Is your first-aid kit and training OSHA compliant?

Federal OSHA's standard 1910.151, Medical Services and First Aid, is less than 100 words long and includes limited information; yet it applies to all general industry employers, from offices to factories, even if a company has only one employee. It also covers temporary workers.

While more information can be found in the over 60 Letters of Interpretation (LoI), Appendix A of the standard, and OSHA's Best Practices Guide: Fundamentals of a Workplace First-Aid Program, many employers are uncertain about what their obligations are when it comes to first aid kits. OSHA recommends that employers conduct a workplace assessment to identify processes that may cause injury or illness to employees, types of accidents that have occurred in the past or may occur in the future, and occupational hazards of the worksite. Bottom line: OSHA will not tell employers what to have in the kits or how many kits to have, but expects employers to "provide medical and first aid personnel and supplies commensurate with the hazards of the workplace..."

Requirements and common issues

• Adequate first aid personnel

  The standard requires,"In the absence of an infirmary, clinic, or hospital in near proximity to the workplace, which is used for the treatment of all injured employees, a person or persons shall be adequately trained to render first aid." OSHA has long interpreted the term "near proximity" to mean that emergency care must be available within no more than 3-4 minutes from the workplace for serious incidents.

  According to letters of interpretation, it is not enough to simply have a medical facility in near proximity to the workplace, the employer must take appropriate steps prior to any accident to ensure that emergency medical assistance will be promptly available when an injury occurs. Such steps include contacting the responder and verifying their response time, availability for all workdays and hours, and their capacity to respond to an emergency.

  If you opt to use outside responder(s), employees need to know the quickest way to reach them. Further, trained employees should not be discouraged from rendering first aid. A LoI notes, "...the rendering of first aid should be encouraged by trained employees in addition to calling 911."

  In many cases, training employees to render first aid is the best option. The standard does not specify the number of workers to train, although it does address elements of the type and frequency of training. It's ideal to have more than one person trained for all work shifts. A training program must include instructor observation of hands-on skills, along with written performance assessments, and nationally accepted and medically sound first aid programs meet the requirements of 1910.151. It cannot be all computer-based. Instructor-led retraining for life-threatening emergencies should occur at least annually. Other training should be repeated periodically.

  Although CPR training isn't required under this standard, the Best Practices Guide recommends that responders have CPR certifications, and other OSHA standards specifically require it. The standard does not address AEDs and most requirements related to AEDs come from state laws.

  If an employee is properly trained but panics in a real-life situation and is unable to perform, OSHA would not cite the employer but would investigate, if deemed necessary, to ensure that proper training was implemented.



• Readily available and appropriate supplies

  Federal OSHA expects employers to have first aid supplies readily available, in easily accessible areas, and be sufficient and appropriate for the type of work performed. It does not specify the types of supplies or how many kits are needed nor where they should be placed. A LoI applied the 3-4-minute response time for the availability of supplies. There should not be barriers to easy access such as having to traverse several hallways, doorways, and stairways or locked kits with no easy access to the keys.

  In determining how many kits and where to place them, employers should consider the size and layout of the workspace, the number of employees, and the type of work performed, including indoor and outside. For potentially serious injuries, access should be within 3 - 4 minutes, for areas of low injury possibility, such as offices, a maximum of up to 15 minutes may be reasonable. Performing a risk assessment is key. Working alone in remote locations does not eliminate the desired response times.

  Regarding the type of supplies, a LoI notes "employers are required to provide first aid supplies that are most appropriate to respond to incidents at their workplaces." Appendix A notes, "The employer can use the OSHA 300 log, OSHA 301 log, or other reports to identify these unique problems...Employers should assess the specific needs of their worksite periodically and augment the first aid kit appropriately." Designating a person to check expiration dates and adequacy of supplies on a regular basis is key. OSHA and ISEA recommend inspecting first aid kits at least once a month or after they are used to treat an injury.

  Another helpful source for the type of supplies is ANSI/ISEA Z308.1 - "Minimum Requirements for Workplace First-aid Kits." Although OSHA does not mandate compliance, it acknowledges the value of its guidance as a best practice.

  OSHA does not address over-the-counter (OTC) medications, but the ANSI standard says, if included, they should be in a single dose, tamper-evident packaging and should not contain ingredients that cause drowsiness. Due to liability concerns, some employers only offer them through a vending machine or not at all.

  While some state plans require written approval of the supplies, federal OSHA does not.



• Recordable injuries

  A common mistake is misclassifying a first aid case as a recordable injury or illness. Minor injuries that only require first aid don't need to be recorded on an OSHA 300 log and recording "just in case" is not a good idea since it will inflate the total number of recordable cases on the 300A form, which is used for enforcement efforts. OSHA does have helpful definitions of recordable cases vs. first aid. If the injury or illness is treated only with items on the first aid list and does not result in days away from work, work restrictions, or another recordable outcome, do not include it as a recordable incident on the 300 log.

  Another common misconception is who administers the treatment or where it occurs makes a difference for recordability. The determining factor for recordability is the type of treatment given, not who administers it or where it happens.



• Other regulations

  Other OSHA regulations

  A white paper by JJ Keller Compliance network, Understanding and Meeting Your First Aid Obligations, notes that several federal OSHA standards require trained responders onsite or both first aid and CPR training. Some examples are:

  • 1910.146 Permit-required confined spaces
  • 1910.266 Logging operations
  • 1910.269 Electric power generation, transmission, and distribution
  • 1910.410 Qualifications of dive team
  • 1926.950 Power transmission and distribution

  Also, employees expected to provide first aid are covered by the Bloodborne Pathogens Standard (1910.1030), triggering its training and other obligations.

  
  

  State Plans

  Some State Plans, such as California's Cal/OSHA, have significantly more stringent and specific requirements for first aid. A recently passed law requires naloxone hydrochloride or another Food and Drug Administration-approved opioid-reversal medication to be included in all workplace first aid kits in California no later than Dec. 1, 2028. State health statutes can also apply.