Addressing the persistent, but preventable, problem of fatal and nonfatal falls

Despite continued improvement in fall protection measures and equipment, falls from heights are the top cause of death for workers and the hazard is the number one OSHA-cited violation year after year; yet it is easy to spot and it is preventable. In 2021, the Bureau of Labor Statistics reported that falls from elevation led to 351 of the 1,008 deaths among construction workers, or about one-third of construction-related deaths. For the 11th consecutive year in 2021, Fall Protection - General requirements topped the list of OSHA violations with 5,295 citations.

The Center for Construction Research and Training (CPWR) delved deep into the question of "Why?" by surveying individuals directly knowledgeable about construction workplaces, as well as workplaces in other industries where falls are common. Of the 671 respondents, 495 had been involved in, witnessed or investigated a fall incident, representing 62.9 percent in construction and 37.1 percent in other industries. Just over a quarter (26.9 percent) of the incidents reported were fatal and 79.1 percent required medical care.

The report, Underlying Causes of Falls from Heights identified the primary causes for falls as:

• Insufficient or ineffective pre-work planning
  Notably, the odds of using fall protection were 71 percent lower for workers whose employer or competent person didn't complete a pre-work task plan. There was a significant association between not using fall protection and failure to do planning, including pre-bid planning, review and approval of Job Hazard Analyses, daily task assessments, a full written fall protection plan, rescue training, and obtaining fall protection or equipment permits.
• Work culture and perception: fall protection provided but not used
  The survey found that 48.8 percent said no fall protection was being used at the time of a fall. After an incident, employers will often say we provide everything, but the employees don't use it. But employers must look beyond the employee's behavior. An investigation "must inquire why hazardous conditions occurred." Why weren't they using the fall protection? Were they properly trained? Is the requirement enforced? When employees believed that their company's fall prevention policy was strongly associated with the use of fall protection and they believed that fall protection was required, "they were eight times more likely to use fall protection compared to those who did not believe that it was required."
• Incorrect fall protection for situation
  Employers who provided incorrect fall protection for the situation were four times more likely to cause a fatal fall than employers who provided the correct fall protection for the situation. A personal fall arrest system (PFAS) failure was 8.9 times more likely to cause a fatal fall compared to PFASs that did not fail. The higher the height of the fall, the greater the likelihood the fall would be fatal. However, even falls from lower heights led to fatal injuries, with 5.3 percent of fatalities occurring from a height of less than 6 feet.
• Improper or no training and misuse of equipment
  Individuals who did not use fall protection were less likely to have had training. Among those who did not have training, 73.7 percent did not use fall protection.
• Workers employed by subcontractors face an elevated risk of dying from falls
  Workers who work for a subcontractor were 2.7 times more likely to die from a fall compared with those who work for a general contractor. Among the individuals who had a fatal fall, 63.7% worked for a subcontractor; among those who had a nonfatal fall, 44.2% worked for a subcontractor. Failure of the construction manager to properly coordinate the sequence of work of multiple trades working in the same area as well as inadequate training contributed to the increased risk.
• Rescue training was not provided
  The survey also found that rescue training may help reduce fall-related deaths; the odds of a fall being fatal were 76 percent lower for workers who had self-rescue training.

Fatal falls had serious consequences for employers, including OSHA citation/penalty, higher insurance premiums, regional government citation/penalty, going out of business, and decreased business volume. Employers who had a fatal fall on their job site were more likely to institute changes, 53.7 percent compared to 45.8 percent for nonfatal falls. The most common adjustments include changes in training (44.4 percent); policy, procedure, and planning (39.2 percent); equipment and physical environment (29.8 percent); and/or compliance and management (15.8 percent). Less common responses included changes in personnel (5.9 percent), an investigation (4.7 percent), and/or other (4.7 percent). Some tried to address hazards for the specific task the individual was performing at the time of the fall, while others completely restructured their approaches.