, the same processes and generally the same conditions, construction projects evolve and change from day to day. Walls are erected, new workers from different trades arrive, materials change, employers change as they complete their portions of the work, and most projects are affected to some degree just by the changes in the weather.

When one project is completed, workers and employers move on to other projects to start all over again. This indicates the dynamic nature of the industry. Some employers work in several different cities, provinces, states or even countries. Similarly, many skilled construction workers move with the work. These factors influence many aspects of health and safety, including workers’ compensation, health and safety regulations, performance measurement and training.

Summary

The construction industry is presented with some very different conditions from those in fixed industry. These conditions must be considered when control strategies are being contemplated and may help to explain why things are done differently in the construction industry. Solutions developed with the input from both construction labour and construction management, who know these conditions and how to deal effectively with them, offer the best chance for improving health and safety performance.

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Improving Occupational Health and Safety

Construction companies are increasingly adopting the quality management systems spelled out by the International Organization for Standardization (ISO), such as the ISO 9000 series and the subsequent regulations that have been based on it. Although no recommendations on occupational health and safety are specified in this set of standards, there are cogent reasons for including preventive measures when implementing a management system such as that required by the ISO 9000.

Occupational health and safety regulations are written and implemented and are continuously being adapted to technological progress as well as to new safety techniques and to advances in occupational medicine. All too often, however, they are not followed, either deliberately or out of ignorance. When this occurs, models for safety management, such as the ISO 9000 series, assist in integrating the structure and content of preventive measures into management. The advantages of such a comprehensive approach are obvious.

Integrated management means that occupational health and safety regulations are no longer looked at in isolation, but gain relevance from the corresponding sections of a quality management handbook, as well as in process and work instructions, thus creating a fully integrated system. This integral approach can improve the chances of greater attention to accident prevention measures in daily construction practice and, thereby, reduce the number of workplace accidents and injuries. Dissemination of a handbook that integrates occupational health and safety procedures into the processes it describes is crucial for this process.

New management methods are aimed at putting people closer to the centre of the processes. Co-workers are being more actively involved. Information, communication and cooperation are promoted across hierarchical barriers. The reduction of absences due to illness or workplace accidents enhances the implementation of the principles of quality management in construction.

With the development of new building methods and equipment, safety requirements increase steadily in number. The increasing concern with environmental protection makes the problem even more complex. Coping with the demands of modern prevention is difficult without appropriate regulations and a centrally directed articulation of the process and work instructions. Clear divisions of responsibility and effective coordination for the prevention plan should, therefore, be written into the quality management system.

Improving Competitiveness

Documentation of the existence of an occupational safety management system is increasingly required when contractors submit bids for work, and its effectiveness has become one of the criteria for awarding a contract.

The pressure of international competition could become even greater in the future. It seems prudent, therefore, to integrate preventive measures into the quality management system now, rather than waiting and being forced by increasing competitive pressure to do so later, when the pressure of time and the costs of personnel and financing will be much greater. Furthermore, a not inconsiderable benefit of an integrated prevention/quality management system is that having such a well-documented programme in place is likely to reduce the costs of coverage, not only for workers’ compensation, but also for product liability.

Company Management

Company management must be committed to the integration of occupational health and safety into the management system. Goals specifying the content and time-frame of this effort should be defined and included in the basic statement of company policy. The necessary resources should be made available and appropriate personnel assigned to accomplish the project goals. Specialized safety personnel are generally required in large and mid-sized construction companies. In smaller companies, the employer must take the responsibility for the preventive aspects of the quality management system.

A periodic company management review closes the circle. The collective experiences in utilizing the integrated prevention/ quality management system should be examined and assessed, and plans for revision and for subsequent review should be formulated by company management.

Assessing Results

Assessment of results of the occupational safety management system that has been instituted is the second step in the integration of preventive measures and quality management.

The dates, kinds, frequency, causes and costs of accidents should be compiled, analysed and shared with all those in the company with relevant responsibilities. Such an analysis enables the company to set priorities in formulating or modifying process and work instructions. It also makes clear the extent to which occupational health and safety experience affects all divisions and all processes in the construction company. For this reason, defining the interface between company processes and preventive aspects takes on great importance. During bid preparation, the resources in time and money needed for comprehensive preventive measures, such as those incurred in clearing debris, can be precisely calculated.

When purchasing construction materials, attention should be paid to the availability of substitutes for potentially dangerous materials. From the beginning of a project responsibility for occupational health and safety should be assigned for particular aspects and each phase of the construction project. The need and availability for special training in occupational health and safety as well as the relative risks of injury and disease should be compelling considerations in the adoption of particular construction processes. These conditions must be recognized early on so that appropriately qualified workers can be selected and the courses of instruction can be arranged in a timely manner.

The responsibilities and authorities of the personnel assigned to safety and how they fit into the daily work should be documented in writing and collated with the onsite task descriptions. The construction company’s occupational safety staff should appear shown in its organizational chart, which, along with a clear responsibility matrix and schematic flow-charts of processes, should appear in the quality management handbook.

An Example from Germany

In practice, there are four formal procedures and their combinations for integrating occupational health and safety into a quality management system that have been implemented in Germany:

1. A quality management handbook and a separate occupational safety management handbook are developed. Each has its own procedures and work instructions. In extreme cases, this creates ineffective, insular organizational solutions, which require twice the amount of work and in practice do not accomplish the desired results.
2. An additional section is inserted into the quality management handbook with the heading “Occupational health and safety”. All statements on occupational health and safety are organized in this section. This path is chosen by some construction companies. Positioning a health and safety problem in a separate section may well highlight the importance of prevention, but it entails the risk being ignored as a “fifth wheel” and serves more as an evidence of intent rather than a command for appropriate action.
3. All aspects of occupational health and safety are worked directly into the quality management system. This is the most systematic implementation of the basic idea of integration. The integrated and flexible structuring of the presentation models of the German DIN EN ISO 9001-9003 permits such an inclusion.
4. The Underground Construction Trade Organization (Berufs-genossenschaft) favours a modular integration. This concept is explained below.

Integration in Quality Management

Once the assessment is completed, at the latest, those responsible for the construction project should contact the quality management officers and decide on the steps for actually integrating occupational safety into the management system. Comprehensive preparatory work should facilitate setting common priorities during the work that promise the greatest preventive results.

The demands of prevention that come out of the assessment are first divided into those that can be categorized according to the processes specific to the company and those that should be considered separately since they are more widespread, more comprehensive or of such a special character that they demand separate consideration. The following question can be of assistance in this categorization: Where would the interested reader of the handbook (e.g., the “customer” or the worker) most likely look for the relevant preventive policy, the section of a chapter devoted to a process specific to the company, or in a special section on occupational health and safety? Thus, it appears, a specialized procedural instruction on transporting hazardous materials would make the most sense in almost all construction companies if it were included in section on handling, storing, packing, conserving and shipping.

Coordination and Implementation

After this formal categorization should come linguistic coordination to ensure easy readability (this means presentation in the appropriate language(s) and in terms easily understood by individuals with educational levels characteristic of the particular workforce). Finally, the final documents must be formally endorsed by the top management of the company. At this juncture, it would be useful to publicize the significance of the changed or newly-implemented procedures and work instructions in company bulletins, safety circles, memos and any other available media, and to promote their application.

General Audits

To assess the effectiveness of the instructions, appropriate questions may be prepared for inclusion into general audits. In this manner, the coherence of work processes and occupational health and safety considerations is made unmistakably clear to the worker. Experience has shown that workers may at first be surprised when an audit team on the construction site in their particular division routinely asks questions on accident prevention as a matter of course. The consequent increase in the attention paid to safety and health by the workforce confirms the value of the integration of prevention into the quality management programme.

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