Slips, trips and falls make up most general industry related accidents. Injuries caused by these slips, trips and falls can be sprains and strains, bruises and contusions, lacerations, fractures, other soft tissue injuries and even death.
Let’s have a look at the difference between the three terms:
- A slip happens when there is too little friction between the footwear and the walking surface, resulting in loss of balance
- A trip happens when one of two things takes place: Either the person’s foot or leg is obstructed by an object and the upper body of the person continues moving, resulting in loss of balance or the person steps down to a lower surface and loses his / her balance
- A fall is when a person descends under the force of gravity through loss or lack of support and this can be on the same level, to a different level or into something
Assessing the risks
The risk assessment addressing slip, trip and fall risks must be a step by step systematic process that includes all areas of the workplace to identify those things that may cause harm to people through slips, trips and/or falls. By using the following five steps, the assessor can be guided systematically through the risk assessment:
- Start by drawing a map of the area and recording the current weather conditions during the time of the assessment. Rain can influence the assessment, even inside a workshop if the workshop (or office or other work place environment) entrance areas are not preventing the water from entering the workshop, or if the roof is not well maintained. The aim is to observe if there are any slip and trip hazards in the work environment: uneven walking areas, cables lying in the walk ways, spillages, poor housekeeping with tools lying around all over the floor area, etc.
- Identify the people who might be at risk – visitors, employees working in the area, etc.
- Give a weight to the risks: probability x frequency x consequence is one method to use. ‘What if’ analysis is another method to use – What will happen if we do not clean up the spillage and Johnny continues to work in that area?
- Record all findings and take them to the SHE meeting so that objectives and targets can be set so as to eliminate the risks if possible.
- Review the assessment as determined by the SHE committee members.
Falls need to be addressed in two categories:
- Falls from the same level
- Elevated falls
When considering the risk of falling, one should keep in mind the definition of a “Fall Risk” according to the Construction Regulations of the South African Occupational Health and Safety Act, 85 of 1993. The definition of a fall risk according to these regulations is “any potential exposure to falling either from, off or into.” That is a very wide definition and can mean anything from an open manhole or excavation area, to a staircase or working on elevated levels such as scaffolding. It is good to keep in mind that 65% of all fall injuries result from falling from the same level. Also, keep in mind that a slip or trip can lead to a fall.
The slip potential model in the above diagram is a useful tool to use when assessing slips, trips and falls and will force one to address all elements in the workplace that can lead to a slip, trip or fall. For example, during scaffold erection, the fall risks can be assessed by considering the following:
- Is there a procedure in place for cleaning the scaffold components and is it followed?
- Is the flooring used for the scaffold platform conforming to legal and safety requirements?
- What are the weather conditions or is there anything else in the environment that can cause a potential slip, trip or fall?
- Is every worker issued with the correct footwear and do they wear it as instructed?
- Is there a contamination risk?
- What are the people risks?
- Does everyone have a valid medical examination certificate to work on elevated levels?
- Were all staff trained and are training certificates still valid?
Slip potential model
Risk mapping can be used as a preventative tool to identify potential and previous hazards in the work environment. It is an easy step by step assessment of potential hazards and will assist management in establishing controls to prevent slips and trips in the workplace. The following guidelines can be used when risk mapping slip and trip hazards:
- Draw a sketch of the area that is being assessed
- Indicate all the trips and slips that took place in the area over the past 12 months with an “x”
- Indicate any near misses on the sketch: “nm”
- Interview employees to identify other possible slip and trip hazards
- As soon as the map is completed, discuss it on the next health and safety meeting
- Decide on the actions that must be taken to eliminate the hazards
- Continuously monitor the control measures to ensure that the controls were put in place and are working effectively
Good housekeeping is key in preventing slips, trips and falls in the workplace. The golden rule should be “a place for everything and everything in its place”. Keeping the demarcated walkways free from trip and slip hazards should be the focus of all employees.
Floors must be kept clean and dry, and when the floors are being cleaned, people must be prevented from walking on wet floors by clearly demarcating the area and providing a dry area where they can indeed pass safely. Where wet processes are used, adequate drainage should be in place. Oil and grease spillages must be cleaned up immediately, keeping the environment and ISO standards in mind when doing so.
Aisles and exits should be kept clear from obstructing items. Damaged flooring should be repaired as soon as possible and demarcated for the period that the hazard remains. Use drip pans and guards where no other means of prevention can be put in place. Make use of mirrors and warning signs where there is a hazard of blind spots.
Medical fitness to work
In South Africa the Occupational Health and Safety Act, Act 85 of 1993 and its regulations promulgate the safety of persons at work and the protection of persons other than persons at work, against the hazards to health and safety relating to the activities of persons at work. It does not apply to the mines or shipping industry. Section 8 of the Act instructs the employer to ensure that as far as reasonably practicable, the employer provides a working environment that is safe and without risk to the health of its employees. This includes the prevention of trip, slip and fall risks, but also ensures that all employees are declared medically fit to work in the environment as is required by the workplace.
“good housekeeping is key in preventing slips, trips and falls in the workplace”
To close the loop between the employer who needs the employee to be without a medical risk in the workplace, and the Occupational Health Practitioner (OHP) who needs to ensure that the person is fit to work in a specific environment, the Man Job Specification (also called the Occupational Risk Exposure Profile, or OREP) should always accompany a person when he or she is sent for the medical examination. It is the plant supervisor’s responsibility to ensure that the Man Job Specification is completed precisely.
The Man Job Specification should be the formal documentation of the results of both the Risk Assessment and the Hygiene Survey Report for a single occupational exposure group (also called a homogenous exposure group, or HEG). It should comprise a one-page document divided into two main groups:
- The inherent capability requirements of the specific HEG, i.e. lifting 20kg or more for 40% of the shift; crouching 10% of the shift; driving a forklift 5% of the shift; working at heights 80% of the shift.
- The hazardous exposures unique to the specific HEG, i.e. wet floor surfaces 80% of the shift; noise above 85dB 100% of the shift; uneven floor surfaces 80% of the shift.
After declaring the person fit to work in the conditions as indicated on the Man Job Specification, the Occupational Health Practitioner should sign off the Man Job Specification and send it back to the supervisor as proof that the medical examination was done according to the risks in the workplace.
Return to work after sick leave medicals
It is always good practice to first send an employee for medical fitness to work assessment after the employee was booked off sick for something more than just a minor injury or disease. Especially if such an employee is expected to work in a non-office environment. This will ensure that the Occupational Medical Practitioner can do a thorough assessment of the employee’s ability to go back into the working environment without a risk towards an accident or incident occurring because of a medical condition.
Examples of such conditions can be:
• A hip / femur / tibia or fibula / ankle fracture
• Post hip replacement
• Head injury and or concussion
• Medical condition that can lead to dizzy spells or vertigo
• Multiple Sclerosis or other similar diseases
• Auto Immune diseases like Guillain- Barre Syndrome
The human resources manager should always send all sick notes (as soon as the treating physician is booking a person back to work) with the employee to the OHP for his / her medical examination for Fit to Work assessment. This can provide the OHP with information not always mentioned by the employee under examination. Early intervention by the OHP may result in workplace incidents being prevented should a slip, trip or fall hazard exist after being booked off sick because of the medical condition. Disability management processes can also be implemented timeously when indicated by the medical assessment outcomes.
Medical conditions that can lead to slips, trips and falls
Keeping the Man Job Specifications in mind, the Occupational Health Practitioner should be on the lookout for any medical conditions that may lead to a slip, trip or fall hazard if these hazards are an inherent part of the occupation of the person being examined. Conditions that may need exceptional care when assessing a person to be declared fit to work in such an environment can be, but are not limited to:
- Arthritis or other joint related diseases
- Birth defects, i.e. clubfeet
- Previous leg injuries and bone fractures
- Infections that can damage the tissues in the legs, i.e. cellulitis
- Inner ear infections
- History of vertigo or Meniere’s syndrome
- Disorders of the central nervous system, i.e. Parkinson’s syndrome or cerebral palsy
The medical examination alone is therefore not enough and it is important that a full medical and occupational history is obtained prior to examining the person. The history should include at least the following questions:
- Previous workplace and other accidents/injuries away from the workplace and the type of injury that was sustained
- Previous hospitalisations and their causes
- Any treatment for diseases received previously as well as currently
- Specific attention should be given to the central nervous system, head injuries, bone and joint injury or diseases, diseases like epilepsy as well as diseases that may influence the way in which a person walks or perform his / her motor functions.
Part of the examination should be to observe the employee for walking abnormalities. Based on their symptoms, walking abnormalities are divided into five groups:
- Propulsive gait where the person walks with the head and neck thrust forward and is characterised by a rigid posture. Examples of diseases that can cause a propulsive gait are Manganese Poisoning and Parkinson’s Disease.
- Scissors gait where the person walks with the legs bent lightly inward and as they walk, the knees and thighs may cross hit each other. Examples of diseases that can cause a scissors gait is head trauma, brain tumour, spinal cord tumour or multiple sclerosis.
- Spastic gait where a person drags their feet while walking. Examples of diseases that can cause a spastic gait are the same as for a scissors gait.
- Steppage gait (also called a neuropathic gait) where a person walks with their toes pointing downward, causing the toes to scrape on the ground while walking requiring a person to lift the legs higher when walking. Examples of diseases that can cause a neuropathic gait are muscle weakness of the tibia, multiple sclerosis, Guillain-Barre Syndrome, spinal cord injury, and herniated lumber disk.
- Waddling gait causes a person to waddle from side to side when walking. Examples of diseases that can cause waddling gait are congenital hip dysplasia, muscular dystrophy, spinal muscle atrophy.
A limp can be permanent or temporary depending on the cause of the limp and is also considered a walking abnormality.
Slips, trips and falls contribute to most industry related accidents. Control of these hazards should comprise a comprehensive risk assessment that includes past accidents and incidents, risk mapping and the aspects listed in the slip potential model. Important tools in controlling the risks are good housekeeping and ensuring that employees are sent for their Medical Assessment for Fit to Work Certification.