Back to Basics is a weekly feature that highlights important but possibly overlooked information that any EHS professional should know. This week, we examine slips, trips, and falls.
How much are workplace slips, trips, and falls costing you?
“Falls on the same level” often get lumped together with falls from height in slips, trips, and falls. While falls from height can sometimes be fatal, falls on the same level can lead to costly nonfatal injuries, resulting in several days away from work for injured workers and workers’ compensation claims for employers.
According to insurer Liberty Mutual, falls on the same level cost employers $8.98 billion a year. Falls on the same level are the second-leading cause of seriously disabling workplace injuries in the insurer’s 2023 Liberty Mutual Workplace Safety Index.
“Overexertion involving outside sources,” or lifting heavy objects, is the index’s leading cause of disabling injuries.
“Slip or trip without fall” is the ninth leading cause of disabling injury, according to Liberty Mutual’s index. Liberty Mutual reported that injuries on slippery or uneven walkways cost employers $1.98 billion a year.
First, some definitions: Slips are a loss of balance directly caused by too little friction between workers’ feet and walking surfaces. Wet surfaces, spills, and weather hazards like ice and snow can lead to a lack of friction.
Trips occur when workers’ feet hit an object and workers are moving with enough momentum to be thrown off balance.
Falls on the same level occur when workers get too far off their center of balance.
Safety professionals aware of slip, trip, fall hazards
Travelers, another insurer, reported that slips, trips, and falls on the same level are the second-leading cause of injury, accounting for 15% of all accidents, with approximately 25,000 slip, trip, and fall accidents occurring daily in the United States.
According to the National Safety Council (NSC), falls on the same level are the third-leading type of preventable injury at work after exposure to harmful substances and overexertion injuries. Falls on the same level affect every industry and workplace but are prevalent in the service, healthcare, and retail industries, according to the NSC.
Data shows that the median number of days away from work following a fall on the same level is 12 days.
The NSC suggests that effective signage can help prevent injuries, regulatory violations, and higher insurance premiums.
Slip, trip, and fall hazards show up in many industries, but wholesale and retail trade (WRT) establishments suffer high rates of slip, trip, and fall injuries. The National Institute for Occupational Safety and Health (NIOSH) offered several recommendations for protecting workers in the wholesale and retail industries.
Hazardous workplace factors include boxes or containers that obstruct workers’ field of vision; ice, rain, and snow; loose mats or rugs; poor lighting; spills that can create slippery surfaces; and walking surfaces that are in disrepair, have protruding nails and boards, or have changes in floor height.
NIOSH’s recommendations for employers include the following:
- Develop a written slip, trip, and fall prevention policy that spells out both employer and worker responsibilities.
- Ensure that aisles and passageways are free of clutter and other tripping hazards.
- Provide proper lighting in all areas indoors and outdoors to reduce shadows, dark areas, and glare so that trip hazards or surface irregularities are clearly visible, and promptly replace burnt-out light bulbs.
- If electrical cords are regularly used in a workspace, install outlets so that cords don’t cross walkways.
- Select flooring material according to the work performed in an area.
- Provide cleanup supplies—paper towels, absorbent material, “wet floor” signs, etc.—at convenient locations in the facility.
- Provide umbrella bags to prevent rainwater from dripping onto the floor.
- Use mats to provide slip-resistant walking surfaces by absorbing liquid and removing dirt, debris, and liquid from shoes. Mats should be large enough so that several footsteps fall on the mat and clean contaminants off the shoes.
- Provide water-absorbent mats near entrances and other areas where water, ice, or snow may drip or be tracked onto the floor.
- In grocery stores, ensure water from produce spray misters is directed onto produce and not spraying onto the floor.
- In grocery stores, provide customers with paper towels and plastic bags and for wet produce to prevent it from dripping water onto the floor.
You should supplement engineering controls with worker training. You need to train employees to identify slip, trip, and fall hazards and how to prevent slips, trips, and falls by using safe cleaning procedures and placing caution signs and/or cones around the site to warn other employees and visitors to avoid wet walking surfaces.
NIOSH also has employer guidance for preventing slips, trips, and falls in health care. According to NIOSH, the top slip, trip, and fall hazards in health care are:
- Contaminants (fluids, food, grease, oil, and water) on the floor;
- Poor drainage of drains and pipes;
- Walking surface irregularities indoors and outdoors like uneven flooring or ground and holes, protrusions, and rocks;
- Weather conditions like ice and snow;
- Inadequate lighting;
- Stairs and handrails;
- Stepstools and ladders;
- Tripping hazards like clutter, loose cords, hoses, wires, and medical tubing; and
- Improper use of floor mats and runners.
NIOSH’s guide includes an extensive checklist of slip, trip, and fall hazards that should be addressed in a healthcare facility.
OSHA has its own checklist for recognizing slip, trip, and fall hazards in the workplace. The list covers the general work environment, as well as aisles and walkways; escalators; elevated surfaces; floor and wall openings; ladders and scaffolding; parking lots and sidewalks; and ramps, stairs, and stairways.
NIOSH also warns young retail workers that slips, trips, and falls can result in bruises, bumps, cuts, fractures, scratches, sprains, and strains. The institute cautions young workers to clear stairs and walkways of tripping hazards like cords and wires, clutter, and empty cartons; to use handrails when walking up and downstairs; and to clean up spills and anything slippery on floors and the rungs, steps, and feet of ladders.
Control measures and training can be further supplemented with personal protective equipment. Employees who work on wet or contaminated walking surfaces should wear slip-resistant shoes. Workers should choose footwear that’s also resistant to chemicals, heat, and oil.
NIOSH has looked into the value of wearing slip-resistant shoes.
Laboratory studies of slip-resistant footwear to reduce slips, trips, and falls had shown promise in reducing slips, but until a few years ago, there was little research showing the effectiveness of slip-resistant shoes.
In 2019, NIOSH researched the effectiveness of slip-resistant shoes in a study of 17,000 food service workers in 226 school districts serving kindergarten through 12th-grade students. Workers were randomly assigned either to a group that received no-cost, “5-star-rated” slip-resistant shoes or to a group that bought their own slip-resistant shoes.
Researchers looked at workers’ compensation injury claims for accidents caused by slipping on wet or greasy surfaces to evaluate the effectiveness of the shoes.
The group that was provided with highly rated slip-resistant shoes saw a 67% reduction in claims for slip injuries.
There was a baseline of 3.54 slipping injuries per 10,000 months worked among the intervention group, which was reduced to 1.18 slipping injuries per 10,000 months worked after slip-resistant shoes were provided.
Employees who handle materials should ensure the walkways are unobstructed before transporting large materials that might block their view. They should walk with caution and make wide turns at corners. They also should push rather than pull carts to allow a better line of sight.
Housekeeping measures can also help prevent slips, trips, and falls. Your housekeeping policies should include:
- Cleaning floors and work surfaces as soon as they become wet;
- Inspecting refrigerated and freezer cases for water leakage onto the floor surfaces and placing absorbent strips and water-absorbent mats on the floor until the unit is repaired;
- Placing warning signs in wet-floor areas and removing them promptly when floors are clean and dry;
- Using no-skid waxes in slippery areas and using soap that doesn’t leave a slippery residue;
- Maintaining drainage and providing false floors (elevated floors usually 2 to 4 inches above the structural floor designed to provide a surface for safe transit), platforms, or nonslip mats during wet or oily processes;
- Cleaning only one side of a passageway at a time to allow room for passing;
- Keeping passageways clear at all times and marking permanent aisles and passageways; and
- Taping or anchoring electrical cords to floors if they cross walkways.
Workplace housekeeping
In a safety talk handout, the NSC emphasizes the importance of workplace housekeeping in factories and manufacturing plants, offices, and warehouses.
Workplace housekeeping can prevent slip, trip, and fall hazards, as well as control fire hazards and prevent falling objects.
The NSC recommends housekeeping measures suggested by the Canadian Centre for Occupational Safety and Health (CCOSH) that include:
- Cleaning all spills immediately;
- Mopping or sweeping debris from floors;
- Marking spills and wet areas;
- Removing obstacles from walkways and keeping walkways free of clutter;
- Securing carpets, mats, and rugs that don’t lay flat (tacking or taping floor coverings, for example);
- Ensuring file cabinet or storage drawers are closed;
- Covering cables or cords that cross walkways; and
- Keeping working areas and walkways well lit and replacing used light bulbs and faulty light switches.
Some industry groups tout “how to fall” training as a method of mitigating slip, trip, and fall injuries. Others offer “safe walking” tips like “watch where you are going,” “be aware of your environment,” “keep an eye out for changes in elevation,” and “take your time and don’t rush.”
According to the CCOSH, specialty footwear or training on proper walking and “safe falling” will never be fully effective without adequate housekeeping practices.
Federal regulation
Slip, trip, and fall hazards are addressed in the Occupational Safety and Health Administration’s (OSHA) walking-working surfaces standards (29 Code of Federal Regulations (CFR) Part 1910 Subpart D). In 2016, OSHA issued a final rule revising subpart D to incorporate advances in technology, industry best practices, and national consensus standards to ensure cost-efficient and effective worker protection. The revised rule requires employers to inspect walking-working surfaces regularly to correct, repair, or guard against hazardous conditions.
OSHA defines a “walking-working surface” as “any horizontal or vertical surface on or through which an employee walks, works, or gains access to a work area or workplace location.” Ensure aisles and walkways in your facility are kept clear of slipping or tripping hazards that lead to falls on the same level.