Standardizing industrial hygiene data collection forms used by workers’ compensation insurers (original) (raw)

2018, Journal of Occupational and Environmental Hygiene

Supplemental Table 1. Recommended Data Elements from ACGIH-AIHA Joint Task Group Data Element Definition A. Facility/Site Information A-1* Company/Organization Name of the company or organization that operates or is directly responsible for the facility (work establishment, work site, or premises). A-2* Facility Name Legal name of facility (work establishment, work site, or premises). A-3* Facility Address Facility street, city, state/province, and zip code/postal code. A-4* SIC Code Four-digit Standard Industrial Classification code for the facility (work establishment, site, or premises). Seven-digit SIC code may be used when available. A-5* Industrial Category Text description of the overall purpose(s), product(s), service(s), and activity(ies) of the facility (work establishment, site, or premises). Information supplements the more generic SIC code as recorded above. A-6* Contractor Information If survey involves contractor employees inside a larger facility (e.g., construction or maintenance contractors), record name, type, and SIC of contractor, and name of main contractor if necessary. A-7* Number of Employees Total number of employees in facility (establishment, site). If contractor in a larger workplace, also record number of contractor employees. B. Survey Tracking Information B-1* Survey Number (Reference Number) A unique number for tracking the survey and any associated report(s). B-2* Survey Date Date(s) survey was performed. B-3* Person Performing Survey Name, unique identifier (e.g., SSN, employee number), and position of the person responsible for the survey. B-4 Report Number Link to report with conclusions and recommendations of the survey. B-5 Is Follow-up Required? Do survey results or observations require follow-up? Coded: Yes, follow-up is required. No, follow-up is not required. B-6 Follow-up Summary Text summarizing the specific follow-up action(s) required or recommended (e.g., routine monitoring, protective equipment, installation of controls, medical surveillance, etc.). B-7 Person(s) Responsible for Follow-up Name, position, and SSN or employee number of the person(s) responsible for followup. Supplemental Table 1. Recommended Data Elements from ACGIH-AIHA Joint Task Group, continued Data Element Definition B-8 Date Follow-up Completed The date(s) when follow-up action(s) were completed. B-9* Quality Control Review Name, position, and SSN or employee number of the person who reviewed the survey data for accuracy and completeness. B-10* Date of Quality Control Review The date the quality control review was performed. B-11 General Survey Comments Additional comments. C. Work Area Information C-1* Building/Zone A distinct part of the facility (work establishment, work site). May be a building or a distinct zone within the facility (work establishment, work site). It is possible to have multiple building zones for a mobile employee. C-2* Room/Area Specific room or area within the building or zone. It is possible to have multiple rooms/areas for a mobile employee. C-3* Department Organizational or functional assignment of work area (e.g., assembly department, shipping and receiving department). Note that department may or may not represent a distinct physical area. C-4* Type of Work Area Type of work area. Coded: Open air. Enclosed indoor space (e.g., typical workroom or walled work area). Confined space (restricted space with reduced ventilation). Describe with text. Equipment cab (e.g., crane, bulldozer). Other. Describe with text.