Journal of Cleaner Production 262 (2020) 121346

Contents lists available at ScienceDirect

Journal of Cleaner Production

journal homepage: www.elsevier.com/locate/jclepro

Integrated management systems as a key facilitator of occupational

health and safety risk management: A case study in a medium sized
waste management firm
Delfina Ramos a, b, *, Paulo Afonso b, Matilde A. Rodrigues c, b
a
Centre for Research & Development in Mechanical Engineering (CIDEM), School of Engineering of Porto (ISEP), Polytechnic of Porto, 4200-072, Porto,
Portugal
b ~es, Portugal
Algoritmi Centre, School of Engineering, University of Minho, Guimara
c
Research Centre on Environment and Health, Department of Environmental Health, School of Health of Polytechnic Institute of Porto, Porto, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: The positive impact of introducing Occupational Health & Safety (OH&S) standards at the organization
Received 5 February 2019 level is recognized by governments, employers and workers. Nevertheless, the knowledge on its effective
Received in revised form use in Small and Medium-Sized Enterprises is still limited. This case study aims to provide a better
15 March 2020
understanding of how the implementation of Integrated Management Systems (IMSs) influences the
Accepted 24 March 2020
Available online 30 March 2020
improvement of OH&S risk management process in medium-sized business. Particular attention was
given to employees’ awareness about risk management effectiveness. The study was conducted in a
Handling editor: Tomas B. Ramos company working in the area of solid waste treatment certified in 2009 with an IMSs for Quality,
Environment, Occupational Health and Safety. The evolution of accidents before and after the imple-
Keywords: mentation of the IMSs was analyzed and a questionnaire was used to capture the perceptions of the
Occupational health and safety technicians on the risk management system. The questionnaire was answered by 16 technicians of the
Risk management company from different departments and in a second phase were conducted interviews with the Chief
Integrated management systems Executive Officer and the Technician responsible for the Management System. Finally, it was proved that
Workers’ perceptions
there was an improvement in the record of occupational accidents and that the IMSs brought a greater
Solid waste treatment
involvement of workers in risk management activities, but their participation has not yet reached the
desired level.
© 2020 Elsevier Ltd. All rights reserved.

1. Introduction implemented independently, but without the advantages related to

The implementation of Integrated Management Systems (IMSs)
is a strategic and operational decision for an organization, which
contributes to an efficient functioning in terms of Quality, Envi-
ronment, and Occupational Health & Safety (OH&S) (Domingues
et al., 2016; Rebelo et al., 2016). In fact, there has been a tendency
to implement IMSs covering the ISO 45001 (or OSHAS, 18001), ISO
14001 and ISO 9001 standards, where this integration can render
the process more efficient and effective, reducing bureaucracy and
saving money (Hamidi et al., 2012; Rebelo et al., 2014; Nunhes et al.,
2016). However, an OH&S management system can be
* Corresponding author. Centre for Research & Development in Mechanical En-
gineering (CIDEM), School of Engineering of Porto (ISEP), Polytechnic of Porto, Rua
nio Bernardino de Almeida, 431 4249-015, Porto, Portugal.
Dr. Anto
E-mail address: dgr@isep.ipp.pt (D. Ramos).
IMSs (Domingues et al., 2016; Rebelo et al., 2016). Its fundamental
objective is to promote the continuous improvement of OH&S
performance (ISO 45001: 2018). Additionally, it contributes for
strategy and competitiveness, helping organizations to demon-
strate to both public and customers that they are fulfilling appli-
cable legal requirements and other guidelines, that they have
appropriate work environment conditions, as well as mechanisms
to improve OH&S performance and practices, protecting and
enhancing brand image, sales, profits, profitability and brand value
(Fernandez-Mun ~ iz et al., 2009; Granerud and Rocha, 2011).
According to Fern andez-Mun ~ iz et al. (2007), an effective OH&S
management system requires a safety policy, the employees
participation in OH&S activities, training and development of em-
ployee’s competencies, mechanisms to communicate and inform
about the possible risks in the workplace and the respective control
measures, planning procedures for safety actions (including

https://doi.org/10.1016/j.jclepro.2020.121346
0959-6526/© 2020 Elsevier Ltd. All rights reserved.
2 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346
hazards identification, risk assessment and risk control), and finally,
the control and review of activities carried out within the organi-
zation. In this framework, the success of an OH&S management
system is dependent of commitment and participation from all
levels of the organization, i.e., both managers and employees
(Ferna ndez-Mun ~ iz et al., 2012; Skład, 2019). These aspects are also
emphasized in ISO 45001: 2018, which adds that enterprises can
achieve improvements in their OH&S performance through a sys-
tematic process which should start with top management support,
mainly in what regards their leadership and commitment towards
the OH&S management system, a culture in the organization that
supports this system and the allocation of the necessary resources
for its sustainability. Additionally, it is important to have the inte-
gration of the OH&S management system into the organization’s
business processes.
According to Marhavilas et al. (2018), the positive impact of
introducing OH&S standards at the organization level is recognized
by governments, employers and workers. This has an effect on the
reduction of occupational hazards and accidents, improving not
only the risk management and compliance with legal obligations,
but also on productivity, leading to more effective usage of re-
sources and an increased capability to deliver consistent services
and products and at the same time improving the financial per-
formance (Marhavilas et al., 2018; Barbosa et al., 2019).
When the OH&S management system is mature and good
practices are applied, not only an improved performance is ex-
pected, but also the companies’ overall performance. Ferna ndez-
Mun ~ iz et al. (2009) establish that good practices in OH&S
contribute to reduce the companies’ accident rate and simulta-
neously improve working conditions. OH&S certification also helps
to improve management’s commitment, employee’s participation
and contributes to the improvement of the communication chan-
nels (Santos et al., 2011; Ferna ndez-Mun ~ iz et al., 2012; Sampaio and
Neves, 2012).
Despite the benefits of an IMSs when different standards are
considered, including ISO 45001: 2018, the knowledge about how it
contributes to improve OH&S risk management in Small and
Medium-Sized Enterprises (SMEs) is still limited. Previous studies
pointed out that SMEs are characterized by less effective OH&S
management systems and perform risk assessments of lower
quality than larger firms (Sørensen et al., 2007; Cagno et al., 2011).
The limited human, economic and technological resources, the low
level of knowledge about the enterprise’s risks by the owner/
manager and deficiencies in organizational processes are often
highlighted as obstacles to the firms’ OH&S performance, which
may also create constraints to the IMSs (or OH&S management
systems when applied independently) (Jensen et al., 2001; Fabiano
et al., 2004; Sørensen et al., 2007; Barbosa et al., 2019). In fact, in
these companies, certification may not be an easy and straightfor-
ward process due to the costs involved, lack of employees’ moti-
vation, difficulties in changing the company’s safety culture and
increased bureaucracy (Santos et al., 2014). According to Nunhes
et al. (2017), one of the main difficulties in the implementation of
a management system is the high amount of human and financial
resources spent. Additionally, the owner and other managers in
these companies need to deal with several tasks, relegating tasks
related to risk management activities to second place (Hasle and
Limborg, 2006; Hasle et al., 2012). However, it is also important
to note that SMEs are frequently referred as a single group of firms
while they may differ mainly in what regards their size and re-
sources, which may also have implications in their risk manage-
ment system performance.
In view of the foregoing, this study aims to contribute to a better
understanding on how IMSs improve the OH&S risk management
process in medium-sized business. To this purpose, a case study
was developed in a medium-sized enterprise, where the evolution
of accident rates along the years and perceptions about risk man-
agement were analyzed. The studied company develops its activity
in the area of solid waste treatment and was certified in 2009 with
an IMSs for Quality, Environment, Occupational Health and Safety.
2. The role of perceptions on the integration of risk
management in the occupational health and safety system
The understanding of perceptions about risk management sys-
tem is very important in order to turn its integration into the OH&S
system more effective. Misperceptions of workers, managers and
other stakeholders about this matter can create obstacles to this
process. Additionally, perceptions can also influence risk behaviors,
which are an important insight to safety management (Zhao et al.,
2016).
Several factors influencing risk perception in the field of OH&S
are well known, such as the characteristics of the situation, its
surroundings and personal factors such as knowledge, beliefs,
values, experiences, feelings and attitudes (Renn, 1998; Cameron
and Raman, 2005; Lima, 2005; Ji et al., 2011). Accordingly, per-
ceptions are also influenced by the human and structural capital.
According to Nun ~ ez and Villanueva (2011), human capital is the
stock of knowledge and skills that belong to the firm’s employees
but are at the firm’s disposal for the duration of their contracts.
Experience and training are examples of the elements that
constitute human capital. Similarly, OH&S training, the individual
capacity to anticipate and recognize hazards, the ability to react in
an emergency, or the worker’s physical strength are some elements
of the safety human capital. Structural capital is defined as the set of
knowledge, procedures and practices that remain in the firm, even
when the employees have left it. Work routines, control mechanism
and emergency procedures, for example, all form part of the
structural capital. The formalization of hazardous tasks, risk sig-
nalling, and accident investigation and analysis, meanwhile, all
form part of safety structural capital.
Perceptions of risk is of paramount importance in order to
develop a proper safety culture. In fact, previous studies showed
that risk perception is a predictor of the organizations’ safety
climate (Rodrigues et al., 2015a). The challenge is how to have a
positive influence on an organisation’s health and safety culture
(IOSH, 2015).
Despite the importance of risk perception, misperceptions are
frequently reported. Many studies have shown how people tend to
overestimate the risks that have a high severity (e.g. Lin and
Petersen, 2007; Jørgensen, 2016; Aven, 2016). These are usually
risks that are seen as technologically complex, scientifically un-
known, where people are involuntarily exposed, where the risk is
controlled by others, where the risk or the consequences are dealt
with irresponsibly, or where the risk is memorable from recently-
occurring accidents. The risks that are underestimated are nor-
mally the low severity risks (Rodrigues et al., 2015b), where
exposure is seen to be voluntary, where the risks are scientifically
well known, risks that can be controlled or dealt with responsibly,
where the consequences are reversible and the risk is not dramatic
or memorable. These findings show that awareness is more about
feelings than about knowledge or objective risk assessments and
the prevention efforts and safety activities have to take this into
account.
Perceptions can be more critical in SMEs. Despite the accident
rate be higher in smaller-sized firms, because of the reduced
number of workers employed the firms can remain several years
without record an accident (Barbosa et al., 2019). This can have a
critical impact in workers and employers’ perceptions about the
risk of occupational accidents. Additionally, measuring the cost of
 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346
accidents and occupational diseases is also a challenge for these
organizations (Haslam et al., 2016). According to Bonafede et al.
(2016), enterprises with lower size report higher constraints and
perceive OH&S as an economic burden much more than an op-
portunity to grow.
Public health policies and interventions to improve OH&S in
small-sized businesses should be drawn up taking into account
their structural, economic and productive characteristics and pro-
vide answers to the need of bureaucratic, administrative and leg-
islative simplification on one side and increase public investments
and economic incentives on the other (Bonafede et al., 2016;
Haslam et al., 2016; Ramos et al., 2016, 2017). Strengthening
external advisory and intermediary support actions should be
recommended to increase knowledge of and access to public
funding. Actions should be aimed to change the employers’ attitude
toward OH&S and to improve the safety culture.
3. Material and methods
3.1. Study population and sample
The research has been carried out in a company which is
devoted to solid waste recovery and treatment for six municipal-
ities Northern Portugal. The activities that are developed include
the reception of wastes, the selective collection of wastes (waste
sorting points) and specific collection in restaurants and similar
establishments, including the collection of used oils for production
of biodiesel. This company has a certified Integrated Management
System since 2009, including Quality (ISO 9001: 2008), Environ-
ment (ISO 14001: 2004) and Occupational Health and Safety
(OHSAS, 18001:, 2007).
The company is managed by a Board of Directors, which reports
to the Executive General Director. The company has a total of 136
employees that are divided into 4 departments: Technical Depart-
ment; Quality, Environment and Safety Department;
Administrative-Financial Department; and Department of
Communication and Image.
In this case study, 16 technicians of each department, each one
responsible for a team of operators according to the organizational
chart of the company, were included. Because the sample was
limited to the companies’ employer and employees, different ap-
proaches were used in this study, in order to achieve the proposed
objectives. Questionnaires were applied to all 16 technicians.
Additionally, interviews were performed with the CEO and the
Technician responsible for the Integrated System (Quality, Envi-
ronment and Safety).
3.2. Accidents analysis
The occupational accidents that occurred during the period
2007 to 2013 were analyzed. All injured workers, i.e. both techni-
cians and operators, were considered. The analysis was done per
workplace in each analyzed year. Data about occupational accidents
was gathered by the OH&S Office of the enterprise and derived
from the accidents reported by workers.
In this case study, the accident analysis was particularly rele-
vant, helping in the understanding of the evolution of occupational
accidents over the years in what regards to its number and severity,
relating them to the implementation/maturity of the OH&S man-
agement system.
3
3.3. Analysis of the technicians’ perceptions about the IMSs and its
contribution to OH&S risk management
With the aim of studying the technicians’ knowledge and per-
ceptions about the effectiveness of the risk management process, in
a context where an IMSs is implemented, a questionnaire was
developed and applied. In a first stage, an exhaustive literature
review was performed in order to identify the variables to include
in the analysis. As a result, international standards (e.g. OSHAS,
18001:, 2007; ISO 31000:, 2018) and empirical studies (e.g. Fung
et al., 2010; Badri et al., 2012; Yoon et al., 2013) were taken into
account in the construction of the questions.
Before the application of the questionnaire, a validation pro-
cedure was performed with 3 technicians, to check the clarity of
meaning of the questions and linguistic terms, as well as the
applicability of questions and scales used. Based on this procedure,
some questions were re-worded in order to increase clarity and
comprehension.
The final version of the questionnaire was divided into four
sections. The questionnaire starts with an initial section with 7
questions about general information, allowing to analyse results in
terms of several aspects, namely gender, age, years working in the
organization, department, function/activity in the firm, education
level and number of occupational accidents.
The second section comprised four questions to analyse the
technicians’ perceptions about the evolution of the IMSs and its
benefits to risk management in the organization. Respondents were
required to report their degree of satisfaction with the manage-
ment system implemented in the company (5-point Likert scale;
“1 ¼ Not satisfied”; “5 ¼ Very satisfied”). Then, four items assessed
their perceptions about the motivation for the management system
implementation: Legal requirements; Reduction of the occupa-
tional risks; Reducing costs related to OH&S; Respond and act in
accordance with stakeholders (5-point Likert scale;
“1 ¼ Completely disagree” to “5 ¼ Completely agree”). Their per-
ceptions about the benefits of the management system in relation
to seven indicators were analyzed (5-point Likert scale;
“1 ¼ Completely disagree” to “5 ¼ Completely agree”). The in-
dicators chosen were related to safety performance, in particular
accident and severity rates, compliance with legal requirements,
improved workers’ safety, improved transparency in terms of ac-
cidents, increased employees’ awareness for OH&S. Additionally,
indicators related to the organization’ performance were also
included, such as the improvement of the profits of the overall
organization, improved company’s visibility. In the last question,
respondents were asked to classify the evolution of the OH&S
management system in their company (5-point Likert Scale;
“1 ¼ Very low”; “5 ¼ Very high”).
The third section of the questionnaire was designed to analyse
the involvement of both, technicians and management, in the risk
management process. According to ISO 31000: 2018, risk man-
agement includes three main steps: risk analysis, risk assessment
and risk control. In a first stage, the technicians’ knowledge about
each one of these steps was analyzed. Then, they were asked to
assess the level of effectiveness of the risk management activities in
the company, according to their own perceptions. In the last
question of the section, respondents were requested to assess their
own contribution to the following steps: context establishment,
risk assessment, risk treatment, risk communication and consul-
tation, and monitoring and review. All items were rated on the
same 5-point Likert scale (e.g., “Very low” to “Very high”).
In the last section of the questionnaire, respondents were asked
about the importance of some actions to improve OH&S, such as an
4 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346
effective communication of risks to the workers, effective safety
instructions, involvement of all workers in safety training and
promotion of employees’ OH&S participation (5-point Likert scale;
“1 ¼ Completely disagree” to “5 ¼ Completely agree”).
3.4. Interviews
To better understand the employees’ involvement and percep-
tion about IMSs and risk management activities, 60-min semi-
structured interviews were performed with the Executive General
Director and the Technician responsible for the IMSs. In addition,
interviews served to validate and supplement the survey and safety
observations data. The interviews were conducted individually, in
the presence of two researchers, one acting as the interviewer and
the other being responsible to record the session and take notes.
The interview phase followed a predefined protocol. The inter-
viewer made the following questions:
Question 1 (Q1): How do you feature the participation of com-
pany employees in the risk management process? What kind of
participation, which are the employees participating in the
process, how does such participation occur? How has this
participation evolved?
Question 2 (Q2): How do you rate the degree of perception of
risk on the part of the employees of the company? Are there any
differences between different employees to report? How has
this perception evolved?
Question 3 (Q3): What is the contribution of the Integrated
Management System for Quality, Environment, Occupational
Health and Safety for an increased or better employee partici-
pation in the risk management process and their perception of
risk?
The interviews were recorded and transcribed verbatim.
3.5. Data analysis
Accident rates were calculated according to the Portuguese
Legislation (Ordinance nº 55/2010, 21st January) and as described
below. The Injury Frequency Rate (IFR) represents the number of
occupational accidents per million hours effectively worked:
Rf ¼ number of work accidents  106 / number of hours effectively
worked
The Injury Severity Rate (ISR) represents the number of work
days lost per million hours effectively worked:
Rs ¼ number of work days lost  106 / number of hours effectively
worked
Data was described in terms of relative frequency. Bivariate
correlation analysis was performed for relevant variables using the
statistical software package IBM SPSS® version 21.
4. Results and discussion
4.1. Accidents analysis
Occupational accidents have a key impact on human probity,
create high expenses for the social health/insurance system of any
country and deteriorate the sustainability of societies (Marhavilas
et al., 2018). In this case study, the analysis of the accidents was
particularly relevant to contextualize the evolution of the safety
performance in the organization, since it has been previously
identified as an indicator of OH&S performance in SMEs (Barbosa
et al., 2019). It was expected that when an OH&S management
system is implemented, accident rates decrease (Ferna ndez-Mun ~ iz
et al., 2009). Thus, accident rates for frequency and severity were
computed. Fig. 1 represents the evolution of the accident rates
during the period under analysis.
Data denote that severity rates decreased in most of the years,
except for the years 2010, 2012 and 2014. The severity rate in 2013
has been only about 1/3 of the severity rate in 2007, but with some
fluctuations in intermediate years. Nevertheless, in 2014 the
severity rate increased again. These fluctuations were found also in
the injury frequency rates.
In 2009, the organization decided to request the audit of
concession of OH&S management system for the first time and
then, practices were developed to improve the system, including
several awareness actions in terms of OH&S and the implementa-
tion of improvements in the company (signaling, protection of
machinery, provision of personal protective equipment - PPE,
implementation of consultation with employees in terms of OH&S,
more detailed reviews of risk). These initiatives were designed to
lead to a greater awareness on safety by all employees and improve
their level of risk perception. In a company with an OH&S man-
agement system, activities related to the risk management devel-
oped by the organization are optimized, such as workplace
inspections, risk assessment, risk control, risk communication and
consultation, accident recording and analysis, as well as safety
training (Aksorn and Hadikusumo, 2010; Vinodkumar and Bhasi,
2009; Abad et al., 2013). Consequently, the work conditions are
improved and the risk perception levels increase, influencing em-
ployees’ safety behaviors, and consequently, the accident rates
(Arezes and Miguel, 2008; Ferna ndez-Mun ~ iz et al., 2009; Ji et al.,
2011; Barbosa et al., 2019). However, when an OH&S manage-
ment system is implemented is not strange to observe in the first
years some indicators worsened, such as injury frequency rates.
When an OH&S management system is mature and good practices
are applied, workers tend to report more minor accidents than in
the past, increasing this indicator.
Most of the accidents recorded during the analyzed years
resulted in temporary disability, in most of the cases with a leave
from 4 to 30 days (40.9%) and a significant value with a leave higher
than 30 days (21.9%). According to these results, several recorded
accidents presented a moderate severity (Rodrigues et al., 2015c),
which is a result of the risks that workers are exposed to. In fact, in
waste management companies, workers are exposed to several risk
factors, that can result in occupational accidents and diseases
(Poulsen et al., 1995; Marth et al., 1997; Lavoie and Guertin, 2001;
Engkvist, 2010; Neitzel et al., 2013; Reinhold et al., 2015).
Fig. 2 describes the evolution of the accident risk in the com-
pany, represented as IFR x ISR. Results denoted a decrease in the
risk of accident from 2009 until 2011. In 2012 there was an increase
in these values and in 2014 results were very close from the ones
obtained in 2007. The increase previously observed in the IFR can
explain these results.
The distribution of the IFR by gender is described in Fig. 3. In all
the analyzed years (2007e2014), the injured workers were more
men than women. These results are related to the tasks developed.
Most of the women perform functions at the screening station or
administrative, while the men are distributed for the remaining
activities such as waste handling, storage and transportation, which
are physically demanding tasks (Engkvist, 2010).
Data also showed that, with the exception of the years 2009 and
2012, accidents occurring within the facilities were greater (56.0%)
than accidents outside the facilities (44.0%). This can be explained
by the fact that outside the premises only occur the activities of
selective collection and maintenance of selective disposal sites; all
 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346 5

Fig. 1. Evolution of injury frequency rate (IFR) and injury severity rate (ISR).

Fig. 2. Evolution of Injury Frequency Rate (IFR) x Injury Severity Rate (ISR).

Fig. 3. Injury Frequency Rate (IFR) distribution by gender.

6 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346
other activities are performed in the premises of the company.
Human errors, including intended and unintended actions, are
frequently pointed as one of the most important causes of occu-
pational accidents in different settings (Jacinto et al., 2009; Silva
and Jacinto, 2015). In the analyzed company this was also
observed. Data denoted “Imprudence/distraction” as the most
frequent cause of accidents, representing 52.48% of the overall ac-
cidents occurred during the analyzed period, followed by “not
compliance with the rules” which was associated to 33.66% of the
accidents recorded. Few accidents occurred due to “lack of use of
PPE” (8.91%).
In general terms, in this case, there was an improvement in the
recording of accidents, not necessarily linked to a decrease in the
real number of accidents but to a reduction in the injury severity
rate.
The accidents were also analyzed considering among other as-
pects, its distribution by age group, considering seniority and work
experience, period of the day accidents occur, causes and effects of
accidents, etc. Considering the age group and seniority in the
company, a normal distribution is observed, with younger and
older employees being associated with fewer situations. However,
more than 75% of accidents occur with employees with more than 2
years of experience in the company. The distribution of accidents
throughout the day also follows a normal distribution, with fewer
accidents occurring at the beginning and the end of the day. These
results indicate that accidents tend to occur in situations where
workers may be acting in a more passive and eventually more
inattentive way. Considering the causes of accidents, we must
highlight falls, impacts caused by objects and excessive efforts, of
which 2/3 result in sprains, injuries and wounds and also approx-
imately 2/3 affect the trunk, hands, upper limbs, head and eyes.
Almost half of the accidents are associated with material handling,
with machines and tools accounting for only 15% of the causes of
accidents recorded in the period under analysis.
4.2. Technicians’ perceptions about the IMSs and its contribution to
OH&S risk management
The IMSs system has been implemented in 2009 and is
considered as still in progress. Seven years after the company
started its implementation, the technicians’ perceptions about the
evolution and effectiveness of the system were analyzed. Data
showed that they were satisfied with the evolution of the system
along the years (56.3%) and classified its evolution as high in the
company (50%). The main benefits of the IMSs in what regards
OH&S which have been highlighted by respondents are presented
in Table 1.
A significant positive correlation was found between the
reduction of the number/severity of accidents and both, the
worker’s safety awareness (r ¼ 0.599; p < 0.05) and legal compli-
ance (r ¼ 0.655; p < 0.01). In fact, an OH&S management system
was previously found by Santos et al. (2011) to make it easier for
Table 1
Benefits of the management system for OH&S perceived by technicians.
Items CD (%)
Promote worker’s safety 0.00
Increase profits 25.00
Increase legal compliance 0.00
Increase market visibility 12.50
Improve transparency in terms of accidents 0.00
Promote employee’s safety awareness 0.00
Reduce accidents and severity rates 0.00
Legend: CD e Completely disagree; D e Disagree; NAD - Neither agree nor disagree; A e Agree; CA - Completely agree.
SMEs to comply with legislation and to promote employees’
training, improving their knowledge and awareness level about
occupational risks. As a result, lower accident rates are expected
(Burke et al., 2011; Aluko et al., 2016; Stemn et al., 2018).
When management systems are implemented, benefits related
to the visibility of the company with customers and suppliers are
expected (Santos et al., 2011; Nunhes et al., 2017). In our study, the
technicians’ opinions about this benefit were split (50% agree and
50% disagree). However, considering the “business” characteristics
of the company, it provides an essential service to society, having
already high visibility among stakeholders, a fact that is common
knowledge among technicians.
Results also show, that technicians do not recognize the
contribution of the management system for the company’s profit.
Indeed, the indirect nature of such contribution adds to this
perspective, which may compromise the engagement of workers in
OH&S and their contribution for the effectiveness of integrated
management systems. Accountants and financial responsibility
may be important to translate the economic benefits of such sys-
tems into a better understood language and figures for operational
workers.
It was expected that reduced costs with accidents would result
of an IMSs, leading to higher perceptions about cost reduction and
profit maximization (Robson et al., 2007; Choudhry et al., 2008).
However, because accidents recording before the implementation
of the management system was inefficient and the company had a
subnotification problem, the employees did not have a real
perception of the accident risk. This is frequent observed in SMEs
(Antonsson et al., 2002; Sørensen et al., 2007). With the imple-
mentation of the management system, the total recordable acci-
dents increased (Fig. 1) due to an optimized accident management
system and the benefits related to the reduction of accident costs,
including reduced insurance premiums, were not recognized.
Moreover, most workers were unaware of the costs of the man-
agement system, because the costs before and after implementa-
tion of the system had never been analyzed, in particular in what
regards health and safety. According to Bianchini et al. (2017), in
these cases, where accidents reduction and cost reduction are not
evident, investments in the management system can be perceived
as unprofitable. Perceptions and not only facts are, indeed,
extremely important for the recognition of the importance of
management systems supporting effective processes of institu-
tionalization of good practices. Table 2 describes the technicians’
perceptions about the motivations that led the company to
implement the management systems, in particular in what regards
OH&S.
Compliance with legal requirements was pointed as one of the
key motives (Agree ¼ 81.75”; Completely agree ¼ 6.30). For several
SMEs, the management of OH&S consists essentially of compliance
with regulations (Masi and Cagno, 2015). However, legal re-
quirements are frequently considered excessive by these com-
panies and the process of risk management is complex and
D (%) NAD (%) A (%) CA (%)
12.50 0.00 62.50 25.00
31.25 12.50 18.75 12.50
18.80 12.50 43.80 25.00
37.50 6.25 37.50 6.25
7.14 0.00 64.29 28.57
0.00 0.00 71.43 28.57
7.14 0.00 78.57 14.29
 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346 7

Table 2
Motivation for the implementation of the management system for OH&S.

Items CD (%) D (%) NAD (%) A (%) CA (%)

Legal requirements 0.00 0.00 12.50 81.75 6.30

Reduce the occupational risks 0.00 12.50 6.35 68.75 12.50
Reduce costs related to OH&S 0.00 31.25 31.25 31.25 6.25
Respond and act in accordance with stakeholders 0.00 31.25 12.50 56.26 0.00

Legend: CD e Completely disagree; D e Disagree; NAD - Neither agree nor disagree; A e Agree; CA - Completely agree.

bureaucratic (Micheli and Cagno, 2010; Cagno et al., 2013). In view

of this, SMEs can have more difficulties to implement legal re-
quirements. An OH&S management system can assist an organi-
zation to adhere to regulations (ISO 45001 : 2018). Processes to
determine legal requirements and how they should be managed
inside the company are defined. They can result in risks and op-
portunities for the organizations (ISO 45001 : 2018). As a result of
an effective OH&S management, occupational risks are expected to
be reduced. This is in accordance with the technicians’ perceptions
(“Agree” ¼ 68.75”; “Completely agree”¼12.50).
Companies operate in a networked organizational structure,
where it is essential to secure good relationships with stakeholders
(customers, financers, etc.). Their image can benefit from an
effective OSH management system, which results in reduced acci-
dent rates and improved working conditions, ensuring stake-
holder’s expectations and requirements. More than half of the
inquired technicians agreed that to respond and act in accordance
with stakeholders was a motivation of the company to implement
an OH&S management system.
One of the direct benefits of an OH&S management system re-
ported in the literature is the reduced level of accident costs as Fig. 4. Technicians’ contributions to the risk management process.
previously noticed (Robson et al., 2007; Choudhry et al., 2008), Note: 1 ¼ Very low; 5 ¼ Very high.
mainly in what regards insurance costs, workers’ absence and
turnover. Additionally, resources management can be also
improved, such as the need of PPE, etc., which is also related to effective. However, the ones that tend to consider the risk control
reduced costs with OH&S. However, in this work, results showed effective are the same that realize the contribution of the system to
that reducing costs related to OH&S was not the most relevant reduce accident rates (r ¼ 0.545; p < 0.05). These results may be
reason pointed out for the system implementation. According to related to the fact that the related risk assessment is made by an
these results, to improve working conditions was the key goal of external OH&S practitioner and later monitoring is performed by
the implementation of the management system according to an internal worker with less knowledge. Because OH&S manage-
technicians’ perceptions. Managers may regard an effective OH&S ment activities are not the primary function of the in-house
prevention, creating working conditions that ensure the workers’ responsible person, the risk management process could not be
health and safety, as part of the company’s management strategy sufficient and the remaining technicians can have this perception.
independently of the costs related to this process. Technicians were requested to assess their own contribution to
Table 3 describes the technicians’ knowledge on the risk man- the risk management process. Results of the 95% confidence in-
agement process, as well as their perceptions about the effective- terval are presented in Fig. 4.
ness of each step. Technicians considered their participation as “intermediate”.
Most of the answers show a high knowledge of the steps that are However, workers’ participation in all steps of the OH&S manage-
included in the risk appreciation, which suggests their involvement ment system is an essential feedback mechanism in a top-down
in the overall process. However, the process was not considered so management process, crucial to effectively reduce risks at work
effective as expected. Almost 44% of the technicians did not (ISO 31000 : 2018). This may explain the limited effectiveness of the
consider the risk analysis and risk assessment processes in the risk management process previously noticed, mainly in what
company to be effective. Additionally, only about a third of the regards the risk control step. In fact, a significant positive correla-
technicians considered that the risk control in the company is tion was found between the technicians’ “contribution to risk

Table 3
Technicians’ knowledge and perception of effectiveness about the risk management process.

Knowledge level Perception of effectiveness

Risk analysis Risk assessment Risk control Risk analysis Risk assessment Risk control

Very low 0.00 0.00 0.00 0.00 0.00 6.25

Low 0.00 0.00 0.00 18.75 18.75 37.50
Intermediate 6.25 0.00 0.00 25.00 25.00 25.00
High 43.75 56.25 50.00 50.00 50.00 25.00
Very high 50.00 43.75 50.00 6.25 6.25 6.25
8 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346
Table 4
Perceptions about the importance of some risk management related activities to improve OSH.
Actions CD (%)
Risk communication 0.00
OH&S instructions 0.00
OH&S training 0.00
Employees’ participation in OH&S management 0.00
Legend: CD e Completely disagree; D e Disagree; NAD - Neither agree nor disagree; A e Agree; CA - Completely agree.
communication” and “effectiveness of risk control in the firm”
(r ¼ 0.571; p < 0.05).
Furthermore, perceptions about the importance of some actions
to improve OH&S are presented in Table 4.
The expressed opinion was almost unanimous to consider that
communicating risks to all workers and providing appropriate
training are particularly important to improve safety and health in
the organization. In fact, workers need to be aware of the risks that
they are exposed to and the control measures applied. To this end,
they should be informed about the risk, as well as attend a proper
OH&S training. These are essential actions to improve OH&S con-
ditions and avoid unsafe behaviours, reducing the accident rates
(Stave and To€rner, 2007; Jacinto et al., 2009; Burke et al., 2011). The
majority of the inquired technicians also considered the OH&S in-
structions relevant. However, in what regards the employees’
participation in OH&S management they tended to be more indif-
ferent (“Neither agree nor disagree” ¼ 35.71%). For effective and
efficient learning to occur from safety incidents, certain factors and
conditions related to the organization, the actors or agents of
learning, the learning process and the incidents themselves must
be considered (Stemn et al., 2018).
4.3. Discussion
The first part of the study emphasized the limited participation
of the technicians in the risk management process. This is partic-
ularly critical when they are the people responsible for the different
working teams. Interviews with the CEO and with the Quality,
Environment and Safety director supported these results, extend-
ing the problem to the remaining workers. Despite both consid-
ering that IMSs has brought a higher involvement of workers in the
risk management activities, their participation has not yet reached
the desired level and it is a standstill. Because the OH&S practi-
tioner is the person responsible to assess the risks and decide about
control measures, other stakeholders can be left out of the process.
In fact, workers’ participation is in most cases still limited to acci-
dent reporting and, eventually, if requested, they may have some
intervention in the risk assessment process. According to the words
of the CEO:
“(…) the risk management process in the company is mostly carried
out by an external occupational health and safety practitioner. He/
she interacts with the two employees involved in the quality
management system in order to gather some relevant information.
In addition, upon the occurrence of accidents, the practitioner
analyzes the situation occurred with the injured employee in order
to detect the existence of “new” risks. Worker participation in the
risk management process has improved, however, it still needs to be
improved.” (CEO)
This is corroborated by the technician responsible for the
Quality, Environment and Safety integrated management system of
the company:
D (%) NAD (%) A (%) CA (%)
0.00 0.00 6.25 93.75
0.00 0.00 31.25 67.75
0.00 0.00 6.25 93.75
7.14 35.71 50.00 7.14
“(…) the participation of workers in the risk management process is
relatively small. Participation is based on the contribution made by
some workers to the assessment of OH&S risk made by the Senior
Occupational Safety and Health Practitioner. There may also be
some contribution in the investigation of accidents suffered by the
workers, this is because a revision is made to the said evaluation. In
either case, any worker may intervene. Middle/senior managers
participate more actively given that they provide much of the in-
formation related to work environment features, to the Senior
Occupational Safety and Health Practitioner. Participation has
evolved reasonably in the first years of implementation of the
system, having stagnated with the systematization of the process”.
(person responsible for the Integrated Management System)
These findings seem to go in line with the results of previous
studies (Fern andez-Mun ~ iz et al., 2012; Skład, 2019). Indeed, pre-
vious research confirm that the success of an OH&S management
system depends on the commitment and participation of all levels
of organization but also emphasizes the low level of involvement of
workers in this process. The literature identifies some causes and
consequences of this behavior. In this research project it was
highlighted that the routinization of the process does not include
the workers i.e., these practices are systematized and later included
as routines in the day-to-day of the company and, eventually,
institutionalized, excluding the workers. They participate more or
less actively in the beginning of the risk management process and
also in the initial phases of the analysis of each accident but, the
habits and routines that characterize these systems in practice
ignore them later. Further research work on the institutionalization
of risk management is required to understand better this phe-
nomenon and to help in the design of strategies that mitigate these
problems turning risk management more effective and efficient.
Both the CEO and the person responsible for the Quality, Envi-
ronment and Safety Integrated Management System agree that the
management system contributed to promote worker’s safety
awareness. However, they also recognize differences when the
technicians are compared with the remaining workers. According
to his own words, the CEO considers:
“(…) the degree of risk perception is different among the employees.
The specialized technicians have a higher perception of risk than
unskilled workers, and there are different perceptions among these
workers. I believe that the perception of risk has increased over
time, however, the risk is still not fully recognized by all employees.”
(CEO)
The results of the research conducted by Rodrigues et al. (2015a)
and Zhao et al. (2016) confirm that perceptions can influence risk
behaviors and vary from individual to individual. According to Zhao
et al. (2016), there are discordance of risk perceptions among
stakeholders, which can jeopardize the risk management process.
Thus, if is important to include workers in the risk management
process, we might argue that if they have a limited or inaccurate
perception of risk that may cause problems or result in additional
 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346
risks. Rodrigues et al. (2015a) state that, when faced with a risk
situation, workers with lower risk perceptions are more willing to
work unsafely, not complying with company procedures and pol-
icies, displaying unsafe behaviors and not participating in risk
management. This is an argument to justify the status quo where
workers have a limited role in the risk management process.
Maybe, we may have here a trade-off that should be managed and a
balanced contribution of workers in the risk management process
can be more effective than a more extensive one. The sensitiveness
for such level of contribution and the understanding of the condi-
tions and contingencies that determine is a cornerstone of this
problem. Indeed, the problem is far more complex than it is
generally considered in both the academy and the industry. These
differences were also noticed by the person responsible for the
Quality, Environment and Safety Integrated Management System.
She stated that
“(…) the degree of perception of risks by workers depends on
worker to worker and the type of activity performed. (…) Risk
perception has increased as the management system has evolved,
since OH&S actions are frequently carried out and incidents/acci-
dents are more often reported by workers, which in part means
that they are more aware [of these situations].” (person responsible
for the Integrated Management System)
Nevertheless, this analysis should consider also the character-
istics of each collaborator and his/her personal perception of risk
who may result in a biased idea of the real risks. For example, the
research of Lin and Petersen (2007), Jørgensen (2016), and Aven
(2016) have shown how people tend to overestimate the risks
that have a high severity.
The limited risk perception observed was related to some
resistance to change evidenced by some workers. According to the
person responsible for Quality, Environment and Safety
“(…) the more recent employees in the company are more cautious
while the older ones facilitate the observance of OH&S procedures
and rules when they are performing the same tasks.” (person
responsible for the Integrated Management System)
The influence of workers’ age and experience in risk manage-
ment has been discussed widely in previous studies. While some
studies identified high accident rates among young and less
experienced workers mostly due to a low knowledge and percep-
tion about occupational risks (Suarez-Cebador et al., 2015; Carrillo-
Castrillo et al., 2016), older workers are the ones that suffer the
seriousness accidents (Camino Lo  pez et al., 2011; Arquillos et al.,
2012). Older workers have more knowledge and experience, but
at the same time have greater self-esteem and confidence
(Choudhry and Fang, 2008; Shuang et al., 2019), being more pre-
disposed to ignore the dangers and, consequently, the rules
(Koustellis et al., 2013; Shuang et al., 2019).
The first part of the study also pointed out benefits of the system
related to the accident rates, compliance with legal requirements,
and improvements in workers’ safety. This was because
“(…) the management system implemented processes that imply a
higher control and more rigor in compliance with OH&S legislation,
hence there was a greater participation of employees in risk
management.” (CEO)
“(…) this system was able to implement OH&S procedures that did
not exist, making workers aware of OH&S issues and, consequently,
increasing their perception of risks.” (person responsible for the
Integrated Management System)
9
This finding seems to go in line with the guidelines of ISO 45001
: 2018, i.e., implementing an OH&S management system enables an
organization to manage its OH&S risks and improve its perfor-
mance as well as assists an organization to fulfil legal and other
requirements. Thus, and finally, non-human actors (e.g., software
and management systems) can play an important role in the
organizational network that supports the risk management pro-
cess. These non-human actors may be important to mitigate the
problems, obstacles and resistance explained before and they may
play a relevant role in the institutionalization of effective risk
management in organizations.
The management system has implemented control measures
that did not exist, making workers aware of OH&S issues and,
consequently, increasing their perception of risks. The main bene-
fits are related to the improvement of workers’ safety and health,
namely the reduction of accident rates, as well as compliance with
legal requirements (Boustras et al., 2015; Bonafede et al., 2016;
Gopang et al., 2017). In such processes, a high involvement of the
workers is essential, but also the active participation of the CEO is
fundamental. This is a particular important issue for SMEs that
frequently deal with several problems into fulfil with legal re-
quirements. For some of these enterprises the number of legal
obligations is excessive, very strict, the overall process considered
too bureaucratic by the management and both the management
and workers do not realize the real benefits of an OH&S manage-
ment system (Ozmec et al., 2015; Masi and Cagno, 2015). The
management involvement has been broadly emphasized. The re-
sults of the investigation conducted by Skład (2019) clearly confirm
that the impact of OH&S management system on safety perfor-
mance depends to the greatest extent on how the OSH leadership
process is implemented in the company.
The company’s trend in 2019 is towards the continuous
improvement of the integrated management system. It should be
noted that in 2018 the company completed the process of migration
to the new versions of the management standards, namely ISO
9001: 2015, ISO 14001: 2015 and OHSAS 18001 : 2007. The three
systems were certified by the AENOR entity with certificates valid
until 2021. Migration to ISO 45001: 2018 will then take place.
5. Conclusions
The implementation of integrated management systems allows
organizations to achieve efficient results in reducing risks and
increasing productivity, providing a better understanding of how
management systems influence the OH&S risk management in
organizations, particularly in SMEs. The success of the integration
of risk management in OH&S depends on both technical and hu-
man aspects.
In the present study, the analysis of the accident was particu-
larly relevant, helping in the understanding the evolution of
occupational accidents over the years in what regards to its number
and severity, relating them to the implementation/maturity of the
OH&S management system. Results of this research show that,
although the frequency of accidents has increased since 2009, the
severity has been reduced. The analysis of the accidents has proved
that “Imprudence/distraction” was most frequent cause of accident,
representing 52% of the overall accidents, followed by “non
compliance with the rules” which was associated to 34% of the
accidents recorded. According to the technicians’ perceptions of the
IMSs and its contribution for OH&S risk management, they were
satisfied with the evolution of the system over the years (56%) and
classified its evolution as high in the company (50%). Perceptions
about the importance of some risk management related activities to
improve OH&S. The majority of the inquired technicians considered
10 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346
that communicating risks to all workers and providing appropriate
training are particularly important to improve safety and health in
the organization. The benefits of the OH&S management system
were realized by the technicians. Compliance with legal re-
quirements was cited as one of the main reasons for the imple-
mentation of the OH&S management system. Most of the
technicians who have been consulted considered that communi-
cating risks to all workers and providing appropriate training are
particularly important for improving safety and health in the or-
ganization. According to the CEO, there was a higher control and
rigor in compliance with OH&S legislation and a greater partici-
pation of employees in risk management. The improvement of the
OH&S risk management in the company has led to a higher
involvement of the CEO and of the workers, a better recording of
work accidents and a reduction of the injury severity rate. The
workers’ participation and awareness have contributed positively
to these results. Finally, it was proved that IMSs has brought a
higher involvement of workers in the risk management activities,
but their participation has not yet reached the desired level.
As future work, a more widespread study extended to different
SME which have implemented an Integrated Management System
in recent years can be useful to confirm the importance of the
involvement of workers and the role of leadership in this process.
Author contribution statement
All the authors have contributed to the paper and agreed with
the revised version.
The corresponding author is responsible for ensuring that the
descriptions are accurate and agreed by all authors.
Declaration of competing interest
The authors declare that they have no known competing
financial interests or personal relationships that could have
appeared to influence the work reported in this paper.
Acknowledgements
We acknowledge the financial support of CIDEM and ALGO-
RITMI Research Center, R&D units funded by the FCT e Portuguese
Foundation for the Development of Science and Technology, Min-
istry of Science, Technology and Higher Education, under the
Project UID/EMS/0615/2019 and UIDB/00319/2020, respectively.
References
Abad, J., Lafuente, E., Vilajosana, J., 2013. An assessment of the OHSAS 18001 cer-
tification process: objective drivers and consequences on safety performance
and labour productivity. Saf. Sci. 60, 47e56.
Aksorn, T., Hadikusumo, B.H.W., 2010. Measuring effectiveness of safety pro-
grammes in the Thai construction industry. Construct. Manag. Econ. Retrieved
from http://www.tandfonline.com/doi/abs/10.1080/01446190801918722#.
VPN6Fy5cqSo.
Aluko, O.O., Adebayo, A.E., Adebisi, T.F., Ewegbemi, M.K., Abidoye, A.T., Popoola, B.F.,
2016. Knowledge, attitudes and perceptions of occupational hazards and safety
practices in Nigerian healthcare workers. BMC Res. Notes 9, 71.
Antonsson, A.B., Birgersdotter, L., Bornberger-Dankvardt, S., 2002. Small Enterprises
in Sweden. Health and Safety and the Significance of Intermediaries in Pre-
ventive Health and Safety. National Institute for Working Life, Stockholm,
Sweden.
Arezes, P.M., Miguel, A.S., 2008. Risk perception and safety behavior: a study in an
occupational environment. Saf. Sci. 46 (6), 900e907.
Arquillos, A., Carlos, J., Romero, R., Gibb, A., 2012. Analysis of construction accidents
in Spain, 2003-2008. J. Saf. Res. 43 (5e6), 885e899.
Aven, T., 2016. Risk assessment and risk management: review of recent advances on
their foundation. Eur. J. Oper. Res. 253, 1e13.
Badri, A., Gbodossou, A., Nadeau, S., 2012. Occupational health and safety risks:
towards the integration into project management. Saf. Sci. 50, 190e198.
Barbosa, C., Azevedo, R., Rodrigues, M.A., 2019. Occupational safety and health
performance indicators in SMEs: a literature review. Work: J. Prev. Assess.
Rehabil. 64 (2), 217e227.
Bianchini, A., Donini, F., Pellegrini, M., Saccani, C., 2017. An innovative methodology
for measuring the effective implementation of an occupational health and
safety management system in the European union. Saf. Sci. 92, 26e33.
Bonafede, M., Corfiati, M., Gagliardi, D., Boccuni, F., Ronchetti, M., Valenti, A.,
Marinaccio, A., Iavicoli, S., 2016. OHS management and employers’ perception:
differences by firm size in a large Italian company survey. Saf. Sci. 89, 11e18.
Boustras, G., Hadjimanolis, A., Economides, A., Yiannaki, A., Nicolaides, L., 2015.
Management of health and safety in micro-firms in Cypruseresults from a
nationwide survey. Saf. Sci. 79 (1), 305e313.
BS OHSAS 18001, 2007. Occupational Health and Safety Management Systems e
Requirements.
Burke, M., Salvador, R., Smith-Crowe, K., Chan Serafin, S., Smith, A., Sonesh, S., 2011.
The dread factor: how hazards and safety training influence learning and per-
formance. J. Appl. Psychol. 96 (1), 46e70.
Cagno, E., Micheli, G.J.L., Masi, D., Jacinto, C., 2013. Economic evaluation of OSH and
its way to SMEs: a constructive review. Saf. Sci. 53, 134e152.
Cagno, E., Micheli, G.J., Perotti, S., 2011. Identification of OHS-related factors and
interactions among those and OHS performance in SMEs. Saf. Sci. 49 (2),
216e225.
Cameron, I., Raman, R., 2005. Process Systems Risk Management. Elsevier, San
Diego, USA.
pez, M.A., Fontaneda, I., Gonz
Camino Lo alez Alc
antara, O.J., Ritzel, D.O., 2011. The
special severity of occupational accidents in the afternoon: ‘‘The lunch effect’’.
Accid. Anal. Prev. 43, 1104e1116.
Carrillo-Castrillo, J.A., Rubio-Romero, J.C., Onieva, L., Lo pez-Arquillos, A., 2016. The
causes of severe accidents in the Andalusian manufacturing sector: the role of
human factors in official accident investigations. Hum. Factors Ergon. Manuf.
Serv. Ind. 26 (1), 68e83.
Choudhry, R.M., Fang, D., 2008. Why operatives engage in unsafe work behavior:
investigating factors on construction sites. Saf. Sci. 46 (4), 566e584.
Choudhry, M.R., Fang, D., Ahmed, M.S., 2008. Safety management in construction:
best practices in Hong Kong. J. Prof. Issues Eng. Educ. Pract. 134, 20e32.
Domingues, P., Sampaio, P., Arezes, P., 2016. Integrated management systems
assessment: a maturity model proposal. J. Clean. Prod. 124, 164e174.
Engkvist, I.-L., 2010. Working conditions at recycling centres in Sweden e physical
and psychosocial work environment. Appl. Ergon. 41 (3), 347e354.
Fabiano, B., Curro , F., Pastorino, R., 2004. A study of the relationship between
occupational injuries and firm seize and type in the Ilatian industry. Saf. Sci. 42,
587e600.
Fern andez-Mun ~ iz, B., Montes-Peo n, J.M., Vazquez-Ordas, C.J., 2007. Safety man-
agement system: development and validation of a multidimensional scale.
J. Loss Prev. Process. Ind. 20, 52e68.
Fern andez-Mun ~ iz, B., Montes-Peo  n, J.M., V
azquez-Ordas, C.J., 2009. Relation be-
tween occupational safety management and firm performance. Saf. Sci. 47,
980e991.
Fern andez-Mun ~ iz, B., Montes-Peo n, J.M., Va
zquez-Ordas, C.J., 2012. Safety climate in
OHSAS 18001-certified organisations: antecedents and consequences of safety
behaviour. Accid. Anal. Prev. 45, 745e758.
Fung, I.W.H., Tam, V.W.Y., Lo, T.Y., Lu, L.L.H., 2010. Developing a risk assessment
model for construction safety. Int. J. Proj. Manag. 28, 593e600.
Gopang, M.A., Nebhwani, M., Khatri, A., Marri, H.B., 2017. An assessment of occu-
pational health and safety measures and performance of SMEs: an empirical
investigation. Saf. Sci. 93, 127e133.
Granerud, R.L., Rocha, R.S., 2011. Organisational learning and continuous improve-
ment of health and safety in certified manufacturers. Saf. Sci. 49 (7), 1030e1039.
Hamidi, N., Omidvari, M., Meftahi, M., 2012. The effect of integrated management
system on safety and productivity indices: case study; Iranian cement in-
dustries. Saf. Sci. 50 (5), 1180e1189.
Haslam, C., Hara, J., Kazi, A., Twumasi, R., Haslam, R., 2016. Proactive occupational
safety and health management: promoting good health and good business. Saf.
Sci. 81, 99e108.
Hasle, P., Kvorning, L.V., Rasmussen, C.D., Smith, L.H., Flyvholm, M.A., 2012. A model
for design of tailored working environment intervention programmes for small
enterprises. Saf. Health Work 3 (3), 181e191.
Hasle, P., Limborg, H.J., 2006. A review of the literature on preventive occupational
health and safety activities in small enterprises. Ind. Health 44 (1), 6e12.
IOSH, 2015. Institution of Occupational Safety and Health. Promoting a Positive
Culture. A Guide to Health and Safety Culture [consulted September 2018].
Available at: www.iosh.co.uk/positiveculture.
ISO 14001, 2015. Environmental Management Systems e Requirements. Interna-
tional Organization for Standardization, Geneva.
ISO 31000, 2018. Risk Management e Principles and Guidelines, second ed. Inter-
national Organization for Standardization, Geneva.
ISO 45001, 2018. Occupational Health and Safety Management Systems e Re-
quirements with Guidance for Use. International Organization for Standardi-
zation, Geneva.
ISO 9001, 2015. Quality Management Systems e Requirements. International Or-
ganization for Standardization, Geneva.
Jacinto, C., Canoa, M., Soares, C.G., 2009. Workplace and organisational factors in
accident analysis within the Food Industry. Saf. Sci. 47, 626e635.
Jensen, P.L., Alstrup, L., Thoft, E., 2001. Workplace assessment: a tool for occupa-
tional health and safety management in small firms? Appl. Ergon. 32, 433e440.
Ji, M., You, X., Lan, J., Yang, S., 2011. The impact of risk tolerance, risk perception and
 D. Ramos et al. / Journal of Cleaner Production 262 (2020) 121346
hazardous attitude on safety operation among airline pilots in China. Saf. Sci. 49
(10), 1412-140.
Jørgensen, K., 2016. Prevention of ‘‘simple accidents at work’’ with major conse-
quences. Saf. Sci. 81, 46e58.
Koustellis, J.D., Halevidis, C.D., Polykrati, A.D., Bourkas, P.D., 2013. Analysis of a fatal
electrical injury due to improper switch operation. Saf. Sci. 53, 226e232.
Lavoie, J., Guertin, S., 2001. Evaluation of health and safety risks in municipal solid
waste recycling plants. J. Air Waste Manag. Assoc. 51 (3), 352e360.
Lima, M.L.P., 2005. Perceça ~o de riscos ambientais. In: Soczka, L. (Ed.), Contextos
humanos e psicologia ambiental. Fundaç~ ao Calouste Gukbenkian, Lisboa,
Portugal.
Lin, I., Petersen, D., 2007. Risk Communication in Action e the Tools of Message
Mapping. United States Environmental Protection Agency. Cincinnati: EPA/625/
R-06/012.
Marhavilas, P.K., Koulouriotis, D.E., Nikolaou, I., Tsotoulidou, S., 2018. International
occupational health and safety management-systems standards as a frame for
the sustainability: mapping the territory. Sustainability 10, 3663.
Marth, E., Reinthaler, F.F., Schaffler, K., Jelovcan, S., Haselbacher, S., Eibel, U.,
Kleinhappl, B., 1997. Occupational health risks to employees of waste treatment
facilities. Ann. Agric. Environ. Med. 4 (143), 147.
Masi, D., Cagno, E., 2015. Barriers to OHS interventions in small and medium-sized
enterprises. Safety Science 71, 226e241.
Micheli, G., Cagno, E., 2010. Dealing with SMEs as a whole in OHS issues: Warnings
from empirical evidence. Saf. Sci. 48 (6), 729e733.
Neitzel, R.L., Crollard, A., Dominguez, C., Stover, B., Seixas, N.S., 2013. A mixed-
methods evaluation of health and safety hazards at a scrap metal recycling
facility. Saf. Sci. 51 (1), 432e440.
Nun~ ez, I., Villanueva, M., 2011. Safety capital: the management of organizational
knowledge on occupational health and safety. J. Workplace Learn. 23 (1), 56e71.
Nunhes, T.V., Barbosa, L.C.F.M., Jose de Oliveira, O., 2017. Identification and analysis
of the elements and functions integrable in integrated management systems.
J. Clean. Prod. 142, 3225e3235.
Nunhes, T.V., Ferreira Motta, L.C., Oliveira, O.J., 2016. Evolution of integrated man-
agement systems research on the Journal of Cleaner Production: identification
of contributions and gaps in the literature. J. Clean. Prod. 139, 1234e1244.
Ozmec, M.N., Karlsen, I.L., Kines, P., Andersen, L.P.S., Nielsen, K.J., 2015. Negotiating
safety practice in small construction companies. Saf. Sci. 71, 275e281.
Poulsen, O.M., Breum, N.O., Ebbehøj, N., Hansen, Å.M., Ivens, U.I., van Lelieveld, D.,
Schibye, B., 1995. Sorting and recycling of domestic waste. Review of occupa-
tional health problems and their possible causes. Sci. Total Environ. 168 (1),
33e56.
Ramos, D., Arezes, P., Afonso, P., 2016. Application of the Delphi Method for the
inclusion of externalities in occupational safety and health analysis. Int. J. DYNA
83 (199), 14e20.
Ramos, D., Arezes, P., Afonso, P., 2017. Analysis of the return on preventive measures
in musculoskeletal disorders through the benefit-cost ratio: a case study in a
hospital. Int. J. Ind. Ergon. 60, 14e25.
Rebelo, M.F., Santos, G., Silva, R., 2014. A generic model for integration of quality,
environment and safety management systems. TQM J. 26, 143e159.
Rebelo, M.F., Santos, G., Silva, R., 2016. Integration of management systems: towards
a sustained success and development of organizations. J. Clean. Prod. 127,
96e111.
Reinhold, K., J€ arvis, M., Tint, P., 2015. Practical tool and procedure for workplace risk
11
assessment: evidence from SMEs in Estonia. Saf. Sci. 71, 282e291.
Renn, O., 1998. Three decades of risk research: accomplishments and new chal-
lenges. J. Risk Res. 1 (1), 49e71.
Robson, L.S., Clarke, J.A., Cullen, K., Bielecky, A., Severin, C., Bigelow, P.L., et al., 2007.
The effectiveness of occupational health and safety management system in-
terventions: a systematic review. Saf. Sci. 45, 329e353.
Rodrigues, M.A., Arezes, P., Le~ ao, C.P., 2015a. Safety climate and its relationship with
furniture companies’ safety performance and workers’ risk acceptance. Theor.
Issues Ergon. Sci. 16 (4), 412e428.
Rodrigues, M.A., Arezes, P., Lea ~o, C.P., 2015b. Risk acceptance in the furniture sector:
analysis of acceptance level and relevant influence factors. Hum. Ecol. Risk
Assess. 21 (5), 1361e1378.
Rodrigues, M.A., Arezes, P., Lea ~o, C.P., 2015c. Defining risk acceptance criteria in
occupational settings: a case study in the furniture industrial sector. Saf. Sci. 80,
288e295.
Sampaio, P., Neves, A., 2012. Integrated management systems quality, environment
and safety - implementation and evaluation of efficiency. Tech. Method. Qual. 3,
130e145.
Santos, G., Rebelo, M., Barros, S., Pereira, M., Ramos, G., Lopes, N., 2014. De-
velopments regarding the integration of the occupational safety and health
with quality and environment management systems. In: Kavouras, Ilias G.,
Chalbot, Marie-Cecile G. (Eds.), Occupational Safety and Health. Nova Science
Publishers, New York, ISBN 978-1-63117-698-2, pp. 113e146.
Santos, G., Mendes, F., Barbosa, J., 2011. Certification and integration of management
systems: the experience of Portuguese small and medium enterprises. J. Clean.
Prod. 19, 1965e1974.
Shuang, D., Heng, L., Skitmore, M., QinChoudhry, Y., 2019. An experimental study of
intrusion behaviors on construction sites: the role of age and gender. Saf. Sci.
115, 425e434.
Silva, J.F., Jacinto, C., 2015. Finding occupational accident patterns in the extractive
industry using a systematic data mining approach. Reliab. Eng. Syst. Saf. 108,
108e122.
Skład, A., 2019. Assessing the impact of processes on the Occupational Safety and
Health Management System’s effectiveness using the fuzzy cognitive maps
approach. Saf. Sci. 117, 71e80.
Sørensen, O.H., Hasle, P., Bach, E., 2007. Working in small enterprises e is there a
special risk? Saf. Sci. 45, 1044e1059.
Stave, C., To €rner, M., 2007. Exploring the organisational preconditions for occupa-
tional accidents in food industry: a qualitative approach. Saf. Sci. 45, 355e371.
Stemn, E., Bofinger, C., Cliff, D., Hassall, M., 2018. Failure to learn from safety in-
cidents: status, challenges and opportunities. Saf. Sci. 101, 313e325.
Suarez-Cebador, M., Rubio-Romero, J.C., Carrillo-Castrillo, J.A., Lo pez-Arquillos, A.,
2015. A decade of occupational accidents in Andalusian (Spain) public univer-
sities. Saf. Sci. 80, 23e32.
Vinodkumar, M.N., Bhasi, M., 2009. Safety climate factors and its relationship with
accidents and personal attributes in the chemical industry. Saf. Sci. 47 (5),
659e667.
Yoon, S.J., Lin, H.K., Chen, G., Yi, S., Choi, J., Rui, Z., 2013. Effect of occupational health
and safety management system on work-related accident rate and differences
of occupational health and safety management system Awareness between
managers in South Korea’s construction industry. Saf. Health Work 4, 201e209.
Zhao, D., McCoy, A.P., Kleiner, B.M., Mills, T.H., Lingard, H., 2016. Stakeholder per-
ceptions of risk in construction. Saf. Sci. 82, 111e119.