1. Management's involvement demonstrated through personal concern for employee safety and health by the priority placed on eliminating the ergonomic hazards.
2. A policy that places safety and health on the same level of importance as production. The responsible implementation of this policy requires management to integrate production processes and safety and health protection to assure that this protection is part of the daily production activity within each facility.
3. Employer commitment to assign and communicate the responsibility for the various aspects of the ergonomics program so that all managers, supervisors, and employees involved know what is expected of them.
4. Employer commitment to provide adequate authority and resources to all responsible parties, so that assigned responsibilities can be met.
5. Employer commitment to ensure that each manager, supervisor, and employee responsible for the ergonomics program in the workplace is accountable for carrying out those responsibilities.

1. An employee complaint or suggestion procedure that allows workers to bring their concerns to management and provide feedback without fear of reprisal.
2. A procedure that encourages prompt and accurate reporting of signs and symptoms of CTDs by employees so that they can be evaluated and, if warranted, treated.
3. Safety and health committees that receive information on ergonomic problem areas, analyze them, and make recommendations for corrective action.
4. Ergonomic teams or monitors with the required skills to identify and analyze jobs for ergonomic stress and recommend solutions.

1. Analysis of trends in injury/illness rates.
2. Employee surveys.
3. Before and after surveys/evaluations of job/worksite changes
4. Review of results of plant evaluations.
5. Up-to-date records or logs of job improvements tried or implemented.

• Chronic muscle contraction or steady force.
• Extreme or awkward finger/hand/arm positions.
• Repetitive forceful motions.
• Tool vibration.
• Excessive gripping. pinching, pressing with the hand and fingers.

• Proper cutting techniques, including work methods that improve posture arid reduce stress and strain on extremities.
• Good knife care, including steeling and the regular sharpening or steeling of knives.
• Correct lifting techniques (proper body mechanics).
• Proper use and maintenance of pneumatic and power tools.
• Correct use of ergonomically designed work stations and fixtures.

    b. New Employee Conditioning Period. Jobs in the meat industry will usually require conditioning, or break-in, periods, which may last several weeks. New and returning employees should be gradually integrated into a full workload as appropriate for specific jobs and individuals. Employees should be assigned to an experienced trainer for job training and evaluation during the break-in period. Employees reassigned to new jobs should also have a break-in period.

    c. Monitoring. Regular monitoring at all levels of operation helps to ensure that employees continue to use proper work practices. This monitoring should include a periodic review of the techniques in use and their effectiveness, including a determination of whether the procedures in use are those specified; if not, then it should be determined why changes have occurred and whether corrective action is necessary.


    d. Adjustments and Modifications. Modify work change. Such adjustments include changes in the following:

• Line speeds.
• Staffing at position
• Type, size, weight, or temperature of the product handled.

• Reducing the total number of repetitions per employee by such means as decreasing production rates and limiting overtime work.
• Providing rest pauses to relieve fatigued muscle-tendon groups. The length of time needed depends on the task's overall effort and total cycle time.
• Increasing the number of employees assigned to a task to alleviate severe conditions, especially in lifting heavy objects.
• Using job rotation, used with caution and as a preventive measure, not as a response to symptoms. The principle of job rotation is to alleviate physical fatigue and stress of a particular set of muscles and tendons by rotating employees among use different muscle-tendon groups. If rotation is utilized, the job analyses must be reviewed by a qualified person to ensure that the same muscle-tendon groups are not used.
• Providing sufficient numbers of standby/relief personnel to compensate for foreseeable upset conditions on the line (e.g.. loss of workers).
• Job enlargement-see the guidance on "Design of Conservative treatment. Work Methods" given in Sections 11. B. 1. and 111. B.

• A preventive maintenance program for mechanical and power tools and equipment, such as powered knives and saws. to verify that they are in proper working order and within original manufacturer's specifications. This may include vibration monitoring.
• Perform maintenance regularly and whenever workers report suspected problems. Sufficient numbers of spare tools should be available to facilitate regular maintenance.
• A specific knife sharpening program. Sharp knives should be readily available.
• Effective housekeeping programs to minimize slippery work surfaces and related hazards such as slips and falls.

• Injury and illness recordkeeping.
• Early recognition and reporting.
• Systematic evaluation and referral.
• Conservative treatment.
• Conservative return to work.
• Systematic monitoring
• Adequate staffing and facilities.

• All affected employees.
• Engineers and maintenance personnel.
• Managers.
• Health care providers.

1. General Training
   
   Employees who are potentially exposed to ergonomic hazards should be given formal instruction on the hazards associated with their jobs and with their equipment. This includes information on the varieties of CTDs, what risk factors cause or contribute to them, how to recognize and report symptoms, and how to prevent these disorders. This instruction should be repeated for each employee as necessary. OSHA's experience indicates that, at minimum, annual retraining is advisable.
   
   
2. Job-Specific Training
   
   New employees and reassigned workers should receive an initial orientation and hands-on training prior to being placed in a full-production job. Training lines may be used for this purpose. Each new hire should receive a demonstration of the proper use of and procedures for all tools and equipment. The initial training program should include the following:
   
   
   • Care, use, and handling techniques for knives.
   • Use of special tools and devices associated with individual work stations.
   • Use of appropriate guards and safety equipment, including personal protective equipment.
   • Use of proper lifting techniques and devices.
     
     On-the-job training should emphasize employee development and use of safe and efficient techniques. (See also the section on "New Employee Conditioning Period" under Work Practice Controls, 11. B. 1. b.)
     
3. Training for Supervisors
   
   Supervisors are responsible for ensuring that employees follow safe work practices and receive appropriate training to enable them to do this. Supervisors therefore should undergo training comparable to that of the employees, and such additional training as will enable them to recognize early signs and symptoms of CTDs to recognize hazardous work practices to correct such practices, and to reinforce the employer's ergonomic program, especially through the ergonomic training of employees as may be needed.
   
   
4. Training for Managers
   
   Managers should be aware of their safety and health responsibilities and should receive sufficient training pertaining to ergonomic issues at each work station and in the production process as a whole so that they can effectively carry out their responsibilities.
   
   
5. Training for Engineers and Maintenance Personnel
   
   Plant engineers and maintenance personnel should be trained in the prevention and correction of ergonomic hazards through job and work station design and proper maintenance, both in general and as applied to the specific conditions of the facility.

1. Gathering information from available sources;
2. Conducting baseline screening surveys to determine which jobs need a closer analysis;
3. Performing ergonomic job hazard analyses of those work stations with identified risk factors; and -- after implementing control measures --
4. Conducting periodic surveys and followup to evaluate changes.

Incidence =  (number of new cases/yr) x (200,000 work hrs) per facility*
  Rate                     number of hours worked/facility/yr

• Repetitive and/or prolonged activities.
• Forceful exertions, usually with the hands (including pinch grips).
• Prolonged static postures.
• Awkward postures of the upper body, including reaching above the shoulders or behind the back, and twisting the wrists and other joints to perform tasks.
• Continued physical contact with work surfaces; e.g., contact with edges.
• Excessive vibration from power tools.
• Cold temperatures.
• Inappropriate or inadequate hand tools.

• Bad body mechanics such as (1) continued bending over at the waist; (2) continued lifting from below the knuckles or above the shoulders; and (3) twisting at the waist, especially while lifting.
• Lifting or moving objects of excessive weight or asymmetric size.
• Prolonged sitting, especially with poor posture.
• Lack of adjustable chairs, footrests, body supports, and work surfaces at work stations.
• Poor grips on handles.
• Slippery footing.

e. Multiple Risk Factors. Jobs, operations, or work stations that have multiple risk factors have a higher probability of causing CTDs. The combined effect of several risk factors in the development of CTDs is sometimes referred to as "multiple causation."

3. Ergonomic Job Hazard Analyses

At this point, the employer has identified-through the information sources and screening surveys discussed above-jobs that place employees at risk of developing CTDs. As an essential third step in the worksite analysis, an effective ergonomics program requires a job hazard analysis for each job so identified.

Job hazard analyses should be routinely performed by a qualified person for jobs that put workers at risk of developing CTDs. This type of analysis helps to verify lower risk factors at light duty or restricted activity work positions and to determine if risk factors for a work position have been reduced or eliminated to the extent feasible.

a. Work Station Analysis. An adequate analysis would be expected to identify all risk factors present in each studied job or workstation.

For upper extremities, three measurements of repetitiveness are the total hand manipulations per cycle, the cycle time, and the total manipulations or cycles per work shift.

Force measurements may be noted as an estimated average effort, and a peak force. They may be recorded as "light ," "moderate ," and "heavy." (See also Putz-Anderson, Selected Bibliography, pp. 57-59, for additional guidance on force measurements.)

Tools should be checked for excessive vibration. (See also NIOSH criteria document on hand/arm vibration, Selected Bibliography.)

The tools, personal protective equipment, and dimensions and adjustability of the work station should be noted for each job hazard analysis.

Finally, hand, arm, and shoulder postures and movements should be assessed for levels of risk.

b. Lifting Hazards. For manual materials handling, the maximum weight-lifting values should be calculated. (See the NIOSH Work Practices Guide for Manual Lifting, 1981, in the Selected Bibliography. for basic calculations. Note that this guide does not address lifting that involves twisting or turning motions.)

c. Videotape Method. The use of videotape, where feasible, is suggested as a method for analysis of the work process. Slow-motion videotape or equivalent visual records of workers performing their routine job tasks should be analyzed to determine the demands of the task on the worker and how each worker actually performs each task.

NOTE: Ergonomic analysis is not complete without implementation of controls. Section III. B., which follows, offers examples of engineering controls and other methods that will be useful in reducing ergonomic hazards.

4. Periodic Ergonomic Surveys

The fourth step in worksite analysis is to conduct periodic review. Periodic surveys should be conducted, to identify previously unnoticed risk factors or failures or deficiencies in work practice or engineering controls. The "symptoms survey" described in Section III. C. is an effective tool in identifying jobs that require ergonomic job hazard analysis.

The periodic review process should also include the following:

a. Feedback and Followup. A reliable system should be provided so that employees can notify management about conditions which appear to be ergonomic hazards and to utilize their insight and experience to determine work practice and engineering controls. This might be initiated by an ergonomic questionnaire and be maintained through an active safety and health committee, or by employee participation with the "ergonomic team."

Reports of ergonomic hazards or signs and symptoms of potential CTDs should be investigated by ergonomic screening surveys and appropriate ergonomic hazard analyses in order to identify risk factors and controls.

b. Trend Analysis. Trends of injuries and illnesses related to actual or potential CTDs should be calculated, using several years of data where possible.

Trends should be calculated for several departments, process units, job titles, or work stations. These trends may also be used to determine which work positions are most hazardous and need to be analyzed by the qualified person.

Using standardized job descriptions, incidence rates may be calculated for work positions in successive years to identify trends. Using trend information can help to determine the priority of screening surveys and/or ergonomic hazard analyses.

B. Hazard Prevention and Control: Examples of Engineering Controls for the Meat Industry

Engineering solutions, where feasible, are the preferred method of control for ergonomic hazards. The focus of an ergonomics program is to make the job fit the person, not to make the person fit the job. This is accomplished by redesigning the work station, work methods, or tool to reduce the demands of the job, including high force, repetitive motion, and awkward postures. A program toward this end entails research into currently available controls and technology. It also includes provisions for utilizing new technologies as they become available and for in-house research and testing.

The following are examples of engineering controls that have been found to be effective and achievable in the industry.


1. Work Station Design

Work stations should be designed to accommodate the persons who actually work on a given job; it is not adequate to design for the "average" or typical worker. Work stations should be easily adjustable and either designed or selected to fit a specific task: so that they are comfortable for the workers using them. The work space should be large enough to allow for the full range of required movements, especially where knives, saws, hooks, and similar tools are used.

a. EXAMPLES of methods for the reduction of extreme and awkward postures include the following:

• Adjustable fixtures and rotating cutting tables so that the position of the meat can be easily manipulated.
• Work stations and delivery bins that can accommodate the heights and reach limitations of various-sized workers.
• Work platforms that move up and down for operations such as splitters.

• Adjustable fixtures to allow cuts and movements to be made easily.
• Bins properly located so that workers do not have to toss products and by-products.
• Mechanical or powered assists to eliminate the use of extreme force.
• Suspension of heavy tools.

• The use of diverging conveyors off the main line so that certain activities can be performed at slower rates.

• Enabling the worker to perform the task with two hands instead of one.
• Conforming with the NIOSH Work Practices Guide for Manual Lifting

• The use of automation, such as automated deboners.
• The use of mechanical devices to aid in removing bones and in separating meat from bones, and for heavy lifting.
• Substitution of power tools where manual tools are now in use.
• The use of articulated arms and counter balances suspended by overhead racks to reduce the force needed to operate and control power tools.
• Ensuring that the meat to be processed is kept from freezing and is completely thawed.

• Increasing the number of workers performing a task. Lessening repetition by combining jobs with very short cycle times, thereby increasing cycle time. (Sometimes referred to as "job enlargement.")
• Using automation.
• Designing jobs to allow self-pacing, when feasible.
• Designing jobs to allow sufficient rest pauses.

• Matching the type of tool or knife to the task.
• Designing or selecting the tool handle or knife so that extreme and awkward postures are minimized.
• Using knife or tool handles with textured grips in preference to those with ridges and grooves.
• Designing tools to be used by either hand or providing tools for both left- and right-handed workers.
• Using tools with triggers that depress easily and are activated by two or more fingers.
• Using handles and grips that distribute the pressure over the fleshy part of the palm, so that the tool does not dig into the palm.
• Designing tools for minimum weight; counter-balancing tools heavier than one or two pounds.
• Selecting pneumatic and power tools that exhibit minimal vibration and maintaining them in accordance with manufacturer's specifications, or with an adequate vibration monitoring program. Wrapping handles and grips with insulation material (other than wraps provided by the manufacturer for this purpose) is normally not recommended, as it may interfere with a proper grip and increase stress.

• Applying heat or cold. Ice is used to treat overuse strains and muscle/tendon disorders for relief of pain and swelling, thus allowing more mobility. Ice decreases the inflammation associated with CTDs even if no overt signs of inflammation (redness, warmth, or swelling) are present. The use of ice may be inappropriate for Raynaud's disease (vibration syndrome), rheumatoid arthritis, and diabetic conditions. Heat treatments should be used only for muscle strains where no physical signs of inflammation are present. (See Putz-Anderson, p. 125, Selected Bibliography.)
  
  
• Nonsteroidal anti-inflammatory agents. These agents may be helpful in reducing inflammation and pain. Examples of these types of agents include aspirin and ibuprofen.
  
  
• Special exercise. If active exercises are utilized for employees with CTDs, they should be administered under the supervision of the OHN or physical therapist. If these active exercises are performed improperly, they may aggravate the existing condition. (See Putz-Anderson, p. 126, Selected Bibliography.)
  
  
• Splints. A splint may be used to immobilize movement of the muscles, tendons, and nerves. Splints should not be used during working activities unless it has been determined by the OHN and ergonomist that no wrist deviation or bending is performed on the job. Splinting can result in a weakening of the muscle, loss of normal range of motion due to inactivity, or even greater stress on the area if activities are carried out while wearing the splint.

• Repetitive and/or prolonged physical activities.
• Forceful exertions, usually with the hands (including tools requiring pinching or gripping).
• Awkward postures of the upper body, including reaching above the shoulders or behind the back, and angulation of the wrists to perform tasks.
• Localized contact areas between the work or workstation and the worker's body; i.e., contact with surfaces or edges.
• Excessive vibration from power tools.
• Cold temperatures.

• At least one physical finding (e.g., positive Tinel's, Phalen's, or Finkelstein's test; or swelling, redness, or deformity; or loss of motion); OR
• At least one subjective symptom (e.g., pain, numbness, tingling, aching, stiffness, or burning), and at least one of the following:

                                                 
Plant     Dept      Job #     Job Name

                                                  years       months
Shift      Supervisor   Hours worked/week   Time on THIS job

Other jobs you have done in the last year (for more than 2 weeks)

                            months       weeks 
Job #   Job Name      Time on THIS job 

                                     months       weeks
Dept    Job #   Job Name       Time on THIS job 
(If more than 2 jobs, include those you worked on the most)

Have you had any pain or discomfort during the last year?
     1)Yes       2)No     (If NO, stop here)

If YES, carefully shade in the area of the drawing which bothers you the most.

(Complete a separate page for each area that bothers you)


Check Area: Neck     Shoulder     Elbow/Forearm     Hand/Wrist     Fingers   
Upper Back     Low Back     Thigh/Knee     Low Leg     Ankle/Foot   

1. Please put a check by the word(s) that best describe your problem

      1) Aching            5) Numbness(asleep)     9) Tingling    
      2) Burning           6) Pain                10) Weakness
      3) Cramping          7) Swelling            11) Other
      4) Loss of Color     8) Stiffness


2. When did you first notice the problem    (month)     (year)

3. How long does each episode last? (Mark an X along the line)
    1 hour     1 day     1 week     1 month     6 months

           /          /          /           /          

4. How many separate episodes have you had in the last year?     

5. What do you think caused the problem?                        
                                                                

6. Have you had this problem in the last 7 days? 1)Yes      2)No   

7. How would you rate this problem (mark an X on the line)

Now
                                                          
      None                                      Unbearable

When it was the WORST
                                                          

      None                                      Unbearable

8. Have you had medical treatment for this problem? 1)Yes      2)No   

     8a. If NO, why not                           
     8b. If YES, where did you receive treatment?
          1. Company Medical         Times in past year    
          2. Personal doctor         Times in past year    
          3. Other                   Times in past year    
     8c. If YES, did the treatment help? 1)Yes      2)No   

9. How much time have you lost in the last year 
   because of this problem?                days

10.How many days in the last year were you on restricted
   or light duty because of this problem?                days

11.Please comment on what you think would improve your symptoms.


                                Exhibit 2
                                Screening Tests

Positive Tinel's sign:          Gentle tapping over the median nerve at the wrist
                                resulting in pain, tingling, or numbness in the 
                                median nerve distribution.
                          
Positive Finkelstein's test:    Ulnar deviation of the hand with the thumb flexed
                                against the palm and the finger flexed over the thumb.
                                Severe pain results at the radial styloid due to 
                                stretching of the abductor pollicus longus and extensor
                                pollicus brevis.

Positive Phalen's test:         Unforced, complete flexion of the wrist for 60 seconds
                                resulting in pain, numbness, or tingling in the median
                                nerve distribution
                                
                                Exhibit 3
                                Upper Extremity (UE) Cumulative Trauma
                                Disorders (CTDs) Algorithm

• management commitment and employee involvement;
• worksite analysis
• hazard prevention and control; and
• safety and health training