The Ergonomics Connection : Workplace Safety and Insurance Board and Employers

1. The Ergonomics Connection : Workplace Safety and Insurance Board and Employers Shelley Gibbons, CCPE, B.Sc. (HK) & Joanne Blake, Adjudicator, WSIB

2. Presentation Purpose Goals : • To improve communication between the workplace and WSIB • To improve decision making in return to work (RTW) and entitlement • To examine roles of WSIB Ergonomist and employer Health and Safety Representatives: How do we work together to effect a positive RTW? • To improve independence in the workplace with RTW issues

3. Understanding the challenges - medical precautions • Timeliness of decisions by the WSIB and the Employer are important - need to ensure communication of relevant information to ensure this timeliness

4. Presentation Outline • The WSI Act and RTW • WSIB Ergonomist involvement • Interpreting medical precautions • The employer’s role • Reviewing and interpreting jobs • Potential RTW best practices

5. Duty to co-operate in return to work Section 40 (1) The employer of an injured worker shall co-operate in the early and safe return to work of the worker by, • (a) contacting the worker as soon as possible after the injury occurs and maintaining communication throughout the period of the worker’s recovery and impairment; • (b) attempting to provide suitable employment that is available and consistent with the worker’s functional abilities and that, when possible, restores the worker’s pre-injury earnings; • (c) giving the Board such information as the Board may request concerning the worker’s return to work; and • (d) doing such other things as may be prescribed. 1997, c. 16, Sched. A, s. 40 (1).

6. Duty to accommodate Section 41(6) • The employer shall accommodate the work or the workplace for the worker to the extent that the accommodation does not cause the employer undue hardship. 1997, c. 16, Sched. A, s. 41 (6). - where the employer has a re-employment obligation From www.ccohs.ca

7. Suitable Work Employers should attempt to provide suitable work that: • Is safe and within your worker's (functional) physical capabilities • Your worker has the skills to do (or can acquire the skills to do) • Restores your worker's pre-injury earnings as closely as possible From www.ccohs.ca

9. The Ergonomist at the WSIB • Currently 31 Ergonomists employed by the WSIB, province wide. • Offices in Windsor, London, Hamilton, Kitchener, Toronto, Kingston, Ottawa, Sudbury, Sault Ste. Marie, Thunder Bay • Cover all industry sectors - automotive, manufacturing, food, health care, services, etc. From www.ccohs.ca

10. When does the WSIB Ergonomist get Involved WSIB Claims Adjudicator (decision maker) requests assistance when: • There is a disagreement between the workplace parties that needs to be resolved • The injured worker is experiencing some difficulty in their job (pre-injury, modified or alternate job) • There is a general lack of pertinent information on file to allow for a decision From www.ccohs.ca

11. WSIB Ergonomist Outcomes Review injured workers jobs and form an opinion on: 1) Suitability - opinion on whether job demands exceed the medical precautions or could aggravate the worker’s injury 2) Accommodations - suggest accommodations in an effort to ensure the work is suitable within medical precautions 3) Compatibility - opinion on whether risk factors exist in the job for a particular injury From www.ccohs.ca

13. Medical Precautions • Suitable work - the job must not exceed a worker’s medical precautions • Functional Abilities Form • Standard WSIB medical precautions • Official Disability Guidelines • Regional Evaluation Centre (REC) – multi-disciplinary health care assessment

14. Standard Shoulder Precautions • Avoid repetitive shoulder movement (R/L) • Avoid heavy lifting - Lifting limitation • Avoid above shoulder activity • Avoid repetitive use of upper extremity against resistance (R/L)

15. Standard Neck Precautions • Avoid repetitive neck movement • Avoid above shoulder and overhead activity • Lifting limitation

16. Official Disability Guidelines • SHOULDER/CERVICAL: • Manual work:   • Reaching above shoulder not more than 12 times/hr with up to 15 lbs of weight; • Reaching to shoulder up to 15 times/hr with up to 25 lbs of weight; • Holding arm in abduction or flexion up to 12 times/hr with up to 15 lbs of weight;

17. Official Disability Guidelines • SHOULDER/CERVICAL: • Pulling and pushing up to 60 lbs 20 times/hr; • Lifting and carrying up to 40 lbs 15 times/hr; • Single upper extremity work using injured arm for moderate work only (full use of non-injured arm); possible immobilization by abduction brace, sling, or clavicle brace; • Climbing ladders up to 50 rungs/hr.

18. Challenges with Medical Precautions • Lifting limitations - What is heavy? • Repetitive movements - What is repetitive? • Movement limitations - How much movement is too much? • Time limitation - What is prolonged?

19. Answering the Challenges It’s a matter of providing pertinent information • Important to remember every injury is different • Important to remember injured workers vary in measurements of body size (anthropometrics) • Must include the injured worker in the process of gathering pertinent information about the job and determining return to work

20. Look at force, posture and time factors • The Ergonomist identifies if relevant risk factors for work-related musculoskeletal disorders (WMSDs) are evident • Determine if force, posture and/or time factors are increasing the risk of injury

21. FORCE DEMANDS • Activities of Lifting, Carrying, Pushing, Pulling, Gripping, Pinching • Describe the activities - weights, forces, size of object, distance from body, coupling, frequency

22. Awkward Postures • Look at the involved joint • Determine if the posture is neutral or close to neutral • Describe the range of movement of the involved joint - e.g. upper arm is held away from the front of the body, back bends forwards to reach low levels

23. TIME FACTORS • Frequency of movements - how many? • Duration of postures – for how long? • Recovery or rest time between movements and postures

25. Force, Posture and Time Factors • Look at how the force, posture and time factors interact in activities/duties • The risk of WMSDs is magnified when risk factors exist in combination.

26. Employer’s Role Prior to an Injury • Know the jobs – what is being done, how it is being done • Understand the risk factors for work-related musculoskeletal injuries • Establish an ergonomics committee • Communicate with the workers

27. Health Care

28. Employer’s Role After an Injury • Early and safe return to work • “Is the job within the worker’s medical precautions?” • Review the job with the worker - are there risk factors that need to be addressed?

29. Employer’s Role After an Injury • Consider accommodations to Pre-injury job (what caused the injury in the first place?) • Review modified or alternate jobs for RTW • Provide physical demands information to the WSIB for identified job(s) • Involve the worker for the best chance of success

30. Physical Demands Information FormPDIF 2830A See www.wsib.on.ca (employers  forms)

31. Gathering job information • Look at WHAT is being done in the job • Describe the “WHAT” under the job title, job objective, job duties and job design • E.g. Personal Support Worker Home Care Worker

32. Gathering Job Information • Job Title: Personal Support Worker • Job Objective: To assist residents with activities of daily living • Job Design; 8 hour shifts, assigned to a certain wing • Job Duties: - Get residents up in morning - Take residents to washroom - Make beds - Bathe residents - Feed residents

33. Gather Relevant Physical Demands • HOW is the work being performed • Look at the “HOW” relevant to the area of injury

34. Gather Relevant Physical Demands • Force demands – lifting, carrying, pushing, pulling, gripping, pinching – describe the activity, include weights and forces • Postures – neutral vs awkward postures • Time factors - Frequency (how many times?) and duration (how long?) • Specific measurements are important - Numbers, Numbers, Numbers

35. Gathering Job Information • Look at “how” job is being done relevant to the area of injury • E.g. shoulder • Describe force demands – lifting, carrying, pushing, pulling • Describe postures – reaching , heights involved • Describe time factors – frequency of lifting, reaching, duration of holding the same shoulder posture

36. Interpreting the Information Variety of programs, equations, tables, research findings to help determine risk: • NIOSH equation http://www.cdc.gov/niosh/94-110.html • Snook / Mital tables • Rapid Upper Limb Assessment (RULA) http://www.ergonomics.co.uk/Rula/Ergo/index.html • Kilbom repetition guidelines (1994) • Strain index • Biomechanic software programs (4D watbak, 3D static, Bakpak) • Scientific references (WSIB ergos have a reference document with ~200 citations)

38. RTW Considerations • Pre-Injury vs. Modified vs. Alternate job • Review of pre-injury job regardless of RTW • Working at their own pace • Locus of control & value added work • Variability of movement • Communication with worker / medical personnel • One hand / One arm work

39. Potential RTW Best Practices • Complete PDIF – customize to your workplace • Focus on Force / Posture / Time factors • Review any job where worker claims to have an injury - fix any problems • Create a comfortable non-hostile work environment • Review job in question across a few different workers • Questions, Questions, Questions • Where possible, try the job

40. Potential RTW Best Practices • Communicate, involve the worker (have the worker present when reviewing the job) • Review jobs in detail prior to offering to the worker - consider the medical precautions • Ensure everyone knows about RTW guidelines (include the supervisors)

41. RTW PLAN • Return-to-work Plan • Interim return to work date: ________ • Transitional job – (eg. Pre-injury accommodated) _________________ • Review Date: __________ • Target End Date: __________ • End goal job – (eg. Pre-injury) ___________________ • Employee’s Name: _____________________________ Phone No. ____________ • Supervisor/Manager: ___________________________ Phone No. ____________ • Treating Physician(s): ___________________________ Phone No.(s) __________ • WSIB Claims Adjudicator: ________________________ Phone No. ____________ • WSIB Claim Number ____________________________ • Transitional return to work date ____________________ • Description of Employees Job: • (Attach Physical Demands Report for Employees Job) • Transitional Work Plan: • Pre-Injury Job, comparable work • Pre-Injury Job with accommodations alternative work • (e.g., wages, hours, rotation, min’s/max’s,) • Medical Precautions • (Attach most recent Functional Abilities Report) • Description of Transitional Work • (Attach Physical Demands Report for Transitional Work) • Supervisor Comments Worker Comments/Concerns • Provide copies of RTW Plan to all interested parties. • ___________________________________________ ____________________________________________ • Supervisor/Occ Health/Administrator Employee • Date:

42. Sample letter to Treating practitioner Dear Practitioner: At 123 Healthcare Corporation, we are committed to returning valued team members to meaningful work through the use of a fair and consistent return to work program, following a workplace or non-workplace injury or illness. Your patient, __________, has injured herself at work. In order to assist her with a work hardening program, we are using the following precautions for her low back condition: • Use disability guidelines for soft tissue – low back strain We ask your cooperation in the completion of the attached functional abilities form (FAF). After your assessment, if you feel there are additional precautions to assist all parties understand her capabilities, please list them on the attached FAF. We will be providing her with the following work activities using the above soft tissue guidelines for her low back: • List duties The work can also be accommodated, by reducing her work hour schedule, if necessary, to ease her back into a full work schedule, modified work, alternative work or through a combination of the above. If you have any questions with respect to this return to work program that is available for her next schedule shift, please give me a call. Thank you for your valued input and assistance. Jan Safety, 123 Healthcare Corporation

43. Accommodation Resources • Canadian Centre for Occupational Health and Safety CCOHS (www.ccohs.ca) • Health and Safety Associations (see www.wsib.on.ca for association web links) • Association of Canadian Ergonomists (www.ace-ergocanada.ca/) • Job Accommodation Network (http://janweb.icdi.wvu.edu) • Occupational Health Clinic for Ontario Workers (www.ohcow.on.ca) • National Institute for Occupational Safety and Health (USA http://www.cdc.gov/niosh)

44. Thank-youHave a Safe Day