Stakeholder Meeting on
Preventing Occupational Hearing Loss
Washington, D.C.

November 3, 2011

Meeting Summary Report

Table of Contents

1 INTRODUCTION
2 OPENING REMARKS
3 ADMINISTRATION OF THE MEETING
4 POINTS OF DISCUSSION
5 WRAP-UP AND NEXT STEPS

1. Introduction
   
   This report summarizes key discussion points made during an informal stakeholder meeting that the Occupational Safety and Health Administration (OSHA) convened to provide a forum and gather information on the best practices for noise reduction in the workplace. The meeting included a discussion on personal protective equipment, hearing conservation programs, and engineering controls. The four-hour meeting was held from 9:00 a.m. to 1:00 p.m. EDT on November 3, 2011, at the U.S. Department of Labor (DOL) Frances Perkins Building in Washington, D.C. The purpose of the meeting was to elicit the views of employers, workers, and noise control and safety and health professionals about the hazards of occupational exposure to noise and how best to control them. OSHA held this stakeholder meeting as part of its commitment to work with stakeholders on approaches to prevent hearing loss.
   
   On October 19, 2010, OSHA published in the Federal Register a proposed interpretation titled "Interpretation of OSHA's Provisions for Feasible Administrative or Engineering Controls of Occupational Noise." The proposed interpretation clarified the term "feasible administrative or engineering controls" as used in OSHA's noise standard. Comments were due December 20, 2010; however, in response to several requests from the regulated community, OSHA extended the comment period by 90 days to March 21, 2011. Over 90 comments were received. OSHA stated that it would review all of the comments before making its final decision. On January 19, 2011, the proposal was withdrawn: OSHA decided to suspend work on it in order to conduct an education, outreach, and consultation initiative on preventing work-related hearing loss. As part of this initiative, OSHA committed to holding a stakeholder meeting on preventing occupational hearing loss.
   
   An announcement of the stakeholder meeting was published in the Federal Register on October 6, 2011, and explained that parties interested in attending and participating should register in advance. This meeting had 30 participants, representing industry, trade organizations, academia, unions, and government agencies, as well as consultants, attorneys, and other parties. All participants were given the opportunity to provide verbal comments at the meeting. Members of the general public were allowed to observe the meeting (but not participate) on a first-come, first-served basis as space permitted. Approximately 50 people attended the meeting as observers, either in person or by teleconference.
   
   This report captures the main discussion points that stakeholders raised during the meeting, but is not a verbatim transcript of the meeting. Its content reflects stakeholders' remarks at the meeting and does not represent the opinions of OSHA.
   
   
2. Opening Remarks
   
   William Perry, Deputy Director, Directorate of Standards and Guidance, welcomed the stakeholders and gave the following remarks.
   
   Good morning everyone. I'm William Perry, Deputy Director of the Directorate of Standards and Guidance. I would like to thank you for taking the time to talk to us today on this important issue. I know that many of you have very busy schedules and that some of you have had to travel a long distance. We truly appreciate your taking the time to be here, to share your expertise and your concerns, and to help us move forward to continue working with stakeholders on approaches to preventing occupational hearing loss.
   
   Today's stakeholder meeting is an important step in helping us to assure that we get the best available information. The panel will be presenting four questions today on which we are seeking your input and comments. This meeting will give us an opportunity to establish a constructive dialog that will build trust and facilitate the flow of information, not only today, but as we move through the process.
   
   Before we begin our discussion today, I would like to introduce the members of OSHA's panel. Debbie Berkowitz, Chief of Staff for the Occupational Safety and Health Administration; Richard Fairfax, Deputy Assistant Secretary of Labor; Nancy Hauter, Director, Office of Health Enforcement in the Directorate of Enforcement Programs; Audrey Profitt-Henry, Senior Industrial Hygienist, Directorate of Enforcement Programs; Brian Liddell, Health Response Team, Directorate of Technical Support and Emergency Management; and Bryan Seal, Senior Industrial Hygienist, Directorate of Standards and Guidance. And joining us later will be Dorothy Dougherty, Director of the Directorate of Standards and Guidance.
   
   I want to emphasize that stakeholders should consider this meeting an informal discussion to help OSHA identify best practices, rather that a formal meeting or hearing. We are not transcribing this meeting; however we will be taking notes and placing a summary in the docket and on our Web site.
   
   I am very pleased to see this turnout and I look forward to what I know will be a very productive meeting. Thank you again for being here with us today. I look forward to working with you in the future as we move through the process.
   
   Deborah Berkowitz, Chief of Staff, OSHA, gave the following opening statement. I also want to welcome everybody and let you know how grateful we are that you are here. We know how busy everyone is, and I want to thank you on behalf of the full agency for your time and your interest in being here. I especially want to thank those that have come in from around the country to discuss this important issue.
   
   We are here to discuss preventing occupationally-related hearing loss. From 2004-2009, the BLS has reported that over 125,000 workers suffered significant, permanent hearing loss from work. We are all here today because we care about this issue, and we are looking to share information and ideas on how best to move the ball forward on protecting workers. OSHA is committed to working with our stakeholders –you – on finding approaches to reduce this toll.
   
   OSHA is here today to listen. Last January, we announced that we would hold this stakeholder meeting to elicit the views of employers and their representatives, workers and their representatives, noise control experts and public health professionals on preventing occupational hearing loss. And that is who is here today.
   
   We are also committed to continuing our education and outreach effort to provide enhanced technical information on preventing occupational hearing loss. I hope you have visited our new webpage on Occupational Noise Exposure. We are looking forward to updating this page with new information and ideas gleaned from today's meetings.
   
   We have a series of questions we asked in the Federal Register notice to help in guiding this discussion. But before we begin, I want to introduce Rich Fairfax, our Deputy Assistant Secretary, who has a few opening remarks.
   
   Richard Fairfax, Deputy Assistant Secretary of Labor, explained that many in the regulated community are misinformed about how OSHA approaches noise reduction in the workplace. Many believe that OSHA requires every employer to lower noise levels below 90 decibels (dB). This is the target noise level, but OSHA is most concerned with achieving a significant reduction in noise—which could be a reduction of only 3 dB in some workplaces As far as noise control goes, the Agency has always worked fairly and cooperatively with employers and we will continue to do so – our procedures for evaluating noise exposure I think you will find, at least in my opinion, quite fair and reasonable.
   
   The Agency has always followed the same principles in citing and requiring an employer to implement noise controls. And we have always accepted the use of a combination of controls that include: engineering controls, work practice controls, and administrative controls. While engineering controls are always the preferred control method – OSHA does not require employers to implement 100% engineering controls – again we allow and accept a combination of control methods.
   
   I am assuming most all of you are familiar with noise energy and the fact that we are actually measuring the energy in the form of sound pressure levels – like an earthquake, noise energy is expressed on a logarithmic scale. For noise measurement, there are a several logarithmic scales used – the most common ones revolve around what is referred to as an exchange rate of either 3 dB or 5 dB. Under these scales, the noise energy doubles with every 3 or 5 dB increase in the noise level. For measurement and enforcement purposes, OSHA uses a 5 dB exchange rate – meaning the sound energy to which a worker is exposed is considered to double with every 5 dB increase in the noise level. However, it is generally accepted that use of a 3 dB exchange rate for assessing noise exposure is more appropriate – which means the sound energy doubles with every 3 dB increase in the noise level. What this means in simple terms is that with a 5 dB exchange rate, the exposure one gets for 8 hours of exposure at 90 dB(A), is equivalent to 4 hours of exposure at 95 dB(A); or using a 3 dB exchange rate, the exposure to 90 dB(A) for 8 hours is equivalent to 93 dB for 4 hours.
   
   As I said earlier, OSHA has never said that one needs to reduce the noise levels down to 90 dB(A) or lower for a average 8 hour exposure to noise. OSHA has always looked at what we call a "significant reduction in the noise level." And for OSHA purposes that significant reduction is a 3 dB exchange rate NOT the 5 dB exchange rate we use for measurement and citation.
   
   So, the noise levels at a facility averaged 100 dB(A) OSHA would: 1) measure the noise levels and determine an 8 hour time weighted average exposure; 2) conduct an octave band analysis to determine the frequency range and predominate noise frequency; 3) review the engineering, work practice, and administrative controls that would be applicable, based upon the circumstances at the facility; and 4) calculate the expected noise reductions and examine what options are available for reducing the noise levels.
   
   Then, if the combination of noise reduction options and the calculations in noise reduction levels achieved a 3 dB reduction or more – we would cite and require a combination of controls. If we could not show a minimum of 3 dB we would not cite for controls and the employer could rely on hearing protection and a hearing conservation program.
   
   If an employer has been cited for controls, the Agency has always been very flexible with the time allowed for abatement. We have typically worked with employers on abatement schedules that can last a year with the opportunity to extend the abatement period further. I can recall one mill in Georgia where the employer was given a 10 year abatement period.
   
   
3. Administration of the Meeting
   
   The meeting facilitator provided the stakeholders with an overview of the meeting format, which was an informal discussion with stakeholders, not a formal meeting or hearing. The facilitator explained that OSHA was not there to answer questions; rather, the purpose of the meeting was to listen to stakeholder input on four topics related to the prevention of occupational hearing loss. The facilitator also presented an overview of the agenda, including the specific questions that OSHA was asking the stakeholders to address. Each of the four questions was discussed for approximately 45 minutes, with a 20-minute break after the second discussion. Participants introduced themselves by giving their names and organizations when called upon to speak for the first time.
   
   
4. Points of Discussion
   
   OSHA sought stakeholder input on the four questions regarding occupational hearing loss prevention: 1) What are the best practices regarding hearing conservation programs? 2) What are the best practices for, as well as concerns with, using personal protective equipment for noise control? 3) What are the best practices for using feasible engineering controls? 4) What are companies' experiences with effective noise control programs and what are the key elements of their programs?
   
   The following is a summary of the key stakeholder comments made during the meeting. Comments are grouped together by topic, without reference to the identity of the commenter.
   
   4.1 What are the best practices regarding hearing conservation programs?
   
   Nancy Hauter, Director, Office of Health Enforcement, thanked everyone for coming to the meeting and provided an introduction to hearing conservation programs and their elements.
   
   Hearing conservation programs include the following elements: 1) monitoring noise in the workplace to identify employees at or above an exposure of 85 dB for an eight-hour time-weighted average (TWA); 2) notifying these employees that they are exposed; 3) allowing those workers to observe the monitoring that was conducted; 4) establishing and maintaining an audiometric testing program; 5) informing workers of the results of their hearing tests; 6) providing adequate hearing protection to workers; 7) training exposed workers on the effects of noise, the use of hearing protection, and the purpose of audiometric testing programs; 8) posting OSHA's noise standard in the workplace; and 9) keeping records of noise exposure measurements and audiometric testing results.
   
   Many companies rely heavily on hearing conservation programs to protect employees. The effectiveness of these programs is determined by the results of the hearing tests. The goal of a hearing conservation program is to prevent hearing loss. OSHA compliance officers sometimes encounter problems with audiometric testing. Audiometric testing is often conducted improperly, or is not conducted in a timely fashion. In fact, the audiometric testing paragraph of the noise standard is the most frequently cited paragraph in the standard. The second most frequently cited paragraph is the hearing conservation program itself.
   
   Stakeholders provided the following comments and recommendations regarding best practices for hearing conservation programs:
   
   
   • Audiometric testing:
     
     – A best practice is to ensure that the background noise level is low enough during audiometric testing that it does not interfere with obtaining an accurate threshold measurement.
     
     – A baseline hearing test for employees should be performed sooner rather than later. Under the current noise standard, employers have a year to perform baseline hearing tests for employees. Employees should not be exposed to noise for 14 to 20 hours before a baseline hearing test. Simply wearing hearing protection during the period before a baseline test does not always prevent exposure to noise, since hearing protectors may not work if worn incorrectly.
     
     – Everyone who performs hearing testing in an occupational context should be certified by the Council for Accreditation in Occupational Hearing Conservation. This organization provides standardized and uniform training.
     
     – Audiometric testing does not save hearing by itself. Testing needs to be followed up with counseling and training, or else the hearing conservation program simply serves as a way to document hearing loss. Many companies believe they are complying with the noise standard just by performing audiometric testing.
     
     – Employees in some industries tend to move from job to job. Someone should create a credential that workers can carry with them that lists their results from a baseline hearing test. This would establish a worker's baseline on the first day of a new job.
     
     
   • Construction industry:
     
     – Best practices for hearing conservation programs are in their infancy in the construction industry, because the OSHA hearing conservation standard does not apply to construction. There is a provision that says construction companies have to have a program, but the specific elements are not spelled out, as in the general industry standard. The result is that the only practice on construction sites is to hand out ear plugs. A comprehensive hearing conservation program requirement should be included in the construction noise standard. OSHA should think of ways to raise the bar as to what is required for the construction industry to be in compliance with the noise standard.
     
     – The construction industry is different than the manufacturing sector. What works for large, wealthy companies may not work for small construction companies, which dominate the construction industry and struggle with the regulatory burden. OSHA should focus on ways to help small businesses reduce noise levels, through rulemaking or guidance documents, not simply by listing best practices.
     
     
   • Hearing protectors:
     
     – It is a best practice to provide a variety of hearing protectors. This will make it more likely that a worker will find the hearing protector to be comfortable, which will increase the chance that the worker will wear it.
     
     – If employers make a good faith effort to reduce noise through noise controls, it should be an incentive for workers to wear hearing protection.
     
     – Fit-testing is an important best practice in having effective hearing protection, but if workers do not wear the hearing protection or wear it incorrectly, it is still ineffective. Effective fit-testing is important, but does not replace noise controls or other elements of the hearing conservation program. An OSHA alliance document identifies fit-testing as a best practice in hearing protection.
     
     – Attenuation is a secondary issue for hearing protection. Hearing protector use is the primary issue, since workers need to wear personal protective equipment (PPE) in order for it to work. This means that enforcement of PPE use by employers is a best practice.
     
     – Relying on workers to use PPE shifts responsibility from employers to workers. This is contrary to the Occupational Safety and Health Act, which places the burden on employers. The noise standard has been a failure, because hearing conservation programs have not prevented occupational hearing loss as intended.
     
     – Hearing protection devices can interfere with speech and alarm detection for workers. This is especially true for many older workers, who already have noise-induced hearing loss. Hearing protectors often attenuate higher frequencies, which is the range in which speech and information is often conveyed. Making hearing protection devices compulsory puts some workers in danger. In fact, many workers find ways to sabotage hearing protection in order to communicate.
     
     – In response to the previous statement, another stakeholder said that there are solutions for being able to communicate and wear hearing protection at the same time.
     
     
   • Training and education:
     
     – Training offered to employees should be motivational, rather than just providing education.
     
     – Many maritime workers believe they cannot use hearing protection, because it will inhibit their ability to communicate and hear warning sounds. Better training is needed to combat this attitude.
     
     – Anytime we rely on workers to protect themselves, training becomes a crucial part of a hearing conservation program, even though the training is often inadequate. There is a standard from the American National Standards Institute (ANSI), A10.46-2007, Hearing Loss Prevention for Construction and Demolition Workers, which is relevant and may contribute ideas for hearing conservation programs for other industries.
     
     – Since sometimes 15 languages are represented in a workplace, consideration should be taken to effectively communicate training materials to employees.
     
     – In the food industry, the amount of time devoted to hearing protection and other safety issues is being reduced. A best practice, therefore, is to ensure that adequate time is spent on hearing protection training.
     
     – Changing personal behaviors so that workers wear hearing protection will solve a lot of hearing loss problems. Sometime the victim has to take responsibility for their own behavior. Dr. Shulz has an article in the March 2011 edition of The Synergist that does a good job of discussing conservation and prevention ("From Conservation to Prevention: Metrics for Moving From a Traditional Compliance-Based Hearing Conservation Program to One More Firmly Based in Best Practices").
     
     – Many hearing conservation education materials are difficult to find. The stakeholder encourages OSHA to make these materials easier to access.
     
     – Employees should be retrained regularly, since one-time training is not effective.
     
     – A stakeholder discussed two studies from the University of Washington that examined hearing protector behavior change and non-occupational hearing loss. The first study found that the one-time training and "toolbox" training approaches to motivate proper use of hearing protectors were ineffective in changing worker behavior. The only workers to change their behavior were those who received real-time feedback. The second study found that non-occupational noise exposure caused virtually none of the hearing loss experienced by the vast majority of construction workers.
     
     
   • Awards and model programs:
     
     – The Safe and Sound Award recognizes innovative hearing conservation programs. OSHA should find a way to recognize successful programs. Sharing success stories would help other companies develop model hearing conservation programs.
     
     – Washington's Division of Occupational Safety and Health has a comprehensive hearing conservation requirement, including enforcement and noise controls.
     
     – NASA has implemented a noise control program that involves a process for purchasing Buy Quiet and Quiet by Design products. If the agency is spending money on retrofit noise control, it makes more sense to spend the money up front to design out the noise.
     
     – Retrofitting is often more expensive and less technically feasible.
     
     
   • Noise monitoring and exposure assessment:
     
     – OSHA should require employers to upgrade noise exposure monitoring to the extent that individuals and groups who are exposed to noise hazards can be identified. Current monitoring efforts are rarely done to the degree and accuracy necessary.
     
     – A best practice is for companies to form a joint employee-management committee that is assigned noise control responsibilities. This committee helps to find and reduce noise levels. It can also review major purchases and new processes to ensure they will not expose workers to noise hazards.
     
     – Understanding sources of noise exposure is the first step in reducing noise levels.
     
     – It is important to track individual workers' job responsibilities, to better understand which workers are exposed to which noise hazards. This would help identify the "low-hanging fruit" in a facility, which would be the easiest to lower noise levels. The Council for Accreditation of Occupational Safety and Health is developing a new noise measurement program that will provide instruction on how to perform noise measurements.
     
     – The use of real-time monitors on workers will often trigger workers to wear their hearing protection. If a worker sees in real-time that he or she is over a certain noise threshold, a correction can be made.
     
     
   • Noise controls:
     
     – Noise controls should be OSHA's primary focus. Noise controls will encourage employees to participate in other elements of the hearing conservation program.
     
     – Every one of the Safe and Sound Award winners had a noise control element to some degree in their program.
     
     
   • Noise exposure threshold levels:
     
     – OSHA currently uses two threshold levels: one is a Permissible Exposure Limit (PEL) threshold of 90 dB and the other threshold, for hearing conservation inclusion, is 85 dB. Employers have to have two TWAs per worker, which is confusing. A best practice is to eliminate the higher threshold, or eliminate both thresholds. With developments in technology, two TWAs are no longer necessary.
     
     
   • Non-occupational hearing loss:
     
     – There is a lot of data backing the assertion that the worker population, particularly the younger population, is suffering hearing loss from non-occupational sources. Therefore, a best practice in hearing conservation programs is to look at the worker in a holistic way in order to identify sources of hearing loss.
     
     
   • Program evaluation:
     
     – Companies should not simply be compliant, but need to show that their hearing conservation program is effective. OSHA should include program evaluation as a key element in these programs. One metric in evaluating program effectiveness is to measure whether hearing protectors are lowering noise exposure below 90 dB.
     
     – A regular audit for compliance and effectiveness should be a part of hearing conservation programs. Companies should also use incidence documentation to figure out the sources that caused the shift in noise.
     
     
   • Using an 85 dB exposure limit:
     
     – Many global companies are using an 85 dB TWA with a 3 dB exchange rate, which is more stringent than the legal requirements in the United States. There is scientific evidence that shows there will be occupationally caused hearing loss between 85 and 90 dB.
     
     – Studies at the University of Washington have documented hearing loss occurring at sounds levels of 85 dBA, and even slightly less. A standard of 90 dBA is not stringent enough.
     
     
   • Other discussion points:
     
     – Rotating employees in and out of high-noise areas should not be a best practice. This exposes workers to noise hazards who would otherwise not be exposed.
     
     – When considering exposure levels, OSHA should consider the growing body of evidence that suggests concurrent autotoxic exposures augment the effects of noise exposure on workers. Additionally, the Department of Defense is keenly interested in engineering controls, since exposure levels are exceeding protection capacities.
     
     – OSHA needs to find out what works, not what stakeholders think. The National Institute for Occupational Safety and Health (NIOSH) has not looked into this question for 30 years either. The noise standard will need to be changed in order to adopt many of the best practices suggested today. Changes will need to be supported by scientific data and substantial evidence.
     
     – Another stakeholder responded to the previous comment by pointing out a 2010 international study by Dr. Thais Morata, in which NIOSH participated, that examined what is working and what is not for preventing occupational hearing loss. NIOSH has established a strategic plan with a goal of developing evidence-based best practices.
   4.2 What are the best practices for, as well as concerns with, using personal protective equipment for noise control?
   
   Audrey Profitt-Henry, Senior Industrial Hygienist, Directorate of Enforcement Programs, briefly introduced the next topic and explained some of the comments that OSHA had received in response to its notice in the Federal Register last fall.
   
   Some of the comments received were simply statements, while others were accompanied by studies or surveys. One commenter pointed out that there are workers who have worn hearing protection their entire careers but still experienced hearing loss. Another commenter said that hearing protectors create problems that noise controls avoid. Another asserted that hearing protection can interfere with sound localization, which is more of an issue for workers who already have some hearing loss. Another complained that hearing protection is ineffective in the workplace, due to misuse and a lack of supervisory enforcement. The final commenter mentioned that it does not make sense to control sound with engineering controls when workers can simply wear ear plugs and ear muffs at a much lower cost.
   
   Stakeholders responded with the following discussion points and recommendations regarding best practices for, and concerns with, the use of PPE for noise control:
   
   
   • Reporting PPE use:
     
     – Several studies have documented that workers and supervisors are not always accurate when reporting whether they used PPE on the job. Workers and employers cannot be relied upon to accurately report PPE use.
     
     
   • Use of punitive measures:
     
     – In many plants, the use of punitive measures against employees for failing to wear PPE can actually serve as a deterrent to wearing PPE. A best practice would be to ban all punitive programs that might deter workers from using PPE.
     
     – In response to the above comment, another stakeholder emphasized the importance of punitive measures against employees as a tool in enforcing hearing protection rules. The following steps were suggested as a best practice: the employer 1) develops a rule; 2) communicates the rule through training, toolbox meetings, and other means; 3) audits the program at different levels; and 4) resolves problems in a proactive manner when identified.
     
     
   • Employee inclusion:
     
     – A best practice is to include employees in the process of identifying barriers preventing workers from wearing hearing protection.
     
     
   • Fit-testing:
     
     – There are substantial training benefits to fit-testing beyond compliance. Fit-testing provides real-time reinforcement to workers on how PPE is supposed to feel and how it provides protection.
     
     – During training, a hearing protection fitting practicum should be included.
     
     – In a study by Carl Johnson, the results of several thousand fit tests were examined. The study found that 60 percent of employees with no coaching were receiving adequate hearing protection and needed no additional training. 15 to 20 percent were not receiving adequate attenuation, but were able to achieve better results after a short training session. Another 15 to 20 percent had to change to a different size or another type of hearing protector to receive adequate hearing protection. Less than 5 percent could not wear any of the ear plugs and needed ear muffs or another device. This shows the importance of employers providing a variety of hearing protector sizes and models.
     
     – Another stakeholder pointed out a study in which 75 percent of workers could accurately say how much protection they were receiving from hearing protectors after a few rounds of real-time fit-testing feedback.
     
     
   • Construction industry and task-based hearing protector requirements:
     
     – A lot of the noise exposure on construction sites is due to impact noise, which may not increase the noise level beyond the TWA, but has been shown to often be more harmful than sustained noises near the TWA. When developing its standard A10.46-2007, Hearing Loss Prevention for Construction and Demolition Workers, ANSI created task-based hearing protector requirements. In this system, workers wear hearing protection when performing certain tasks, or when in certain areas. Workers do not have to wear hearing protection at all times and employers are not permitted to choose protectors that provide overprotection or reduce noise exposure below 70 dB.
     
     – Another stakeholder reinforced the idea that instantaneous exposure levels are often easier for employees and employers to understand than TWAs. In addition, instantaneous exposure levels are often equivalent to or more conservative than TWAs. NASA already uses instantaneous exposure levels. It is important to remember that TWAs do not cover visitors to loud areas, whereas instantaneous exposure levels do. Another benefit is that hearing protector requirements for specific tools or tasks are more easily translated to non-occupational use.
     
     
   • In-ear dosimetry:
     
     – This is a relatively new technology that allows measurements of the noise exposure beneath hearing protectors. This provides a more accurate measurement of the noise level to which a worker is exposed while wearing certain hearing protectors.
     
     
   • Hearing protection for flight attendants:
     
     – The Federal Aviation Administration has asserted jurisdiction for the safety and health of flight workers in the cabins of aircrafts but has not addressed the exposure of flight attendants to noise hazards. NIOSH has made recommendations, but these have not been adopted.
     
     
   • Color coding and standardized labeling of hearing protection:
     
     – Small contractors need an easy way to identify noise reduction rates for hearing protection equipment. One possible way to accomplish this is to develop a standardized labeling or color coding system.
     
     – Another stakeholder responded to the previous comment by pointing out that the EPA may change the way hearing protectors are labeled, which may actually require more education for small employers. The International Safety Equipment Association and other groups have laid the groundwork for an outreach document to explain to small employers what a new labeling system may look like. A document with few words and numerous pictures would be ideal.
     
     – Labeling requirements in the European Union are more stringent, allowing consumers to compare machines by their labels in the store. A lot of equipment is manufactured for European export only. There needs to be motivation for companies to offer quiet products in the United States.
     
     – The current noise reduction rating does not accurately estimate the noise exposure to a worker in the field, since it is based on results from a laboratory. A new label would be simpler, since it would be field-based and would not have a noise correction factor. To take advantage of new hearing protector technologies, such as sound restoration devices and active noise reduction, the new labeling procedures being considered by the EPA are needed.
     
     – The EPA has completed the proposed labeling rule, but there is not much promise for it to move forward in the foreseeable future.
     
     
   • Developments in hearing protector technology:
     
     – In recent years there have been significant technological developments in hearing protection devices, which allow ambient noise cancelation and enhanced communication. These technologies will be on display at next year's National Safety Congress.
     
     – Another stakeholder explained that there are now devices to help workers communicate using flat attenuation, in which everything is attenuated to the same level across frequencies. These devices help when workers have normal hearing, but are less effective for workers with existing hearing loss. Additionally, some devices for communication cost $50 per set, but others cost as much as $1,000 per set, which is very expensive for smaller businesses.
     
     
   • Demonstrating the effectiveness of PPE at a threshold shift:
     
     – Employers are required to demonstrate that the PPE provided to employees is adequate whenever an employee demonstrates any kind of threshold shift. Neither of the following formulas demonstrates that hearing protection is adequate:

     Estimated Exposure (dBA) = TWA (dBC) - NRR
     Estimated Exposure (dBA) = TWA (dBA) - (NRR-7)

     An employer can demonstrate the adequacy of hearing protection in a low-tech way by using occluded and un-occluded audiograms. This would emphasize the importance of the requirement for employers to demonstrate the adequacy of their hearing protection after a demonstrated threshold shift.
     
     
   • Developing a noise attenuation training tape:
     
     – One effective tool in demonstrating the effects of hearing loss would be a video that shows what happens when noise is attenuated at different frequencies. This can emphasize the serious nature of hearing loss to workers in a memorable way.
     
     – In response to the above comment, another stakeholder pointed out that NASA has produced a CD that demonstrates the effects of hearing loss at various levels.
     
     
   • Multiple layers of protection:
     
     – In food processing plants, workers are wearing various types of PPE. There are concerns that this combined use may have hazards. Additionally, in many food processing plants, workers do not have an opportunity to adjust their hearing protector during their shift if it is uncomfortable or does not fit properly.
     
     – In response to the above comment, a stakeholder mentioned that there are known solutions to the concerns that were raised.
     
     
   • Additional comments and concerns:
     
     – Currently, there is no guidance from OSHA on how companies can use the results of fit-testing to comply with 1910.95. It also makes sense to allow the use of a personal attenuation rating to demonstrate compliance with the hearing protection section of the noise standard.
     
     – For the past 20 years, OSHA has allowed employers to rely on PPE too heavily. This is a failed enforcement policy and puts too much of the burden on one solution.
     
     – The availability of hearing protectors to employees in the workplace would significantly increase their use. Employers should provide access to hearing protectors, even in areas where the use of hearing protection is voluntary.
     
     
   4.3 What are the best practices for using feasible engineering controls?
   
   Brian Liddell, Health Response Team, Directorate of Technical Support and Emergency Management, provided a brief overview of engineering controls in the context of controlling sources of noise. Mr. Liddell also posed several questions concerning engineering controls that are of interest to OSHA.
   
   OSHA inspectors see many examples of engineering controls in the field, in many different industries. Some engineering controls are simple, such as installing pneumatic silencers on compressed air exhausts or adding damping materials to vibrating surfaces. Engineering controls can be added in three places to reduce noise: at the source, along the transmission path, and at the receiver. Even a 3 dB reduction in noise is significant, and a 5 dB reduction reduces a worker's exposure to noise by half when utilizing an exposure standard with a 5 dB exchange rate.
   
   Mr. Liddell then posed several relevant questions: What are the main issues in the design and implementation of engineering controls? What are the best approaches to be used when assessing noise control programs? What issues exist in the identification, design, and implementation of noise controls? How can these be addressed? Given that European manufacturers are well ahead of the United States in designing quieter equipment, how can OSHA work with industry and other associations to encourage the development of new noise control technologies? What helpful resources can OSHA provide?
   
   Stakeholders responded with the following discussion points and recommendations regarding best practices for using feasible engineering controls:
   
   
   • Emphasizing engineering controls:
     
     The OSHA field manual, which is instruction and not a regulation, says that an inspector can count on hearing protection devices up to 100 dB before issuing a citation. This seems to discourage the use of engineering controls in favor of hearing protection. The stakeholder also drew attention to Technology for a Quieter America and the The Bridge, a magazine that has published papers by Bob Bruce about best practices.
     
     Why is it that there is quieter equipment available in other countries that is not available here in the U.S.?
     
     
   • Noise control best practices database:
     
     – The Institute of Noise Control Engineering has 50,000 papers about noise control posted online, classified by subject. It would be useful if experts in the field went through these papers to distribute those relevant to best practices.
     
     
   • Buy Quiet and Quiet by Design programs:
     
     – The International Institute of Noise Control Engineering has empowered a study committee to define best practices in Buy Quiet programs. The study is expected to be finished in approximately two years.
     
     – The federal government could require a Buy Quiet element for all federal construction projects without any new regulations. This would serve as a major driver for quieter equipment in the private sector. It might also give equipment manufacturers an incentive to be transparent about the noise levels of their equipment.
     
     – A best practice for these programs is to quantify the long-term costs of exposure and compare them to the purchase costs of quiet equipment.
     
     – Another best practice is to develop a structured program with a process to follow, including data on available equipment, approval forms, and verifications required at the shop and in the field. A structured program will document an informed purchasing decision and will force management to justify occasions when quiet equipment is not purchased.
     
     – Buy Quiet programs should be tailored to the company's culture and operations. If protocols and communication channels for other safety issues exist, a company can also use these for Buy Quiet and Quiet by Design programs.
     
     – Large companies can partner with suppliers to design large equipment. Noise labeling for off-the-shelf products would make it easier for consumers to choose quiet equipment.
     
     
   • Outreach materials and useful resources:
     
     – An old OSHA booklet with cartoons of principles and applications of noise control has been updated and is now available in the public domain. It would be useful to have this document posted on OSHA's website.
     
     – There are several reports from other countries regarding noise control: the British Health and Safety Executive published 60 case studies on noise reduction techniques, British Columbia has a report on controlling construction noise, Singapore's Department of Environmental Protection has a practical guide on reducing noise from construction sites, and the European Union has a noise control guide. It would be helpful if OSHA put together a simple solutions book regarding noise control.
     
     – The Cochrane Report found that traditional hearing programs that did not include noise controls were not effective.
     
     – OSHA or NIOSH should prepare materials that assess what is known about the effectiveness and limitations of hearing conservation approaches.
     
     
   • Return on investment (ROI) for engineering controls:
     
     – There are often concerns regarding the costs associated with engineering controls versus their effectiveness. OSHA should prepare a document that describes the ROI for engineering controls.
     
     – Another stakeholder explained that, before attempting to convince the business community to use engineering controls, OSHA needs to use concrete facts to demonstrate why they are the most effective solution. This can be done by measuring the outcomes of engineering controls currently in place in real workplaces, using either standard threshold shifts or occupational hearing loss to determine recordability. Providing this proof to the business community is necessary because money spent on engineering controls is money that cannot be spent on something else.
     
     – A stakeholder responded to the previous comment by stating that the cost-effectiveness of noise controls has been shown for a long time. Relying on hearing conservation programs is ineffective, as shown by the number of cases of occupationally caused hearing loss in the United States.
     
     – It costs 10 times as much to abate an existing noise problem with a retrofit as to take care of it during the design and manufacturing of the machine. Designing quiet equipment typically adds about 5 to 10 percent to the cost. Additionally, designing quiet machines often produces more efficient machines that require less maintenance.
     
     – One stakeholder has calculated the cost of hearing conservation programs for several companies. The average cost per employee per year is between $300 and $350. This should be compared to the cost of engineering out the noise and eliminating the need for hearing conservation.
     
     – Compressed air is the most significant noise exposure in many plants, and there are proven solutions to reduce noise. The ROI for quiet design devices is nine to 12 months, due to the energy savings realized. Maintenance is another easy way to reduce noise emissions.
     
     – Cost needs to be a consideration. In a foundry, engineering controls would have a high cost and would not reduce noise levels to the point where PPE would not be required.
     
     – Smaller companies do not have in-house programs and have to rely on mobile services for hearing conservation programs, which are more expensive. These programs become more expensive per employee as the cost is calculated for smaller companies. For companies with between one and 19 employees, the cost might be $700 to $800 per employee per year.
     
     – If companies have limited resources and have to choose between a large fine from the EPA and a smaller fine from OSHA, a company will choose the smaller fine. OSHA should use the ROI of noise controls as a selling point to convince executives to put money towards protecting employee hearing.
     
     – A study by the International Social Security Association reported that for every dollar the United States spends on occupational safety and health programs, $2.20 will eventually return.
     
     – The enormous cost of hearing loss to the employee is often not accounted for in ROI calculations. This is especially true in transient industries, such as construction (Scott Schneider).
     
     
   • Overexposure to noise in manufacturing:
     
     – Using a 90 dB threshold, less than 10 percent of workers in the manufacturing industry are overexposed to noise. When the original OSHA regulation was promulgated, this estimate was closer to 19 percent, but many of these jobs have since moved outside the United States.
     
     
   • Employee participation:
     
     – A best practice in engineering controls is for employees trained in safety and health to participate in the purchase of new equipment and in the design of new industrial processes.
     
     
   • Economic and technical feasibility:
     
     – Engineering controls are often not transferrable between industries, and the economic and technical feasibility for these controls needs to be determined on a case-by-case basis. The idea of installing a process and making it a criterion for demonstrating compliance might be a good substitute for questions of determining economic feasibility.
     
     
   • Metrics for determining the effectiveness of engineering controls:
     
     – "Effectiveness" should be defined and tools should be developed to help determine effectiveness of engineering controls. Not all engineering controls are effective 100 percent of the time. NIOSH found that cabs on heavy equipment were not preventing operators from being overexposed to noise, since the operators kept the cab door open.
     
     
   • Incremental improvements:
     
     – Improvements in engineering controls are often incremental, though this still represents a reduction in risk. OSHA should emphasize the approach outlined by Mr. Fairfax at the beginning of the meeting, which characterized a 3 dB noise reduction as significant even if it does not reduce the noise level below 90 dB.
     
     
   • Hierarchy of controls:
     
     – Most of the stakeholders viewed the hierarchy of controls as an effective system to aid in prioritizing controls to choose. A stakeholder brought up the point, however, that the premise of the hierarchy of controls should be reviewed to document whether it is still true, given the technological developments over the past 30 years.
     
     
   • Engineering control process:
     
     – The first best practice is for a well-trained person to take noise measurements. If a noise problem is detected, the facility needs a detailed written noise control plan to identify the "low-hanging fruit." The noise problems need to be quantified and the options to remedy the problems need to be evaluated. If the best option is to buy new equipment, quiet products should be considered. It may be possible to use engineering controls while still realizing cost savings, an increase in productivity, and increased profit.
     
     
   • Leadership:
     
     – The person controlling the money in a company needs to support protecting employee hearing. If a manufacturer develops a noise control treatment for a plant and the plant ultimately does not want to spend the money, this sends a message to the manufacturers that industry is not interested in buying quiet equipment.
     
     
   • Small business considerations:
     
     – Engineering controls can be simple, such as placing a sheet of plywood in front of a generator, or may be expensive, such as purchasing a quiet generator. Additionally, roofers may be exposed to variable levels of noise, depending on the day. It is very difficult to engineer the noise out of this industry. In this situation, hearing protection may be the most effective and least expensive solution. Small contractors, who buy tools from retailers like Home Depot or Sears, do not have the option to buy quieter equipment if manufacturers do not sell it.
     
     
   • Case law regarding engineering controls:
     
     – Over the past 30 years, the case law has been consistently in favor of using PPE unless engineering controls are less expensive. Hearing loss declined by 27 percent between 2005 and 2009; it now affects less than 1 percent of the workforce in the United States. Trying to convince the regulated community to implement engineering controls will be met with resistance.
     
     
   4.4 What are companies' experiences with effective noise control programs and what are the key elements of their programs?
   
   Bryan Seal, Senior Industrial Hygienist, Directorate of Standards and Guidance, introduced the final discussion topic by outlining his experience implementing a noise control program at a book bindery.
   
   Mr. Seal worked with a book bindery company with approximately 120 employees. He evaluated the company's hearing conservation program, assessed the noise levels and TWA exposures, and ensured that all workers were trained to recognize noise levels and hazards and how to protect themselves from these hazards. The major sources of noise in the bindery were identified and engineering controls were installed. Noise levels were reduced to below 85 dB and an effective noise control program was maintained. The company oriented its efforts on the results of annual exposure assessments and measured noise levels, not on the TWA exposures.
   
   Stakeholders responded with the following discussion points and recommendations regarding companies' experiences with effective noise control programs and their key elements:
   • NASA's Buy Quiet program:
     
     – NASA had been spending money on retrofit noise controls while still buying new loud equipment. It was decided that a two-pronged approach was needed: buying new quiet equipment while continuing to fix old noisy equipment.
     
     – NASA's Chief Health and Medical Officer implemented a Buy Quiet and Quiet by Design requirement for the agency. This required noise emissions to be considered equally with other considerations when buying equipment near an 80 dBA threshold.
     
     – This policy was designed to be adaptable to NASA's many field sites, and covered the purchase of major equipment and off-the-shelf items.
     
     – The Buy Quiet Process Roadmap is an online tool developed to help procurement employees through the process of purchasing quiet equipment. The roadmap is publically available and is generic enough to be adapted to other organizations. It can be found online at http://adl.amygelfand.com/buy-quiet-purchasing/buy-quiet-process-roadmap/.
     
     – Four steps were identified in the process of procuring quiet products: 1) use publically available information to identify an achievable noise emission criterion for a piece of equipment, starting with an 80 dBA assumption; 2) identify the simplest procurement vehicle available (GSA schedule, bank card purchasing, simplest allowable procurement); 3) develop the specification, unless it is an off-the-shelf item; and 4) quantify and evaluate the long-term costs of noise exposure for the candidate products being considered for purchase.
     
     – The roadmap includes authorization forms, calculation worksheets, test verification forms to document rationale if loud equipment is chosen, PowerPoint presentations for generic use, and links to online databases of sound levels for various items.
     
     
   • Examples of companies with effective noise control programs:
     
     – Shaw Carpeting won a Safe and Sound Award for its hearing conservation program, which used engineering controls and fit-testing. More information can be found at http://www.hearforever.org.
     
     – The Army Hearing Program focuses on combat effectiveness, which can translate to other industries as mission effectiveness. The Army's program is enhanced with a better ability to communicate. ALCOA has been successful with its efforts in fit-testing and in ear dosimetry. Companies in the Voluntary Protection Programs Participants' Association have successful programs. OSHA needs to develop better ways to highlight and share these successful programs.
     
     – General Motors and Ford show reductions in employee noise exposures year after year in their annual facility surveys. These successful programs have two common components: 1) joint employee and management committees tasked with noise control and 2) employee upstream participation in the review of new equipment and processes before they are introduced into the plants.
     
     – The auto industry turns over equipment more frequently than other industries, because it continually makes new car models. This allows the industry to reap the benefits of new Buy Quiet equipment. The percentage of employees exposed to 90 dBA has been dramatically reduced in the past 20 years.
     
     Common denominators of companies with effective noise control programs:
     
     – Clear identification of the interrelationship between noise sources and what composes a worker's noise exposure is needed. Once the noise sources are identified, a company can prioritize where to spend money to achieve the biggest dB reduction for employees. Employers can then work with manufacturers to determine cost information to incorporate into an ROI calculation.
     
     – Companies with effective hearing conservation programs are using common metrics as well. On the noise control side, these companies measure the decrease in dB for a certain number of employees over time, and the number of employees removed from the hearing conservation program. Additionally, audiometric testing should be done toward the end of a work shift: this measures temporary threshold shifts, which are a leading indicator of hearing loss, as opposed to measuring the lagging indicator of permanent threshold shifts.
     
     – Another crucial component of an effective program is to investigate the cause of a standard threshold shift or OSHA recordable injury. Many employers record the shift and move on, but it makes more sense to understand why the shift occurred, which allows the employer to take actions to prevent standard threshold shifts in the future.
     
     
   • Proactive companies:
     
     – A lot of what companies do is proactive, not motivated by compliance. For example, 3M has set its exposure limit at 85 dB, which is lower than OSHA's required 90 dB.
     
     – Some company cultures achieve more than is required for compliance for all safety programs. This points to the importance of a strong safety culture at the top levels of a company.
     
     – When employers who implement an 85 dB threshold with a 3 dB exchange rate are asked why they went beyond OSHA's requirement, many respond that the science supports this threshold as being more protective for workers. The stakeholder encourages OSHA to move in the same direction.
     
     – Another stakeholder asked if OSHA has already unofficially adopted a 3 dB exchange rate, since the agency is considering 3 dB to be a significant reduction.
     
     – A stakeholder pointed out that there seemed to be general consensus that an 85 dB threshold with a 3 dB exchange rate is a best practice.
     
     – A stakeholder highlighted an article written by Alice Suter about the benefits of an 85 dB exposure level with a 3 dB exchange rate. This article can be found online at http://hearinglossprevention.org/default.aspx.
     
     – These companies are providing more protection than is required, but NIOSH found that an employee exposed to 90 dB for his or her entire working life has a one in four chance of hearing loss. This is too high a percentage, given that the Supreme Court considers a significant risk for occupation-related illness or injury to be 1 in 1,000. Higher standards ought to be the norm within industry.
     
     – A stakeholder responded to the previous comment by clarifying that the Supreme Court considers 1 in 1,000 a significant risk for an outcome that results in death.
     
     
   • Enforcement by OSHA:
     
     – It is important for OSHA to gather examples of effective programs to be communicated to the regulated community, but it is also important to identify the bad actors in industry and to use them as examples to deter the same behavior in other companies. Employers that are trying to avoid penalties will be more likely to seek out success stories and to model their own programs on them.
     
     – A stakeholder pointed out that Section 5 of the Occupational Safety and Health Act has two parts, one that places responsibilities on employers and another that places responsibilities on employees. There is a need to have some sort of enforcement mechanism for employees that violate their duties.
     
     – A stakeholder believes that OSHA has been using a command and control approach to enforcement for too long. OSHA needs to help small businesses understand the issues in their facilities, as well as specific changes to fix these issues.
5. Wrap-Up and Next Steps
   
   Dorothy Dougherty, Director, Directorate of Standards and Guidance, thanked everyone who had participated in and observed the meeting. She also thanked those who had helped plan the meeting, and thanked the facilitator. She communicated OSHA's desire to have further contact with the stakeholders regarding his important issue. The notes will be posted on the OSHA website, and will be advertised on OSHA QuickTakes (http://www.osha.gov/as/opa/quicktakes/) when posted. Ms. Berkowitz concluded with a reminder that OSHA has a toll-free phone number, 1-800-321-OSHA (6742). OSHA provides free on-site visits and can help small businesses with noise issues.