Assessing Occupational Safety
and Health Training

With Technical Assistance from:
Raymond Sinclair
Jerry Newman
Ronald Schuler

June 1998

Mention of company names or products does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC).

Copies of this and other NIOSH documents are available from the
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Cincinnati, Ohio 45226-1998

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Occupational safety and health training remains a fundamental element in workplace hazard control programs. As training objectives, recognition of job hazards, learning safe work practices and appreciating other preventive measures are expected to contribute to the goal of reducing occupational risk of injury and disease. This report reviews data found in the literature reflecting the significance of training in meeting these kinds of objectives and outcomes. As will be seen, there is much positive evidence but the results seem very selective and highly qualified. An analysis to identify factors underlying a successful training experience is also presented and does confirm basic principles of learning. Here too, however, important gaps are noted in the available data. The document proceeds to offer an agenda for addressing outstanding needs and ways for strengthening the role that training can play in improving workplace safety and health. The reader audience concerned with these kinds of issues should find this report to be most informative.

Linda Rosenstock, M.D., M.P.H.
Director, NIOSH

Abstract

More than 100 Occupational Safety and Health Administration (OSHA) standards for hazard control in the workplace contain requirements for training aimed at reducing risk factors for injury or disease; others limit certain jobs to persons deemed competent by virtue of special training. A literature review was undertaken to assess the merits of such training rules to achieve this objective and to sort out factors of consequence. The review focussed heavily on published reports, primarily drawn from the period 1980 through 1996, wherein training was used as an intervention effort to reduce risk of work-related injury and disease. Eighty (80) such reports were found and gave overwhelming evidence to show the merits of training in increasing worker knowledge of job hazards, and in effecting safer work practices and other positive actions in a wide array of worksites. Reports from select surveys and investigations of worker injuries and workplace fatalities were also accessed with many implicating lack of training as a contributing factor to the mishaps. In still other studies, workplace training devoted to first aid instruction showed linkage to reduced worker injury rates, suggesting that even this kind of training has benefits to job safety overall.

A critical analysis of the above findings found certain qualifications in viewing training impacts and successes with regard to current workplace standards. For example, most of the reported training intervention studies did not address OSHA training rules per se, and knowledge gain and safe behavior measures were used in many evaluations as opposed to actual injury/disease indicators. Also, in some instances, the training was coupled with other forms of intervention to make attribution difficult. Training deficits noted in some surveys of work injury cases lacked for confirmation and no information was available on the quality of the instruction if given at all.

Despite the above reservations and uncertainties, training's role as a necessary element in developing and maintaining effective hazard control activities remained firmly supported by the available literature. What did emerge from this review and analysis was an appreciation of meaningful training procedures and the recognition of factors both within and beyond the training process that could greatly affect its impact. In this regard, the OSHA voluntary training guidelines were described along with illustrations from the reports to show how the various steps contained within them can be met in realistic ways and have merit in framing an effective program. In addition, factors both within and beyond the training process were assessed for their effects on training outcomes based on data found in the reviewed literature. Variables such as size of training group, length/frequency of training, manner of instruction, and trainer credentials were each shown to be significant determinants to the training process. Equally important were extra-training factors such as goal setting, feedback and motivational incentives along with managerial actions to promote the transfer of learning to the jobsite.

Based on the literature review, follow-on efforts to address outstanding issues and needs regarding effective occupational safety and health training were noted.

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Executive Summary This review sought evidence from the literature bearing on two questions: Are occupational safety and health training (OS&H) requirements, as cited in many Federal standards governing workplace conditions and operations, effective in reducing work related injury and illness? Does the available evidence show certain training factors or practices to be more important than others in having positive effects on these outcome measures? The literature search focussed on reports of training intervention efforts designed in whole or in part to enhance worker knowledge of workplace hazards, effect behavior changes to ensure compliance with safe work practices, or prompt other actions aimed at reducing the risk of occupational injury or disease. Eighty (80) such reports met criteria for inclusion. They were products of two literature searches. The first search covered the period up to 1993; the second extended the first search through 1996. The included work came mainly from the period 1980 through 1996 and, by intent, addressed five types of hazardous agents. These were: traumatic injury forces, toxic chemicals/materials, harmful physical factors, ergonomic stressors, and biologic/infectious agents as encountered in an array of work settings. The search also examined data from select surveys and investigative reports where training factors were either implicated in the etiology of workplace injury or disease incidents or, alternatively, were considered a key element to the success of worksite hazard control programs that showed exemplary safety and health records. Still another source for information was reports of worksite training directed to other needs (e.g., first aid) but that had apparent positive effects on worksite safety and health indicators as well. With regard to answering the first question, the literature accessed and reviewed in this report offered much direct and indirect evidence to show the benefits of training in establishing safe and healthful working conditions. The intervention studies in particular were especially supportive. Findings here were near unanimous in showing how training can attain objectives such as increased hazard awareness among the workers at risk, knowledge of and adoption of safe work practices, and other actions that improve workplace safety and health protection. Data from other types of studies suggested too that lack of required training may have contributed to events where workers were injured or killed. Although affirming the effectiveness of training to meet hazard control objectives, this review also drew attention to some shortcomings in the supportive data. For example, the training intervention work that offered the most positive evidence did not address OSHA training requirements per se. Rather, the training interventions targeted site-specific problems, and while showing success in resolving such problems, i.e., improving safety performance, their exact relationship to OSHA mandated training rules was unclear. Moreover, where studies reported lower injury rates, reduced lost time or medical costs after training, analyses were lacking to show how the improvements could be accounted for by the positive results from training when measured in terms of knowledge gain or behavior indicators. One study that attempted such an analysis found that the targeted training could only account for 25% of the observed reduction in injury rate. Also, in some instances, the training was coupled to other forms of intervention (engineering, ergonomic) so as to make attribution even more difficult. Still another tempering fact was that successful training results appeared greatly influenced by "extra-training" considerations. Management's role/support of safety training and its transfer to the jobsite, setting goals and providing feedback to motivate use of the knowledge gained, and offering incentives or rewards for reinforcing safe performance all seemed crucial to attaining a positive result. These types of factors are not acknowledged in OSHA training requirements. It is noteworthy that a proposed OSHA safety and health program standard does recognize the need for management actions to support OS&H training among other critical components. Some reports that suggested training deficits as factors contributing to injury/health problems lacked for confirmatory information. In other reports, workers who had received training to protect them against certain job hazards were nevertheless afflicted. Missing in these cases was information about the quality of the training offered; whether it met OSHA requirements, or took note of any of the extra-training factors noted above. Even with the above reservations and uncertainties, however, the role of training as a necessary element in developing and maintaining effective hazard control activities appeared firm. Indeed, the issue was not so much whether OS&H training could make a difference in reducing risks from workplace hazards. Clearly, it can. But rather ascertaining the conditions for maximizing these training effects. This was the second question posed in this review and two approaches were used to offer a response. One effort focussed on the OSHA voluntary training guidelines wherein examples were extracted from the set of intervention studies to highlight the different steps that had to be taken. Various exhibits in this exercise showed how the steps could be met in realistic ways and could have merit in framing and implementing an effective training program. A second approach considered factors not covered in the OSHA guidelines but more specific to the training process itself or the attainment of its objectives. Variables included were the size of training group, length and/or frequency of training, manner of instruction, trainer credentials, and training/transfer conditions. Addressed among the latter conditions were extra-training factors such as management/supervisory roles and motivational techniques for reinforcing the learning at the jobsite. The intervention studies were examined for data that could justify statements as to the significance of these factors and/or conditions and where they had the greatest potential for effecting successful training outcomes. A set of statements, tying together evaluative information from the different reports, emerged from this exercise. Some were more supportable than others owing to limitations in the data contained in the reports under review. Most statements about specific factors agreed with concepts in the general learning and motivation literature, i.e., increases in training time per unit group of workers or use of more frequent and shorter sessions suggested more favorable outcomes as did active learning experiences stressing jobsite applications. Some unique extensions or refinements were also noted such as the added benefits of having supervisors or foremen assume a more active trainer role in workplace safety and health training as opposed to others who may have that special responsibility. Particular attention was drawn to the length and frequency of training because of its implications for training schedules, both for initial and for refresher instruction. Needs to develop a decision logic for this purpose were mentioned along with some of the variables to be addressed. Suggestions for follow-on work were offered to take account of the gaps in the reviewed literature or other shortcomings in responding to the two questions posed. Among those recommended were: 1) Undertaking studies to ascertain how industry is responding to OSHA training rules and the quality of such efforts. The major data set used in this literature review were researcher directed efforts and, for that reason were not the norm. Focussing the efforts on the most prevalent types of injuries and illnesses and selecting industries or work operations where they are most recurrent would be ideal. Differences in how the mandated training rules were met at the various selected sites and links between the training undertaken and specific injury and disease risk factors would be analyzed. The extent to which the operant practices followed OSHA training guidelines, and the resulting experiences could offer an important reference in gauging their utility. 2) Conducting in-depth studies of training practices and their interrelationship with other elements in an establishment's hazard control program. Directing this effort at companies showing exemplary safety and health records could offer program models for effective training that can best complement or enhance other workplace measures aimed at maximizing risk management. 3) Using case-control or cohort studies to compare differences in the level of training of workers injured or afflicted by occupational disease against those not so affected. The intent here would be to get a better assessment of how training deficits can lead to such problems. Such an analysis would require measures to separate out many nontraining factors that could also be responsible for apparent differences in these cases. 4) Convene workshops to discuss issues concerned with the effectiveness of worksite OS&H training both now and in the future. Invitees would include experts and practitioners conversant with OS&H training, job skills training, health education, organizational behavior and evaluation subject areas. The workshops would seek to pool ideas bearing on the questions posed in this report and added concerns such as the adequacy of current regulatory language in OSHA training rules, future training challenges due to changing workplace technologies, worker demographics, measurement outcomes for assessing the effectiveness of training, the merit of merging different workplace training domains (i.e., OS&H training, job skills training, worksite health promotion), and other issues.

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Table of Contents

Abstract

I.     Introduction
II.   Occupational Safety and Health Training in Broad Perspective

A.  Basic Program Thrusts
B.  Worksite Training on Health Protection/Health Promotion

III.  Occupational Safety and Health Training in Relation to Other Worksite Activities
IV.  General Training Considerations

A.  Some Definitions
B.   Critical Training Elements

1.  Needs Assessment
2.  Establishing Training Objectives
3.  Specifying Training Content and Media
4.  Accounting for Individual Differences
5.  Specifying Learning Conditions
6.  Evaluating Training
7.  Revising the Training

V.   Occupational Safety and Health Training Rules as Found in Current Workplace Standards

A.  Nature of Existing OSHA Training Rules

1.  Content
2.  Frequency/Duration
3.  Documentation/Assurance
4.  Trainer Qualifications and Specialty Training
5.  Methods

B.  OSHA Voluntary Training Guidelines

1.  Determining If Training Is Needed
2.  Identifying Training Needs
3.  Identifying Goals and Objectives
4.  Developing Learning Activities
5.  Conducting the Training
6.  Evaluating Program Effectiveness
7.  Improving the Program

C.  Summary

VI.  Data on Effectiveness of Occupational Safety/Health Training

A.  Nature of the Literature Review
B.  Data Sources Tapped
C.  Training Intervention Studies

1.  Data Set and General Observations
2.  Intervention Data on OSHA Requirements/Guidelines

D.  Training Data from Studies of Afflicted Workers

1.  Bureau of Labor Statistics Work Injury Reports
2.  Investigative Studies Acknowledging Training Needs and Effectiveness
3.  Appraisal of Training Data on Afflicted Workers

E.  Training Factors in the Context of Other Worksite Programs

1.  Training in Successful Occupational Safety and Health Programs
2.  Implications of First Aid Training
3.  Worksite Physical Fitness/Exercise Training

VII. Verifying Critical Elements/Program Factors for Effective Occupational Safety and Health Training

A.  Examples Supporting OSHA Voluntary Training Guidelines
B.  Evidence for Distinctive Training and Extra-Training Factors
VIII. Summary

A.  General Conclusions on Training Effectiveness
B.  General Conclusions on Critical Training Factors
C.  Needs for Follow-on Work
IX. References


APPENDIX A:


Training Intervention Studies as Found in the Literature
Addressing Various Types of Occupational Hazards

APPENDIX B:


Extracts from Bureau of Labor Statistics (BLS) Work Injury Reports
for Discerning Real/Possible Gaps in Job Safety/Health Training

I

Introduction
azard control and prevention strategies to assure every working man and woman safe, healthful workplace conditions regard training as an axiomatic part of all such efforts. To reinforce this point, requirements for worker safety and health training are found in more than 100 occupational safety and health standards promulgated by the Occupational Safety and Health Administration (OSHA); others limit certain jobs assignments to persons judged competent by way of special training. Yet, the merits of training provisions in worksite hazard control regulations and for hazard control efforts in general have not been without question. Indeed, instances where training has been shown to be ineffective in reducing work related disabilities have been reported (Tan et al., 1991, Snook, Campanelli & Hart, 1978, Linnemann, et al., 1991), and at least one review has raised concerns about the worth of workplace safety training programs (Hale, 1984). In its defense, training shortcomings could reflect use of inadequate instructional techniques or situational factors that confound the learning process or its objectives. More importantly, however, the notion that training is somehow exempt from the accountability demands of business operations is no longer tenable. Moreover, in appreciating that adherence to training rules imposes added costs on responsible employers and extra burdens on workers too, knowledge of factors that can influence success in training efforts would be especially important. Indeed, one could argue that faulty or bad training may have worse consequences than no training at all.

It was these issues that prompted this literature review. The originally conceived purpose was to address two questions:

Q-1: Can the occupational safety and health (OS&H) training requirements cited in numerous Federal standards governing workplace conditions and operations be shown to be truly effective in reducing work related injuries and illness?
Q-2: Does the evidence single out certain elements or characteristics of training programs as having the most positive effects on worker safety and health?

Approaches to answering these questions would seem straightforward. Among the more obvious:

(1) Search the literature for reports on how employers implemented applicable OSHA training requirements and the associated change in their work injury and disease experience.
(2) Locate data sources comparing the extent and nature of OS&H training given workers who incurred work related injury or disease with those who have not but who are in similar occupations or work situations.
(3) Analyze the safety/health training practices of employers having exemplary injury/disease control programs and contrast them with others having worse performance but comparable job operations, workforce size/makeup, and other workplace factors.

As noted in the course of this review, the existing literature only partially satisfies these approaches. For example, reports of efforts to comply with prescribed OSHA training rules are relatively few; more common in the literature are training studies targeting site-specific problems that may or may not be covered by regulation. Knowledge gain, attitude change, indications of safer work procedures being adopted by the workers are most frequently used to measure the training impact. Fewer studies note reduced injuries or disease outcomes from training, and if they do, there are cautions about drawing cause-effect conclusions. Results of epidemiology studies of occupational injury and disease may suggest training shortcomings as contributing factors but lack for baseline data or other evidence needed to support such claims. Assessments of OS&H training practices or the merits of certain instructional methods as found in the literature may not always be able to separate training-specific effects from other workplace factors. Also, in many instances, data collection for worksite training evaluation purposes may not always follow sound study design principles.

Clearly, then, the current literature cannot supply complete answers to the questions posed. Definitive responses require more research and some suggestions for such work are described at the conclusion of this report. Even with the above reservations, the benefits of a literature review at this time are believed twofold. First, to offer a preliminary appraisal of the merits of training directed to workplace safety and health concerns. Second, to offer a conceptual framework for treating OS&H training so as to clarify the issues that should be addressed in follow-on efforts.

Although the literature has much theory on learning having relevance to training, this review is not theory driven, i.e., intended to serve as a test of specific hypotheses derived from specific theoretical formulations. As will be noted, the treatment in various places does take account of suggested training models or guidelines for purposes of organizing and analyzing the material under review.

It is envisioned that this report can serve different audiences. For one, policy-makers engaged in setting OS&H standards need to be assured that training requirements are essential to achieving improved workplace safety and health. Finding such supportive evidence for training rules would offer this assurance. Also, information on whether certain rule formulations have more merit than others in producing successful training results would be of benefit to policy-makers. A second audience would be researchers. This review reveals both strengths and weaknesses in the database for effective training procedures and factors affecting OS&H training. Especially challenging and needed are studies to definitively tie immediate training results, e.g., increased knowledge of hazards and safer work behaviors, to outcome indicators such as reduced worker injuries and illness. A third and last audience for this report would be those who conduct OS&H training. Indeed, the wealth of training studies appended to this report is an information resource on instructional methods and evaluation techniques. By addressing different types of hazards in a variety of work settings and offering measures for indicating effects, they offer important lessons for OS&H trainers.

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II

Occupational Safety and Health Training in
Broad Perspective

A. Basic Program Thrusts

OS&H training embodies instructing workers in recognizing known hazards and using available methods for protection. Worker education, in contrast, prepares one to deal with potential hazards or unforeseen problems; guidance is given in ways to become better informed and to seek actions aimed at eliminating the hazard. As explained in a 1985 Office of Technology Assessment (OTA) report on preventing illness and injury in the workplace, the distinction between worker training and education programs is often blurred and depends on the role that the worker is expected to assume in the process. "The narrower the role, the more the instruction is training; the broader the role, the more the instruction is education" (OTA, 1985, Pg.189). Much of the information in this review draws on the narrower training reference, but worker education approaches are also acknowledged.

The OTA report included an analysis of 40 worker training and worker education programs conducted by business firms, trade associations, unions, hospitals and universities, and coalitions of OS&H groups. The analysis of activities and objectives suggested four types of programs: fundamental, recognition, problem-solving, and empowerment programs.

Fundamentals Programs: These programs involve instruction in prevention of work-related injury and illness through proper use and maintenance of tools, equipment, materials; knowledge of emergency procedures; personal hygiene measures; needs for medical monitoring; and use of personal protective equipment for non-routine operations or as an interim safeguard until engineering controls can be implemented.

Training interventions having these objectives permeate the literature and comprise most of the reports in Appendix A, which offers an inventory of studies aimed at evaluating the effectiveness of OS&H training for controlling workplace hazards.

Recognition Programs: These programs include instruction emphasizing awareness of workplace hazards; knowledge of methods of hazard elimination or control; understanding right-to-know laws and ways for collecting information on workplace hazards; recognizing symptoms of toxic exposures; and observing and reporting hazards or potential hazards to appropriate bodies. Training activities of this type were spurred largely by the OSHA Hazard Communication Standard (OSHA, 1983). The standard required employers to inform workers of chemical hazards found in their work areas and of ways to reduce apparent risk. Use of Material Safety Data Sheets and labels along with training are the three means prescribed for communicating the essential information. Several reports evaluating training efforts of this type are found in Appendix A.

Problem-Solving Programs: Instruction is aimed at giving workers the information and skills enabling them to participate in hazard recognition and control activities; to help identify/solve problems through teamwork, to use union and management means, and to exercise rights to have outside agencies investigate workplace hazards when warranted. Inviting worker input in company planning or in design of new operations or processes is recognized as a viable means for improving productivity, quality of products, and worker motivation. Extending this approach to hazard control seems reasonable especially since workers, owing to their everyday job work experience, possess an intimate knowledge of the hazards connected with their jobs and could be a rich source for corrective ideas. One report in assessing a worker participation approach to hazard control at a worksite (Lin & Cohen, 1983) found the overall effort to be successful but at the same time took note of some gaps of worker knowledge for which added worker instruction would have been of benefit. This report is listed in Appendix A along with other reports of union-sponsored efforts to sharpen worker skills in addressing the requirements of specific OS&H standards so that they could play a more effective role in responding to their workplace needs.

Empowerment Programs: These programs provide instruction to build and broaden worker skills in hazard recognition and problem-solving skills much like that noted above. Emphasis, however, is on worker activism with the goal of ensuring their rights to an illness-and injury-free workplace (Wallerstein & Baker, 1994). Hence, the program aims at enabling workers to effect necessary control measures through educating co-workers and supervisors, and through use of committee processes or in health/safety contract negotiations. This approach is in accord with the current "Total Quality Management" philosophy - having rank-and-file workers along with their supervisors share greater roles in and be more accountable for addressing workplace hazard control needs. Several reports of union and university coalitions engaged in furnishing such training and some first attempts to provide outcome measures are noted in Appendix A.

The above types of training suggest a progression from a workforce learning basic forms of protection to known hazards, through instruction aimed at enhancing their awareness of potential problems and problem-solving skills, and then learning how to make it all happen in their workplaces. Although treated separately, any given training program may contain elements of these approaches in varying degrees.

B. Worksite Training on Health Protection/Health Promotion

The aforementioned training and education activities are all directed to worksite health protection, that is, to controlling occupational/environmental risk factors for disease or injury. They should not be confused with worksite health promotion programs that also involve training/education activities but whose objectives are to alter personal lifestyle factors that may pose risks to one's health and well-being. Instruction here targets smoking, substance abuse, inadequate diet, poor physical fitness among other problems and the intent is to effect behavior change for risk reduction.

Personal lifestyle and occupational risk factors may interact in ways that can heighten the potential for adverse outcomes. For example, asbestos workers who smoke may have a 10-fold greater risk for lung cancer (Hammond, et al., 1979); alcohol or illicit drug use has been implicated in work accidents in high risk jobs (Holcomb, Lehman & Simpson, 1993). Alternatively, exercise training for enhancing physical fitness has been suggested as an added means to limit strains from jobs imposing undue stress on the musculoskeletal system (Genaidy, Gupta, & Alshedi, 1990; Hilyer et al., 1990; Shi, 1993). For these reasons, training and education activities addressing worksite health protection and health protection goals in combination may have mutually reinforcing effects. While health promotion studies are outside the scope of this literature review, some reports of these worksite activities have been evaluated from the standpoint of reducing occupational risks and will be so noted.

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III

Occupational Safety and Health Training in
Relation to Other Worksite Activities

OS&H training as implemented at the workplace rarely has a stand-alone status. For example, OS&H training may be a natural part of job skills training or a simple add-on. On-the-job type of training, of necessity, would have to cover both objectives. In some cases, work methods to be learned and safe work practices prescribed by OSHA standards are much the same. In occupations such as logging, "poor technique" is widely reported as a cause of injury with inadequate training cited as the underlying problem. This shortcoming refers to a failure to develop (learn) proper work methods and the safety precautions that derive from them (Slappendel et al., 1993).

OS&H training is also an element of hazard control programming. Instruction in hazard recognition and control methods, knowledge of emergency procedures, and use of personal protective equipment may or may not be distinctive-the degree depends on what OSHA requirements may dictate. The Hazard Communication Standard (OSHA, 1983) for example, requires a written training plan describing the nature of instruction to ensure workers understand the chemical hazards to which they might be exposed, recognition of symptoms of overexposure, safeguards to be taken Other standards merely acknowledge the need for training but are less explicit as to requiring evidence of a plan for its implementation. Although not always recognized, OS&H training may also be needed to cover operational aspects of engineering or physical hazard control systems so that their benefits are realized to the fullest extent.

OS&H instruction as a component of both regular job training and worksite hazard control program practices is depicted in Figure 1 as nested in and representing the overlapping parts of these two types of activities. Encircling the job training and occupational safety and health program efforts are factors which can shape the success of these activities and their respective impacts on productivity and safety/health experience. Indeed, the transferability of training to actual jobsite demands, use of promotional or motivational efforts to drive the training exercise as well as boost post-training performance in both productivity and hazard control terms, and management's commitment to these activities as communicated to the workers can do much to affect these kinds of outcomes. Encompassing all of the above and shaping the ultimate results are an employer's goals and objectives. Presumably, management policies and actions that do not put company productivity and worker safety and health in conflict but rather stress their positive interrelationships would be ideal.

Viewing OS&H training in this context underscores the difficulty in attempts to treat or evaluate its effects separate from other workplace considerations. This is especially true if "bottom line" outcomes such as work related injuries and illness are used in the assessment. As will be noted, many evaluations of OS&H training use measures more immediate to the learning process itself (e.g., knowledge gained); others may take account of the instruction plus certain extra- or post-training factors in assessing on-the-job safety performance. In these instances, surrogate indicators for injury or disease reduction may be used (e.g., increased compliance with safe work practices and/or associated changes in exposure levels); these indicators can offer more opportunity for discerning effects than injury or illness measures. It must be remembered that work related injury or disease cases at least at the individual employer level are rare events which can complicate efforts at evaluating change.



Figure 1. Depiction of occupational safety/health (OSH) training as nested in other employer programs which are affected by numerous extra- or post-training factors. Interactions here complicate efforts to assess training-specific impacts on safety/health experience or productivity/performance measures. Employer goals and objectives and related policies ultimately determine the priorities or trade-offs between the two outcomes.

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IV

General Training Considerations

A. Some Definitions

In general, training refers to instruction and practice for acquiring skills and knowledge of rules, concepts, or attitudes necessary to function effectively in specified task situations. With regard to OS&H, training can consist of instruction in hazard recognition and control measures, learning safe work practices and proper use of personal protective equipment, and acquiring knowledge of emergency procedures and preventive actions. As noted in the OTA report (1985), training could also provide workers with ways to obtain added information about potential hazards and their control; they could gain skills to assume a more active role in implementing hazard control programs or to effect organizational changes that would enhance worksite protection.

Performance represents observable actions or behaviors reflecting the knowledge or skill acquired from training to meet a task demand. With regard to OS&H, performance can mean signs of complying with safe work practices, using protective equipment as prescribed, demonstrating increased awareness of hazards by reporting unsafe conditions to prompt corrective efforts, and executing emergency procedures should such events occur.

Motivation refers to processes or conditions that can energize and direct a person's behaviors in ways intended to gain rewards or satisfy needs. Setting goals for performance coincident with learning objectives and use of feed-back to note progress have motivational value. With regard to OS&H, motivation can mean one's readiness to adopt or exhibit safe behaviors, take precautions, or carry out self-protective actions as instructed. Bonuses, prizes, or special recognition can act as motivational incentives or rewards in eliciting as well as reinforcing these behaviors when they are displayed.

Knowledge or skills acquired in training may not always result in improved performance in actual work situations. This may indicate 1) lack of suitable motivation, 2) training content does not fit job demands (i.e., a problem in defining suitable training objectives, or 3) dissimilarity or conflicts between the instruction/practice in training conditions when compared to actual job conditions (i.e., a problem in transfer of training). More is said about this in the sections to follow.

B. Critical Training Elements

Different authoritative reviews of the general training literature (Goldstein & Buxton (1982), Campbell (1988), Tannenbaum & Yukl (1992)), and job training in particular, emphasize the importance of certain elements as critical to an effective program. They are noted below. The OSHA set of voluntary training guidelines to assist employers in furnishing safety and health information and instruction to workers (OSHA, 1988) mimics most of the same elements within an OS&H context. They are treated in a later section.

1.       Needs Assessment

According to the general literature, training goals presuppose: 1) consistency with organizational goals, 2) the presence of jobs designed to yield performance outputs that meet the organization's goals, and 3) performance levels dependent on knowledge of the job tasks, skill, attentiveness to the work or factors where training can make a difference. On the last point, expecting training to solve problems related to internal organizational conflicts or to overcome deficiencies in equipment or work methods is unrealistic. Job analyses determine which of the relevant performance factors comprise the highest priority training needs either now or in the future. The process includes defining the tasks involved, their order of importance (in terms of frequency, criticality, complexity), and details of the steps necessary to accomplish them.

2.       Establishing Training Objectives
According to the general training literature, the needs assessment provides the information to establish the objectives of the training program. These are stated as observable behaviors expected of the trainee after the instruction, and they may acknowledge the conditions under which they should be performed and the required level of proficiency.

3.       Specifying Training Content and Media
According to the general training literature, content represents the knowledge or skill that the trainee must master to be able to meet the behavioral objectives. The judgement of those who know the job demands is the most common approach to specifying training contents. Other approaches may be the products of problem-solving exercises, or be based on mistakes people make in using a skill such as to design corrective learning measures. Evidence that one teaching method such as lectures, televised instruction, computer-aided instruction, or interactive video methods is superior to another is not that clear (Kearsley, 1991). Much depends on the specific training needs, makeup of trainee group and other factors. Why or how a particular method facilitates learning and how it can be made more effective are issues requiring further study.

4.       Accounting for Individual Differences
According to the general literature, effective training should take account of the characteristics or attributes of the trainees. Aside from differences in aptitude, literacy, or pretraining skill levels, how trainees view the training program in terms of improving their job performance or self-efficacy may dictate variable approaches. The kind and level of training for new job applicants versus long-term or older workers reassigned to the same tasks also has to be addressed.

5.       Specifying Learning Conditions
In general, instructional events comprising the training method should not inhibit, conflict with, or be unrelated to the processes that lead to mastery. If the learning is to develop capabilities in problem-solving techniques, the instructional approach should stress thinking/reasoning approaches not rote memorization. Training methods should require the trainee to use the training content in active or productive ways, e.g., restating or applying principles rather than just recalling them, or adapting the information to new situations rather than mere repetition in the same one. The current literature suggests that using learning events that require productive behavior or that provide appropriate feedback (positive/accurate/credible) and opportunities for practice under conditions that promote transfer to the actual job are ideal.

6.       Evaluating Training
According to Kirkpatrick (1967), training evaluations in the general literature can take four forms which are viewed as a series of steps or levels. They are:

Step #1: Reaction—How did the trainees like the program? Typically this is done through evaluation sheets completed at the end of the training. Typical items inquire as to whether the material was well organized, relevant to the trainees needs, made interesting through the instructor's manner of presentation or use of visual aids, demonstrations, etc.

Step #2: Knowledge Gain (or Skills Acquired)—What principles, facts and techniques were learned? Knowledge of facts and principles is usually evaluated via pre/post paper-and-pencil tests or quizzes. Assessment of skills may be done through performance tests before and after training. An untrained or control group can be similarly tested to indicate any differences resulting from just the test-retest experience

Step #3: Behavior Change—What changes in behavior occurred as a result of the program? For this purpose, reports by the trainees themselves (self-appraisals) of their on-the-job performance, or observations by their peers, supervisors, instructors can be used. A time interval between the end of training and the observations may be necessary to allow for the training to be put into practice. Post-training measures taken at different time points are also suggested to determine if the training effect is sustained or needs refreshment. Again similar observations for a control group are recommended to acknowledge any effects from repeated testing. These control data also provide an added reference for gauging the significance of the apparent behavior changes in the training group.

Step #4: Results—What were the tangible results of the program in terms of its objectives or goals for the organization? Did it result in reduced injuries or illness, lower medical costs, improved productivity? As noted in Figure 1, extra- or post-training factors can affect these types of outcomes, and it is not always possible to design evaluations that can isolate the specific training contribution. Undertaking evaluations where these "extra-training factors" are held constant during the pre-and post stages of the training assessment or can be segregated as to their influence through use of suitable control groups are ideal. Needless to say, training impacts at the organization level can require an extended time line especially in using injury/illness outcomes owing to their infrequency.

Criteria for rating training effects are the focus of much discussion in the literature. Several points that deserve mention or added emphasis in light of the subject of this report are:

(1) Past surveys have shown that most in-house assessments of training programs measure only trainee reactions of how well they liked the instruction (Smeltzer, 1979; Smith, 1980; Parker, 1984, Alliger & Janak, 1989). Efforts to determine the extent to which the training content was absorbed or resulted in changes in actual on-the-job behaviors, or had impacts on organizational measures (e.g., quantity/quality of production, sales, absences/turnover, injury/illness rates) were rarer. Among reasons offered for the lack of more intensive efforts at evaluating training were the unquestioned beliefs that training works, that workplace conditions do not readily lend themselves to systematic assessments of training, and that more rigorous attempts will entail high costs. Increasingly, however, there is the call for more extensive training evaluations to verify the benefits as witness this exercise (Blomberg, et al., 1988).

(2) Reinforcing the above statement, trainee reactions to instruction may bear little relationship to the extent of actual learning. (Liking the instruction does not imply learning). Hence, it should not be used as the sole criterion to gauge effectiveness. Similarly, pre- and post-training quizzes or tests of skill showing the gains from instruction may or may not be related to improved on-the-job performance. Needs for multiple measures of effectiveness are apparent.

(3) As already noted in Figure 1, the effect of training is greatly affected by other workplace factors both in the training and post-training environment. Evaluations will need to account for these factors in terms of their influence on the training outcome.

(4) Simple performance outcome measures representing various levels of achievement may be critical to determining the validity of the instruction but may not indicate the factors that influenced these results. Provision of "process" measures, reflecting various amounts of training time, modes of training, trainer attitude/competency, can indicate why the overall results were or were not achieved. This can be important in efforts to revise the training to improve its efficacy.

7.       Revising the Training
The evaluation of training as noted by Goldstein and Buxton (1982) offers information as to whether the instruction has had its intended effect on the measures set out for that purpose. Seldom do the data indicate a program was a complete success or a failure, given multiple criteria for gauging the results. Rather, the data may indicate better understanding, retention or application of some course material as compared with others. Gaps or variations in knowledge or competencies resulting from the training may reflect needs to consider more training time, alternative instructional techniques, or more capable instructors.

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V

Occupational Safety and Health Training Rules as
Found in Current Workplace Standards

A. Nature of Existing OSHA Training Rules

Because of the agency's hazard-by-hazard approach to rule-making, OSHA training requirements in current safety and health standards number in the hundreds and vary greatly in nature. In 1992, OSHA excerpted and collected the various training provisions into a single report to ease the difficulty in locating them in the different standards. OSHA also contracted for a second report to identify and classify their common elements (Meridian Research, 1993). Underlying the latter effort is the thought of developing a stand-alone generic training standard offering possibilities for portraying the existing rules in a more integrated and easier-to-follow format. But this categorization aside, excerpts of the training requirements listed in the OSHA 1992 report show the wide variation in the manner and detail of the applicable training requirements - requirements befitting differences in the scope and complexity of the conditions addressed by the standards. The discussion below elaborates on the variable nature of the training rules with regard to factors such as content, frequency/duration, documentation/assurance, trainer qualifications, and methods used.

1.       Content

A number of standards are quite explicit about what safe practices should be taught. Training rules for pulpwood logging and materials handling operations are of this nature. For example, the pulpwood logging standard lists the details of chainsaw instruction. A sample item: "Chainsaw operators shall be instructed to start the saw at least 10 feet away from the fueling area" (29 CFR 1910.266(c)(5)(v)).¹ Similar exposition occurs in a materials handling standard dealing with the servicing of single rim wheels. In this case the instruction must cover safe work practices so as to ensure ". . . that tires shall be completely deflated by removal of the valve core before demounting; mounting and demounting of the tire shall only be done from the narrow ledge side of the wheel; tires shall not be inflated when any flat solid surface is in the trajectory and within one foot of the sidewall" (29 CFR 1910.177(g)(1)(2)(7). In contrast, other standards are more general as to the content of the training. For example, the powered industrial truck standard states: "Only trained and authorized operators shall be permitted to operate a powered industrial truck. Methods shall be devised to train operators in the safe operation of powered industrial trucks" (29 CFR 1910.178). Nothing more is specified. Still other standards acknowledge topics to be covered (e.g., recognition of hazardous conditions, risk factors and potential outcomes, needs for and means for hazard control) but do not go further, thus leaving the specific content up to the employer.

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¹ Excerpts of the training standards cited in Chapter V are taken from the OSHA (1992) report. More complete statements are found in Collert (1996).

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2.       Frequency/Duration

Standards covering exposures to toxic agents dictate that employees receive training before an initial job placement and repeat training on some periodic basis. Reflecting more explicit requirements, the Hazardous Waste Operations and Emergency Standard (29 CFR 1910.120(e)) indicates minimum durations for initial training offsite and supervised onsite instruction plus yearly refresher training. At the other extreme, a number of standards make no reference either to the duration of required training or to the need for repeat or follow-up instruction.

3.       Documentation/Assurance

Certain standards require evidence of a formal training plan or training materials, or both as well as written documents certifying successful completion of the necessary training. The standards covering powered platform operations (29 CFR 1910.66) and hazardous waste operations and emergency response (29 CFR 1910.120) contain such provisions. So too do various standards governing exposures to toxic chemicals and harmful dusts. The regulation on asbestos abatement work first drafted by the Environmental Protection Agency and adopted by OSHA (29 CFR 1915 1001(k)(9)) even requires written examinations of the trainees and attainment of a minimum score to assure competency. The language in most other standards is less specific about either the needs for a formalized program, records of employee participation or achievement. A number of standards indicate that employees shall demonstrate proficiency following instruction but do not actually require certification.

4.       Trainer Qualifications and Specialty Training

Some standards indicate teaching requirements for those slated to instruct employees or stipulate tasks to be undertaken by competent persons. Competent persons are defined as those having acquired necessary skills by virtue of attending training schools, holding academic degrees, or possessing specialty experience. Related to this point, the hazardous waste operations and emergency response standard acknowledges separate training requirements for waste site workers versus those having management or supervisor roles. The revised OSHA asbestos standard mentioned above (29 CFR 1915.1001(k)(9)) dictates different training for asbestos abatement workers, supervisors, inspectors, management planners, and project designers.

5.       Methods

With few exceptions, current standards do not dictate methods to be used in meeting the required training objectives. One standard on powered platform operations (29 CFR 1910.66)) mentions that pictorial methods can be used instead of written work procedures in the training activity. Several others stipulate a portion of the training time to be a "hands-on" learning experience. More generally, however, the "how to" of training is left to the discretion of the employer.

Foreign Occupational Safety and Health Training Rules

Heath in a series of four papers (1982(a), 1982(b), 1982(c), 1982(d) summarized OS&H training as practiced in six industrialized western nations which included Canada, Great Britain, Federal Republic of Germany, Sweden, France and the U.S.. Like the U.S., legislation requiring employers to provide information and instruction on workplace risks were also found in the other five countries. There was much similarity too in how rules on training content and informational materials pertaining to use of equipment, exposures to agents were developed by governmental agencies with inputs from health and safety professionals, trade associations, union and insurance groups. Heath noted two major differences between the U.S. and the other countries in the rule-making area. One was that foreign country legislation was far more precise than that in the U.S. in designating who was responsible for carrying out the training requirements in a work establishment. An excerpt from one country reads: "Every employer shall ensure the adequate direction and instruction of workers in the safe performance of their duties. Every supervisor shall be responsible for the proper instruction of workers under his direction or control and for ensuring that the work is performed without undue risk." (cited in Heath 1982(a), pg. 8). Second, the U.S. was the lone country providing central government funding to support job safety and health training programs. In the foreign countries, this burden was assumed by employers, insurance companies, private safety and health organizations. But more pertinent to the subject of this literature review, Heath found that the evidence in these countries to show that training was an effective countermeasure to reducing worksite injury and illness ranged from poor to nonexistent (Heath, 1982(b)).

B. OSHA Voluntary Training Guidelines

In the matter of how best to implement required training, OSHA has training guidelines to assist employers in furnishing safety and health information and instruction to workers (OSHA, 1988a). The guidelines are voluntary and are meant to enhance or supplement other employer training activities. Tailoring their application to meet individual worksite needs or local working conditions is encouraged.

The OSHA voluntary training guidelines follow a model whose elements reiterate most of those in the general job training literature reviewed earlier. The seven guidelines below makes this readily apparent.

1.       Determining If Training Is Needed

Are the needs for hazard control more readily solvable by training, i.e., increased knowledge of a work process or adoption of safe work practices as opposed to engineering or physical control alternatives?

2.       Identifying Training Needs

Job hazard analyses plus examinations of company health/safety records and worker perceptions of job risks are suggested as means for identifying what training is needed and where improvements can be made in hazard control. Obviously, reference to applicable federal/state standards will also shape the training content.

3.       Identifying Goals and Objectives

The OSHA guidelines call for identifying what the instruction is intended to achieve and defining evidence for it being met in explicit, observable terms. OSHA indicates that a specific objective (e.g., "An employee will be able to describe how a respirator works, how to ensure an effective fitting, and when it should be used" ) is preferable to a vague goal (e.g., "The employee will understand the use of a respirator")(Pg. 5, OSHA, 1992).

4.       Developing Learning Activities

The OSHA guidelines suggest learning activities be aimed at well-defined objectives and in substance take account of mental and/or physical skill factors as may be required to meet specified needs. The actual content or coverage of topics may be dictated by OSHA regulations. Instruction that employs task sequences and situations to simulate the actual job conditions are suggested to ensure the transfer of this training to the work situation. Like the general training literature, the OSHA guidelines acknowledge that training materials and techniques can vary; the important point is that the activities allow the employees to demonstrate that they have acquired the desired knowledge.

5.       Conducting the Training

This OSHA guideline, like the one in the general training literature, stresses the need for an instructional format that invites worker inputs into the training process, and provides for hands-on experiences and exercises promoting active learning. It also makes reference to other means of motivating and maintaining worker interest. Relating the training to their current skill levels and experiences and emphasizing the benefits (increased worker knowledge and skills, more marketable attributes as an employee who is informed and safety conscious) are among the ideas offered.

6.       Evaluating Program Effectiveness

Each program should determine whether the training has accomplished its goal. Trainee opinions, supervisor observations and workplace improvements resulting in reduced injury or illness are among the means recognized for this purpose. As already mentioned, incidents of illness/injuries for rating the impact of OS&H training programs or other intervention activities are such rare events that surrogate measures may be needed. Frequencies of "near miss" incidents, evidence of reduced exposure levels to a hazard, measures of compliance with safe work practices offer possibilities. Also, reduced injury and disease as outcomes of training would have to account for other factors as well. (See Figure 1).

7.       Improving the Program

If the evaluation proved that the training was deficient, efforts to revise aspects of the training or to offer periodic retraining may be in order. Repeating the steps in the training model may help determine where course revision is needed.

The OSHA voluntary training guidelines also contain suggestions for identifying those workers who may be at higher levels of risk and thus have the greatest need for training. Occupations posing known exposure hazards or otherwise shown to be associated with excess injury/illness are one determinant. The age and job service of the worker group in question can be another. (Young, new workers show a disproportionate number of injuries and illnesses.) Still another may be the size of the establishment. (Though the pattern may vary with industry, medium size companies (50 to 249 workers) tend to have higher incident rates than the rates for smaller or larger firms (Bureau of Labor Statistics, 1997).

C. Summary

Upon reflection, the following points summarize the current state of affairs regarding the regulatory language covering training in most OSHA standards.
(1) Requirements appear fragmented without a sense of a whole plan. Steps to realize training objectives are rarely given. (As the OSHA voluntary training guidelines are a recent development, older standards lacked for an adequate frame of reference). The most detailed requirements for training are found in the Hazardous Waste Operations and Emergency Response standard (1910.120) and the OSHA adoption of the EPA asbestos abatement work rule (40 CFR 763(e)Appendix (C). These provisions may be a prototype for addressing training needs in future rule formulations.
(2) Without explicit requirements for a plan embodying more of the elements to meet the training objectives cited in the standards, employers may opt for minimal efforts whose results are marginal at best.
(3) Perhaps most critical is the need to ascertain whether the OSHA voluntary plan has merit. Reports of field efforts to implement various aspects of the guidelines and the resultant indications of success or failure in terms of impacting workplace safety/health problems can offer evidence. Further, a review and analyses of this work could define factors that would realize the training objectives and improve safety/health outcomes. The balance of this review is devoted to this task.

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VI

VI. Data on Effectiveness of Occupational
Safety/Health Training

A. Nature of the Literature review

This review sought empirical information relevant to assessing whether OS&H training as dictated by OSHA standards had any beneficial effects in reducing the risk of work related injury and illness, and factors that were especially critical to successful training efforts. Specifically, the following types of documentation were sought:
(1) Reports of studies where training interventions were used for purposes of reducing apparent worker risks of workplace injury or disease and evaluative data obtained to indicate their significance. References took account of training programs undertaken at specific jobsites, laboratory studies with training simulators, and efforts to implement OSHA training rules by user/affected groups (i.e., unions/trades organizations) and indications of results.
(2) Surveys or investigative reports offering data on training (or the lack thereof), as well as other factors contributing to work related injuries, fatalities, and health problems.
(3) Reports on occupational safety and health program practices for employers having exemplary safety/health performance to isolate training factors that may have contributed to their success.
(4) Other studies in the education/learning field or ancillary areas that deal with issues especially pertinent to effective OS&H training.

Regarding items (1) and (4) above, the literature review was confined to those reports that described training plans and objectives, manner of implementation, methods for evaluation, and data/results reflecting effectiveness. Articles offering testimonials to various training approaches, or anecdotal references were not considered. Item (2) dealt with results from questionnaire surveys of persons having certain types of work injuries and investigative reports of workplace incidents where workers were injured, killed or found to exhibit health problems. The intent in both cases was to examine any references to training in appreciating why and how the injury producing event or health problems occurred. Item (3) sought analytical information on company program practices, especially aspects of worker training that were relatable to their success in hazard control.

B. Data Sources Tapped

The search strategy made use of NIOSHTIC, the National Institute for Occupational Safety and Health database which covers a broad range of OS&H literature, plus other on-line computerized reference systems and abstract listings for specialty areas available through DIALOGUE Information Services and the National Institute of Medicine MEDLARS system. Searches for relevant citations in specialty areas tapped databases in applied psychology (e.g., PsychScan, PsychINFO), education (e.g., ERIC), social science (e.g., Social Scisearch), health planning and administration (e.g., HEALTH/MEDLARS), trade/industry/occupation issues (e.g., AGRICOLA, Trade & Industry ASAP), specific occupational health topics/problems (e.g., CANCERLIT, TOXLINE, TOXLIT), among others.

A total of 25 different reference systems were scanned in the course of searching for documentation. The uniqueness of the indexing systems used with the various information sources coupled with the multidisciplinary nature and use of training concepts made a single list of keywords for searching impractical. In many instances, a customized list of database specific terms made up of a root or common word in combination with free-text search terms having proximal connection to the keyword had to be devised for the search. Some sample terms for one database (MEDLARS) included program-evaluation, risk-management, attitude-to-health, evaluation-studies, dangerous-behavior, inservice-training, patient compliance. Searches for titles through the various databases were conducted while constantly varying the mix of keywords and free-text in essentially a round-robin fashion. This yielded a listing of over 2000 citations which after deleting duplicates, eliminating false hits, was reduced to approximately 700 titles. Abstracts and references to these reports in other reviews found less than 150 to meet one of the four selection requirements noted earlier. The literature base for this review was the product of two searches. The one just described was concluded in 1993 and included reports published no later than that year. A second, subsequent search extended coverage through 1996 and yielded 188 additional titles. Screening abstracts of these reports found no more than 15 to be worthy of further consideration with regard to the purposes of this review.

The references drawn from the two search efforts were mostly from the period 1980 to 1996, though supplemented in some cases by earlier studies believed cogent to training evaluation issues. Final selection ensured representation in five different hazard agent categories which were:

•  Injury-producing forces,
•  Toxic chemicals or materials,
•  Harmful physical agents,
•  Ergonomic stressors,
•  Biologic/infectious agents.


The 5 agent conditions were chosen to reflect work related exposure risks recognized in various ways by current OSHA standards or those under development. (NOTE: Ergonomic agents were included in the data set in light of OSHA plans to develop a standard for controlling work related risks of musculoskeletal disorders (OSHA, 1992).

C. Training Intervention Studies

1.       Data Set and General Observations
APPENDIX A to this report summarizes 80 studies in which training, in whole or part, constituted an intervention effort aimed at hazard control. For this reason, these reports are viewed as offering the pivotal data to this assessment exercise. The studies are classified by five different agent/hazard conditions, namely, injury-producing hazards, chemical agent hazards, physical agent hazards, ergonomic agent hazards, and biologic agent hazards.

To varying degrees, the listed reports met the requirements stated above in describing training objectives, some form of training, efforts at implementation, and data collection on certain measures to evaluate the results of the instruction. Where noted extra-training factors of consequence to the evaluation are also entered in the listing. Although the 80 reports do not exhaust the available literature, they represent a large and diverse sample of empirical work which offers the reader a sense of the types of training efforts that have been conducted in addressing workplace hazards, the approaches used in their evaluation, and the results obtained.

Some overall impressions can be gained from viewing Tables 1 and 2 whose entries are culled from the studies listed in APPENDIX A.²

Table 1 tallies the evaluative measures found in the various training intervention studies using a modified version of Kirkpatrick's (1967) classification and the results reported on the measures. Specifically, under the heading of "Subjective/Self-Reports" are columns for "Reaction" (measures of whether the trainee thought the training interesting, worthwhile or relevant); "Knowledge Test" (scores on a quiz or other inquiry to determine their knowledge gain); and "Application" (reports from the trainees that they have changed their work practices as a result of the training or applied the learning in some other way). The heading "Objective/Surrogates" refers to more independent indicators, listing direct observations of "behavior change" or "other markers" (biological, environmental) that can be a product of the behavior changes. Positive changes from training on either of these measures can serve as surrogates for improved health/safety outcomes. The last columns of the table refer to actual measures of safety/health experience reflecting the organizational impact of the training. Note that some studies used more than one evaluative measure so the total number of entries in Table 1 exceeds the 80 reports.

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² Where the text cites a study summarized in APPENDIX A, the notation (A-I, A-II, A-III, A-IV, or A-V) in bold will appear with the author(s) name(s), year citation to aid the reader in locating the material by section. Specifically, Roman numerals indicate the reference by hazard section: A-I=Injury; A-II= Chemical; A-III= Physical; A-IV= Ergonomic; and A-V= Biologic, and the entries found therein are listed alphabetically by senior author. Example: The work cited as Komaki, Heinzman & Lawson, 1980 [A-I] is listed in APPENDIX A in the Injury section under Komaki.

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Table 1: Nature of Evaluative Measure Used in Training Interventions and Effects Reported

Table 2 collates the studies in terms of key elements of the methodology employed and related factors in the interventions. The headings and descriptor terms found therein require some explanation. Under "Basic Design" are entries defining whether the data collection for assessment involved only post-training measures on trainees (Post Test), or comparisons between pre- and post-training measures on a trainee group (Pre/Post), or repeated measures on a trainee group before, during and after training referred to as a time series design (TimeSer). In none of these instances was an untrained or control group compared with those receiving the training. The remaining designs did so: One form comparing post-test measures on a trained group versus a non-trained control group (Post/Ctr); another before and after training measures for a trained group compared with similar measures for a non-trained group (Pre/Post/Ctr); and last, a multiple baseline method (MultBsl) where repeated measures were taken on different groups before, during and after training and upon the introduction of other factors which may influence the training outcome. Through staggering the schedule of treatments, the latter method enabled the measures on one group to serve as an added control for measuring training plus other factors affecting other groups.

The training target column in Table 2 uses the OTA categorization (1985) for defining the objectives of the study. As noted earlier, these were defined as learning fundamental work practices (FndtWkPract), training in hazard recognition-awareness (HazRecog), worker directed or participative efforts in hazard recognition and control (WkrPartic), and worker empowerment training for the same purpose (WkrEmpwr). The variables column describes the nature of the training conditions and/or other factors manipulated during training or in the follow-on evaluation. Those noted refer to training only (TrngOnly); feedback (FdBk) with and without goal setting (GlSet); use of incentives (Trng&Incentives); and where the training plan called for specific manipulations of training content/delivery variables (TrngMode).

The post-training measures column takes note of the frequency and time span of the data collected on the evaluative measures. The basic categories were short- versus long-term (ShTm, LgTm), and whether the data were collected one or more times (One, Rep). Long-term (LgTm) refers to a post-training period exceeding 3 months,

The last column, headed "Other Considerations", identifies other conditions described in the studies that deserved special mention in light of their likely effect on the results. Nature of management support, workplace constraints or aids to facilitating the training or its application in the post-training environment were among the factors noted.

The following observations elaborate upon the summary data contained in
Tables 1 and 2:

(1) First and foremost, the number of entries indicating a positive effect attributed to the training or training plus other factors in the intervention is near overwhelming. In Table 1, 119 of 138 entries show a positive change from the training or instructional effort on the measures indicated and 10 others show partial success. In only nine cases do the findings display no effect which includes one that sought to convey safety instructions to workers via slogans in an informational campaign (Saarela, Saari & Alltonen, 1989 [A-I]). Admittedly, one could question whether this was a true training effort. Since the bulk of reports come from scientific journals, it could be alleged that these impressive results supporting a training effect could be a product of a bias toward publishing work showing positive findings. The consistency of the findings, however, given fairly similar training approaches for addressing the same or different agent hazards, is reassuring as is the fact that other types of reports (government documents, thesis studies) yield similar results.


(2) As displayed in Table 1, for the few cases where training plans failed to yield positive results or achieved only partial success, most occurred in the ergonomic agent category. Training interventions for back injury prevention are primarily responsible for this result which is not surprising given the complex etiology of back disorders, lingering questions as to what constitutes safe lifting positions, and apparent constraints posed by workplace conditions to using learned lifting techniques. Studies by Carlton (1987 [A-IV]) and Scholey (1983 [A-IV]) in particular illustrate how situational factors can complicate the transfer of safe lifting instruction. In Carlton's study, for example, kitchen workers in training sessions held away from their jobsites, learned and demonstrated ways for lifting trays that imposed less strain on the low back. Subsequent observations found that these types of lifts could not be performed in their work areas because the layout and obstacles made them assume awkward postures in handling loads of trays and the work pace precluded time to follow through on the acts required for risk reduction. Scholey reported that nurses could not transfer methods learned to ease the burden imposed in patient handling/lifting tasks because some patients refused to cooperate in moving to the edge of the bed or chair to facilitate the move. But even with these difficulties, the ergonomics agent category also shows some of the more substantial reductions in the frequency and cost of work related injuries reported as outcomes from training. Illustrative are reports of Hilyer et al., (1990 [A-IV]); McKenzie et al., (1985 [A-IV]); Schwartz (1987 [A-IV]) and Lepore, Olson & Tomer (1984 [A-IV]). As noted in Table 2 and APPENDIX A, because these studies did include ergonomic enhancements (i.e., improved workstation layout, tool redesign) along with training as part of the intervention, it is difficult to determine the specific training effect on these measures.

(3) Self-reports, especially knowledge gain and expressions of use in jobs, and objective behavioral measures predominate as outcome indicators in the training interventions. Positive findings of behavioral change from training such as adoption of safe work practices were in a number of instances coupled with reductions in injury, illness, and lost-days cost figures. Although suggestive, the reader is cautioned not to draw conclusions about a training specific effect on the latter indicators. One reason is that the instruction may have focussed on select (high risk) groups whereas the injury reports are for the whole organization. (Work reported by Lepore, Olson & Tomer, 1984 [A-IV] is an example). Some studies lacked proper control groups to rule out other factors that may have been responsible for the result on these types of outcome measures. Also, as one report notes (Reber & Wallin, 1984 [A-I]}), the findings may reflect changes in the manner of reporting mishaps during the intervention period. One deliberate effort to tie successful training outcomes such as improved work practices with reduced injury rates found that the adoption of the recommended work practices could only account for 25% of the actual reduction (Saari & Nasanen, 1989 [A-I]). In this study, worker training focussed on correcting housekeeping conditions believed responsible for an excess number of injuries based on accident reports. Post training observations indicated reduced injury rates far greater than those that could be accounted for by increased compliance with the better housekeeping practices also observed. The authors speculated that the gains in housekeeping left increased capacity for workers to notice other potential hazards. Another effort (Sulzer-Azaroff et al., 1990 [A-I]) suggested that attaining certain targeted safe work practices was responsible for reductions in lost-time injuries but furnished no definitive analysis to show an actual cause-effect relationship.

(4) As noted in Table 2, the work settings/occupational groups as training targets for the intervention studies were diverse. Most major industry categories are represented by the entries- agriculture, mining, construction, manufacturing, transportation, public services. Some entries are in several agent categories owing to the variety of hazards encountered in such work environs. As examples, there are reports of training interventions for health care workers (public services) at risk to injury, ergonomic and biologic hazards; metal fabricators (manufacturing) at risk to injury, chemical, ergonomic and physical agent hazards; warehousemen (transportation) at risk to injury and ergonomic hazards, etc. Employing the OTA classification of training emphases, most of the intervention work reported here is directed to learning fundamental work practices, but the more recent reports show worker empowerment approaches to be popular as well. This is especially true in hazardous waste site training where labor groups in concert with universities are conducting such activities. (Examples are McQuiston et al., 1994 [A-II]; Luskin et al., 1992 [A-II]; Cole and Brown, 1996 [A-II]). Hazard recognition training is also noted as are efforts at worker participation in problem solving. A one-mode training approach has been used in most studies with pre/post types of evaluations performed on the trainee group to assess the effects. Actual training objectives and training approaches, however, are much more varied than this summary would suggest. For example, fundamental type training objectives range from appreciating the more typical safeguards, e.g., use of personal protective equipment, proper operation of machines, housekeeping needs in factory environments, to the more exotic techniques such as defusing potentially violent patients in a mental hospital. The training methods also depict an assortment of approaches-classroom lecture, on-the-job instruction, audio-visual techniques, simulators, demonstrations/role play- with sessions of varying length and frequency. (See APPENDIX A for details.) This wide array of training situations and conditions combined with the positive results underscores the versatility of the learning process. At the same time, it invites efforts to examine whether some factors or factor combinations are more critical than others to attaining successful training outcomes.

2.       Intervention Data on OSHA Training Requirements/Guidelines

Ideally, to answer the question of whether OSHA training rules and guidelines have the intended benefit of reducing work related injury or disease, available documentation should offer evidence of:
(1) Training objectives presumably keyed to meeting the requirements of a specified OSHA standard.
(2) A training plan following the training guidelines mentioned earlier that can be reasonably implemented.
(3) A sound evaluation strategy that relates attainments of the training objectives to improved safety/health outcomes.
(4) Evaluative data reflecting increased knowledge/skills in hazard recognition and preventive measures, or commensurate worker actions resulting in reduced worker injuries or illnesses, or both.

The intervention studies reported in APPENDIX A and summarized above, though representing deliberate efforts to use training for hazard control purposes, provide only approximations to the ideal. Key limitations are:

Training Objectives: Many of the reports show training to be successful in improving protective actions or reducing a potentially hazardous condition but reference no particular OSHA standard or requirement pertaining to the situation posing a problem. Indeed, much of the work has been conducted by researchers who seek opportune targets for training that can yield results within a reasonably short time frame. Thus, positive results from training in these cases may or may not be considered as cogent support for any OSHA mandated rule. But having said this, the training plan in many reports does follow the OSHA guidelines in using a hazard analysis or injury reports to target the training needs and objectives, and in undertaking other steps for putting the plan in place. In this regard, the training effort may even be more relevant to the conditions under study. Perhaps OSHA rulemaking language calling for a training plan that defines and addresses site specific needs as opposed to one that dictates what they are a priori is worthy of discussion.

Training Effects/Outcome Measures: Whether the positive training effects reported such as knowledge gained, self-reports and/or actual observations of compliance with safe work practices can account for the reduced accidents, injury and lost days reported in several studies remain debatable. As already mentioned, the presence of other forms of hazard control introduced with training and uncertainties surrounding the basis for the accident/injury statistics argue against any such conclusions. Assessing the effects of training to reduce the risk of work-related chronic disease is even more problematic because of the long latency period needed to observe these kinds of outcomes. The reports on training plans undertaken in response to the OSHA foundry and coke standard show benefits in terms of increased worker knowledge of hazards and their professing greater adherence to safe work practices and protective behaviors (e.g., Parkinson et al., 1989 [A-II]). Although plausible, evidence that these training benefits have or will result in reduced lung/cancer diseases or other occupational illnesses for these work groups may require 10 or more years of surveillance. Similarly, it is too soon to say whether hazardous waste site workers and emergency responders who report that they were better able to manage chemical spills after taking required OSHA training (McQuiston et al., 1994 [A-II]) will also show fewer cases of diseases owing to better control of the exposure hazards.

Evaluation Design: In almost half of the reported studies, training effects were determined by evaluations of post-training measures for a given group or through pre- and post-training differences or comparisons before, during, and after training again on the same group. Since many of the interventions took the form of research projects, there is no way of separating out elements of novelty and researcher effects, which could have influenced the outcomes in these subject groups apart from any training effect. Some studies used comparable but untrained groups as ways to control these kinds of factors. Still, as noted in Table 2, other factors were present during the course of the evaluation, factors whose effects could not be accounted for in the results reported. In this regard, a variety of management actions were noted that deserve particular mention. For example, in one set of studies, they played roles in reinforcing and sustaining the learned behaviors (e.g., Zohar & Fussfeld, 1981 [A-III]). In other cases, supervisors were themselves the trainees and used to spearhead and effect the hazard control practices subject to evaluation (McKenzie et al., 1985 [A-IV]; Maples et al., 1982 [A-II]). As part of the training effort reported in other studies, supervisors were directed to increase their surveillance (Millican et al., 1981 [A-III]), or consider staff compliance in performance evaluations (Lynch et al.,1990 [A-V]). In still other reports, the authors indicate management's indifference to the training objectives (Fox & Sulzer-Azaroff, 1987 [A-I]). Being linked with management, these actions and other more subtle ones probably had profound effects on the evaluations which could not be sorted out because of the lack of suitable control groups or other confounding conditions.

There were other design weaknesses as well. Table 2 shows that more than half of the studies measured post-training effects less than 3 months after the instruction ended or only once after a longer interval of time. Thus, questions as to the durability of the reported effects, or possible intervening events affecting the longer term measures can be raised. Several studies did consider these issues with the results being somewhat gratifying (Zohar, Cohen & Azar, 1980 [A-III]; Hopkins 1983 [A-II]). In a few cases the subject groups were too small to make generalizable conclusions, and others assigned workers to training conditions on a non-random basis which could question the representativeness of the findings. Nevertheless, the sheer number of positive results found in so many different settings suggests that training effects are real even though the appraisals do not meet the more rigorous scientific standards.

Practicality Considerations: Given the success of the many intervention efforts noted in this report, there is the issue of whether the training plans under evaluation would be doable as a general practice at the worksite. The techniques employed in some studies to effect success were most elaborate. One example was the University of Kansas work (1982 [A-II]) in defining fundamental safe work practices and housekeeping measures as training objectives, and proceeding through formal instruction, practice trials plus incentives to establish worker compliance. But in targeting similar needs, the training plans in other reports seem almost incidental, confined to a brief session or two to define safe and unsafe practices. Having workers establish goals for conformance with safe practices when at the jobsite and provide feedback as to progress being made to the workers appear to be the more critical elements in the success of this approach. Studies by Reber & Wallin (1984 [A-II]), Fox & Sulzer-Azaroff (1987 [A-I]), Komaki, Barwick & Scott (1978 [A-I]) offer such examples as does an extensive review by Sulzer-Azaroff, Harris and McCann (1994). Provisions for goal setting and feedback as part of worksite training would not appear to be that formidable. Reports of training beyond learning fundamental work practices accent worker participation, active learning-type experiences using problem-solving exercises or other forms of instruction that show cogency to conditions found at one's workplace. In this regard, the merits of a learner-centered plan to address safety and health problems along with learning experiences that promote worker activism to effect improvements at their worksites have become emphasized. And, indeed, first results from evaluating this approach in hazardous waste site training programs appear promising [McQuiston et al., 1994 [A-II], Luskin et al., 1992 [A-II]; Cole & Brown, 1996 [A-II]). However, these findings are based on self-reports and thus have some limitation. Feasibility problems have also been noted. For example, needs to cover the subject matter of the course as well as to infuse empowerment ideas within usual time periods allotted to training mean that some topics get little treatment (Luskin et al., 1992 [A-II]). Another problem is the growing diversity of the workforce; this imposes added challenges in training approaches which stress worker inputs, group discussions and shared experiences. Cultural/language differences, among other factors, may be inhibiting (Cole & Brown, 1996 [A-II]). Two intervention studies reported in this review suggest ways for accommodating to language differences (Barnett et al., 1984 [A-II]; Weinger & Lyons, 1992 [A-II]). But perhaps the more important point is that training programs must be flexible in order to adapt methods and expectations to different working conditions and worker groups.

In summary, evidence for the effectiveness of OS&H training based upon the intervention studies reviewed above suggest the following observations:

(1) Taken as a whole, there is substantial documentation showing how training can meet objectives of knowledge gain, behavior change for improving worker health and safety. Reductions in work injuries and medical costs may also be noted in conjunction with these changes but evidence to show actual linkage or dependency remains to be ascertained.

(2) Because the intervention work does not address specific OSHA rules, the merits of specific training requirements can't be judged. On the other hand, the literature illustrates the benefits of training in meeting a variety of site-specific health and safety needs and objectives.

(3) Successful training outcomes in enhancing worker knowledge and control of workplace hazards and conformance with safe work practices depend greatly on extra-training or post-training environmental factors. Included in the latter are management's role/actions in favoring conditions which enable the knowledge gained from training or learned behaviors to be readily transferred to the jobsite. A proposed safety and health program standard as currently drafted by OSHA (OSHA, 1996) recognizes the merit of using a systematic approach to workplace safety and health. In doing so, management actions aimed at reinforcing training objectives along with other elements are duly noted.

The intervention literature on training in OS&H appears to be a collection of demonstration studies, some stronger in design than others in making a case for the benefits of a training approach (or in a few instances its shortcomings). As noted, more definitive analyses are needed to show how the outcomes of training relate to observed changes in injury or illness incidence. Also, and to be mentioned in a later section, certain factors critical to the learning process and post-training results, such as the length and frequency of the instruction, remain to be addressed in a more systematic way.

Even with all of the above uncertainties and qualifications, the array of evidence showing training-type interventions to effect positive changes in workplace safety and health remains formidable. Clearly, OS&H training can make a difference in reducing risks from workplace hazards. Rather than debate the issue of whether training is worthwhile, it would appear far more productive to determine what training procedures and related considerations are most crucial to optimizing its effects. Further support for this position comes from reviewing other sources of data bearing on the role of workplace training which are described below.

D. Training Data from Studies on Afflicted Workers

1.       Bureau of Labor Statistics Work Injury Reports
A second level of information pertinent to answering questions about the value of job safety and health training may be derived from worker injury record data or investigations of occupational accidents resulting in injury or fatalities. Indications that significant numbers of those affected didn't recognize hazards or lacked for knowledge of fundamental safe work practices could suggest training shortcomings as a factor in the occurrences. During the years 1978 to 1990, the Bureau of Labor Statistics conducted 20 surveys of workers injured on the job. The surveys focussed on specific injuries and/or on those resulting from high risk job operations. The workers sampled were drawn from workmens' compensation cases in 26 states where awards were made during select reporting periods for the injuries in question.

Using mail questionnaires, information was gathered on demographic factors, working conditions at the time of the injury event, use of personal protective equipment and extent or nature of safety training.

APPENDIX B describes the survey samples and includes extracts of the findings from 19 of 20 BLS survey reports reflecting worker responses to questions dealing with training issues. (One of the BLS reports [falls on stairs] did not include any training questions). The column entries are self-explanatory and cover the essential training-related data found in the surveys. The shaded entries are meant to suggest a serious training deficit for sizeable percentages of the afflicted workers. The authors hasten to note that this is purely judgmental; other readers may have different views about what is and is not noteworthy.

Table 3 summarizes the findings of APPENDIX B, reproducing in part those entries which suggest real or possible gaps in the job safety/health training as reported by the injured workers. For each of the 19 surveys listed, worker responses reveal at least one form of an apparent training deficit or a related problem. All but one injury category have at least two gaps and nine have three or more. "Limited coverage", meaning the percentage of those injured who lacked for any safety training, or had no training specific to their job needs, is the most frequent entry followed by "policy/action lapses" used to address training gaps after injury occurrence. "Content lacking" entries in Table 3 mainly referred to insufficient instruction in fitting, use, or limits of personal protective equipment issued workers. The "inexperience factor" was included in the listing insofar as it warrants even greater concern for adequate training. Entries here show that from 22% to as many as 78% of the affected workers had no more than 1 year's experience at the time of injury; for several categories more than 15% were injured within the first 6 months at the job. Fewer entries are noted in the "refresher needs" column because 13 of the 19 surveys did not include items about the time of the last safety training. Of the six surveys that did, percentage of injured workers with training more than 1 year old exceeded 50% in four of the six cases, and was above 25% in another.



Taken as a whole, Table 3 suggests many training inadequacies that may have contributed to the injury occurrences. However, the self-report nature of the data set, the possible bias of workers in avoiding any semblance of blame, and the lack of any confirmatory observations raises questions about drawing such a conclusion. Other data sources were sought to provide added clarification. These are summarized in the next section.

2.       Investigative Studies Acknowledging Training Needs and Effectiveness

Several studies have focussed on training issues directly or indirectly in the course of investigating workplace hazards and related risk factors for disease and injury. Those offering training-specific data are reviewed here to furnish added information bearing on the question of the efficacy of training in this context. The studies reference the injury, chemical, and ergonomic hazard agent categories and are presented in that order.

Injury Investigations: As part of a NIOSH-supported epidemiological study of workplace fatalities, Manwaring & Conroy (1990) reported the results of on-site investigations of 55 confined-space incidents where 88 workers lost their lives. Through interviews with co-workers and company officials, data were obtained on the conditions surrounding the events, and applicable company safety policy and employee training. This was augmented by information contained in reports from the medical examiners, OSHA compliance officer, responding emergency medical services personnel. Analyses of the 55 incidents to establish possible patterns to the occurrences or common factors revealed that in only three events did workers receive any training in confined-space safety. In these three cases, two supervisors and two workers died, three of whom had received the training. Further testifying to an apparent lack of training among other factors, no testing of the confined-space atmosphere was done before entry in any of the events, nor were confined spaces labeled with appropriate warning signs. Also few events gave evidence of confined-space ventilation prior to entry and no formal space entry authorization procedure was in place. Indications of the wrong type or improper use of respirators were also noted. The authors used the findings to stress the need to increase worker understanding and awareness of confined space entry through development and implementation of confined-space entry procedures and worker training. Poor implementation of training procedures was still evident in a later NIOSH report which summarized the data gained from a greater number of confined-space fatality investigations (NIOSH, 1994).

A similar NIOSH investigation of 201 electrocution-type incidents with 217 worker fatalities also suggested training deficits as a contributing factor but the available data were not as convincing as that shown above for confined spaces (Casini, 1993). In these cases, laborers, who typically received minimal training, showed the highest number of fatalities (42 of the 217 victims). But not far behind were linemen (40 of the 217 victims) who generally received extensive training in electrical safety. A total of 180 victims did receive some typical on-the-job training, in many cases from small employers. This investigation raised questions as to the adequacy of the training, and mentioned needs for more structure and ways to demonstrate that the workers understand the hazards and can carry out recommended safety measures.

Tan et al. (1991) interviewed 41 hospitalized patients who were being treated for hand injuries sustained at their workplaces. The interview took place shortly after the patients were admitted and gathered information on the nature and extent of the patient's training plus factors such as length of job service, description of the circumstances of the injury event. Regarding the latter, rollers, guillotines and chain saws were the machines commonly involved; most workers were unable to give a specific reason for the injury. Twenty-one patients had no job training and 20 had either formal or supervised on-the-job training of variable length. Three weeks of training was noted for the majority of workers. To determine whether training could have prevented the injury, patients having training were compared with those who had none in terms of the time each spent on the job before the injury occurred. The results showed little differences between the two groups. Indeed, 3 workers with training were injured on the first day and 7 were hurt within 12 weeks of starting their jobs as compared with 8 untrained workers who injured their hands during the same period. The authors questioned the adequacy of training in light of these results.

Chemical Hazard Investigation: Bryant, Visser & Yoshida (1989) collected questionnaire data from 165 hospital workers involved in ethylene oxide (EtO) sterilizing work. They found from 20% to 40% of the respondents to suffer from headaches, eye/skin irritations, and sore throats attributed to the exposures. Other symptoms reported were nausea (19%), running nose (16%), shortness of breadth (15%), and drowsiness (20%). Included in the questionnaire were items asking about the amount of training, which for the sample ranged from less than 1 hour to more than 1 day. In more than one-third of the cases first aid was included, and use of protective equipment (i.e., gloves, gowns, masks) while working with EtO. Environmental samples of EtO were collected during each sterilizer task for the 18 hospitals which employed the 165 hospital workers. Correlational analyses showed amount of training time and use of protective equipment to each bear an inverse relation to the prevalence of reported symptoms; however, only a few of the symptoms showed a significant decrease. Moreover, the expected decrease in exposure levels from the use of protective clothing did not cause users to report fewer symptoms of short-term irritation. Indeed, 80% of the workers still complained of one or more symptoms despite exposures within current OSHA regulatory limits.

Ergonomic Hazard Investigations: Snook, Campanelli & Hart (1978) analyzed questionnaire returns from insurance agents who provided data on the latest compensible occupational back injury case in their workload. A total of 191 cases were described; the data included information as to onset of back pain, previous back injuries, act at time of injury along with selection and training procedures the employer was using to reduce the risk of back injury. Lifting/pushing tasks when implicated in the injury were rated in terms of percentage of population who could safely perform the same act without overexertion, and were the tasks used to supply job design or ergonomic reference data in the evaluation. The cases were separated in terms of the presence or absence of various techniques of selection (medical history, low back X-rays), whether or not training in safe lifting techniques was given, and whether the jobs rated below or above the 75% limits of overexertion risk. Neither training nor any of the selection techniques were found to have any significant differential effect on the numbers of reported cases. Only the job load variable proved significant. The authors concluded that selection or training approaches were not effective controls for low back injuries.

Green and Briggs (1989) conducted a questionnaire survey of 514 keyboard operators in a university workforce to determine the benefits of adjustable work station furniture-furniture used to alleviate postural discomfort as well as other ergonomic problems. The respondents included those who were classified as sufferers or nonsufferers of repetitive strain from keyboard work based upon symptoms previously associated with overuse injury. The questionnaire items sought information related to the adjustability of different components of the user's workstation (i.e., desk, chair, monitor), instruction received on how to make such adjustments, and the adequacy of both the instruction and the adjustability features for ensuring comfort. In addition to questionnaire data, anthropometric measures were taken on a subsample of the sufferer and nonsufferer groups on seated postures, specifically popliteal and elbow-rest height. Related to training and though recommended, a full-scale educational program to inform operators on use of the workstation and strategies for relieving discomfort was not followed; rather advice on use of adjustable workstations was handled by issuing circulars diagramming proper positions to the users, and by small seminars and demonstrations run by the safety officer at the request of individual departments.

Respondent data indicated that sufferers had more negative perceptions of the equipment. Significantly more sufferers constantly readjusted the workstations (70% vs 43% for nonsufferers), could not get comfortable (35% vs 18% for nonsufferers), and were more likely to report insufficient adjustability (50% vs 20% for nonsufferers). The anthropometric data found chair heights not in accord with guides distributed. The authors believed that these problems were due to the lack of appropriate information being given to the operators. Almost 40% of the respondents could not recall receiving any guidance on how to adjust their workstations. Only 12% noted the literature distributed by the university; the most common source of information (64%) was from other persons with no formal ergonomic training. The authors concluded that there is a great need for training and/or information on workstation adjustment among keyboard operators, and that the preference for verbal instruction is greater than for printed forms of instruction. Given the widespread use of fellow workers as sources of information, it was also suggested that supervisors as well as keyboard operators be trained to cover new employee needs.

3.       Appraisal of Training Data of Afflicted Workers

The BLS work injury reports combined with the NIOSH findings on confined space fatalities and the problems seen in the postural discomfort/workstation adjustment survey strongly suggest that training deficiencies can contribute to these outcomes. This further supports the need for OS&H training. Yet, some workers who received training in these and the other studies cited in this section were still afflicted. Could the quality of training account for this result? That is, were sound training practices used? Did they, for example, follow the OSHA guidelines noted earlier? Even if they did, could other workplace factors (see Figure 1) have been present to nullify efforts to reduce injury or disease risk through training? Only two of above reviewed reports mention the instruction process. One found distinct weaknesses (Green & Briggs, 1989), and the other described nothing more than the length of training and whether it was formal or supervised "on-the-job" instruction. (Tan et al., 1991). Details of the training plan are sparse or non-existent in most of the above work.

In summary, workers without any OS&H training would appear at high risk for workplace injury or illness. Where training is given, the adequacy of the procedures in use becomes the issue. For this purpose, and like the intervention studies reviewed earlier, factors and conditions associated with effective OS&H training need to be ascertained.

In amplifying this point, OS&H training practices presently conducted throughout U.S. work establishments have not been examined to determine their adequacy in addressing known hazards and compliance with regulatory standards. One effort, limited to a small sample of companies engaged in waste site management, did in fact find many to be deficient in meeting existing OSHA training rules (Cole et al., 1994). The intervention studies summarized earlier cannot offer representative data since they were primarily demonstration efforts and special programs; they are not the norm. Although a new, independent survey would be ideal, much information characterizing OS&H training is already collected but remains buried in various databanks and report files that exist within NIOSH (e.g., Health Hazard Evaluation Reports, National Occupational Exposure Survey databank) and OSHA (e.g., compliance officer inspection reports). Systematic efforts to extract and assemble training related data from these sources could do much to provide a status statement on OS&H training practices and critical points.

E. Training Factors in the Context of Other Worksite Programs and Activities

1.       Training in Successful Occupational Safety and Health Programs
As already mentioned, hazard control programs include a variety of activities, training being one that is interwoven with others in efforts to minimize risk of work related injury and disease. Attempts have been made to isolate factors in such programs-factors which are important to achieving these goals. For this purpose, the safety program practices of companies differing significantly in their injury experience have been compared and other studies have analyzed hazard control efforts among employers who have achieved exemplary safety performance records. Of relevance to this literature review was whether there were any data to show if the training practices noted in these programs made a difference in safety performance or contributed in a unique way to the success experiences reported. Of the literature in this area, the studies noted below were most notable in terms of examining training differences, among other practices, in contrasting high- and low-accident workplaces.

NIOSH Studies: During the period 1975-1979, NIOSH published several reports resulting from a project aimed at defining factors in successful occupational safety programs. The project comprised three phases. The first was a questionnaire survey of the safety program practices of 42 pairs of companies in one state that were matched in type of industry, workforce size and locale but differed by more than two-to-one in recorded injury rate (Cohen, Smith & Cohen, 1975). The second phase comprised site visits to a sub-sample of the above group to verify and observe more closely apparent differences between the pairs that could explain the differential injury rate (Smith, Cohen & Cohen, 1978). The third phase used both mail questionnaires and site visits in collecting information from five companies recognized as having outstanding safety records based on total numbers of hours worked without a disabling injury (Cleveland et al., 1979). This third effort sought added confirmation of the findings from the previous two phases. Data collection for all phases focussed on such factors as management's commitment to the program, job safety training, safety incentives, hazard control measures, accident investigation/reporting procedures, and workforce characteristics. The general finding concerning training was that early indoctrination of new workers in safe job procedures with follow-up instruction to reinforce the learning was most frequently linked with successful safety performance. Formal classroom instruction versus on-the-job training or the use of varied instructional techniques were less notable considerations. The significance of training as compared with other program practices in accounting for safe performance could not be established. It is important to note, however, that management commitment factors both in these studies and others appeared to be the dominant or controlling element (Cohen, 1977).

Bureau of Mines Work: Peters (1989) summarized a number of studies supported largely by the Bureau of Mines dealing with organizational and behavioral factors associated with mine safety. Included were descriptions contrasting training practices and related miner knowledge in several surveys comparing high and low accident rate mines. The following were among the more notable observations:

(1) New miners in high-accident mines were less informed as to how to do their jobs than those in low accident mines.

(2) Lack of training in proper use of safety and health protective equipment was more frequently cited as being an important reason for miners not using the devices in high-accident mines.

(3) Having specific training in how the electrical system works; dealing with hazards such as coal dusts, gases and noise; and how to use tools, equipment was especially prevalent in the low-accident mines.

The Peters report noted that training for managers and supervisors produced significant improvements in mine safety and cited intervention studies demonstrating its effectiveness. One such study (Fiedler et al., 1984 [A-I]) is described in the collection of intervention work listed in APPENDIX A. This study found that the introduction of a structured supervisor training program accenting leadership style and skills in human relations or one stressing team-building and group problem-solving were each linked with reduced rates of injury and reduced MSHA citations at the mines under study.

Three observations about training derive from these NIOSH and BOM studies. The first is that training differences do exist between workplaces with good and poor safety records, but their overall importance remains to be ascertained. The second is that the differences seem relative, i.e., greater or more deliberate efforts are made to train, and to commit supervisor time and resources in the workplaces with better safety records. The third and related to the second is that supervisor training in how best to deliver and reinforce safe work practices seems crucial to the overall training effort and the success of the hazard control program. Somewhat at variance to this last point, one intervention study found that using external instructors to directly train employees was superior to a train-the-trainer approach in implementing aspects of a hazard materials information system in a large sample of companies (Saari et al., 1994 [A-II]). The differences between the two approaches, however, were least significant for companies with other well-established safety and health program practices. This suggests again, as shown in Figure 1, that training effectiveness depends greatly on other variables which complicates efforts at its assessment.

2.       Implications of First Aid Training.

Several OSHA rules (e.g., 29CFR Part 1910.151(b); Part 1926.21(b)) require that persons be trained to render first aid in the event that workers are injured and in need of treatment to maintain life, reduce suffering, or prevent the condition from becoming worse until more expert help arrives. Although one could argue that even these forms of instruction need to be evaluated as to their efficacy, there is evidence to show that workers who have first aid training tend to have fewer workplace injuries than those who lack for this type of training. Miller & Agnew (1973) first reported these findings which were confirmed later in more thorough evaluations by McKenna & Hale (1981; 1982). The importance of these results for this exercise is twofold: First, it documents that certain types of workplace training, though having other objectives, can apparently generalize and benefit workplace health and safety performance. Second, it suggests that melding first aid training with other requirements for OS&H instruction may have a reinforcing effect on the desired hazard control objective. The Miller and Agnew and McKenna and Hale studies offer speculations as to interactions between first aid and regular job safety training. These are contained in the summary of their work noted below.

Miller and Agnew (1973) analyzed frequencies of accidents as reported for workers in five different Canadian work establishments over time periods ranging from 3 months to 3 years. For each workplace, workers trained in first aid, whether on a voluntary basis or as a requirement of the job, were found to have fewer injuries than those who did not have the training. Miller and Agnew speculated that worksite regulations and actions taken for hazard control in combination with the first aid instruction produced an increased safety consciousness in the workforce.

McKenna & Hale (1981; 1982) compared worker injuries in two factories for 1-year periods before and after the completion of first aid training. The training was given in two 2-hour sessions and covered the usual topics (i.e., treatment of asphyxia, shock, poisons, wounds and bleeding, fractures, etc.). This instruction was administered to one group of volunteers (the "experimental group") who before the training had worse injury records than a "control" group of workers matched by job, age, sex, and job- specific experience. Following the training, the experimental group showed a marked reduction in the injury rate as compared with the changes observed for the control group. Interview data collected 6 months before and 6 months after the training revealed no differences between the trainees and control workers in hazard awareness. When compared with the control group, however, the trainees did show shifts in attitudes and beliefs about accidents and injuries believed due to the first aid instruction. The major change was that the trainees regarded more accidents as being preventable and felt more responsibility for taking preventive actions. On this basis, McKenna and Hale suggest that the first aid training served as a personal motivator for adopting safe work practices and improving workplace safety conditions.

3.       Worksite Physical Fitness/Exercise Training

Health promotion programs, though directed to lifestyle as opposed to workplace risk factors, can encompass training and education in areas that may have some add-on benefits to occupational hazard control objectives. Physical fitness training and exercise, in particular, through its goals of building muscle strength, maintaining joint flexibility and range of motion, reducing fatigue, increasing blood flow to stressed areas, is seen as a way to increase one's endurance or capacity to handle physically stressful job demands (Genaidy, Gupta & Alshedi, 1990). Efforts to apply this form of intervention in job situations where other measures are not feasible have been reported. The study of Hilyer et al. (1990 [A-IV]) described in APPENDIX A offers one such example. In this instance, back, shoulder, knee flexibility exercises were introduced to reduce musculoskeletal disorders among firefighters in a city fire department. These disorders were the leading type of on-duty injuries reported for these municipal workers. A 2-year post-training appraisal found that although firefighters engaged in this exercise showed no differences in the occurrence of sprain, strain, or muscle tear type injuries from their nontrained cohorts, it did reveal less severe injuries, speedier recoveries, and reduced medical costs. A similar attempt by Silverstein et al. (1988 [A-IV]) to apply exercise training to relieve risks for upper extremity disorders from assembly and packaging jobs requiring repetitive, forceful motions, and awkward postures was not as successful. The latter type of situation would appear more amenable to other forms of intervention such as job redesign and changes in work station layout. These should be the priority hazard control measures.

Worksite health promotion programs that can enhance not substitute for required forms of hazard control is a laudable goal. Some intervention efforts combining elements of hazard protection and health promotion are beginning to appear but do not allow one to determine the contributions of each to the overall gains from the intervention. Shi (1993) for example, reported on a back injury prevention program for California county workers who in recent years experienced the highest prevalence of back pain and back-related injuries. The program combined 1) education on backache, weight control; 2) back safety training focussed on body mechanics and hazardous lifting tasks, 3) physical fitness emphasizing participation in regular exercises and 4) ergonomics improvements (e.g., making safety equipment more accessible, improving seating/work stations for easing postural stress, rearranging storage for minimizing materials handling burdens). Comparisons of questionnaire and medical claims data taken before and 1 year after the program showed significant reductions in individual risk factors for back pain (as much as 64% in the highest risk group), a decline in actual back pain experience (10-12%), and a 12% drop in medical costs per claim (versus a 15% increase in other groups not involved in the program). Although encouraged by the overall results, Shi admits that the study design is incapable of differentiating the individual effects of the program's components.

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VII

Verifying Critical Elements/Program Factors
for Effective Occupational Safety and Health Training
o far the focus of this review has been on whether training as required in various OSHA standards is efficacious in terms of reducing work-related injury and disease based on data found in the literature. The findings from the training intervention work offer the strongest support for such outcomes but as already noted there are several qualifications. In particular, the targets of most of these training studies have not been OSHA rules per se, and the evaluative measures, which do show gains in workplace safety/health knowledge and practices, may fall short in accounting for actual reductions in injuries or illness should they also be reported. Yet, the intervention studies do show the potential for training to produce positive health and safety effects and do include measures that can serve as surrogates or risk indicators for the bottom line injury/disease experience.

The question to be addressed here is whether certain factors stand out as crucial to attaining a successful training outcome in targeting some occupational safety and health objective. Two approaches to answering this question are taken. One verifies the importance of certain of the steps contained in the OSHA voluntary training guidelines by using empirical examples taken from the literature under review. A second considers evidence for singling out instructional factors as well as extra-training factors for their importance to the training experience and benefits to hazard control.

As a preface to this discussion, two points should be made. First, that the bulk of the training intervention literature reveals many studies showing positive results despite differences in training plans, targeted objectives, and evaluation methods. Indeed, few approaches seem ineffective which hampers the search for critical factors. Second, few efforts have been made to independently vary certain learning variables or conditions affecting the transfer of training to the jobsite so as to study their effects on outcome measures. This too nullifies a basis for rating the significance of key factors. Nevertheless, both in the intervention studies and other literature noted above, there are suggestions of controlling factors or at least factors that deserve more systematic evaluation to establish their importance. They will be noted along with other apparent needs in sorting out critical determinants in effective OS&H training.

A.  Examples Supporting OSHA Voluntary Training Guidelines

Examples of training situations with outcomes confirming the merits of the OSHA voluntary training guidelines or, at the minimum, offering ways for implementing them are found throughout the literature cited in this review. Those thought to best illustrate or capture the essential points of the different guidelines are described in this section, classified by the particular guideline of reference.

OSHA Guideline: Determining if Training is Needed, i.e., whether a (hazard control) problem is solvable by training.

Exhibit #1: Cohen & Jensen (1984 [A-I]) found their training plan, though effective in having operators adopt certain targeted behaviors critical to safer use of forklift trucks in warehouses, could not effect a change in one that required them to do more driving in reverse and to continuously look over their shoulders when doing so. Inquiry revealed that this change was resisted for two reasons: First, lift trucks were propane-powered and driving in reverse caused the operators to breathe in more of the noxious fumes. Second, constantly looking over one's shoulder is unnatural and an uncomfortable posture to endure for prolonged periods. Use of battery-powered vehicles and installation of rear view mirrors would appear reasonable alternatives for alleviating these problems.

Exhibit #2: Carlton (1987 [A-IV]) instructed food service workers in the straight back/bent knee method of lifting and to recognize high risk workstyle factors (horizontal extension, spinal torque) for back problems. This group proceeded to score higher in a biomechanics assessment of their performance in a novel task of lifting/lowering trays of varying weight when compared with an untrained group. No such differences were found, however, for their on-the-job behaviors. Thwarting the transfer of this training were worksite obstructions that forced the workers to assume awkward positions, to engage in much extended horizontal lifts, and to subvert other actions aimed at risk reduction. Clearly, unless work station layout problems are addressed in this context, the benefits of training for reducing materials handling hazards will not be achieved.

OSHA Guideline #2: Identifying the Training Needs, i.e., what the worker is expected to do with regards to job hazard control and in what ways.

Exhibit #1: A University of Kansas study (1982 [A-II]), via industrial hygiene surveys, mapped out areas in plants manufacturing fiberglass products where concentrations of styrene, a hardening agent used in the production process and a known neurotoxin, were found to be the greatest. For these identified areas, job analyses plus interviews with managers and workers were then conducted to determine what tasks and worker actions could most influence exposure levels for work performed at these locations. This effort yielded a control plan, which included needs to effect worker compliance with 11 work practices and 20 housekeeping measures aimed at reducing exposure levels. Samples of prescribed work practices included avoidance of high exposure areas when there is no need to be present (e.g., keeping one's head out of a spray booth except when spraying), and exploiting existing engineering controls (e.g., spray toward exhaust ventilation). Housekeeping measures sought to reduce added sources of styrene exposure through covering waste cans of excess styrene coatings and locating them near exhaust ventilation ports; and covering floors with disposable material that could be changed frequently to reduce overspray buildup. These and other proposed actions constituted well-defined targets for the training program set in place. Compliance to the work practices and housekeeping measures as developed in this program resulted in significant reductions in styrene exposures to the workforce under study.

Exhibit #2: Sulzer-Azaroff et al. (1990 [A-I]), in instituting an injury prevention program in a large plant, reviewed accident and injury records, interviewed safety personnel, managers, and workers, and made direct observations to determine "hot spot" work areas and high risk job behaviors that would be candidates for intervention efforts. The diversity of ongoing operations dictated a subdivision of work units, each having its own set of safety performance targets, with the program starting in those groups where the bulk of accidents were happening. Safety performance targets included personal behaviors (e.g., wear eye protection; sort no more than one or two boards at one time), as well as behaviors affecting conditions (e.g., keep aisles clear; load carts without overhang). Targeted safety actions following training were achieved in all high risk units with some showing reductions in injury rates. All units showed a reduction in lost time cases and savings in medical costs.

OSHA Guideline #3: Identifying Goals and Objectives, i.e., specifying what the instruction is to attain in clear and measurable terms.

Exhibit #1: Zohar, Cohen & Azar (1980 [A-III]) undertook a program to promote awareness of the damaging effects of noise on hearing among workers who were at risk and to increase their motivation to wear ear protection. In addition to a conventional hearing conservation lecture, workers took hearing tests before and after their workshift to demonstrate how much temporary hearing loss occurred on days when they wore and did not wear ear protectors. Use of the protectors minimized such loss and the audiograms of those who routinely wore protection were posted along with those who didn't to show the benefits of the protection. The nonusers' audiograms showed profound permanent hearing losses which further accentuated the program's endgoals. This approach yielded a 50% increase in ear protector usage.

Exhibit #2: Bentley & Horstman (1986 [A-II]) instructed lumbermen on how to reduce dermal contact/exposure to timber coated with chlorophenol, a preservative agent with toxic properties. For this purpose, workers were counseled on the need to use gloves/aprons, apply barrier creams, wash hands at breaks, and each day wear freshly laundered clothes offering maximum skin coverage. Through adding a fluorescent agent to the chlorophenol, workers could see the extent of skin contact under ultraviolet light resulting from their work tasks. Workers were encouraged to view themselves under this light source during the course of training to show how the various protective practices helped to reduce their exposure. Post-training results for these workers found significant decreases in metabolites reflecting reduced exposure to chlorophenol which was attributed to the protective measures taken.

OSHA Guideline #4: Developing Learning Activities, i.e., instruction that emphasizes cognitive or physical skill factors commensurate with job demands and that is offered in ways that facilitate transfer to the actual job situation.

Exhibit #1: Michaels, et al. (1992 [A-II]) composed a training plan and materials for increasing worker awareness/knowledge of chemical hazards. The target groups were public employees engaged in shop work of various kinds (e.g., vehicle maintenance, carpentry/plumbing, printing) and in construction, custodial tasks. Materials were developed through site visits, interviews with workers to assess their health/safety concerns, and determinations of amounts of chemicals in use at site-specific locations. Consultations with the city OS&H office were also included. The training course covered the Hazard Communication Standard, how to read material safety data sheets, and to gain information on toxic chemicals, routes of entry, symptoms, health effects, and control measures. Information was tailored to fit exposures associated with different job titles and was offered to workers and their foremen/supervisors in such departments. Besides lecture, exercises used throughout the instruction allowed workers maximal input in identifying hazards of greatest concern, and in enabling them to work through various control options and the means for putting them in place. Post-training results indicated follow-through efforts at the workplace to correct a number of shortcomings in OS&H program practices.

Exhibit #2: Hultman, Nordin & Ortengen (1984 [A-III]) sought to train janitorial workers in ways to relieve increased stress on the spine caused by frequent forward bending in mopping tasks. The training plan comprised three 30- to 45-minute sessions. The first covered simple anatomy of the spine, muscle physiology and biomechanics. The second and third sessions included slides of workers performing tasks that put stress on the low back akin to mopping work. Techniques to relieve this loading were demonstrated (e.g., bend knees in mopping rather than flex the back; place water bucket on chair or leave on cart to avoid deep forward bending when bucket is placed on floor). The workers were given opportunities to practice them under the supervision of the instructor. Workers were found to spend more time in upright, less stressful condition following training.

OSHA Guideline #5: Conducting the Training, i.e., the use of an instructional format that promotes active learning with frequent feedback to mark progress, invites worker inputs and takes account of differential worker experience or skill levels to create/sustain motivation.

Exhibit #1: Saarela (1990 [A-I]) used a small group approach for effecting improved housekeeping practices in a shipyard where poor housekeeping was implicated in about one-third of the injuries reported. A steering committee of top management plus safety staff provided information and the basic aims of the program. Planning details and implementation were left to small groups (4-13 persons) formed within each of 13 departments. Each group consisted of the department chief, supervisors and workers. The groups, with the help of a facilitator, met to discuss housekeeping problems within their own areas, how they could be remedied, and once corrected, how they could best be maintained. They arranged training seminars for the total department staff to illustrate improved housekeeping practices, set goals for their attainment, established a system for monitoring compliance, the results of which were posted. All of the groups adopted measures for better housekeeping, the more active ones showing the greatest gains in terms of their department staff perceiving improvements in housekeeping practices. Overall, there was a 20% reduction in injuries associated with housekeeping during the intervention year.

Exhibit #2: Weinger & Lyons (1992 [A-II]) sought to increase farm worker knowledge of the health effects of pesticides, symptoms of poisoning, routes of entry, ways to minimize exposure, first aid procedures, and how to effect better preventive measures against these types of hazards. Needs assessment took account of pesticide exposures as documented by visits to farms and observations of work practices. Focal group discussions were held with farmers to consider content issues, best modes for conducting training as part of a learner-centered approach to address the information, behavioral skills, problem-solving objectives of the training. In some cases, training was in Spanish because of the Hispanic makeup of trainees. Techniques adopted for actual training used role-playing, case studies, and demonstrations to dramatize issues and facilitate worker participation. Post-training measures gave indications of lesser exposures to pesticides among trainees. Also greater activism on their part to report unsafe, hazardous working conditions.

OSHA Guideline #6: Evaluating Program Effectiveness, i.e., the training program should have an evaluation plan built in at the outset and include measures for assessing whether it has met its objectives, preferably indicators reflecting both knowledge and application.

Exhibit #1: Lynch, et al. (1990 [A-V]) instituted an infection control training program in a medical center. Its aim was to enhance staff (clinical, technician, housekeeping) knowledge of infection control and adoption of more stringent barrier practices for body substance isolation. Program content emphasized regular use of gloves/masks/gowns, compliance with upgraded containment/disposal methods in handling specimens, laundry, and trash, and special handling of highly infectious patients. After meetings were held with departments to iron out problems in adopting new procedures, fifty 45-minute lecture and slide sessions were held to inform staff and to maximize attendance. The pre-post training approach used to evaluate the intervention included three measures: 1) a questionnaire to ascertain knowledge, attitudes, and self-reports of infection control actions practiced before and after the training session, 2) appropriate glove use for patient contacts and procedures as recorded by independent observers for periods of 2 to 3 months before and after the training, and 3) use of microbiology lab reports monitoring marker organisms of nosocomial colonization and infection for the year before and 3 years after the intervention. Post-training results indicated significant increase in knowledge of infection control and glove use, plus a decline in the nosocomial colonization and infection rate.

Exhibit #2: Reber & Wallin (1984 [A-I]) divided the 11 plant departments that accounted for 95% of the company's injury reports into 3 groups. One group received safety training only; another, training plus goal setting; and the third, training plus goal setting plus feed-back according to a staggered schedule. The treatments were introduced at different times for the three groups, enabling one group to serve as a control for the other in assessing the impact of the training plus other factors. The training itself consisted of 10 weeks of daily 45-minute safety discussions of safety rules with slides showing safe and unsafe ways of doing job tasks specific to the departments involved. Training effects were evaluated by several measures. One consisted of a quiz given midway (5-week point) during the training to ascertain worker knowledge of safe practices. A second was direct observations of whether the workers were adhering to safe practices using a checklist to score their performance during baseline, training, goal-setting, goal setting plus feedback phases of the program. In addition, the overall injury incidence rate and lost time injury incidence rate was calculated for the 3 years before the training intervention and for the year during which it was implemented. Results showed that workers could identify over 80% of the safe and unsafe conditions at the midpoint of the training and that training, goal setting, and feedback were each found to increase the frequency of observed safe behaviors. Adding feedback to goal setting provided the greatest increase in safety performance. The lost time injury rate decreased post-training, but the authors noted that this effect must be treated with caution because of changes in the safety recordkeeping procedures during the 1980-84 period.

OSHA Guideline #7: Improving the Program, i.e., shortcomings observed in evaluation data such as knowledge gaps, deficient performance levels, poor retention would dictate needs to revise training plan to improve its efficacy.

Exhibit 1: Cole et al. (1988 [A-II]) found that a 14-step procedure for donning a self-rescuer breathing apparatus (SCSR) could not be performed proficiently for effective use in mine emergencies even after years of hands-on training and annual refresher demonstrations. A simplified 3+3 step plan was developed encompassing the major objectives of isolating the lungs and preparing for escape and was structured to overcome the position/sequence problems and slowed response noted in using the 14-step procedure. Instructor modeling of the new procedure and repeated opportunities for each miner trainee to don equipment and observe others doing the same was used for training with the new method. Evaluations comparing the donning times and sequential errors for the new method versus the old procedure found the revised one reduced overall donning time by 50% and displayed smoother, less confused or interrupted actions. As noted in this report, this demonstration of a revised and apparently improved training procedure was done in training rooms above ground and did not take account of the dark, muddy/wet floors and of the dirty/battered SCSR devices found in actual underground conditions. One company trained its miners with the new procedure both above and below ground and found more errors below ground which slowed donning time. Recommendations were made to train miners to high levels of mastery above ground and provide for frequent refresher exercises to overcome this problem. (See also report by Vaught, Brinch & Kellner (1988 [A-II]) on this point).

Exhibit #2: Karmy & Martin (1980 [A-III]) sought to increase ear protector use in a complex of eight plants, each averaging noise levels of 90 dBA. For this purpose, the eight plants were divided into four treatment groups: One group was educated to use ear protection through a poster campaign followed by a videotape presentation; a second was given repeat audiometric tests at 7 to 12 month intervals; a third was given both the educational message and repeat audiometry; and the fourth served as a control. Comparisons of ear protector use in the various plant groups were made over 22 months. The treatments began for the audiometry at the 3-month point; at the 10th month point for posters; and at the 15th month for the videotape. The control group showed little change throughout this period in percentage of workers wearing ear protection. The introduction of the posters resulted in a 15% increase in ear protector use, which then dropped in one plant until the videotape showing. This caused a 25% jump in use, which again trailed off. Repeat audiometry by itself increased ear protection by 40% in one plant and 20% in a second with little signs of regression. Repeat audiometry plus education attained a maximum 30% increase in ear protector use with indications of continued growth. The results here suggest that the educational offering by itself did not produce durable change. The education plus repeat audiometry did so but could be improved if the workers were given feedback regarding the results of their hearing tests to indicate the benefits of the ear protection. No such provision was made in the program, and a recommendation for doing so was offered.

B.  Evidence for Distinctive Training and Extra-Training Factors

The aforementioned OSHA guidelines offer structure to an OS&H training program and the exhibits with the guidelines above give meaning to the various elements based upon empirical work. But inherent to the training process and attainment of its objectives are a number of factors of consequence barely touched upon in the guidelines as described. These include variables such as size of training group, length and/or frequency of training, manner of instruction, trainer credentials, and training transfer factors among others. Motivational considerations and extra-training factors such as management's interest in and concern for worker safety also need to be addressed as they would appear to greatly modify the learning experience and its outcome.

The reports summarized in APPENDIX A plus others cited in the literature offer some data for making statements as to the significance of these types of factors, or suggest the most promising conditions for achieving successful training results. Such evaluative findings are summarized in this section. As will be noted, evidence based on systematic manipulations of acknowledged variables, at least for the OS&H literature reviewed here, is available in only a few cases. Other evidence for significant factors tended to emerge by finding them common to a number of studies with apparent similar influences on the training outcomes. Table 4 lists different factors with capsule statements tying together evaluative information from different reports cited in APPENDIX A to indicate the nature of their effect on or importance to the training process or its outcome.

One immediate impression in viewing Table 4 is that the documentation identified with different factors is quite disproportional. Specifically, the information base on size of group and length/frequency factors is relatively small whereas that shown for motivational/promotional factors is much larger with the others falling in between. The supportive findings for the statements conveying the importance of the size of group and frequency/length of instruction to training are further limited by the fact that they were derived from post hoc data analyses in the few cited reports, not from efforts to vary parameters of each factor to ascertain their significance. Only the statements for mode of training and motivational/promotional factors rest on studies that in the main, employed systematic or controlled manipulation of conditions as a basis for deriving the statements. Evidence of the influence of other factors (as contained in the statements alluding to them) was based on the listed studies yielding similar results for the same factor; this was largely based on all-versus-none treatment comparisons.

Another impression is that many of the statements agree with or are consonant with well-known concepts in the psychology of learning and motivation (Deese, 1952; Ruch, 1963). For example, captured in the statements in Table 4 are the benefits of increasing training time, repeated practice sessions, opportunities for more individualized instruction (through lower student-to-teacher ratios), and active rather than passive learning experiences focussed on conditions that can promote transfer to the areas in need. Learner-centered, small-group problem-solving approaches are newer variants of these ideas. The intent is to prompt student actions to make needed workplace health and safety changes. Similarly, the statements on goal setting, feedback, and token rewards to help learn safe work practices and to strengthen such acts in the workplace are elements of the behavior reinforcement literature in psychology. Some extensions or illustrations of certain factors are also contained in the statements. That supervisors or foremen are key players in ensuring safe and healthful workplace conditions is well taken. Perhaps the trainer role further impresses upon the supervisor or foreman the importance of safety at work and ways to meet production goals without having to forego hazard control measures or permit workers to take undue injury or health risks. As noted, added supervisor/foremen instruction in both workplace safety and health as well as interpersonal relations enhances this result.

There is evidence too of how training is needed to complement or augment engineering or physical hazard control measures to realize successful safety and health outcomes. As described by the studies cited in this context, training is not only necessary to ensure proper use of the control systems that are in place but also to enable workers to adopt work methods that take greater advantage of their capabilities for providing protection. Cohen (1987) provides other examples of how worker actions and behaviors can affect different elements of worksite hazard control systems, all of which could be objectives in a training program.

With one exception, the evidence underlying each of the statements for the various factors in Table 4 reflects data obtained from more than one hazard target and from different work settings or worker groups. (The exception is one statement in Ancillary Factors where all reports dealt with biologic hazards and hospital personnel. Even here, however, the hospital personnel differed in makeup-some being professionals (clinical staff), and others in support services (laboratory technicians, janitorial/laundry workers). This suggests some generalizability of the findings though, as already mentioned, the actual amount of documentation varies greatly from factor to factor (and from factor statement to factor statement).









On the last point, Sechrest and Figueredo (1993) state that the literature on intervention research, of which training is a part, needs to pay more attention to variations in the strength of treatment factors and how they can alter outcomes as opposed to just a treatment versus no treatment (or control) approach. Frequency/length of instruction, one of the two types of factors where the literature in OS&H training proved sparse, would offer certain ways for varying the strength of a training intervention. The importance of the frequency/length factor cannot be stressed enough. It is the basis for defining refresher training needs as well as establishing the type of training regimen necessary to meet and sustain standards of performance in critical skill/emergency situations. Some research data on retention of job skill training over time (Sitterley, Pletan, & Metaftin (1974)) suggests that without practice, or for tasks seldom performed, high level job skills can deteriorate much sooner than anticipated (e.g., between 1 and 4 months for piloting aircraft or firefighting). Also that different skills degrade at different rates, e.g., losses for performing more complex, procedural tasks are greater than those for simpler or straightforward manual operations. In terms of retraining, the same studies found methods offering dynamic, pictorial representations of the task situation (i.e., movies, videotapes) are as effective as hands-on practice, although the combination resulted in the greatest recovery. Implications of these findings to retraining issues in OS&H are obvious. For example, it suggests that priority candidates for more frequent safety and health refresher training would be those procedures that are rarely used but are nevertheless critical when situations arise demanding appropriate action. Emergency events, which would fit this category, would justify frequent practice and drills to offset any loss in the knowledge and performance of actions to be taken. Reports by Cole et al.(1988 [A-II]) and Vaught, Brinch & Kellner (1988 [A-II]) discuss this need in connection with evaluating miner skills in donning the self-contained self-rescuer breathing device used in cases of mine fire and explosion. Similar needs for frequent drill may also exist for prescribed safety and health practices that are counter to natural behaviors or that add extra steps to task performance especially when the hazard risks are not that apparent. Procedures to ensure safe performance in confined space work and rescue actions would appear to fall in this category. For other situations, the basis for establishing training and retraining schedules is less clear. Presumably, criteria for determining such scheduling would take account of the complexity of the hazard control measures to be taught, the degree to which they are integrated into everyday work routines (and thus afford opportunities for practice), local and industry-wide injury and disease incident data for the work in question, among other considerations. The development of a decision logic for OS&H training that dictates selective scheduling of training and retraining when appropriate, not sooner or later or more or less frequent than required, would seem a worthwhile effort. As part of this exercise, it would also be important to acknowledge the kinds of retraining or refresher experience that can best sustain the desired outcome.

The motivational/promotional factors area in Table 4 shows the greatest number of citations. These entries reflect the major attention given to goal-setting and feed-back techniques as ways to promote the learning of safe behaviors during training. But even more, these techniques are shown to reinforce and strengthen the occurrence of such acts in the post-training or actual job situation. Indeed, in many of these studies, the training seems incidental, merely taking the form of workers viewing right and wrong ways of performing various tasks, usually in one session. The real emphasis is given to monitoring worker compliance with the safe acts when at the jobsite and varying the nature of information feed-back to the workers who may have set up safe performance goals to further spur compliance behavior. The overwhelming results from these studies is that the feedback and/or the goal setting conditions effect safer workplace behaviors. This has prompted the conclusion that training by itself does not account for improvements in worker safety and health but that the positive consequences of such actions in the form of feedback indicating compliance or progress in meeting performance goals is responsible (Sulzer-Azaroff, Harris & McCann, 1994). One could argue in these instances, however, that worker training does not end with the one session illustrating safe and unsafe practices. That the follow-on monitoring and feedback provided to workers of their job actions can be interpreted as "on-the-job" training in establishing safe workplace behaviors. The line between training and extra-training factors is difficult to draw and underscores the point noted in Figure 1 of the interactive nature of training with other workplace influences.

The literature on performance feed-back and use of incentives as a means of altering behavior in general and workplace safety in particular have been the subject of separate reviews (Lindell, 1994; Balcazar, Hopkins & Suarez 1985; McAfee & Winn, 1989). Conditions that favor consistently positive results are those where the feedback includes a tangible reward, is administered by a supervisor, and occurs at least biweekly. Private versus public feedback, individual versus group performance feedback appear about equal in effectiveness. Lindell (1994) explains how workers' respond to feed-back and incentive programs in different ways depending on their expectations regarding the outcomes of their actions, and the values they see in the rewards offered. Both he and McAfee & Winn (1989) stress the need for a conceptual framework for understanding relationships between knowledge of results, incentives and safe behavior and offer some formulations in that regard.

Feed-back/incentive programs would appear generally applicable to any situation where workers can be readily observed to assess their compliance with the prescribed safety procedures. Although the near uniform success of these interventions in enhancing safe worker behavior and safer workplace conditions is impressive, one reservation is that withdrawing the feedback or incentives could result in a reversion back to earlier problematic conditions. How management reacts to the gains and takes steps to maintain them can be critical. Instituting new policies stressing safe as well as productive job efforts, increasing supervisory training in and attention to safety conditions, and fostering greater contacts between management and employees on safety issues have been shown to be supportive. Taken together these kinds of actions create a positive safety climate in an organization that can do much to consolidate the benefits of the intervention effort.

Incentive awards raise concerns apart from the economic and delivery factors that might be involved. Those awards that remind one of how it was achieved are best, yet may be the least attractive to workers who would prefer cash or gift certificates offering more options to fit their wants. Group awards may decrease the size of the individual award but provide for peer pressure to maintain safe performance. This, in itself, can have negative consequences because the group might pressure workers to avoid reporting their injuries. As Lindell (1994) notes, "There appears to be little guidance in the research literature or agreement among practitioners regarding the optimum design of incentive plans" (Pg. 224).

In discussing alternatives for effecting the transfer of safety training to the job, Ford & Fisher (1994) suggest that techniques used for other behavior management purposes may have some utility. Reference is made to three different methods. One is a "buddy system" approach successfully used in smoking reduction; this pairs trainees to reinforce the need in each other to maintain learning, offer advice, and be alert for signs of relapse in themselves or their buddy. A second is use of "booster sessions" as an extension of training wherein periodic face-to-face contact between trainee and trainer is required. In weight control studies, inclusion of booster sessions at 2-,3-, and 5-week intervals induced a greater percentage of maintained weight loss than did the absence of such sessions. The third is a relapse prevention method in which the trainees are exposed to situations posing obstacles to their trained skills and are led through exercises preparing them to cope with these difficulties. The latter approach, in design and objective, seems similar to work already reported in this review by Brown & Nguyen-Scott (1992 [A-II] and LaMontagne, et al. (1992 [A-II] embracing worker empowerment ideas. In these instances, trainees defined likely workplace obstacles to improved hazard control, including those posed by organizational factors. Through role play and case study examples the trainees learned ways to resolve them. As noted, first evaluations of these efforts gave encouraging results.

Table 4 suggests conditions for the various factors that favor effective training, reinforcement of behaviors once learned, and success in their transfer to the jobsite. The question of some factors and conditions being more important than others is not addressed and, in actuality, may depend on situation-specific circumstances. One could argue, for example, that size of group, length/frequency, and mode of instruction factors may be less important in training aimed at making workers aware of and observant of fundamental safety rules/housekeeping measures in jobs that are routine in nature, performed at fixed locations and under well-defined conditions. Under these conditions, the emphasis can be less on how the training is conducted than on those factors or conditions that can motivate continued adherence to such practices. In contrast, factors in how the training is administered can be a major concern where knowledge of hazard recognition and control measures plus safe work practices becomes more formidable because of varied job operations and/or uncertain, changing workplace conditions. This would suggest that training regulations be performance-based, allowing employers to develop a training plan that can accomplish the safety training objectives required for their job operations or worksites. At this stage, and speaking in general terms, the statements on various factors noted in Table 4 coupled with the OSHA voluntary training guidelines offer aids in structuring an effective training program based on the current literature. At the same time, and as already mentioned, the knowledge base is not strong regarding certain factors underlying the training process, e.g., length/frequency of instruction. Added efforts to address these kinds of needs and others mentioned in the course of this review seem evident.

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VIII

Summary

This review sought evidence from the literature to determine whether OS&H training requirements, as cited in Federal standards governing workplace conditions and operations, were effective in reducing work related injuries and illnesses. A secondary objective was to determine if the available documentation showed certain training factors or practices to be more important than others in producing positive effects on worker safety and health. Major sources of data used in this review were reports of training intervention efforts designed in whole or part to enhance worker knowledge of workplace hazards, effect compliance with safe work practices, and take other actions aimed at reducing risk of injury or disease. Surveys and investigative reports were also examined to determine whether training factors were implicated in the etiology of occupational injuries or disease or were considered significant to the success of those worksite hazard control programs showing exemplary safety and health performance. Still other sources for data were reports of worksite training directed to other needs but having apparent positive effects on workplace safety and health.

A.  General Conclusions on Training Effectiveness

The literature reviewed in this report offers much direct and indirect evidence to show the benefits of training in ensuring safe and healthful working conditions. Data from the training intervention reports addressing major workplace hazards as encountered in a wide array of work situations is especially supportive. Findings are near unanimous in showing how training can attain objectives such as increased hazard awareness among the worker groups at risk, knowledge of and adoption of safe work practices, and other positive actions that can reduce the risk and improve workplace safety. There are data too from other types of studies suggesting that inadequate or lack of required safety training may have contributed to events where workers were injured or killed. While affirming the benefits of OS&H training, some limitations in the data sources were also noted bearing on the merits of current OSHA training rules in reducing work-related injury and disease. To enumerate:

1. Evidence to show how reduced injury, lost time and medical costs reported in the intervention studies resulted from training, measured in terms of knowledge gain and behavior indicators, was never clearly established. In some instances training was coupled to other forms of interventions so as to make attribution even more difficult.

2. Much of the training intervention work reported in the literature targeted site-specific problems. This afforded researchers opportunities to put into place various training and other strategies that could yield meaningful data in a relatively short time-frame. Many of these efforts did follow the OSHA voluntary training guidelines, and their apparent success in improving protective actions and safe work conditions demonstrate the value of such guidelines. On the other hand, the cogency of these data to any OSHA mandated training rule remains to be seen.

3. Successful training outcomes in the intervention studies appeared greatly influenced by management's role in and support of safety training, especially its transfer to the jobsite. Policies which favor opportunities for applying the knowledge gained from training or reinforce learned behaviors through incentives or other means produce optimum results. Although referred to as extra-training or post-training environmental factors, the above considerations seemed so central to achieving training objectives as to raise the issue of whether they deserve mention in OSHA regulatory language covering training requirements. They are not acknowledged in current training requirements. Separating these kinds of extra-training factors from training per se may be artificial; indeed, everyday experiences on the job are a form of continuing training with safety performance being shaped by management policies and supervisor/worker actions aimed at accountability. OSHA's latest draft of a proposed safety and health program standard emphasizes management actions to ensure effective training results as well as to realize other program goals.

4. Reports suggesting training deficits as factors contributing to worker injuries, health complaints, and workplace fatalities lack confirmation. That workers having received safety and health training are also afflicted indicates needs for ascertaining the essential nature or quality of the training offered and whether it meets OSHA requirements.

Even with these shortcomings, evidence that OS&H training can reduce risks from workplace hazards remains strong. Indeed, the issue is not so much whether OS&H training is worthwhile but what factors both within and beyond the training process can produce the greatest possible impact.

B.  General Conclusions on Critical Training Factors

The literature reviewed in this report portrayed a wide array of training plans and activities, targeted objectives, and evaluation methods that would appear to offer a fertile basis for sorting out those factors or conditions most influential in affecting the training results. This intent was hampered by the fact that so many studies yielded positive training results regardless of which design and technique was used. Indeed, few actually manipulated or compared variables in systematic ways to assess their strengths to the training process. For this and other reasons, the statements below about critical determinants of effective occupational safety and health training programs based on this review must be regarded as somewhat speculative.

1. Numerous examples illustrating the various steps contained in the OSHA voluntary training guidelines are found in the literature and show support for this approach. Various exhibits show how the intent of the guidelines can be met in realistic ways and have merit in framing and implementing an effective training plan.

2. Factors in the actual learning process, which were isolated in this review, included size of group, length/frequency of training, training mode, transfer, motivation, trainer qualifications, management role among others. Documentation was most extensive for motivational factors with evidence that feedback, goal-setting, reward incentives have near uniform success in facilitating safety instruction and the carryover of such knowledge to the jobsite. In contrast, reports and information on size of group and length/frequency of training factors were greatly limited. The latter raises questions about training schedules for safety and health subject matter, and whether the timing for both original and refresher training is appropriate.

3. Factors and conditions favoring effective safety training and its transfer to the jobsite agree with or are consonant with what is known in the general scientific literature on the psychology of learning and motivation. Some refinements are also noted in finding apparent benefits from using supervisors or foremen as safety trainers, and evidence that effective operation of engineering or physical systems for hazard control can be dependent on training.

4. Whether some learning factors are more important than others may vary with situation-specific concerns. The literature suggests that factors influencing safety training focussed on fundamental safety rules and housekeeping practices for routine jobs require no elaborate instructional effort; rather the stress is on factors that can ensure the transfer to the jobsite. Safety training requirements addressing more complex job demands and uncertain work conditions would have to give more consideration to the learning as well as carry-over needs.

5. Even with the qualified answers given in this report to the question of critical training factors, the material presented should benefit users of the OSHA voluntary training guidelines in terms of supplying illustrations of how the different guidelines work in practice, and enabling users to recognize the role that certain factors or conditions can play in moderating the effectiveness of any such training effort.

C.  Needs for Follow-on Work

This literature review has noted gaps in available information and other limitations which suggest needs for further efforts at answering the questions at hand. The following reiterates and elaborates those believed most essential.

1. The training intervention studies reported in this review and showing evident success in meeting their objectives were found wanting for several reasons. One was that most did not address OSHA training requirements found in any particular standard. A second was that most measured training effectiveness in terms of gains in safety knowledge or increased preventive actions; relationships between these measures and reductions in injuries or disease, if also reported, were not clearly shown. Other criticisms were the limited timeframe for studying the results of any training intervention and the site-specific nature of many efforts. These findings could question the generalizability of the findings. More relevant work offering a broader base for evaluation would seem indicated. In this regard, one approach would be to focus on the most prevalent types of injuries and diseases and the select industries or work operations where they occur. Applicable OSHA training requirements for those industries or operations would be noted along with the actual training practices being followed at different sites directed to those specific injury or disease risks. Differences in how the mandated training rules were met at the various sites selected for study, and apparent linkages between the training undertaken and specific injury or disease control measures would be analyzed to assess the effect of training and identify strong or weak practices, etc. This type of study has not been done.³

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³ A report received just after this review was completed comes close to this idea. Its intent was to show the benefits of mandated versus voluntary training for painters who face exposure hazards from toxic paint materials and coatings. Questionnaire data from painters in Alaska where training is mandated versus painters in Washington and Oregon where similar training is done on a voluntary basis showed important contrasts on issues not heretofore raised. Specifically, and as expected, mandated training increased the likelihood that all workers would be trained, regardless of union affiliation, or because of working for small shop employers. This was viewed as an important consideration inasmuch as nonunion and small paint shops were believed more likely to vie for jobs posing higher risk of toxic exposures. Further, it was noted that voluntary training appeared to attract only those painters who had undergone previous training. That is, painters with the least amount of previous training tended to forgo added training under the voluntary system. Information supplied by painting contractors in this survey also found that Alaska's mandatory training requirement did not elevate employers' safety and health expenditures when compared with similar costs for voluntary programs in Washington and Oregon. Although the report goes on to note how the Alaska training program improved respirator and fan use plus other self-protective measures against painting exposure hazards based on the questionnaire responses for those surveyed, data validating these benefits in terms of lesser work-related illness are not given. For more details see Wolford R, Larson M, Merrick D, Andrews M, Tillett S, Morris S, Keiffer M. [January 1997]. A comparison of safety-and-health training of painters in Alaska, Oregon, and Washington. The Center to Protect Workers' Rights, 11 Massachussetts Avenue, N.W., Washington D.C. 20001.

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2. Related to the above proposal in a more general way, little information exists of how industry responds or has responded to various OSHA training rules and the quality of such efforts. Some information of this nature is certain to exist in data files of NIOSH, OSHA, and MSHA as a result of other programmed work undertaken by these agencies. Records from NIOSH Health Hazard Evaluations, fatal accident investigations, and the National Occupational Exposure Survey databank would be good sources to tap as would OSHA and MSHA Compliance Officer inspection files. Efforts to extract and assemble training related data from these files could provide a status statement on OS&H training practices. Depending upon the data actually available, one could determine the extent to which the training follows the OSHA voluntary guidelines or other frameworks and any resultant experiences in attaining hazard control objectives.

3. A major point in this literature review is that OS&H training is embedded within a larger overall hazard control program of an organization, and thus its effectiveness in reducing work-related injury and disease can depend on other factors. Aside from the instruction itself and motivational factors such as goal setting, feedback that reinforces the learning, and its transfer to the jobsite, there are engineering, administrative, and organizational practices that can also affect the training activity and its objectives. Top management commitment to workplace safety and health, supervisor/worker communications on safety and other issues, and accountability stressing both safe performance as well as productivity can greatly influence the degree to which the lessons learned in the training program can be transferred to the shopfloor. To examine which types of training practices by themselves or in combination with these other factors can yield the most positive effects will require indepth studies, and it is proposed that such efforts be focussed on those establishments with exemplary hazard control programs as demonstrated by their low injury/illness rates. The OSHA "STAR" companies in their Voluntary Protection Programs (OSHA, 1988b) would appear to offer a sample of suitable candidates for study.⁴ Although seemingly repeating other work aimed at defining successful program practices, this proposal would look more critically at the training activities, both in isolation and in their interactions with other factors to define the dominant or controlling influences on the training outcomes. The endproduct of this work is envisioned as a series of case study reports describing the characteristics of effective training programs and ways to integrate them with other hazard control measures so as to produce the maximal benefit.

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⁴ "STAR" companies in the OSHA Voluntary Protection Programs must meet comprehensive safety and health program qualifications and maintain lost day injury rates at or below the national rate for that industry. Companies who apply for and receive "STAR" status are evaluated onsite every three years with annual reviews of their injury rates.

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4. Other possibilities for assessing the importance of training could take the form of retrospective studies comparing differences in the level of training of workers who are injured on the job or afflicted with an occupational disease with comparable groups not so affected. The reports cited in this review give uncertain results as to whether appropriate training could have prevented these occurrences. But as noted, one major drawback of these studies is the absence of more factual information on the extent or nature of the training actually received as it relates to the problem. Added efforts to determine whether training gaps or weaknesses can contribute to injury or disease incidents would be worthwhile. Critical to this work, however, would be the need to detail the training practices in place as well as other factors that could moderate their effects. Case-control or cohort approaches would offer ways for obtaining comparative data on affected versus nonaffected persons, given the need to separate out many nontraining factors that could be responsible for the differences.

5. In considering factors inherent to the training process, duration/frequency issues drew special attention. The OS&H literature contained few references dealing with this subject despite its significance to scheduling instruction, both for initial and refresher training purposes so as to ensure a maximal, durable effect. The skills training literature offers some ideas about major variables that should be weighed in deciding on an appropriate schedule, and these could be the starting point for deriving a decision logic to address workplace safety and health training objectives. For this purpose, it is suggested that workshops be convened to discuss this as well as other matters relating to the effectiveness of OS&H training. Invitees would include experts and practitioners conversant with job skill and OS&H training plus others engaged in basic learning research, program evaluation, health education, and organizational behavior representing both the private and public sectors. This would be one way to tap the diverse knowledge applicable to answering the questions raised in this report. In addition to the topic of a decision logic for training schedules, other items on a workshop agenda could include:

•  The adequacy of the current regulatory language on training requirements.
•  Future training challenges owing to changing workplace technologies/job demands and related hazards, worker demographics, emergent occupational injury/illness problems.
•  New training technologies and evaluation strategies for measuring training outcomes.
•  Desirability of merging independent training domains (skills training, OS&H training, health promotion).

Outputs from the workshop would be state-of-the-art information for training fulfilling its role in contributing to improved OS&H conditions, both now and in the future.

Back to the Table of Contents

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APPENDIX A

TRAINING INTERVENTION STUDIES AS FOUND IN THE LITERATURE ADDRESSING
VARIOUS TYPES OF OCCUPATIONAL HAZARDS

 A-I.      Safety/Injury Hazard Control
A-II.     Control of Health Hazards-Chemical Agents

A-III.    Control of Health Hazards-Physical Agents

A-IV.    Control of Ergonomic Hazards

A-V.     Control of Health Hazards-Biologic Agents

APPENDIX B

EXTRACTS FROM BUREAU OF LABOR STATISTICS (BLS) WORK INJURY REPORTS FOR
DISCERNING REAL/POSSIBLE GAPS IN JOB SAFETY/HEALTH TRAINING

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