by of ay, ey mu ont ate ot 50), 16, sd ein my 2000. ty 3 viary [AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 38:155~163 (2000) ‘and managers. impressive percentage of workers 38:155-163, 2000. © 2000 Wiley-Liss, Inc. KEY WORDS: worker worker safety and health INTRODUCTION Safety and health training programs for workers are ‘eonducied at an annual cost in the US of more than $40 nillion (Lee, 1988]. However, attempts to quantify the cffectiveness of training on workplace conditions continue to frostrate companies and training providers [Ford and ‘bey ot Man Baha, Stn lai Heth, veto Abarat mean “Rt ot tem Founda Pt, “erie any ans soe Ue Abarat Berea nat gor soe ttre Evol ath Sees Wr Xan Heung ropa Car gn rama ASESDOESS { _, Simssrare tr Se een Pl, Dei of He Bb 9 Patch, ero ara a sgh Sg A. 520 Ea teu exes 20 arch 2000 | © 2000 Wiley-Liss, Inc Evaluation of Worker Safety and Health Training Snigdha Mukherjee, pho,’ Lynn Overman, ea, Laura Leviton, eno,” and Barbara Hilyer, msen? ! Background Few studies of worker training have addressed the impact on participant's | health and safety behaviors and efforts to change health and safety conditions at the workplace. The present study is an evaluation of these impacts as reported by workers Methods The UAB/CLEAR program has trained over 1,000 participants since 1992. A survey was mailed to a sample of workers and all participating managers Resulis The results revealed that both groups reported increasing personal safety and health behavior, both contributed to emergency preparedness, and both influenced the vvimination of hazardous chemicals. Managers reported greater influence on health and safety which may be explained by thir relatively more powerful position. However, an reported infuuencing changes. Conclusions This pattern indicates that when the environment supports joint decision snaking by workers and management, initiating changes becomeseasier Am. J.Ind. Med. training; Train-the-Trainer; evaluation; workplace safety: Fisher, 1994], To address these problems, the present study focused on employees" assessment of the Iong-term impact of training. We surveyed workers and managers who received training between 1992-1996, including those ‘who had come for the training for 1~5 years. Participants ‘were primarily in paper product manufacturing; a few represented other industries such as motorcycle and small engines manufacturing. The Challenge of Evaluation Worker training programs have evolved to meet the challenges of today’s diverse workforce. Participants in training courses vary widely in experience and work ‘backgrounds, language preference, literacy levels and commitment to safety [Szudy and Arroyo, 1994; Veasey, 1997], ‘This diversity has complicated definitions of successful programs. Investigators have identified charac- teristics of training programs that predict success; however, criteria for “suecess” do not always include measurable changes in the safety of the workplace (Bilis, 1975; Cohen,156 Mukherjee et al 1977; Hugentobler et al., 1990; Johnston et al., 1994; Robins etal, 1994], Most studies tend to focus primarily on process measures (what happens in the class) as well as immediate short-term impact. These measures include: (1) assessments of participant satisfaction with the training (utilizing a scaled form or comment sheet); (2) knowledge gain (frequently through pre-post tests or end-of-course exams); @) increases in positive attitudes regarding safety (worker self-report on completion of training); and (4) instructor assessment of trainees’ specific skills performance [Robins and Klitzman, 1988; Johnston et al., 1994]. Post-training ‘outcomes are less commonly measured, and the evidence is often anecdotal. Many training providers have compiled cases of successful applications to improved spill prepared- ness, as well as response to and avoidance of unsafe situations (Manwaring and Conroy, 1990; Johnston et al. 1994; Ruttenberg, 1996; Veasey, 1997]. In one post-training, survey to evaluate the long-term effects “of training, respondents reported significant use of written resource ‘materials introduced during training, success in fostering ‘improvements in company programs, practices, and equip- ment and improved preparedness for and response 10 chemical spills [Kaminski et al., 1995]. Even with better ‘prevalence estimates of such changes, surveys offer only an implicit comparison; programs are “effective” only by comparison to prior experience, Direct measurement of the primary goal, improved safety and health in the workplace, has proven difficult [Gotsch and Weidner, 1994; McQuiston et al., 1994]. A variety of indicators have been investigated that are ‘presumed to be associated with improved safety and health: an increase in observed ‘safe acts” behavior by workers, a decrease in reported accidents and injuries, decreased sick leave, decreased OSHA violations, and a reduced financial outlay for lost time, injuries, and medical treatment [Fellner and Avaroff, 1984; Parenmark et al., 1988; Israel et al., 1995]. However, many factors besides training affect these indicators, and without a controlled design it has not been feasible to deionstrate that training causes improvements For example, utilizing accident and injury rates as measures, of improved workplace conditions can be deceptive because some programs offer rewards for better safety resulting in under-reporting of accidents (Ford and Fisher, 1994). Investigators also considered using personnel records for ‘occupational illness and injuries, but they discovered that changes in classification rendered the records unreliable [Robins et al., 1990). ‘Another surrogate measure has been to examine whether organizational changes occur that are conducive to making the workplace safer. Many trainers would assert, that a safety culture is required, and that to achieve it, ‘workers must be provided with the skills and knowledge to be equal partners with management on safety issues [Smith et al., 1978; Merrill, 1994; Deutsch, 1996]. Some worker training programs, notably those associated with labor, focus on knowledge and skills to work actively for improved workplace safety through the incorporation of a system of ‘values, attitudes, procedures, and work practices [Waller stein and Baker, 1994] The CLEAR Program In the present stdy, we made use of sel-eport to assest Tonge term impacts. Sine 1992, the University of ‘Alabama a Birmingham (CAB) Centr for Labor Edeaton find Research (CLEAR) has operated a joint university Union taining program. CLEAR has sought to improve Wworkplae safety and t0 measure the improvement witha posttraining survey of participants. Tae United Papervor ers Intemational Union (UPIU), an industrial union representing approximately 240,000 metabers inthe United Stes and Canids, arranged 2-day classes cach yea for 5 year in each ofits 11 geographical regions. A grant fom ihe National Institute of Environmental Health Sciences (NIEHS) supports the trsning. Designers of the program se Fort two goals. Fist each participant is o be waned tothe Fist Responder Awareness Level as deseribed by OSHA Hazard Communication Standard 29 CFR 1910.120() ‘This essentially duplicates the training employers ate required to give all employees who work with oF around hazardous chemicals, and acquains worker with chemical hevard recognition and protection measures, The second goal, “Trainihe-Trainer” is to emplace 2 cadre of pee Trainers in each Tocal union, workplace, of geographic region, who wil tran others tothe same level and wil wok to recognize and remediate hazardous working conditions ‘To facitate the second goa, the classes fostered partic. pants abilities to solve probiems and devise strategies Improve safety and health conditions in the workplace. ‘Trainees were encouraged to take responsibility and 1 control the flow of events for improved safety and heath ‘The cuticulum included topics required for certifies: tion under the OSHA standard, as well s infomation abut adult lamers and practice with effective methods for training them. Patcipatory methods were used thoughout the classes, and tainces ‘were encouraged to choot participatory methods when they themselves trained oe. CLEAR made available to member-ainers a catalog of training materials for a variety of safety and health topics and supported ther onsite traning effrs through telephone Contact anda quarterly newslete. "Super Trainer” classes providing 3 days of taining theory and practice, were held at the end of the instructional year. AS in the hazards materials (hazmat) classes, participatory training methods were sessed a all times Process aid immediate impact measures indicated the classes were successful in achieving the stated goals aePerformance-based learning objectives were met, as eval- ‘uated through performance checklists, questionnaires, and verbal reporis, Trainee satisfaction was high, as measured by course evaluations, Follow-up calls and written requests {or information indicated that some UPIU member-treiners trained large numbers of others in their workplaces and local tunion halls. Yet the question remained, “Does this training ‘meet CLEAR’s goals as listed above?” ‘A mailed-in survey was designed to evaluate participant self-reported perceptions of the effects in the workplace resulting from the training. Specifically the survey exam- ined the degree to which goals were achieved (1) for individual trainees and (2) for their organizations. Self- reported outcomes included: 1. the degree to which participants identified, recognized, and personally avoided hazardous situations; 2a. the degree to which respondents participated in Gecision making about safety and health conditions in the workplace; 2b, the degree to which participants trained other workers in safety and health in the workplace. METHODS Study Populations Survey respondents were not asked for demographic information. However, program statistics give a picture of this population. Between 1992 and 1997, 859 men and 65 ‘women were trained by UAB/CLEAR. Of the trainees, 929% of males and 73.4% of females were White, 4.2% of males and 15.4% of females were Aftican American, 1.5% of ales and 3.1% of females were other racial groups, and 23% of males and 6.2% of females did not provide the information, “Two groups were surveyed: a random sample of 300 worker, and the total mimber of managers who participated in taining, Workers were selected from a list of all Peticipants in the UAB/CLEAR Health and Safety Training from 1992 through 1996. The UPIU international president ovided a cover leter, included in all survey sailings, asking the workers to respond. Three rounds of surveys were mailed; rethinder post cards were twice mailed 10 respondents 10 mail in the surveys for a total of five attempted contacts From the list, we identified and sent out surveys t0 every manager who had participated in the cosponsored UABICLEAR/UPIU training, Managers answered the same surveys as workers, except that the Tisin-the-Trainer questions were omitted from manager surveys. As in the case ofthe worker survey, three mail-outs were sent to the ‘managers. The UAB/CLEAR program director provide the cover letter forthe manager survey. Evaluation of Health and Safety Training 157 Survey Content ‘The survey asked the respondents to evaluate their workplace behavior and to assess the changes in the ‘workplace since their participation in the training program. ‘The first set of questions pertained to recognition and jidemtfication of hazardous chemicals, workers’ personal exposure avoidance and control, and whether workers discussed health and safety with other workers, family, and friends. The second set of questions focused on participants’ proactive efforts to bring about changes in ‘chemical use and safety at the work place. These questions assessed the following changes since training: whether hazardous chemicals had been replaced with safer chemi- cals; whether chemical processing had changed; whether ‘emergeney plans had been writen or improved; and whether emergency plan training had been improved or instituted, Forall these questions, respondents were also asked whether they had influenced decision making. The third set of ‘questions related to the goal of Train-the-Trainer activity: Whether the respondent had taught courses in health and safety at work and at the union local, and whether materials disseminated at the UABICLEAR classes were used. Respondents were encouraged to make additional com- ments and a content analysis was conducted on those responses. Two researchers independently evaluated the responses to the open-ended questions in order to summar- ine the themes running through the responses. RESULTS One hundred thirty-nine workers responded, for a moderate response rate of 46.3%. Sixteen managers responded for a moderate response rate of 53.5%, Objective 1: Recognizing, Identifying, and Avoiding Hazardous Chemicals |AS seen in Table I, the large majority of workers and managers felt the training had made it easier for them to identify and recognize hazardous chemicals. A comparison of the responses of the workers and the managers suggests that there is a significant difference (P < 0.0000) between the responses of the workers and the managers about recognizing, identifying, and avoiding hazardous chemicals, and about. their personal avoidance of exposure to chemicals. A large majority of both workers and managers reported that they were more likely to avoid personal ‘exposure to chemicals after training. An examination of the within-group responses shows a different pattern for managers and workers with more workers reporting ease jn recognizing, identifying, and avoidance of hazardous ‘materials post-training. A sizeable minority of managers indicated no change. Open-ended questions. by some158 Mukherjee et al TABLE L Recognizing Mentying, Avis Hazardous Chemicals and Discussion of Safty Issues since UABICLEARParticpation Recognizing andidentiyinghazarous chemicals ‘About the same Ease tan befor tanag Nore fcutthan beta aning Dartkraw Personal avoidance exposure to chemicals Less ely thanbetrtrning ‘eutihe same Nore ay than before trang Dontknow Discuss heathand safety sues with workers Less often than befor iraing Pbautthe sane ore often than before tain Discuss otheathanc sale ssus wit frends andtamily Less ote tanbefore ang About same exe ten tan before ang Dortkrow workers suggested that some workplaces had good training programs that led workers and possibly, managers, to gain exposure before CLEAR training to information and knowledge about hazardous chemicals. Relatively few patticipants reported any negative results of training, and from open-ended comments it is clear that most negative responses were due to the workers being fired or laid off, or to the plant being shut down, In general, participating in the training also led to heightened awareness in that trainees discussed safety and health issues with other workers and family. The self- assessment of both workers and managers was that these discussions increased quite a bit after training, as seen in the number of responses to “More than before.” Also, the table with workers’ discussion of “health and safety issues with other workers” has nearly identical values for workers and managers; “discussion of safety issues with friends and family” was also similar for these two ‘groups, Workers) Managers) (=n9) (n= 16) m2 138 B12 583 29 00 oo 65 oo 87 490 ot 600 a7 09 of 44505. “ a 252 2a0 134 733 2 =38805 61=2,P=00000 22 09 403 533 588 487 07 00 112 =58408.dt= 2,9 00000 jating Changes at the Workplace ‘The survey responses related to emergency plans ae seen in Table, The survey asked whether emergency pass for the plant had been writen or improved since the respondent's UAB/CLEAR participation, Most manages and over half the workers reported that an emergency plan had been writen or improved sine traning. OF these, only about a third ofthe workers, but flly three-quarters of the managers maintained that they themselves influenced the iasue, Some respondents mentioned that their workplace developed an emergency lan, but not in writing. Given te difference in the sample size ofthe workers (n'= 139) and managers (n= 16) the results of tests of differences 00.8 sub-sampe of tose who assert tht they influenced changes in the workpiace would be uninterpretable. To be in compliance with OSHA, traning and practice of the emergency plan are required. A majority of workesEvaluation of Health and Safety Training 159 TABLE I. Stats of Emergency Plans since UABICLEAR Partcpation and Perceived Influence on Workplace decsions (N= 155) ‘Status of Emergency Pan sce UAB/CLEAR Partition” Workers n= 138) Manages 16) Perv parcansntuence on workplace decisions” Wore 89) Managers (16) Yes Talning or practice Watton or improved su1(79 575,60) 875 (1) 68am 33807 252005) 750(12) 50008) “ttosrspending es, and managers indicated that emergency plan training and practice had occurred since UAB/CLEAR participation. Of the workers, one-quarter who replied in the affirmative felt they influenced the decision to implement an emergency training and practice module, while fully half of the ‘managers perceived that they had influenced changes. Open-ended comments suggest reasons why practice and training did not occur: some companies did not support the idea; for some, time may have been limited; some companies used outdated materials for training purposes; and the emergency plan was still being developed in some ceases (n= 11), As seen in Table IT, almost two-thirds of the workers and a large majority of the managers reported improvernents in chemicals used after UAB/CLEAR training. Of those reporting positive changes, over a quarter of workers and most managers believed that they influenced the changes. With regard to the safety of the new processes that were instituted after taining, almost half ofthe workers and most managers felt that the changes increased safety, The rest of the respondents felt the changes in the safety processes were about the same as before the training. No respondent said a change Was less safe than before training. A majority of the ‘workers and almost all the managers responded that since TABLEIIL. Changesin Chemicals Use and Replacement with Safer Chemicals since UAB/CLEAR Partcpaton Cchangsin came use processes Yes Parcpantintuence® Safety otraw process! about the same Satrthanbetre Hazardous Caicals Replaced by Sater Chemicals Yes Partopantntuencet Changesintherakeypof the safty committee ves Patipantintuence* Good Ganges" Yes *ttoserespndhg es. Wockr Mans exes) ars%18) 2818(89) 62580) se 252) T1868) 750% (12) 5834069 938545) 358560) ese%(r) saaK(@4) esau 3538 69) 498% (7) 4894 68) e25%(1)160 Mukherjee et al ‘waining, hazardous chemicals had been replaced by safer chemicals. Of those who reported changes, about a third of ‘workers and most of the managers felt that they had influenced the change to safer chemicals, ‘Most workers and managers reported changes, either in the composition of the safety committee or its activities. OF those reporting changes, a sizeable minority of both workers and managers believed that they influenced these changes and further, most managers but less than half of workers, considered that the changes were good. ‘These questions were asked of workers only. Forty-six percent replied that they had taught health and safety classes. A total of 11,529 workers have been trained by these respondents, Open-ended comments (n = 22) suggest three reasons why the remaining participants have not trained other workers. First, some companies required control over worker training by the safety director or other designated manager. Second, some companies discussed the ‘issue but did not implement it. Third, some companies already had their own safety training programs in place. ‘Thirty-one percent of the workers reported that they taught classes atthe local union, These respondents taught 2 total of 3,554 trainees in the union setting. Workers who did not train at the union local commented that they go to safety ‘meetings at work, and so they did not fec! the need to have training sessions at the union local, Finally, of those workers who trained others, 53% reported using ideas and materials from the UAB/UPIU class. The Role of Perceived Influence ‘These data indicate that a substantial number of workers perceived influence over the positive changes in their workplace. Table IV presents correlations, for worker respondents only, among the number of years workers participated in CLEAR training, the number of workers they themselves trained, and their reported influence on deci- sions, These decisions included: replacement of hazardous chemicals with safer ones, writing, improving, and practi cing emergency plans, changes in chemical use or processes, and safety committee makeups. The number of years of taining is positively and significantly associated with the number of workers trained and with the perception of influence on three of the five areas of positive change. Also, perceptions of influence over safety decisions are highly correlated with each other, except for safety committee makeup, which shows a modest association with other changes. Summary of Open-Ended Comments Comments accompanying the responses were content- analyzed to understand why training did or did not have impact on workplace safety. It is important to recognize that some respondents reported no changes due to training because the level of health and safety standards were already high (no improvements were needed), Because comments were voluntary, they can provide some insights, but do not indicate the prevalence of reasons, © Company facilitation (a= 12): Comments sub- stantiate the idea that the companies were supportive of the worker's efforts to participate in health and safety training, and to contribute to planning of these programs in the workplace. Example comments included: L 2. ‘We have an excellent training program in our mill.” ‘We have safety team meetings and talk about unsafe items and chemicals.” TABLE IV, Peasors Coreations Among Years of Taining, Number of Workers Tained at Work and at Local Urion, Perceived Worker Invene on Replacement with Safer Cheicals on Emergency Plans Improvement Emergency Plans Practice; on Chemical use Changes; on Safety Commitee MakeUp (v= 139) 1 2 a 4 5 8 1 “Number! years tained - 2. Nuc of workarstranadat wrk a 4 Number of wokestranedatlocaluion 020"(129) 4, Pacived workernfuenceanreglcementwithsalerchemials 028" (8) 5, Peceved worerinuenceonemergencyplansimpoverent 025"(80) 6. Perceived warerintuenceonemergency plans practice 016,69) 7, Paroved worker inence on chemical use changes 26 (74) 8, Peceived worker ntuence crafty committeerakeup 18¢77) oan” - ow) ost") — Or6(a0) 08,60) OBem(e) 02216) 00T(@s} as2"—54) OTE = — 018474) 03074) O75"(63) 47GB) 7052) — ons(77) -008¢7) O31*67) 034189) 03648) O26"3. “Company working ’n improving plan due to training. @ Company barriers (n=13): Comments in this category are divided into barriers due to lack of worker control, and barriers due to lack of company support. A lack of worker control often reflects policies within a company that have prevented workers from using the training. Examples of comments reflecting lack of control: 1, “Division rule that only supervisors will do the safety raining.” 2. “Our safety program is stagnant due to the constant change in management in the last year-and-a-hal A lack of company support often indicated that workers believed management was not interested in safety, as reflected in these comments: 1, “Safety not important to them anymore.” “Company dropped safety meetings.” 3. “The company had and still has no use for my skills in this feta”. © Lack of appropriate setting (n=8): Comments described various issues, such as workers being laid off, mill closings, and changes in job status or position. In general, these comments indicate that the workers no longer had the ‘opportunity to utilize training. @ Role of the local union (n=10): Respondent comments reported union local activities, such as: 1, “We have a local union safety director who actually does the teaching. He uses us (Hazmat) participants to help him develop his training program.” Some comments also suggested barriers within local unions: 1. “Not enough members attend meetings.” 2. “We had some serious problems at our local back then, and I never finished the (3 year) course.” © Adequate safety and health activities (a=12) Comments reflected good training programs already in place and an emergency plan that is prepared and practiced: 1. “Our mill has good training—and T was one of the trainers so 1 had more exposure prior to your training than most people.” DISCUSSION ‘These data suggest that UAB/CLEAR is a successful program, although answers cannot be definitive, Because Evaluation of Health and Safety Training 161 there are few evaluations in this area we have very few {quantified standards of comparison [McQuiston et al., 1994; Kaminski et al, 1995]. However, certain groups are in a position to evaluate the outcome of waining programs because they have substantial training experience them- selves. Our results were presented to three regional directors of UPIU, and to program directors and trainers of unions and university-sponsored worker training programs. All were ‘grantees of the EPA/NIEHS and results were presented to them at a Spring, 1997 meeting of grantees, They found three survey results were impressive: © The degree to which training made it easier to recognize and identify hazardous materials The degree to which trainees became more likely 10 avoid personal exposure to dangerous chemicals © The degree to which trainees were more deeply involved in health and safety issues after training, both formally (through training of other workers) and informally (in, discussion with others). Some other results are worth noting. After training, emergency plans were writen or improved to meet OSHA compliance, More emergency drills were also taking place. Safety committees, both union and joint labor-manage- rent, were changing to reflect the knowledge that chemical awareness training brought to the workforce. The results also indicate that the UAB/CLEAR program has met with Some success in its objective of worker participation in health and safety decisions. This is supported by several comments to the open-ended questions (n= 12). An intriguing finding is that about half the workers suggest that the changes in the makeup of the safety committe: post-iraining, were not “good” changes. An analysis of the open-ended comments did not offer an explanation for this opinion. Although it should not significantly affect the overall postive significant responses, it does suggest the need for additional information and further research. ‘The percentage of positive responses was much greater than these experts expected, given their implicit baseline of training experience. Although itis true that the survey's response rate was modest, many mailed surveys have far lower response rates. Moreover, we attempted five contacts per respondent, which is above the usual standard for mai surveys (Dillman, 1978; Rea and Parker, 1992]. Response rates for surveys of this population have been typically low even for surveys conducted by local unions. Another UABY CLEAR survey designed 10 examine if workers were participating in other training programs elicited a response of 1 out of 41 respondents. Even if we were to assume nonrespondents had nothing. postive to say, che results would stil be quite favorable tothe program from experts point of view. Another potential caveat is that no control ucla162 Mukherjee et al. sroup is available, and some changes may have been initiated irespective of training because of other forees. Further, there were no pre-training data for comparison with post-raining improvements regarding workplace safety However, ths is not our experts’ experience. There are several possible reasons for the postive results, First, the training is voluntary. In comparison, many on-site sessions in work safety are mandatory, or stitly for compliance. Participants may be more likely to enroll inthe training at UAB/CLEAR due to interest and perceived need. Second, positive results may also be a function ofthe quality of waining. The university instructors design, develop, and deliver the CLEAR courses. Previous published results support the success of university-based training, programs [Robins and Klivzman, 1988; Robins et al, 1990; Luskin etal, 1992] A third possible reason is that CLEAR class evaluations are analyzed, and the curiculum is constantly improved or revamped to meet the needs ofthe trainees and of safety and health requirements. A final reason may be tht, ‘word-of-mouth convinced participants that the training was useful, which may have attracted and motivated them. Ailof these forces may Tead to a self-selection of highly motivated participants “The difference in responses of workers and managers eserves some comment. Managers tended to perceive ‘greater personal influence on changes in the workplace thaa did workers. Several forces may explain this difference. First, managers in general, tend to have more prior education, taining, and knowledge of chemicals, and of health and safety issues. Second, managers may have a vested interest in reporting change and cue to the responsibilities of their roles, may perceive things more positively. Finally, managers have greater control in the workplace and therefore have a greater opportunity to influence safety improvements “The extent of perceived control over decision making {ndicates that trainees do take some responsibility to change safety and health outcomes. Enhancing a sense of control over workplace health and safety is central to CLEAR objectives, The sense of perceived contol is termed self efficacy by behavioral researchers [Bandura, 1997] and is @ strong predictor of action across many situations (Zohar, 1980; Brown and Nguyen-Scott, 1992]. In Table IV, perceived influence over positive change was consistent across the areas of chemical safety and use, emergency planning and practice, and safety committee makeup. The associations between perceived control and years of CLEAR taining may indicate that with time, change can eventually occur. However, these associations may also indicate how perceived control over worker safety and health can cause trainees to persevere, by obtaining more training, It may be thatthe most motivated workers were the cones that responded, and these were the ones who perceived the most influence. However, that does not detract from CLEAR’s achievement of its objective, a cadre of self efficacious trainers who combine education in recognizing hazardous materials with the tools to make healthful ‘changes in the workplace. Participants for training come from a broad spectrum of expetience in terms of company adherence to health and safety requirements, worker participation, and decision making regarding health and safety issues. 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