Small organizations can employ occ-health practices effectively

Occupational health considerations can help small business grow safely

For a small business just starting out, occupational health likely is something that is pushed pretty far down the list when it comes to budgeting resources.

"Most small businesses are just concerned with the bottom line when they start out, just getting some profits coming in the door," observes Beverly DaCosta Tobias, MBA, RN, COHN-S, CCM, FAAOHN, an occupational health consultant in San Jose, CA. "It’s not that they don’t care, but it’s a budgetary matter."

Small businesses are the backbone of the American work force. The National Institute for Occupational Safety and Health (NIOSH) reports that nearly 98% of all private industrial companies in the United States have fewer than 100 employees and that 55% of all workers in private industry are employed in these companies.

Even though many small employers don’t think they can afford to spend money on a workplace health and safety program based on OSHA mandates, Tobias and others in the occ-health field are quick to point out that very few can afford not to put at least some measures in from the beginning. Small businesses think, "OSHA compliance" and feel overwhelmed, she says. "If you employ under 10 people, OSHA will say, Do it anyway, because it is a good thing to do,’ but won’t require it," Tobias points out. "But it’s a good thing to just post the [OSHA] regulations, even if you have only one employee. People need to know that their employer is there for them."

OSHA consult one way to start

OSHA offers free consultations for small businesses. Working through the states, consultants — at the employer’s request — will do an evaluation of a workplace to determine potential hazards at the work sites, and make suggestions for improving occupational safety and health management systems. The consultation is separate from the inspection and enforcement arm of OSHA; however, if during the evaluation serious safety risks are identified, a plan for abating the risk is created and must be satisfactorily followed through within a set time, or the employer risks having the matter referred to an enforcement officer.

"OSHA consults will come to small business and say, You don’t have to do these things at this point, until you grow,’ but it’s a good idea to have [the measures] in place; because when you do grow, it will be one less thing to worry about and it will be easier to have your program grow along with your business, rather than starting up later," Tobias says.

An OSHA consult, while free, is not the only avenue for companies to go for an evaluation of how their safety program is doing, or for suggestions on putting one in place.

According to the American Association of Occupational Health Nurses (AAOHN), most small businesses work with occ-health consultants in setting up and maintaining a health and safety program for their employees. When working with a small employer, Tobias says she starts off just like OSHA consultants do — with an audit of the workplace.

"I do an audit and make recommendations, and sometimes I find that ones who only employ a few people are doing things already; other times I find ones who aren’t doing anything," she says. "Some have implemented at least some things that are required by their city, state, or OSHA, so it’s only a matter of going in and reviewing to see what’s there and what is working and what they need to change.

"Then there are people who are just raw — who have zip, nada in place. They say, First aid kit? I should really buy Band-Aids?’"

Recognizing the value

Tobias says the employers she has worked with usually are well aware of their employees’ safety, but can’t see how they can afford to be in compliance with safety standards. An important point Tobias tries to make with those companies is that the money they spend on their employees’ health and safety translates into dollars coming back in later.

"What happens at work directly influences how people do their work," she points out. "Many are not aware of the whole ergonomics issue. Many [ergonomics steps] don’t have to be expensive; for example, if you have a receptionist, or someone multitasking as office assistant or receptionist, just make sure their workplace is comfortable, their seat is set up right, their space is adequate.

"Even in small space, make sure basic safety is observed — then, you have it there, and you can expand it as you grow rather than trying to start when you reach 500 employees and OSHA comes in or the fire department comes in to check on what you’re doing."

OSHA estimates that workplaces that establish safety and health management systems reduce their injury and illness costs by 20%-40%. Conversely, businesses spend $171 billion a year on costs associated with occupational injuries and illness, expenditures that come out of company profits and can comprise as much as 5% of a company’s total costs.

"I just try to get [employers] to compare convenience vs. what it costs to fix it," says Tobias, referring on the costs of injury, illness, missed work, and penalties for OSHA violations. Employees will make things safe or ergonomically correct for themselves," she points out. "Even in a large company, if someone is using a screwdriver all the time and it’s causing a callus, he will tape it up. They will fix it themselves. That’s when the employer needs to jump in and fix it. Lots of employers will say they don’t want to pay $187 for new equipment, but I ask them if they’d rather pay a workers’ compensation claim that will break them."

Start with basics with some employers

Many new business owners start out with plenty of knowledge about their specialty — manufacturing, sales, food service — but no experience with worker health and safety. "Most have heard of this OSHA stuff, but don’t know what it is," says Tobias. "Others have heard of it but don’t think it’s important until something happens."

She uses as an example a client she has worked with. The community-based, nonprofit, mental health service has fewer than 100 employees, and was neglecting their safety.

"They’re providing fantastic services to the community in terms of mental health, but one thing they’re not looking at is health and safety of their own employees," she says. "What I have to do is go in and try to help them see that. See how they can make sure their employees are safe. Especially, in this case, some of the people who come in are not very nice people. How do they protect the staff? Are there barriers to their safe work practices?"

Lots of employers just need to start with the rudimentary step of putting up evacuation plans and the OSHA guidelines for reporting injuries, Tobias says. Posting that information is not only good from a safety standpoint, but also lets employees know that the employer is doing what he or she can to give them a safe work site. "A lot of what is most effective might not cost anything at all," Tobias tells companies.

Some cost-saving — and goodwill-fostering — steps that an employer might take include having one or two employees take first aid and cardiopulmonary resuscitation training, and establishing a relationship with a nearby first aid clinic. The latter step not only tells employees that the company is concerned that they receive prompt care when needed, but can help companies save money that might otherwise be spent on claims if the employees take their injuries to their private physician.

Tobias finds that employers’ willingness to invest in creating a healthy workplace is sometimes based on their ability to look at the big picture. "Some say they don’t want to be bothered, but then an employee shoots himself in the hand with a nail gun, and then they decide they want to look at safety measures. I try to tell them how much they and the employees stand to gain if they put the safety measures in place before that happens," she says.

When occupational health consultants get calls from employers after an accident already has occurred, damage control and prevention steps are in order. Making provisions for the injured employee to return to work to do limited duty not only makes the employee feel that he is cared for, but he is able to perform work for the employer and continue to receive income.

While OSHA has some blanket requirements for all employers of a certain size, every worksite is different and has different inherent risks. An office setting has ergonomic issues; a manufacturer might have more pressing high-risk areas. Tobias said employers, occupational health, and insurers should work together to determine what the actual risks are in each setting, and tailor insurance that truly applies to that company.

When a new or growing company puts together its business plan to present to a bank for funding, safety measures need to be included in that plan, Tobias tells clients. OSHA has created a sample job hazard evaluation form that can be useful in evaluating each position or job within an organization. (See form.) "How many masks do they need? What’s the combustibility of the things around [employees]? If I’m going to do welding, I need to have all my office supplies in a separate area, so I need to make provisions for that. If my employees need aprons, or other safety equipment, that needs to be included," Tobias says.

Making these determinations at the outset helps ensure the employer has enough funding to give their employees a safe environment with the protective equipment necessary, she says.

Employees, too, need to be made aware of risks and necessary safety measures. They should be told, and reminded, of the absolute necessity of knowing and following safety requirements, adhering to safe practices, and using safety and protective equipment, Tobias says.

Companies that start off in the founder’s garage need to take into account many of the same safety and health questions that will be more important as the company grows, Tobias says. "Even if they start off in the garage and don’t get insurance until they get out of the garage, there are still regulatory things to comply with. And as they grow, they need to reassess. Sometimes you’ll see a large employer doing things as if they were still a five-person company, when they really need to be under the auspices of someone familiar with safety," she says. "And I think insurers need to do a better job when they insure small businesses for liability. They need to ask questions that tell them what the company’s liability really is, so the coverage is really what the company needs," Tobias concludes.

For more information, contact:

Beverly DaCosta Tobias, MBA, RN, COHN-S, CCM, FAAOHN, DaCosta-Tobias Associates, Appos, CA. Phone: (831) 688-8955. E-mail:

Occupational Safety and Health Administration. Web site:]