OSHA records: Err on the side of documenting reportable injuries

But be wary of 'over-reporting' anything and everything

Is an injury covered by workers' compensation insurance? Does the worker's supervisor believe the injury didn't really happen at work? Did the employee see a health care provider?

In fact, none of these issues determines whether a given injury is Occupational Safety and Health Administration (OSHA)-recordable.

"My rule of thumb is, put it on the log and work it out later," says Cindy Groves, RN, BSN, COHN-S, clinical manager at Beloit (WI) Health System's Occupational Health Centers. "You've got seven days to be current. It's better to have it on there and line it off, than not have it on there at all."

Bruce E. Cunha, RN, MS, COHN-S, manager of employee health and safety at Marshfield (WI) Clinic, points out that a company can be fined by OSHA for every recordable injury that isn't on the log.

"I have seen very large fines over this in the past. It all boils down to integrity," says Cunha. "As a professional, I would not participate in any practice to 'cook the books.'"

If an injury is questionable, Cunha first logs it and then crosses it off if it turns out to not be recordable. "In the multiple OSHA inspections I have been involved with, we usually are told that we over report," he says.

A workplace may assign the OSHA log to a secretary or manager who does not really understand how to correctly record injuries.

"I have audited facilities and found this to be the case. It is pretty easy to catch," says Cunha. "Just ask for their OSHA log, and also their workers' compensation report. You can tell fairly easily if they know what they are doing." To clear up common misconceptions on OSHA-recordability, consider these items:

1. An injury is not automatically recordable just because an employee sees a health care provider, including an occupational health nurse or physician.

"It is all about the care that is provided, not the diagnosis or who provides the care," says Groves. Work-related cases involving cancer, chronic irreversible disease, a fractured or cracked bone, or a punctured eardrum must always be recorded under the general criteria at the time of diagnosis by a physician or other licensed health care professional, however. This is the case regardless of whether the health care professional prescribes any treatment for the injury or illness to the worker.

If ice and over-the-counter ibuprofen are adequate for a worker's simple muscle sprain, though, the injury would not be OSHA-recordable regardless of whether that individual saw a doctor or not.

Providers may give a prescription to an injured employee — thus, making the injury OSHA-recordable — which is never filled because the medication isn't needed. "The employee may have been just fine if they had taken over-the-counter ibuprofen," says Groves.

To avoid over reporting of injuries, a provider may choose to have the worker return the following day so the medication can be prescribed only if it's truly needed. "It is a matter of good communication between the provider and the patient," Groves says. "That's where occupational health plays a big role."

Since occupational health professionals understand the work environment better than other providers, they're more likely to offer "low-tech" solutions that work. "Ice may not seem 'high tech' enough to some providers, but it is such a huge help for so many injuries," says Groves. "It's all about controlling swelling, which contributes to pain and irritation."

2. Employees should not wait to report injuries.

In fact, if workers are encouraged to avoid reporting unless an injury is serious, they are more likely to see a physician, go on restricted duty, or lose time from work. "If employees are encouraged to report minor injuries early, they can be treated simply and avoid prescription medications," Groves explains.

3. Underreporting injuries can be a red flag.

There is anecdotal evidence that some occupational health care professionals are pressured to consider whether the treatment they administer to employees could affect the recordability of the case on the OSHA log. Some of these health professionals fear loss of their contracts if their treatment results in too many recordable cases, according to OSHA.

However, "if an employer was underreporting, their numbers would be significantly under what would be considered a normal benchmark for their industry," says Groves. "That's going to be a red flag."

OSHA inspectors will be interested in how such a low injury rate is possible. "They will want to see other records, and will want you to prove you're really this good," says Groves.

4. Bigger incentives for safety are potentially dangerous.

Consider whether your programs may be discouraging employees from reporting injuries and illnesses at work. If a prize is very coveted, there's a good chance that workers will think twice about reporting injuries.

"There's nothing wrong with incentivizing people in other ways, but it should be recognition- based — a pizza party, for instance — rather than monetary-based," says Groves.

On the other hand, incentive programs that reward employees who work for some period of time without reporting any injuries or illnesses may discourage reporting.

5. All work-related injuries and illnesses that meet the recording criteria set out in the recordkeeping rule must be entered on the log.

Employers may wrongly believe that only injuries compensable under workers' compensation need to be entered on the OSHA log. Be ready to present documentation on why you decided a particular injury was not recordable.

"You should be able to substantiate how you came to that decision," says Groves. "The best practice is to put the injury on the log if there is any room for doubt that it may be recordable."

Avoiding the other extreme

By the same token, experts caution against the strategy of listing anything and everything as OSHA reportable. Consider this example: An employee hurts his back on a Thursday, takes off work the next day to rest, and reports the injury to a supervisor on Monday. Is it OSHA-recordable?

"There was no doctor involved, no medical treatment received, and the employee decided to take the day off. Return him to regular duty," says Peggy Ann Berry, MSN, RN, COHN-S, SPHR, president of the Ohio Association of Occupational Health Nurses.

The employee may have "lost a day" but the employer did not, and therefore it is not OSHA-recordable, she explains.

When Berry accompanied an OSHA inspector on a general audit of a company that had been fined in the past, she discovered that they were over-recording all reported injuries.

"If someone said they pulled their back, took a couple of Motrin, and iced it, the company recorded it," says Berry. "Even larger companies can over report because of lack of training."

There may be hyper-vigilance because the company has received citations in the past, or management may lack training on which injuries are recordable. "In some instances, it takes medical expertise in speaking with the medical professionals to determine if an OSHA recordable has occurred," says Berry.

Although under-recording appears to be the focus in OSHA inspections, Berry says that over-reporting incidents "might tip the scales for a site visit by OSHA."

To avoid over or under in recording injuries, Berry gives these recommendations:

• Obtain training in how to medically manage the OSHA log.

This can be obtained from OSHA, the third-party administrator, or through the American Association of Occupational Health Nurses. "Work with outside providers to make sure they know what makes an injury OSHA-recordable," says Berry.

• Educate everyone, including human resources, on what is and is not an OSHA-recordable injury or illness.

OSHA-recordable injuries require medical care of prescriptive medications, physical therapy, fractures (teeth included), physician-directed lost time or temporary restrictions. "It is a lot easier to say what is OSHA-recordable than what is not," says Berry. "X-rays for a look-see, a doctor's appointment for an evaluation, and employee-directed time off are not OSHA recordable."

• Contact outside service providers to offer timely input on medical services given.

If you identify increased prescriptive and lost time from a provider group, reach out to that group and find out if it is an education issue. "Not all doctors are well versed in OSHA recordability," says Berry.

• Require every employee needing an outside referral to contact occupational health.

"Occupational health is an invaluable resource to reduce injuries, manage OSHA recordable injuries, and administer temporary modified duty programs and [the Family and Medical Leave Act]," says Berry.


• Bruce E. Cunha, RN, MS, COHN-S, Manager, Employee Health and Safety, Marshfield Clinic, Marshfield, WI. E-mail: cunha.bruce@marshfieldclinic.org.

• Cindy Groves, RN, BSN, COHN-S, Clinical Manager, Beloit Health System, Occupational Health Centers, Beloit, WI. Phone: (608) 364-4666. Fax: (608) 364-4670. E-mail: cgroves@beloithealthsystem.org.

• Peggy Ann Berry, MSN, RN, COHN-S, SPHR, President, Ohio Association of Occupational Health Nurses. Phone: (937) 304-4922. Fax: (937) 436-0128. E-mail: berry_peggyrnmsn@yahoo.com.