Health and Safety

Performance Indicator Definitions

Health and Safety Performance Indicator Definitions

Health and Safety Performance Indicator Definitions

Health and Safety Performance Indicator Definitions

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Health and Safety Performance Indicator Definitions

Contents
Purpose A B C D General Definitions Safety Indicators Health Indicators Injury Numbers Definitions

Appendix: Further Information

Calculated Indicators

Definitions of Health Indicators Used in Data Entry and Reporting Health Metric Definitions Ergonomics Assessment Health indicator criteria Health Risk Assessment

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18 20 28 31

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Health and Safety Performance Indicator Definitions

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Purpose

This document contains the definitions used by ICMM for lagging (outcome) safety and health metrics. These metrics are captured in the ICMM Benchmarking database (http://www.shecbenchmarking.com). Indicators are separated into those collected (and reported) and those not collected, but calculated. The document has been prepared based on input from ICMM member companies and from the International Aluminium Institute (IAI).

The document also contains, as appendices, additional information on metrics, which may be used as a basis for improvements to benchmarking in the future. In particular, the appendices include information on possible leading (system/process implementation/leadership) indicators, and improved health metric indicators which provides information to member companies for determining future direction for health management and health research.

The intent is: • To define a core group of metrics to be used by all ICMM member companies; • To ensure that the metrics are simple to apply and are relatively general in scope; • To provide clear definition of key terms; • To provide additional metrics which may be used on a voluntary basis by individual companies.

1 If you wish to register to use the ICMM Benchmarking Database, please contact the ICMM secretariat (info@icmm.com)

Health and Safety Performance Indicator Definitions

General Definitions
Employee Contractor Occupational Illness

Individual employed directly by the company. The preference in the database is to count directly supervised contractors as contractors, however where companies do not separate this information from employee information, it is acceptable to count them and their associated injuries under employee data. Any individual, company or other legal entity that carries out work, work-related activities, or performs services pursuant to a contract for service. This includes sub-contractors, and personnel working both full time and part time. Work-related Activities Work-related activities are those where the employer can set safety, health and environmental standards, and can supervise and enforce their application. An occupational illness is any abnormal condition or disorder, other than one resulting from an occupational injury, caused by exposures to factors associated with employment. It includes acute or chronic illnesses or diseases, which may be caused by inhalation, absorption, ingestion or direct contact. If an event or exposure in the work environment either caused or significantly contributed to an injury, or significantly aggravated a pre-existing condition, then the case is considered work-related. Work-relatedness is presumed for injuries resulting from events or exposures occurring at the employer’s work establishment unless an exception specifically applies. Work performed as a part of haulage of product between operated sites, whether by directly employed or contract operators, would normally be included as workrelated. Work performed at a contractor’s home base is not included as workrelated unless it is clearly under the supervision and standards of the company. Illnesses are distinguished from injuries in that the latter occur at “an instant in time”. For injury, the gap between exposure and the onset of signs or symptoms is short (minutes to hours, but less than one shift) whereas the gap for illness is longer (days, weeks or years). If there is a known latency period for the development of illness following an acute exposure, then the condition is to be considered an illness. This will also apply to injuries that eventually result in occupational diseases e.g. asthma resulting from acute high level exposure to an irritant gas. Injuries and illnesses occurring away from the work establishment are considered work-related only if the worker is engaged in a work activity or is present as a condition of his or her employment or contract.

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Health and Safety Performance Indicator Definitions

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Injuries and illnesses that occur while the employee is travelling are work-related if at the time of the injury or illness the employee/contractor was engaged in work-related activities “in the interests of the employer”. Examples of these activities include: • Driving or being driven in a vehicle for work-related purposes, irrespective of the cause of any incident involving the vehicle. • Flying to visit another site or customer/supplier contact. • Being transported to and from customer contacts after lodging has been established and as part of work-related activity. • Entertaining, or being entertained to transact, discuss or promote business, provided the entertainment is at the direction of the employer. Work Environment Routine Functions Pre-existing Conditions Significant Aggravation Pre-existing conditions are those which an individual brings with them to the current employer, either caused by exposure at another workplace or by nonoccupational factors. The work environment is defined as the establishment and other locations where one or more employees are working or are present as a condition of their employment. A significant aggravation is defined as occurring when an incident occurring at work results in tangible consequences that go beyond those the worker would have experienced as a result of the pre-existing illness/disease alone, absent the aggravating effects of the workplace.

However when travelling employees check into a hotel, motel or other lodging, they establish a “home away from home”. Thereafter, their activities are evaluated in the same manner as for non-travelling employees. For example, injuries sustained when commuting from a hotel to a temporary work site are not workrelated, just as injuries sustained during an employee’s normal commute from a permanent residence to an office are not considered work-related. Routine Functions are work activities/assigned duties that the employee regularly performs at least once per week or as part of the roster cycle.

Health and Safety Performance Indicator Definitions

Safety Indicators
Injury Numbers
Fatalities Lost Time Injuries

Work-related injury resulting in death of employee or contractor. Fatalities are categorised according to the following types: • Electrical • Explosions and Fires • Falls from Heights • Geotechnical • Hazardous Substances • Machinery, Equipment and Hand Tools • Mobile Equipment • Slips, Trips and Falls • Other Restricted Work Injuries A Restricted Work Injury (RWI) is a work-related injury which results in the employee/contractor being unable to perform one or more of their routine functions for a full working day, from the day after the injury occurred. An RWI should be certified by advice from a suitably qualified health care provider. Lost Time + Restricted Work Injuries Medical Treatment Injuries

A Lost Time Injury (LTI) is a work-related injury resulting in the employee/contractor being unable to attend work on the next calendar day after the day of the injury. If a suitably qualified medical professional advises that the injured person is unable to attend work on the next calendar day after the injury, regardless of the injured person’s next rostered shift, a lost time injury is deemed to have occurred. A Medical Treatment Injury (MTI) is a work-related injury resulting in the management and care of a patient to combat disease or disorder, including any loss of consciousness, which does not result in lost time or restricted work. MTIs include (for example) suturing of any wound, treatment of fractures, treatment of bruises by drainage of blood, treatment of second and third degree burns.

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Some companies do not differentiate between Lost Time and Restricted Work Injuries. For such companies, counts of LTIs reported to the ICMM database include RWIs, and are marked as such in the database. As a result, the main benchmarking injury statistic that should be used is the ‘Lost Time + Restricted Work Injury’ count (and associated frequency rate). However, the preference is that the ICMM database LTI count excludes RWIs and that RWIs are counted separately.

Health and Safety Performance Indicator Definitions

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“Days lost” are counted as the number of calendar days2 after the day of the incident, during which the employee or contractor is unable to perform all of their routine functions or is temporarily assigned to a different job. This includes full days lost, as for a Lost Time Injury. Days lost counting ceases if the person ceases employment with the company, or the person is permanently reassigned to a new job.3 No lost days are recorded for fatalities. Days lost to Lost Time Injuries

MTIs do not include: • Visits to physicians or other licensed health care professional solely for observation or counselling. • The conduct of diagnostic procedures, such as X-rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes (e.g. eye drops to dilate pupils etc.). • Visits to physicians or other licensed health care professionals solely for therapy as a preventative measure (e.g. physiotherapy or massage as preventative therapy, tetanus or flu shots). • First Aid Injuries (FAIs) as listed in the Appendix. First Aid + Medical Treatment Injuries Days Lost Reporting Some companies do not differentiate between Medical Treatment and First Aid Injuries. For such companies, counts of MTIs reported to the ICMM database include FAIs, and are marked as such in the database. The preference is that the ICMM database MTI count excludes FAIs. Days lost are counted during the month in which the days lost occurred. Some companies credit days lost in the month in which the injury or illness occurred rather than the month in which the days lost are incurred. While this is not preferred for the ICMM database, it is an option as it makes very little difference to injury rates over time. Time spent travelling, or waiting for diagnosis following an incident is not included in days lost, unless the injury becomes classified as a Lost Time Injury or a Restricted Work Injury. The number of calendar days during which an employee or contractor is unable to attend work during the month in which the lost days occurred.

2 Some companies count scheduled work days instead of calendar days. Where this is done it is clearly marked as such in the database. Companies using this practice should also indicate whether lost time/ restricted work injuries are counted as such if the injured party is unable to attend work on the next calendar day rather than the next scheduled work day. 3 Some companies cease counting lost days after 180 lost calendar days have elapsed. The preference for the ICMM database is that the full number of lost days is supplied, in other words that a 180 day limit is not applied.

Health and Safety Performance Indicator Definitions

Days lost to Restricted Work Injuries Days lost to Work-related Diseases Exposure Hours

The number of calendar days during which an employee or contractor is able to attend work but is unable to perform one or more of his / her routine functions, during the month in which the lost days occurred. Days lost to Lost Time & Restricted Work Injuries Days lost to Non Work-related Illnesses and Injuries

Total of calendar days lost (both restricted work and lost days) during the month in which the days lost occurred. The number of calendar days during which an employee or contractor is either able to attend work but is unable to perform all his / her routine functions, or is unable to attend work, due to occupational illness which is work-related. The number of calendar days during which an employee or contractor was unable to attend work due to non work-related illness or injury.4 The “exposure hours” used in injury performance calculations are the total number of hours worked by employees or contractors carrying out work-related activities. This includes hours worked onsite, offsite and travelling on behalf of work, but excludes hours spent travelling as part of normal commuting to and from a person's place of residence. Exposure hours reported should reflect actual hours worked, not planned hours.

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4 Not all companies will be able to supply this statistic at this stage, and companies will not be monitored against the supply of this statistic yet.

Health and Safety Performance Indicator Definitions

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Calculated indicators
Frequency Rate (FR)

Total Recordable Injuries (TRIs) Fatality Frequency Rate (FFR)

Injury frequency rates are normally expressed as the number of injuries per million hours worked. Lost Time Injury Frequency Rate (LTIFR) Total Recordable Injury Frequency Rate (TRIFR) FR = Number of injuries * 1,000,000 / hours worked FFR = Fatalities * 1,000,000 / hours worked LTIFR = LTIs * 1,000,000 / hours worked

In some jurisdictions, such rates are expressed per 200,000 hours worked. The ICMM database defaults to calculating frequency rates based on million hours worked, but can also be set to calculate rates per 200,000 hours. Where rates are described in text, the denominator used should be mentioned to avoid confusion. TRIFR = (Fatalities + LTIs + RWIs + MTIs) * 1,000,000 / hours worked

TRI = Number of (Fatalities + Lost Time Injuries + Restricted Work Injuries + Medical Treatment Injuries)

Health and Safety Performance Indicator Definitions

Severity Rate (SR)

Duration Rate (DR)

Absentee Rate (AR)

Total days lost = days lost to LTIs and RWIs plus days lost to work-related diseases plus days lost to non work-related illnesses and injuries. Number of Personnel Total personnel = hours worked per year / 20005

DR = (Days lost to LTIs and RWIs) / Number of (Fatalities + LTIs + RWIs) AR = Total days lost * 1,000,000 / hours worked

SR = (Days lost to LTIs and RWIs) * 1,000,000 / hours worked

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5 2000 hours per year = 50 weeks x 40 hours and is an approximation of an average number of hours per year per person exposed

Health and Safety Performance Indicator Definitions

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Health Indicators
New Cases (per disease):

Definitions of Health Indicators Used in Data Entry and Reporting
Significant aggravation of a pre-existing condition shall also be counted as a new case when all of the above criteria are met. New cases are counted separately for employees and contractors. New cases are counted as of the date the illness/disease is diagnosed and are reported on a calendar year basis. Only new cases are counted for lagging indicators.

To ensure usability of benchmarking data, definitions of cases are provided. These case definitions are not necessarily consistent across all national regulatory frameworks, but do conform to international conventions (e.g., WHO, ISO, ILO, CDC, ATS/ERS, etc.) where possible.

New cases are counted when all of the following criteria are met: • There is a known association between the exposure(s) and the occupational illness or disease. • There is evidence of current or previous exposure to the agent of concern during employment with the current member company. • A dose sufficient (with respect to concentration and duration of exposure) to cause the illness/disease has been documented through an appropriate professional assessment (e.g. industrial hygiene reports) or a professional opinion that the exposure is consistent with the condition. • There is evidence of the illness/disease as diagnosed by a medical practitioner. • The necessary (minimum) latency period exists to establish the probability of association. • There has been no previous recorded illness of same type involving the same body part, or the individual has had a previous recorded illness of same type affecting the same body part but had recovered completely (all signs and symptoms had disappeared) from the previous illness and an event or exposure in the work environment caused the signs or symptoms to reappear (NOTE: for illnesses where the signs or symptoms may recur or continue in the absence of an exposure in the workplace, the case must only be recorded once. Examples include occupational cancer and pneumoconioses).

Health and Safety Performance Indicator Definitions

Fatalities (per disease): Disease Rates:

Number of deaths resulting from an occupational disease within the reporting year, counted according to the date of death.

Disease rates are expressed per 1000 persons at work. The number of personnel at work is calculated as noted on the previous page based on hours worked.

Note: the calculation of meaningful statistics for diseases involving a long lag period prior to the development of the disease poses a definitional challenge. No method is ideal. However, for comparative purposes, and to provide a standard baseline, a disease rate is applied, even for diseases with a long lag period prior to their manifestation. It is recognized that this rate is not a true reflection of risk to the current working population.

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Health and Safety Performance Indicator Definitions

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Health Metric Definitions
Work Related Asthma Pneumoconioses Work Related Cancers Infectious Diseases

Health metric definitions with their associated World Health Organization International Classification of Diseases (ICD-10) identifier. Work Related Chronic Obstructive Pulmonary Disease (COPD)6 For a more detailed criteria, see appendix. Deep Vein Thrombosis (DVT) Cases of COPD should be reported if they meet the following criteria:

Asthma is “work related” when there is an association over time between symptoms and work. A criteria for inclusion of work-related asthma can be found in the appendix. A medical diagnosis of parenchymal lung disease with compatible radiological findings related to exposures to a range of substances (see appendix). Vector-borne diseases (e.g. malaria) in persons not originally from, or living permanently in, relevant disease endemic areas. A medical diagnosis of cancer related to exposures to a range of agents (see appendix for list). Specific guidelines (based on the scientific literature) on work relatedness for bladder and lung cancer in the primary aluminium industry are provided as appendices. A medical diagnosis of DVT that has occurred as a result of work-related travel.

• Recognized by a Workers’ Compensation Authority or equivalent • Recognized as an occupational disease by the physician responsible for the site

[ICD-10: J45, J45.1, J45.9] [ICD-10: J42, J43, J44] [ICD-10: J61, J62, J63, J63.0, J63.1, J63.2, J63.8 ] [ICD-10: I80]

6 Sources used to develop these criteria: Quebec compensation guidelines; review of aluminium industry epidemiology studies (e.g., Moira Chan-Yeung, Norwegian studies and Richard Martin's unpublished study)

[ICD-10: C67 (C67.0C67.9), C34 (C34.0C34.9), C45 (C45.0C45.9)]

Health and Safety Performance Indicator Definitions

[ICD-10: B50-54, A90-99, and potentially others in the “A” and “B” categories]

Silicotuberculosis Hearing Loss7

An X-Ray consistent with silicosis (see Pneumoconioses above) as well as positive sputa microscopy or culture for Mycobacterium tuberculosis. Beryllium Related Beryllium sensitization and chronic beryllium disease (CBD). See appendix for further details. www.osha.gov/recordkeeping/hearinglossflowchart.pdf Hand-Arm Vibration Syndrome Musculo-Skeletal Syndrome Occupational Dermatitis Platinosis (Platinum Salt Sensitivity) A medical diagnosis of disorders and diseases of the musculoskeletal system having a proven causal relationship with work and associated with repetitive motion and/or stress. Disorders arising out of single events are specifically excluded and are regarded as injuries. Vibration White Finger (VWF) equal to or greater than the Stockholm grading of 2.

OSHA Recordable Hearing Shift (Incidence): An age-corrected average hearing shift in either ear of greater than or equal to 10 dB at 2000, 3000 and 4000 Hz when compared to baseline, coupled with a greater than or equal to 25 dB average hearing level in the same ear at 2000, 3000 and 4000 Hz. See: Non-infectious inflammation of the skin provoked by contact with an external chemical or substance, accompanied by itching, cracking, blistering & ulcerations

[ICD-10: J65]

[ICD-10: J63.2, T56.7]

[ICD-10: H83.3] [ICD-10: T56.9]

7 Other definitions of hearing loss (Prevalence and Standard Threshold Shift) are in the Appendix and should be used where applicable.

Allergy to complex halogenated salts of platinum is an acquired hyper-sensitivity to the complex salts of platinum which becomes manifest after a variable period of symptomless exposure. The clinical characteristics include one or more symptoms and signs of dermal, ocular and nasal allergy and/or asthma.

[ICD-10: J45, J45.1, J45.9] [ICD-10: M62.6, G56.0, G57.5, M65, M65.4, M70, M71, W43, etc.]

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Health and Safety Performance Indicator Definitions

[ICD-10: L23 and L23.X, L24 and L24.X, L25 and L25.X]

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Appendix: Further Information
A Definitions
A1 A2 A3 This appendix contains additional definitions and examples to provide further understanding of the definitions above. These definitions are not currently directly used in ICMM benchmarking. First Aid Injury Sickness A First Aid Injury is recorded when first aid treatment is required as a result of a work-related injury. OSHA determines First Aid to mean the following treatments: • Visit(s) to a health care provider for the sole purpose of observation • Diagnostic procedures, including the use of prescription medications solely for diagnostic purposes • Use of non prescription medications including antiseptics • Simple administration of oxygen • Administration of tetanus/diphtheria shot(s) or booster(s) • Cleaning, flushing or soaking wounds on skin surface • Use of wound coverings such as bandages, gauze pads etc. • Use of hot and cold therapy e.g. compresses, soaking, whirlpools, non prescription creams/lotions for local relief except for musculoskeletal disorders. • Use of any totally non-rigid, non-immobilizing means of support e.g. elastic bandages • Drilling of a nail to relieve pressure for subungal haematoma • Use of eye patches • Removal of foreign bodies embedded in the eye if only irrigation or removal with cotton swab is required • Removal of splinters or foreign material from areas other than the eyes by irrigation, tweezers, cotton swabs or other simple means. All of the above are regarded as First Aid Injuries, regardless of the health care provider, who may be a physician, nurse or other health care provider. Lagging and Leading Indicators

The role negotiated with society. Sickness is the external and public mode of being “unhealthy”. Sickness is the social role, a status, a negotiated position in the world, a bargain struck between the person, henceforward called "sick", and a society which is prepared to recognise and sustain the person.

Lagging indicators, also sometimes called trailing, downstream or ‘after-the-fact’ indicators, provide historical information about health and safety performance. With lagging indicators, nothing can be changed to alter the measure of health and safety performance, as it is history. Any changes made may influence future performance but cannot alter the past performance. Classic injury statistics (i.e.,

Health and Safety Performance Indicator Definitions

Management System Certification

injury frequency rate, lost workday rate, etc.) are examples of lagging indicators. A4 The following indicators are considered relevant to the above objectives: Number of plants with recognized health and safety management systems (e.g. OHSAS 18001 or equivalent). Leading Indicators for Occupational Health Description Measure

Ergonomics – Process

Employee Exposure Health risk management is essential for the well-being of employees. This process Assessment involves HIRARC (Hazard Identification, Risk Assessment, Risk Control).

Leading indicators, also sometimes called ‘upstream’ indicators, are used as predictors of health and safety performance. The advantage of using leading indicators of performance is that actions can be taken to alter the course of health and safety performance. If an indicator predicts poor performance, it is not necessary to wait to see if the prediction is correct. Changes can be implemented to increase the probability of improved performance. Thus, leading indicators can provide guidance whereby there is greater assurance of achieving good health and safety performance. Reporting of leading indicators also encourages organizations to adopt recognized occupational and environmental health management practices and is important to the sustainability of the organization and its employees.

Measurement of leading indicators is considered to add value to the understanding of organizational efforts to improve the management of Occupational Health in the workplace.

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IAI Objective: Implementation of Management Systems for Health and Safety in 95% of Member Company plants by 2010. IAI Objective: Implementation of an Employee Exposure Assessment 95% of Member Company plants by 2010.
Is there a formal process in place to identify AND control specific ergonomic risks?

Health and Safety Performance Indicator Definitions

Percentage of sites with process in place

Percentage of plants with a formal process in place that fulfil the defined criteria as specified in the attached criteria document.

Number of plants certified compared with total number of plants asked.

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B Health indicator criteria
B1 Work-aggravated asthma is preexisting or coincidental new onset asthma which is made worse by exposures in the workplace. Allergic/Immunolgic* No association between symptoms and work. Non-Work-Related Asthma Work-aggravated Asthma

Allergic OA is characterized by a latency period between first exposure to a respiratory sensitizer at work and the development of symptoms; the sensitizer may be an agent of high (lgE-mediated) or low molecular weight; latency can range from weeks to years. For some agents causing this type of OA, evidence for an immunologic mechanism is still lacking (or may not exist).

Asthma is ‘work-related’ when there is an association over time between symptoms and work.

All Asthma

Occupational asthma (OA) is asthma caused by workplace exposure and not by factors outside of the workplace. OA can occur in workers with or without prior asthma.

Work-related Asthma

Irritant-induced OA may occur within a few hours of a high concentration exposure to an irritant, gas, fume or vapour at work (e.g. classic acute RADS), or in response to chronic low-level irritant exposures which may manifest after an extended period of time (days to years). Most Asthma in the Primary Aluminium Industry is generally viewed to belong in this latter category.

Work-caused (true OA)

Irritant/Non-Immunologic*

Health and Safety Performance Indicator Definitions

Compatible exposure history AND Compatible symptoms (subjective evidence of airflow limitation) AND Objective evidence of airflow limitation AND Temporal relationship to the work environment/exposure

CRITERIA FOR WORK-RELATED ASTHMA COMMENTS

Supporting Information

a) Spirometry showing reduced FEV1 or FEV1/FVC values relative to personal baseline or appropriate population predicted values, which is at least partially reversible either spontaneously or in response to treatment • Bronchodilator response must demonstrate an increase in FEV1 of >12% and >200 ml from the baseline value during a single testing session; or b) non-specific bronchial hyper-responsiveness as demonstrated by histamine or methacholine inhalation challenge (i.e., PC20 < 8mg/ml or equivalent)

a) One or more of the following: Cough (with exertion or at rest), sputum, wheeze, chest tightness, difficulty in breathing, breathlessness b) Symptoms are typically episodic, and often worse when sleeping following a work shift. c) May occur immediately or delayed (after several hours or during sleep) following exposure

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a) Symptoms improve on days away from work, such as days off, weekends, holidays; or b) Symptoms worsen during or after the work day (less sensitive than ‘a’); or c) Serial pulmonary function measurements: • PEFR: at least 4 readings per day for a sufficient period of time to quantify readings during several continuous days at work as well as several continuous days away from work, and showing a circadian variation of at least 20% on days at work and showing a pattern of improvement on days away from work • Spirometry • Histamine or methacholine challenge testing; or d) Cross-shift spirometry showing a fall in FEV1 of at least 10% • Daily diary: symptoms, medication use, etc. • Diffusing capacity; detailed respiratory function tests • Exclusion of alternative diagnoses

Health and Safety Performance Indicator Definitions

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B2

Definition of COPD (ATS/ERS)

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Although COPD affects the lungs, it also produces significant systemic consequences. Diagnosis of COPD (ATS/ERS) The diagnosis of COPD should be considered in any patient who has the following: symptoms of cough; sputum production; or dyspnoea; or history of exposure to risk factors for the disease. COPD: Diagnosis and classification of severity – World Health Organization
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The diagnosis requires spirometry; a post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <70% confirms the presence of airflow limitation that is not fully reversible. Spirometry should be obtained in all persons with the following history: exposure to cigarettes; and/or environmental or occupational pollutants; and/or presence of cough, sputum production or dyspnoea. Spirometric classification has proved useful in predicting health status, utilisation of healthcare resources, development of exacerbations and mortality in COPD. A simple classification of disease severity into four stages is presented below. The management of COPD is largely symptom-driven, and there is only an imperfect relationship between the degree of airflow limitation and the presence of symptoms. The staging, therefore, is a pragmatic approach aimed at practical implementation and should only be regarded as an educational tool, and a very general indication of the approach to management. FEV1 refers to forced expiratory volume in one second and values refer to measures of FEV1 taken after use of a bronchodilator. FVC refers to forced vital capacity. Poorly reversible airflow limitation associated with other diseases such as bronchiectasis, cystic fibrosis, tuberculosis, or asthma is not included except insofar as these conditions overlap with COPD. In many developing countries both pulmonary tuberculosis and COPD are common. Therefore, in all subjects with symptoms of COPD, a possible diagnosis of tuberculosis should be considered, especially in areas where this disease is known to be prevalent. In countries in which the prevalence of tuberculosis is greatly diminished, the possible diagnosis of this disease is sometimes overlooked.

Work Related Chronic Obstructive Pulmonary Disease (COPD)
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8 *Excerpted from: Eur Respir Jrn 2004: 23; 932-946. ATS/ERS TASK FORCE. Standards for the Diagnosis and Treatment

of Patients with COPD: a summary of the ATS/ERS position paper.

Health and Safety Performance Indicator Definitions

Stage

Stage II

Stage III

Stage 0 Stage I

Severity SEVERE COPD AT RISK

Guidelines for recognition as an occupational disease (Aluminium Industry): The epidemiological literature pertaining to COPD in the primary aluminium industry suggests that COPD is associated with pot-room work exposure. There is insufficient evidence to link COPD with exposures in other areas like casting, carbon-plant operations and alumina refining. If occupational COPD is defined as COPD that would not have arisen without work exposure, some threshold of exposure needs to be agreed upon. The literature does not yield a consistent threshold. It is proposed that for the sake of simplicity in reporting, the following arbitrary criteria be used for physician-designation of occupational COPD: • Non-smokers: 10 years or more of pot-room work • Ex-smokers and smokers: 20 years or more of pot-room work • All COPD cases with a prior diagnosis of pot-room asthma These criteria should not be used to second-guess Workers’ Compensation Authority recognized cases, all of which should be reported.

MODERATE COPD

MILD COPD

Criteria

Characterized by worsening airflow limitation (FEV1/FVC < 70%; 50% < FEV1 < 80% predicted) and usually the progression of symptoms, with shortness of breath typically developing on exertion. This is the stage at which patients typically seek medical attention because of dyspnea or an exacerbation of their disease. The presence of repeated exacerbations has an impact on the quality of life of patients and requires appropriate management. Characterized by severe airflow limitation (FEV1/FVC < 70%; 30% < FEV1 < 50% predicted) or the presence of respiratory failure or clinical signs of right heart failure. Patients may have severe (Stage III) COPD even if the FEV1 is > 30% predicted, whenever these complications are present. At this stage, quality of life is appreciably impaired and exacerbations may be life-threatening.

but not always, by chronic cough and sputum production. At this stage, the individual may not even be aware that his or her lung function is abnormal.

< 70% but FEV1 > 80% predicted values) and usually,

Characterized by mild airflow limitation (FEV1/FVC

Characterized by chronic cough and sputum production. Lung function, as measured by spirometry, is still normal.

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Health and Safety Performance Indicator Definitions

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B3 B4 • • • • • • •

Beryllium sensitization* is an “allergic” condition to beryllium that can develop after a person breathes beryllium dust or fumes. Some researchers think it might also occur if beryllium penetrates the skin through an open cut or from a beryllium splinter. Diagnostic Criteria: • Sensitization requires at least 2 positive BeLPTs, performed as separate tests (2 tests on blood, or one blood and one BAL) • No evidence of abnormal physiological, anatomical or pathological changes consistent with CBD • No symptoms Diagnostic Criteria: • Confirmed sensitization • Plus compatible pathologic, physiologic, functional or radiographic abnormalities • Symptoms may or may not be present Asbestos Cobalt Refractor Ceramic Fibres Silica Cristobalite Coal Workers Pneumoconiosis Other substances known to cause pneumoconiosis. Pneumoconioses – list of substances

Chronic beryllium disease9 (CBD) is a lung condition that can develop after a person breathes beryllium dust or fumes. The immune system sees beryllium as a “foreign invader,” and builds an “army” of cells in the bloodstream that are prepared to react to beryllium wherever they see it in the body. In CBD, the reaction of the immune system against inhaled beryllium particles has resulted in scarring (called granulomas) in the lungs.

Beryllium

9 Source: National Jewish Medical Centre, Denver, Co.

Health and Safety Performance Indicator Definitions

B5 • • • • • • • • • • • • • • • • • • •

B5.1 Cancer agents list: B5.2 Bladder Cancer

RR = Relative Risk AR = Attributable Risk

*Armstrong B, et al. Compensating Bladder Cancer Victims Employed in Aluminium Reduction Plants. Journal of Occupational Medicine 1988: 30; 10. 771775

The following criteria should be used to determine if a case of bladder cancer in an individual working in the primary production of aluminium is ‘work-related’:

Pathology confirmed diagnosis of bladder cancer Individual is currently or has previously worked in a coal tar pitch (CTP) job CTP exposure at the industrial level is documented Latency from first exposure to CTP until onset of symptoms or date of diagnosis of at least 10 years • Calculated attributable risk (i.e., probability of causation) >50%, independent of smoking. • AR% = [(RR exposed – RR unexposed)/RR exposed] X 100 • AR of 50% corresponds to a relative risk (RR) of 2.0, and also to a cumulative exposure to BaP = 19µg/m3 years *

Asbestos Benzidine and salts Bichloromethyl ether (BCME) Chromium and chromium compounds Coal tars and coal tar pitches, soot Beta-naphthylamine Vinyl chloride Benzene or its toxic homologues Toxic nitro- and amino-derivatives of benzene or its homologues Ionizing radiation Pitch, bitumen, mineral oil, anthracene, or the compounds, products or residues of these substances Coke oven emissions Compounds of nickel Dust from wood Cancer caused by any other agents not mentioned in the preceding items where a direct link between the exposure of a worker to this agent and the cancer suffered is established.

Cancers

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Health and Safety Performance Indicator Definitions

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P = Probability that the cancer is of occupational origin (upper 95% confidence limit) B[a]P = ug/m3-year B[a]P total career dose B6. Additional Hearing Loss Metrics P – y = Cumulative tobacco exposure in pack-years Hearing Impairment (Prevalence): As per ISO criteria and at: www.who.int/pbd/deafness/hearing_impairment_grades/en/index.html (see opposite page)

* Armstrong B, Theriault G. Compensating Lung Cancer Patients Occupationally Exposed to Coal Tar Pitch Volatiles. Occupational and Environmental Medicine.1996: 53: 160-167. It is recognized that organizations will require time to implement this metric. The IAI/ICMM committee felt that if the 1000, 2000 and either 3000 or 4000 Hz data were available, then this metric should be reported by the organization.

B5.3 Lung Cancer • • • •

The following criteria should be used to determine if a case of lung cancer in an individual working in the primary production of aluminium is ‘work-related’: Pathology confirmed diagnosis of lung cancer Individual is currently or has previously worked in a coal tar pitch (CTP) job CTP exposure at the individual level is documented Latency from the first exposure to CTP until onset of symptoms or date of diagnosis of at least 10 years • Calculated “P” (i.e., probability of causation) >50%, taking into account the smoking history of the individual.* P = 1 + (0.33)(p - y) + (0.0476)(B[a]P) (0.0476)(B[a]P) x 100%

ICMM and IAI member companies are moving towards using the following hearing loss definitions. Once a reasonable number of companies have data in these formats, the Benchmarking database will be modified to include capture of cases according to these definitions.

OSHA Standard Threshold Shift (Incidence – Early Loss Indicator): Individual sites and organizations are encouraged to collect data on this metric. A standard threshold shift (STS) is an age-corrected change in hearing threshold relative to the baseline audiogram of an average of 10 dB or more at 2000, 3000, and 4000 Hz in either ear. (as per OSHA Regulations: UU1910.95(g)(10)(i)UU).

Health and Safety Performance Indicator Definitions

0 – No impairment

1 – Slight impairment

2 – Moderate impairment 3 – Severe impairment 4 – Profound impairment including deafness

Grades 2, 3 & 4 are classified as disabling hearing impairment B7 Musculoskeletal These may include but are not limited to: • Carpal tunnel syndrome • Rotator cuff syndrome • De Quervain's disorder • Trigger finger • Tarsal tunnel syndrome • Sciatica • Epicondylitis • Tendonitis • Raynaud's phenomenon • Whole body vibration syndrome • Herniated spinal disc • Whole Body Vibration Syndrome.

Grade of Impairment

The audiometric ISO values are averages of values at 500, 1000, 2000, 4000 Hz

25 dB or better (better ear) 26-40 dB (better ear) 41-60 dB (better ear) 61-80 dB (better ear)

81 dB or greater (better ear)

Corresponding audiometric ISO value

No or very slight hearing problems. Able to hear whispers Able to hear some words when shouted into better ear. Unable to hear and understand even a shouted voice.

Able to hear and repeat words spoken in normal voice at 1 metre Able to hear and repeat words spoken in araised voice at 1 metre

Performance

Counseling. Hearing aids may be needed. Hearing aids usually recommended.

Hearing aids needed. If no hearing aids available, lipreading and signing should be taught.

Hearing aids may help understanding words. Additional rehabilitation needed. Lip-reading and sometimes signing essential.

Recommendations

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Health and Safety Performance Indicator Definitions

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C Health Risk Assessment
Name Definition Purpose Unit of measurement Aggregation method Target Condition Measurement methods

3.5 Health Risk Management a. Hazard Identification, Risk Assessment, Risk Control (HIRARC) b. Employee Health Assessment Add up company data

Health risk management is essential for the well-being of employees. This process involves HIRARC and Employee Health Assessment. Percent of plants with a formal process in place that fulfil the defined criteria as specified under Target Condition. Record the number of plants with a formal HIRARC program that meets the defined criteria as specified under Target Condition. Each site should have implemented and update at least annually:

To indicate to what degree the industry has a formal health risk management process in place that meets the criteria for HIRARC and Employee Health Assessment processes.•

A) HIRARC process that includes ALL of the following elements: • Identification/classification of all health hazards (e.g. acceptable – significant or insignificant, uncertain health hazards • Quantitative assessment of risk for all uncertain health hazards • Control of unacceptable health risks via appropriate counter measures (e.g. personal protective equipment, engineering controls, product substitution etc.) • Annual reviews of effectiveness of the process. 1. Occupational Hygiene (OH) Qualitative Exposure Assessments This refers to assessing all chemical and physical agents by Similar Exposure Group (SEG) at a location and deciding whether the SEG should be classified as insignificant, significant, unacceptable, or uncertain. Significant risks are those which exceed 50% of the Occupational Exposure Limit (OEL). By definition, insignificant risk would be less than 50% of the OEL. Unacceptable SEGs would be those exceeding an

Health and Safety Performance Indicator Definitions

Target Condition

2. OH Quantitative Assessments Uncertain SEGs, identified in (1) above, need to be categorized as either insignificant, significant, or unacceptable through quantitative analysis. The number/percentage of uncertain SEGs should be tracked. The ultimate goal is 100% assessments completed (e.g. no uncertain SEGs)

3. Number of Unacceptable SEGs identified by agent and number of impacted employees Unacceptable SEGs are those which exceed an OEL. Agent includes a description of chemical (e.g. CTP, asbestos, silica, etc.) or physical (e.g. noise, heat, radiation, etc.) agents.

4. Percentage compliance with personal protective equipment requirements (PPE) How many of the affected employees in unacceptable SEGs defined above are wearing required PPE (e.g. respirators, hearing protection, protective clothing, etc.)? 5. Percentage of unacceptable EGSs that have been reduced to acceptable status via engineering, administrative, and/or substitution controls. Acceptable means the exposure is less than the OEL B) Employee Health Assessment based on ALL of the following elements: • Pre-placement physical exams covering critical elements: • Relevant periodic health assessments for ALL identified health risks include fitness for duty issues as well as exposure to chemicals, physical, or biological agents. • Fitness for duty evaluations include mobile equipment operators, respirator users and heatexposed individuals.

OEL. Uncertain SEGs would be those for which a decision as to exposure level is unknown. Agents assessed also include process intermediates and byproducts produced in the manufacturing process. In order to state that an OH qualitative exposure assessment is in place, at least 95% of identified agents need to be assessed and categorized.

In order to state that an OH quantitative exposure assessment process is in place, 95% and above of the uncertain SEGs must be quantitatively assessed via OH sampling techniques.

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Health and Safety Performance Indicator Definitions

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Target Condition Data available?

NO. Needs to be included in an annual survey on SD indicators.

Examples of health assessments for relevant exposures: • Hearing tests for noise exposure • Spirometry for exposures to respiratory irritants • Appropriate surveillance measures for exposure to carcinogens • General health and medication review for exposure to heat • General health and medication review and vision tests for vehicle operators.

• • • •

• For chemical exposures, surveillance should be initiated for employees exposed to >50% of the OEL. • For noise, surveillance should be initiated for noise exposures at 80 dbA and above (8-hour TWA) The above exams should be carried out on a frequency that meets accepted health surveillance practices The percentage of required exams completed should be tracked. The ultimate goal should be 100% completion rate for required surveillance exams A system to communicate results to employees An annual site summary of results (without individual attribution) and appropriate follow-up process

Health and Safety Performance Indicator Definitions

D Ergonomics Assessment
Name Definition Purpose Unit of measurement Aggregation method Target condition Measurement methods

Ergonomic Process

Plants with a formal ergonomic process in place to identify AND control specific ergonomic risks which fulfils the defined criteria as specific under Target Condition. Percentage of plants with processes in place. At the IAI level, determine the overall industry number/percentage from reported company data.

When a plant has not satisfied the above target conditions, the plant is considered not to have met the requirements and would not be included in the final tally.

Record the number of plants with a formal ergonomic process that meets the defined criteria as specified under Target Condition. To measure the implementation of company-specific ergonomic processes to favourably impact on ergonomic-related injury and illness. At the company level, add up the data, determine the percentage of plants that meet the criteria.

Each site should have implemented all of the following items: • Written ergonomics policies and procedure • Employee training • An effective medical management program

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And at least one of the following: • Ergonomic risk factor determination (qualitative) on relevant job tasks has been completed • Ergonomic hazard analyses (quantitative) are performed for tasks where ergonomic risk factors have been identified • Significant ergonomic risks have been prioritized for control

Health and Safety Performance Indicator Definitions

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Health and Safety Performance Indicator Definitions

Health and Safety Performance Indicator Definitions

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