Health and Safety Hazards in the Construction Industry

James L. Weeks
George Washington University

Construction workers build, repair, maintain, renovate, modify and demolish houses, office buildings, temples, factories, hospitals, roads, bridges, tunnels, stadiums, docks, airports and more. The International Labor Organization (ILO) classifies the construction industry as government and private-sector firms erecting buildings for habitation or for commercial purposes and public works such as roads, bridges, tunnels, dams or airports. In the United States and some other countries, construction workers also clean hazardous waste sites.

Construction as a proportion of gross domestic product varies widely in industrialized countries. It is about 4% of GDP in the United States, 6.5% in Germany and 17% in Japan. In most countries, employers have relatively few full-time employees. Many companies specialize in skilled trades—electricity, plumbing or tile setting, for instance—and work as subcontractors.

The Construction Labor Force

A large portion of construction workers are unskilled laborers; others are classified in any of several skilled trades (see table 93.1). Construction workers include about 5 to 10% of the workforce in industrialized countries. Throughout the world, over 90% of construction workers are male. In some developing countries, the proportion of women is higher and they tend to be concentrated in unskilled occupations. In some countries, the work is left to migrant workers, and in others, the industry provides relatively well-paid employment and an avenue to financial security. For many, unskilled construction work is the entry into the paid labor force in construction or other industries.

Table 93.1 Selected construction occupations Boilermakers Bricklayers, concrete finishers and masons Carpenters Electricians Elevator constructors Glaziers Hazardous materials (e.g., asbestos, lead, toxic dumps) removal workers Installers of floors (including terrazzo), carpeting Installers of drywall and ceilings (including ceiling tile) Insulation workers (mechanical and floor, ceiling and wall) Iron and steel workers (reinforcement and structural) Laborers Maintenance workers Millwrights Operating engineers (drivers of cranes and other heavy equipment maintenance workers) Painters, plasterers and paperhangers Plumbers and pipefitters Roofers and shinglers Sheet metal workers Tunnel workers

Work Organization and Labor Instability

Construction projects, especially large ones, are complex and dynamic. Several employers may work on one site simultaneously, with the mix of contractors changing with the phases of the project; for example, the general contractor is present at all times, excavating contractors early, then carpenters, electricians and plumbers, followed by floor finishers, painters and landscapers. And as the work develops—for instance, as a building’s walls are erected, as the weather changes or as a tunnel advances—the ambient conditions such as ventilation and temperature change too.

Construction workers typically are hired from project to project and may spend only a few weeks or months at any one project. There are consequences for both workers and work projects. Workers must make and remake productive and safe working relationships with other workers whom they may not know, and this may affect safety at the work site. And in the course of the year, construction workers may have several employers and less than full employment. They might work an average of only 1,500 hours in a year while workers in manufacturing, for example, are more likely to work regular 40 hour weeks and 2,000 hours per year. In order to make up for slack time, many construction workers have other jobs—and exposure to other health or safety hazards—outside of construction.

For a particular project, there is frequent change in the number of workers and the composition of the labor force at any one site. This change results both from the need for different skilled trades at different phases of a work project and from the high turnover of construction workers, particularly unskilled workers. At any one time, a project may include a large proportion of inexperienced, temporary and transient workers who may not be fluent in the common language. Although construction work often must be done in teams, it is difficult to develop effective, safe teamwork under such conditions.

Like the workforce, the universe of construction contractors is marked by high turnover and consists mainly of small operations. Of the 1.9 million construction contractors in the United States identified by the 1990 Census, only 28% had any full-time employees. Just 136,000 (7%) had 10 or more employees. The degree of contractor participation in trade organizations varies by country. In the United States, only about 10 to 15% of contractors participate; in some European countries, this proportion is higher but still involves less than half of contractors. This makes it difficult to identify contractors and inform them of their rights and responsibilities under pertinent health and safety or any other legislation or regulations.

As in some other industries, an increasing proportion of contractors in the United States and Europe consists of individual workers hired as independent contractors by prime- or sub-contractors who employ workers. Ordinarily, an employing contractor does not provide subcontractors with health benefits, workers’ compensation coverage, unemployment insurance, pension benefits or other benefits. Nor do prime contractors have any obligation to subcontractors under health and safety regulations; these regulations govern rights and responsibilities as they apply to their own employees. This arrangement gives some independence to individuals who contract for their services, but at the cost of removing a wide range of benefits. It also relieves employing contractors of the obligation to provide mandated benefits to individuals who are contractors. This private arrangement subverts public policy and has been successfully challenged in court, yet it persists and may become more of a problem for the health and safety of workers on the job, regardless of their employment relationship. The US Bureau of Labor Statistics (BLS) estimates that 9% of the US workforce is self-employed, but in construction as many as 25% of workers are self-employed independent contractors.

Health Hazards on Construction Sites

Construction workers are exposed to a wide variety of health hazards on the job. Exposure differs from trade to trade, from job to job, by the day, even by the hour. Exposure to any one hazard is typically intermittent and of short duration, but is likely to reoccur. A worker may not only encounter the primary hazards of his or her own job, but may also be exposed as a bystander to hazards produced by those who work nearby or upwind. This pattern of exposure is a consequence of having many employers with jobs of relatively short duration and working alongside workers in other trades that generate other hazards. The severity of each hazard depends on the concentration and duration of exposure for that particular job. Bystander exposures can be approximated if one knows the trade of workers nearby. Hazards present for workers in particular trades are listed in table 93.2 .

Table 93.2 Primary hazards encountered in skilled construction trades

Each trade is listed below with an indication of the primary hazards to which a worker in that trade might be exposed. Exposure may occur to either supervisors or to wage earners. Hazards that are common to nearly all construction—heat, risk factors for musculoskeletal disorders and stress—are not listed.

The classifications of construction trades used here are those used in the United States. It includes the construction trades as classified in the Standard Occupational Classification system developed by the US Department of Commerce. This system classifies the trades by the principal skills inherent in the trade.

Occupations	Hazards
Brickmasons	Cement dermatitis, awkward postures, heavy loads
Stonemasons	Cement dermatitis, awkward postures, heavy loads
Hard tile setters	Vapor from bonding agents, dermatitis, awkward postures
Carpenters	Wood dust, heavy loads, repetitive motion
Drywall installers	Plaster dust, walking on stilts, heavy loads, awkward postures
Electricians	Heavy metals in solder fumes, awkward posture, heavy loads, asbestos dust
Electrical power installers and repairers	Heavy metals in solder fumes, heavy loads, asbestos dust
Painters	Solvent vapors, toxic metals in pigments, paint additives
Paperhangers	Vapor from glue, awkward postures
Plasterers	Dermatitis, awkward postures
Plumbers	Lead fumes and particles, welding fumes
Pipefitters	Lead fumes and particles, welding fumes, asbestos dust
Steamfitters	Welding fumes, asbestos dust
Carpet layers	Knee trauma, awkward postures, glue and glue vapor
Soft tile installers	Bonding agents
Concrete and terrazzo finishers	Awkward postures
Glaziers	Awkward postures
Insulation workers	Asbestos, synthetic fibers, awkward postures
Paving, surfacing and tamping equipment operators	Asphalt emissions, gasoline and diesel engine exhaust, heat
Rail- and track-laying equipment operators	Silica dust, heat
Roofers	Roofing tar, heat, working at heights
Sheetmetal duct installers	Awkward postures, heavy loads, noise
Structural metal installers	Awkward postures, heavy loads, working at heights
Welders	Welding emissions
Solderers	Metal fumes, lead, cadmium
Drillers, earth, rock	Silica dust, whole-body vibration, noise
Air hammer operators	Noise, whole-body vibration, silica dust
Pile driving operators	Noise, whole-body vibration
Hoist and winch operators	Noise, lubricating oil

Crane and tower operators	Stress, isolation
Excavating and loading machine operators	Silica dust, histoplasmosis, whole-body vibration, heat stress, noise
Grader, dozer and scraper operators	Silica dust, whole-body vibration, heat noise
Highway and street construction workers	Asphalt emissions, heat, diesel engine exhaust
Truck and tractor equipment operators	Whole-body vibration, diesel engine exhaust
Demolition workers	Asbestos, lead, dust, noise
Hazardous waste workers	Heat, stress

Construction Hazards

As in other jobs, hazards for construction workers are typically of four classes: chemical, physical, biological and social.

Chemical hazards

Chemical hazards are often airborne and can appear as dusts, fumes, mists, vapors or gases; thus, exposure usually occurs by inhalation, although some airborne hazards may settle on and be absorbed through the intact skin (e.g., pesticides and some organic solvents). Chemical hazards also occur in liquid or semi-liquid state (e.g., glues or adhesives, tar) or as powders (e.g., dry cement). Skin contact with chemicals in this state can occur in addition to possible inhalation of the vapor resulting in systemic poisoning or contact dermatitis. Chemicals might also be ingested with food or water, or might be inhaled by smoking.

Several illnesses have been linked to the construction trades, among them:

• silicosis among sand blasters, tunnel builders and rock drill operators
  
• asbestosis (and other diseases caused by asbestos) among asbestos insulation workers, steam pipe fitters, building demolition workers and others
  
• bronchitis among welders
  
• skin allergies among masons and others who work with cement
  
• neurologic disorders among painters and others exposed to organic solvents and lead.

Elevated death rates from cancer of the lung and respiratory tree have been found among asbestos insulation workers, roofers, welders and some woodworkers. Lead poisoning occurs among bridge rehabilitation workers and painters, and heat stress (from wearing full-body protective suits) among hazardous-waste cleanup workers and roofers. White finger (Raynaud’s syndrome) appears among some jackhammer operators and other workers who use vibrating drills (e.g., stopper drills among tunnellers).

Alcoholism and other alcohol-related disease is more frequent than expected among construction workers. Specific occupational causes have not been identified, but it is possible that it is related to stress resulting from lack of control over employment prospects, heavy work demands or social isolation due to unstable working relationships.

Physical hazards

Physical hazards are present in every construction project. These hazards include noise, heat and cold, radiation, vibration and barometric pressure. Construction work often must be done in extreme heat or cold, in windy, rainy, snowy, or foggy weather or at night. Ionizing and non-ionizing radiation is encountered, as are extremes of barometric pressure.

The machines that have transformed construction into an increasingly mechanized activity have also made it increasingly noisy. The sources of noise are engines of all kinds (e.g., on vehicles, air compressors and cranes), winches, rivet guns, nail guns, paint guns, pneumatic hammers, power saws, sanders, routers, planers, explosives and many more. Noise is present on demolition projects by the very activity of demolition. It affects not only the person operating a noise-making machine, but all those close-by and not only causes noise-induced hearing loss, but also masks other sounds that are important for communication and for safety.

Pneumatic hammers, many hand tools and earth-moving and other large mobile machines also subject workers to segmental and whole-body vibration.

Heat and cold hazards arise primarily because a large portion of construction work is conducted while exposed to the weather, the principal source of heat and cold hazards. Roofers are exposed to the sun, often with no protection, and often must heat pots of tar, thus receiving both heavy radiant and convective heat loads in addition to metabolic heat from physical labor. Heavy equipment operators may sit beside a hot engine and work in an enclosed cab with windows and without ventilation. Those that work in an open cab with no roof have no protection from the sun. Workers in protective gear, such as that needed for removal of hazardous waste, may generate metabolic heat from hard physical labor and get little relief since they may be in an airtight suit. A shortage of potable water or shade contributes to heat stress as well. Construction workers also work in especially cold conditions during the winter, with danger of frostbite and hypothermia and risk of slipping on ice.

The principal sources of non-ionizing ultraviolet (UV) radiation are the sun and electric arc welding. Exposure to ionizing radiation is less common, but can occur with x-ray inspection of welds, for example, or it may occur with instruments such as flow meters that use radioactive isotopes. Lasers are becoming more common and may cause injury, especially to the eyes, if the beam is intercepted.

Those who work under water or in pressurized tunnels, in caissons or as divers are exposed to high barometric pressure. Such workers are at risk of developing a variety of conditions associated with high pressure: decompression sickness, inert gas narcosis, aseptic bone necrosis and other disorders.

Strains and sprains are among the most common injuries among construction workers. These, and many chronically disabling musculoskeletal disorders (such as tendinitis, carpal tunnel syndrome and low-back pain) occur as a result of either traumatic injury, repetitive forceful movements, awkward postures or overexertion (see figure 93.1). Falls due to unstable footing, unguarded holes and slips off scaffolding (see figure 93.2) and ladders are very common.

Figure 93.1 Carrying without appropriate work clothing and protective equipment

Figure 93.2 Unsafe scaffolding in Kathmandu, Nepal, 1974

Jane Seegal

Biological hazards

Biological hazards are presented by exposure to infectious microorganisms, to toxic substances of biological origin or animal attacks. Excavation workers, for example, can develop histoplasmosis, an infection of the lung caused by a common soil fungus. Since there is constant change in the composition of the labor force on any one project, individual workers come in contact with other workers and, as a consequence, may become infected with contagious diseases—influenza or tuberculosis, for example. Workers may also be at risk of malaria, yellow fever or Lyme disease if work is conducted in areas where these organisms and their insect vectors are prevalent.

Toxic substances of plant origin come from poison ivy, poison oak, poison sumac and nettles, all of which can cause skin eruptions. Some wood dusts are carcinogenic, and some (e.g., western red cedar) are allergenic.

Attacks by animals are rare but may occur whenever a construction project disturbs them or encroaches on their habitat. This could include wasps, hornets, fire ants, snakes and many others. Underwater workers may be at risk from attack by sharks or other fish.

Social hazards

Social hazards stem from the social organization of the industry. Employment is intermittent and constantly changing, and control over many aspects of employment is limited because construction activity is dependent on many factors over which construction workers have no control, such as the state of an economy or the weather. Because of the same factors, there can be intense pressure to become more productive. Since the workforce is constantly changing, and with it the hours and location of work, and many projects require living in work camps away from home and family, construction workers may lack stable and dependable networks of social support. Features of construction work such as heavy workload, limited control and limited social support are the very factors associated with increased stress in other industries. These hazards are not unique to any trade, but are common to all construction workers in one way or another.

Health Risks of Underground Construction Work

Bohuslav Malek
Hygenic Institute of Prague

Hazards

Underground construction work includes tunneling for roads, highways and railroads and laying pipelines for sewers, hot water, steam, electrical conduits, telephone lines. Hazards in this work include hard physical labour, crystalline silica dust, cement dust, noise, vibration, diesel engine exhaust, chemical vapours, radon and oxygen-deficient atmospheres. Occasionally this work must be done in a pressurized environment. Underground workers are at risk for serious and often fatal injuries. Some hazards are the same as those of construction on the surface, but they are amplified by working in a confined environment. Other hazards are unique to underground work. These include being struck by specialized machinery or being electrocuted, being buried by roof falls or cave-ins and being asphyxiated or injured by fires or explosions. Tunneling operations may encounter unexpected impoundments of water, resulting in floods and drowning.

The construction of tunnels requires a great deal of physical effort. Energy expenditure during manual work is usually from 200 to 350 W, with a great part of static load of the muscles. Heart rate during work with compressed-air drills and pneumatic hammers reaches 150 to 160 per minute. Work is often done in unfavorable cold and humid microclimatic conditions, sometimes in cumbersome work postures. It is usually combined with exposure to other risk factors which depend on the local geological conditions and on the type of technology used. This heavy workload can be an important contribution to heat stress.

The need for heavy manual labour can be reduced by mechanization. But mechanization brings its own hazards. Large and powerful mobile machines in a confined environment introduce risks of serious injury to persons working nearby, who may be struck or crushed. Underground machinery also may generate dust, noise, vibration and diesel exhaust. Mechanization also results in fewer jobs, which reduces the number of persons exposed but at the expense of unemployment and all of its attendant problems.

Crystalline silica (also known as free silica and quartz) occurs naturally in many different types of rock. Sandstone is practically pure silica; granite may contain 75%; shale, 30%; and slate, 10%. Limestone, marble and salt are, for practical purposes, completely free of silica. Considering that silica is ubiquitous in the earth’s crust, dust samples should be taken and analyzed at least at the start of an underground job and whenever the type of rock changes as work progresses through it.

Respirable silica dust is generated whenever silica-bearing rock is crushed, drilled, ground or otherwise pulverized. The main sources of airborne silica dust are compressed-air drills and pneumatic hammers. Work with these tools most often occurs in the fore part of the tunnel and, therefore, workers in these areas are the most heavily exposed. Dust suppression technology should be applied in all instances.

Blasting generates not only flying debris, but also dust and nitrogen oxides. To prevent excessive exposure, the customary procedure is to prevent re-entry to the affected area until the dust and gases have cleared. A common procedure is to blast at the end of the last work shift of the day and to clear out debris during the next shift.

Cement dust is generated when cement is mixed. This dust is a respiratory and mucous membrane irritant in high concentrations, but chronic effects have not been observed. When it settles on skin and mixes with sweat, however, cement dust can cause dermatoses. When wet concrete is sprayed in place, it too can cause dermatoses.

Noise can be significant in underground construction work. Principal sources include pneumatic drills and hammers, diesel engines and fans. Since the underground work environment is confined, there is also considerable reverberant noise. Peak noise levels can exceed 115 dBA, with time-weighted average noise exposure equivalent to 105 dBA. Noise-reducing technology is available for most equipment and should be applied.

Underground construction workers can also be exposed to whole-body vibration from mobile machinery and to hand-arm vibration from pneumatic drills and hammers. The levels of acceleration transmitted to the hands from pneumatic tools can reach about 150 dB (comparable to 10 m/s2). Harmful effects of hand-arm vibration can be aggravated by a cold and damp working environment.

If soil is highly saturated with water or if construction is conducted under water, the work environment may have to be pressurized to keep water out. For underwater work, caissons are used. When workers in such a hyperbaric environment make too rapid a transition to normal air pressure, they risk decompression sickness and related disorders. Since the absorption of most toxic gases and vapours depends on their partial pressure, more may be absorbed at higher pressure. Ten ppm of carbon monoxide (CO) at 2 atmospheres of pressure, for example, will have the effect of 20 PPM CO at 1 atmosphere.

Chemicals are used in underground construction in a variety of ways. For example, insufficiently coherent layers of rock may be stabilized with an infusion of urea formaldehyde resin, polyurethane foam or mixtures of sodium water glass with formamide or with ethyl and butyl acetate. Consequently, vapours of formaldehyde, ammonia, ethyl or butyl alcohol or di-isocyanates may be found in the tunnel atmosphere during application. Following application, these contaminants may escape into the tunnel from the surrounding walls, and it may therefore be difficult to fully control their concentrations, even with intensive mechanical ventilation.

Radon occurs naturally in some rock and may leak into the work environment, where it will decay into other radioactive isotopes. Some of these are alpha emitters that may be inhaled and increase the risk of lung cancer.

Tunnels constructed in inhabited areas can also be contaminated with substances from surrounding pipes. Water, heating and cooking gas, fuel oil, petrol and so on may leak into a tunnel or, if pipes carrying these substances are broken during excavation, they may escape into the work environment.

The construction of vertical shafts using mining technology poses similar health problems to those of tunneling In terrain where organic substances are present, products of microbiological decomposition may be expected.

Maintenance work in tunnels used for traffic differs from similar work on the surface mainly in the difficulty of installing safety and control equipment, for example, ventilation for electric arc welding; this may influence the quality of safety measures. Work in tunnels in which pipelines for hot water or steam are present is associated with great heat load, demanding a special regime of work and breaks.

Oxygen deficiency may occur in tunnels either because oxygen is displaced by other gases or because it is consumed by microbes or by the oxidation of pyrites. Microbes may also release methane or ethane, which not only displace oxygen but, in sufficient concentration, may create the risk of explosion. Carbon dioxide (commonly called blackdamp in Europe) is also generated by microbial contamination. The atmospheres in spaces which have been closed for a long time may contain mostly nitrogen, practically no oxygen and 5 to 15% carbon dioxide.

Blackdamp penetrates into the shaft from the surrounding terrain due to changes in the atmospheric pressure. The composition of the air in the shaft may change very quickly—it may be normal in the morning, but be deficient in oxygen by the afternoon.

Prevention

Prevention of exposure to dust should in the first place be implemented by technical means, such as wet drilling (and/or drilling with LEV), wetting of the material before it is pulled down and loaded to the transport, LEV of mining machines and mechanical ventilation of tunnels. Technical control measures may not be sufficient to lower the concentration of respirable dust to an acceptable level in some technological operations (e.g., during drilling and sometimes also in the case of wet drilling), and therefore it may be necessary to supplement the protection of the workers engaged in such operations by the use of respirators.

The efficiency of technical control measures must be checked by monitoring the concentration of airborne dust. In the case of fibrogenic dust, it is necessary to arrange the programme of monitoring in such a way that it allows the registration of the exposure of individual workers. The individual exposure data, in connection with data about each worker’s health, are necessary for the assessment of the risk of pneumoconiosis in particular work conditions, as well as for the assessment of the efficiency of control measures in the long-run. Last but not least, the individual registration of exposure is necessary for evaluating the ability of individual workers to continue in their jobs.

Due to the nature of underground work, protection against noise depends mostly on the personal protection of hearing. Effective protection against vibrations, on the other hand, can be achieved only by eliminating or decreasing the vibration by mechanization of risky operations. PPE is not effective. Similarly, the risk of diseases due to physical overload of the upper extremities can be lowered only by mechanization.

Exposure to chemical substances can be influenced by the selection of appropriate technology (e.g., the use of formaldehyde resins and formamide should be eliminated), by good maintenance (e.g., of diesel engines) and by adequate ventilation. Organization and work regime precautions are sometimes very effective, especially in the case of the prevention of dermatoses.

Work in underground spaces in which the composition of the air is not known demands strict adherence to safety rules. Entering such spaces without isolating breathing apparatuses must not be allowed. The work should be done only by a group of at least three people—one worker in the underground space, with breathing apparatus and safety harness, the others outside with a rope to secure the inside worker. In case of accident it is necessary to act quickly. Many lives have been lost in efforts to save the victim of an accident when the safety of the rescuer was disregarded.

Pre-placement, periodic and post-employment preventive medical examinations are a necessary part of the health and safety precautions for workers in tunnels. The frequency of periodic examinations and the type and scope of special examinations (x ray, lung functions, audiometry and so on) should be individually determined for each workplace and for each job according to the working conditions.

Prior to groundbreaking for underground work, the site should be inspected and soil samples should be taken in order to plan the excavation. Once work is underway, the work site should be inspected daily to prevent roof falls or cave-ins. The workplace of solitary workers should be inspected at least twice each shift. Fire suppression equipment should be strategically placed throughout the underground work site.

Preventive Health Services in Construction

Pekka Roto, Medicine Officer
Tampere Regional Institute of Occupational Health

The construction industry forms 5 to 15% of the national economy of most countries and is usually one of the three industries having the highest rate of work-related injury risks. The following chronic occupational health risks are pervasive (Commission of the European Communities 1993):

• Musculoskeletal disorders, occupational hearing loss, dermatitis and lung disorders are the most common occupational diseases.
  
• An increased risk of respiratory tract carcinomas and mesothelioma caused by asbestos exposure has been observed in all countries where occupational mortality and morbidity statistics are available.
  
• Disorders resulting from improper nutrition, smoking or use of alcohol and drugs are associated especially with migrant workers, a substantial portion of construction employment in many countries.

Preventive health services for construction workers should be planned with these risks as priorities.

Types of Occupational Health Services

Occupational health services for construction workers consist of three main models:

1. specialized services for construction workers
   
2. occupational health care for construction workers rendered by providers of broad-based occupational health services
   
3. health services provided voluntarily by the employer.

Specialized services are the most effective but also the most expensive in terms of direct costs. Experiences from Sweden indicate that the lowest injury rates on construction sites worldwide and a very low risk for occupational diseases among construction workers are associated with extensive preventive work through specialized service systems. In the Swedish model, called Bygghälsan, technical and medical prevention have been combined. Bygghälsan operates through regional centres and mobile units. During the severe economic recession of the late 1980s, however, Bygghälsan severely cut back its health service activities.

In countries that have occupational health legislation, construction companies usually buy the needed health services from companies serving general industries. In such cases, the training of occupational health personnel is important. Without special knowledge of the circumstances surrounding construction, medical personnel cannot provide effective preventive occupational health programs for construction companies.

Some large multinational companies have well-developed occupational safety and health program that are part of the culture of the enterprise. The cost-benefit calculations have proved these activities economically profitable. Nowadays, occupational safety program are included in quality management of most international companies.

Mobile health clinics

Because construction sites are often situated far from any established providers of health services, mobile health service units may be necessary. Practically all countries that have specialized occupational health services for construction workers use mobile units for delivering the services. The mobile unit’s advantage is the saving of work time by bringing the services to worksites. Mobile health centres are contained in a specially equipped bus or trailer and are especially suitable for all types of screening procedures, such as periodic health examinations. Mobile services should be careful to arrange in advance for collaboration with local providers of health services in order to secure follow-up evaluation and treatment for workers whose test results suggest a health problem.

Standard equipment for a mobile unit includes a basic laboratory with a spirometer and an audiometer, an interview room and x-ray equipment, when needed. It is best to design module units as multipurpose spaces so they can be used for different types of projects. The Finnish experience indicates that mobile units are also suitable for epidemiological studies, which can be incorporated into occupational health program, if properly planned in advance.

Contents of preventive occupational health services

Identification of risk at construction sites should guide medical activity, although this is secondary to prevention through proper design, engineering and work organization. Risk identification requires a multidisciplinary approach; this requires close collaboration between the occupational health personnel and the enterprise. A systematic workplace survey of risks using standardized checklists is one option.

Preplacement and periodic health examinations are usually conducted according to requirements set by legislation or guidance provided by authorities. The examination’s content depends on the exposure history of each worker. Short work contracts and frequent turnover of the construction workforce can result in “missed” or “inappropriate” health examinations, a failure to follow up on findings or unwarranted duplication of health examinations. Therefore, regular standard periodic examinations are recommended for all workers. A standard health examination should contain: an exposure history; symptom and illness histories with special emphasis on musculoskeletal and allergic diseases; a basic physical examination; and audiometry, vision, spirometry and blood pressure tests. The examinations should also provide health education and information on how to avoid occupational risks known to be common.

Musculoskeletal disorders and their prevention

Musculoskeletal disorders have multiple origins. Lifestyle, hereditary susceptibility and aging, combined with improper physical strain and minor injuries, are commonly accepted risk factors for musculoskeletal disorders. The types of musculoskeletal problems have different exposure patterns in different construction professions.

There is no reliable test to predict an individual’s risk for acquiring a musculoskeletal disorder. Medical prevention of musculoskeletal disorders is based on guidance in ergonomic matters and lifestyles. Preplacement and periodic examinations can be used for this purpose. Nonspecific strength testing and routine x rays of the skeletal system have no specific value for prevention. Instead, early detection of symptoms and a detailed work history of musculoskeletal symptoms can be used as a basis for medical counseling. A program that performs periodic symptom surveys to identify work factors that can be changed has been shown to be effective.

Often, workers who have been exposed to heavy physical loads or strain think the work keeps them fit. Several studies have proved that this is not the case. Therefore, it is important that, in the context of health examinations, the examinees be informed about proper ways to maintain their physical fitness. Smoking has also been associated with lumbar disk degeneration and low-back pain. Therefore, anti-smoking information and therapy should be included in the periodic health examinations, too (Workplace Hazard and Tobacco Education Project 1993).

Occupational noise-induced hearing loss

The prevalence of noise-induced hearing loss varies among construction occupations, depending on levels and duration of exposure. In 1974, less than 20% of Swedish construction workers at age 41 had normal hearing in both ears. Implementation of a comprehensive hearing conservation program increased the proportion in that age group having normal hearing to almost 40% by the late 1980s. Statistics from British Columbia, Canada, show that construction workers generally suffer significant loss of hearing after working more than 15 years in the trades (Schneider et al. 1995). Some factors are thought to increase susceptibility to occupational hearing loss (e.g., diabetic neuropathy, hypercholesterolemia and exposure to certain ototoxic solvents). Whole-body vibration and smoking may have an additive effect.

A large-scale program for hearing conservation is advisable for the construction industry. This type of program requires not only collaboration at the worksite level, but also supportive legislation. Hearing conservation program should be specific in work contracts.

Occupational hearing loss is reversible in the first 3 or 4 years after initial exposure. Early detection of hearing loss will provide opportunities for prevention. Regular testing is recommended to detect the earliest possible changes and to motivate workers to protect themselves. At the time of testing, the exposed workers should be educated in the principles of personal protection, as well as the maintenance and proper use of protection devices.

Occupational dermatitis

Occupational dermatitis is prevented mainly by hygienic measures. The proper handling of wet cement and skin protection are effective in promoting hygiene. During health examinations, it is important to stress the importance of avoiding skin contact with wet cement.

Occupational lung diseases

Asbestosis, silicosis, occupational asthma and occupational bronchitis can be found among construction workers, depending on their past work exposures (Finnish Institute of Occupational Health 1987).

There is no medical method to prevent the development of carcinomas after someone has been sufficiently exposed to asbestos. Regular chest x rays, every third year, are the most common recommendation for medical surveillance; there is some evidence that x-ray screening improves the outcome in lung cancer (Strauss, Gleanson and Sugarbaker 1995). Spirometry and anti-smoking information are usually included in the periodic health examination. Diagnostic tests for the early diagnosis of asbestos-related malignant tumors are not available.

Malignant tumors and other lung diseases related to asbestos exposure are widely underdiagnosed. Therefore, many construction workers eligible for compensation remain without benefits. In the late 1980s and early 1990s, Finland conducted a nationwide screening of workers exposed to asbestos. The screening revealed that only one-third of the workers with asbestos-related diseases and who had access to occupational health services had been diagnosed earlier (Finnish Institute of Occupational Health 1994).

Special needs of migrant workers

Depending on the construction site, the social context, sanitary conditions and climate may present important risks to construction workers. Migrant workers often suffer from psychosocial problems. They have a higher risk of work-related injuries than native workers. Their risk of carrying infectious diseases, such as HIV/AIDS, tuberculosis, and parasitic diseases must be taken into account. Malaria and other tropical diseases are problems for workers in areas where they are endemic.

In many large construction projects, a foreign workforce is used. A preplacement medical examination should be conducted in the home country. Also, the spreading of contagious diseases must be prevented through proper vaccination program In the host countries, proper vocational training, health and safety education, and housing should be organized. Migrant workers should be provided the same access to health care and social security as native workers (El Batawi 1992).

In addition to preventing construction-related ailments, the health practitioner should work to promote positive changes in lifestyle, which can improve a worker’s health overall. Avoiding alcohol and smoking are the most important and fruitful themes for health promotion for construction workers. It has been estimated that a smoker costs the employer 20 to 30% more than a nonsmoking worker. Investments in anti-smoking campaigns pay not only in the short term, with lower accident risks and shorter sick leaves, but also in the long term, with lower risks of cardiovascular pulmonary diseases and cancer. In addition, tobacco smoke has harmful multiplier effects with most dusts, especially with asbestos.

Economic benefits

It is difficult to prove any direct economic benefit of occupational health services to an individual construction company, especially if the company is small. Indirect cost-benefit calculations show, however, that accident prevention and health promotion are economically beneficial. Cost-benefit calculations of investments in preventive program are available for companies to use internally. (For a model used extensively in Scandinavia, see Oxenburg 1991.)

Health and Safety Regulations: The Netherlands Experience

Leen Akkers, Managing Director
Stichting Arbouw

Implementation of the EC directive Minimum Regulations for Health and Safety on Temporary and Mobile Building Sites typifies the legal regulations emanating from the Netherlands and from the European Union. Their aim is to improve working conditions, to combat disability and to reduce sickness absenteeism. In the Netherlands, these regulations for the construction industry are expressed in the Arbouw Resolution, Chapter 2, Section 5.

As is often the case, the legislation seems to be following the social changes that began in 1986, when organizations of employers and employees joined to establish the Arbouw Foundation to provide services for construction companies in civil engineering and utility construction, earth works, roadbuilding and water construction and the completion sectors of the industry. Thus, the new regulations are scarcely a problem for the responsible companies already committed to implement health and safety considerations. The fact that these principles are often very difficult to put into practice, however, has led to non-observance and unfair competition and, consequently, the need for legal regulations.

Legal Regulations

The legal regulations focus on preventive measures before the construction project is started and while it is in progress. This will yield the greatest long-term benefit.

The Health and Safety Act stipulates that evaluations of risks must address not only those arising from materials, preparations, tools, equipment and so on, but also those involving special groups of workers (e.g., pregnant women, young and elderly workers and those with disabilities).

Employers are obliged to have written risk evaluations and inventories produced by certified experts, who may be employees or external contractors. The document must include recommendations for eliminating or limiting the risks and must also stipulate phases of the work when qualified specialists will be required. Some construction companies have developed their own approach to the evaluation, the General Business Investigation and Risk Inventory and Evaluation (ABRIE), which has become the prototype for the industry.

The Health and Safety Act obliges employers to offer a periodic health examination to their employees. The purpose is to identify health problems that may make certain jobs especially hazardous for some workers unless certain precautions are taken. This requirement echoes the various collective labor agreements in the construction industry which for years have required employers to provide employees with comprehensive occupational health care, including periodic medical examinations. The Arbouw Foundation has contracted with the Federation of Occupational Health and Safety Care Centres for the provision of these services. Over the years, a wealth of valuable information has been accumulated which has contributed to enhancement of the quality of the risk inventories and evaluations.

Absenteeism Policy

The Health and Safety Act also requires employers to have an absenteeism policy which includes a stipulation that experts in this field be retained to monitor and counsel disabled employees.

Joint Responsibility

Many health and safety risks can be traced to inadequacies in the building and organization choices or to poor planning of the work when setting up a project. To obviate this, the employers, employees and the government agreed in 1989 on a working conditions covenant. Among other things, it specified cooperation between clients and contractors and between contractors and subcontractors. This has resulted in a code of conduct which serves as a model for the implementation of the European directive on temporary and mobile building sites.

As part of the covenant, Arbouw formulated limits for exposure to hazardous substances and materials, along with guidelines for the application in various construction operations.

Under the leadership of Arbouw, the FNV Building Workers and Wood Workers Union, the FNV Industry Union and the Mineral Wool Association, Benelux, agreed to a contract that called for the development of glass wool and mineral wool products with less dust emission, development of the safest possible production methods for glass wool and mineral wool, formulation and promotion of working methods for the safest use of these products and performance of the research necessary to establish safe exposure limits to them. The exposure limit for respirable fibers was set at 2/cm³ although a limit of 1/cm³ was regarded as feasible. They also agreed to eliminate the use of raw and secondary materials that are health risks, using as criteria the exposure limits formulated by Arbouw. Performance under this agreement will be monitored until it expires on 1 January 1999.

Construction Process Quality

The implementation of the EC directive does not stand in isolation but is an integral part of company health and safety policies, along with quality and environmental policies. Health and safety policy is critical part of the quality policy of the companies. The laws and regulations will be enforceable only if the employers and employees of the construction industry have played a role in their development. The government has dictated the development of a model health and safety plan that is practicable and can be enforced to prevent unfair competition from companies that ignore or subvert it.

Organizational Factors Affecting Health and Safety

Doug J. McVitte, Manager Technical Services
Construction Safety Association of Ontario

Diversity of Projects and Work Activities

Many people outside the construction industry are unaware of the diversity and degree of specialization of work undertaken by the industry, though they see portions of it every day. In addition to traffic delays caused by encroachments on roads and street excavations, the public is frequently exposed to buildings being erected, subdivisions being constructed and, occasionally, to the demolition of structures. What is hidden away from view, in most cases, is the large amount of specialized work done either as part of a “new” construction project or as part of the ongoing repairs maintenance associated with almost anything constructed in the past.

The list of activities is very diverse, ranging from electrical, plumbing, heating and ventilating, painting, roofing and flooring work to very specialized work such as installing or repairing overhead doors, setting heavy machinery, applying fireproofing, refrigeration work and installing or testing communications systems.

The value of construction can be partially measured by the value of building permits. Table 93.4 shows the value of construction in Canada in 1993.

Table 93.4 Value of construction projects in Canada, 1993 (based on value of building permits issued in 1993)

Type of Project	Value ($ Cdn)	% of total
Residential building (houses, apartments)	38,432,467,000	40.7
Industrial buildings (factories, mining plants)	2,594,152,000	2.8
Commercial buildings (offices, stores, shops etc.)	11,146,469,000	11.8
Institutional buildings (schools, hospitals)	6,205,352,000	6.6
Other buildings (airports, bus stations, farm buildings, etc.)	2,936,757,000	3.1
Marine facilities (wharves, dredging)	575,865,000	0.6
Roads and highways	6,799,688,000	7.2
Water and sewage systems	3,025,810,000	3.2
Dams and irrigation	333,736,000	0.3
Electric power (thermal/nuclear/hydro)	7,644,985,000	8.1
Railway, telephone, telegraph	3,069,782,000	3.2
Gas and oil (refineries, pipelines)	8,080,664,000	8.6
Other engineering construction (bridges, tunnels, etc.)	3,565,534,000	3.8
Total	94,411,261,000	100

Source: Statistics Canada 1993.

The health and safety aspects of the work depend in large measure on the nature of the project. Each type of project and each work activity presents different hazards and solutions. Often, the severity, scope or size of the problem is related to the size of the project as well.

Client-Contractor Relationships

Clients are the individuals, partnerships, corporations or public authorities for whom construction is carried out. The vast majority of construction is done under contractual arrangements between clients and contractors. A client may select a contractor based on past performance or through an agent such as an architect or engineer. In other cases, it may decide to offer the project through advertising and tendering. The methods used and the client’s own attitude to health and safety can have a profound effect on the project’s health and safety performance.

For example, if a client chooses to “pre-qualify” contractors to ensure that they meet certain criteria, then this process excludes inexperienced contractors, those who may not have had satisfactory performance and those without qualified personnel required for the project. While health and safety performance has not previously been one of the common qualifications sought or considered by clients, it is gaining in usage, primarily with large industrial clients and with government agencies that purchase construction services.

Some clients promote safety much more than others. In some cases, this is due to the risk of damage to their existing facilities when contractors are brought in to perform maintenance or to expand the client’s facilities. Petrochemical companies in particular make it clear that contractor safety performance is a key condition of the contract.

Conversely, those firms who choose to offer their project through an unqualified open bidding process to obtain the lowest price often end up with contractors that may be unqualified to perform the work or who take short cuts to save on time and materials. This can have an adverse effect on health and safety performance.

Contractor-Contractor Relationships

Many people who are not familiar with the nature of the contractual arrangements common in construction presume that one contractor performs all or at least the major part of most building construction. For example, if a new office tower, sports complex or other high-visibility project is being constructed, the general contractor usually erects signs and often company flags to indicate its presence and to create the impression that this is “its project”. Years ago, this impression may have been relatively accurate, since some general contractors actually undertook to perform substantial parts of the project with their own direct-hire forces. However, since the mid-1970s, many, if not most, general contractors have assumed more of a project management role on large projects, with the vast majority of the work contracted out to a network of subcontractors, each of which has special skills in a particular aspect of the project. (See table 93.5)

Table 93.5 Contractors/subcontractors on typical industrial/commercial/institutional projects

Project manager/general contractor Excavating contractor Formwork contractor Reinforcing steel contractor Structural steel contractor Electrical contractor Plumbing contractor Drywall contractor Painting contractor Glazing contractor Masonry contractor Finish carpentry/cabinet work contractor Flooring contractor Heating/ventilation/air conditioning contractor Roofing contractor Landscaping contractor

As a result, the general contractor could actually have fewer staff onsite than any of several subcontractors on the project. In some cases the main contractor has no workforce directly involved in construction activities, but manages the work of subcontractors. On most major projects in the industrial, commercial and institutional (ICI) sector, there are several layers of subcontractors. Typically, the primary level of subcontractors have contracts with the general contractor. However, these subcontractors may contract part of their work out to other smaller or more specialized subcontractors.

The influence that this network of contractors may have on health and safety becomes fairly obvious when it is compared with a fixed worksite such as a factory or a mill. At a typical fixed-industry workplace, there is only one management entity, the employer. The employer has sole responsibility for the workplace, the lines of command and communication are simple and direct, and only one corporate philosophy applies. At a construction project, there may be ten or more employer entities (representing the general contractor and the usual subcontractors), and the lines of communication and authority tend to be more complex, indirect and often confused.

The attention given to health and safety by the person or company in charge can influence the health and safety performance of others. If the general contractor has attached a high degree of importance to health and safety, this can have a positive influence on the health and safety performance of the subcontractors on the project. The converse is also true.

Additionally, the overall health and safety performance of the site can be adversely affected by the performance of one subcontractor (e.g., if one subcontractor has poor housekeeping, leaving a mess behind as his or her forces move through the project, it can create problems for all of the other subcontractors onsite).

Regulatory efforts regarding health and safety are generally more difficult to introduce and administer in these multi-employer workplaces. It may be difficult to determine which employer has responsibility for which hazards or solutions, and any administrative controls which appear to be eminently workable in a single-employer workplace may need significant modification to be workable on a multi-employer construction project. For example, information regarding hazardous materials used on a construction project must be communicated to those who work with or near the materials, and workers must be adequately trained. At a fixed workplace with only one employer, all of the material and the information accompanying it is much more readily obtained, controlled and communicated, whereas on a construction project, any of the various subcontractors may be bringing in hazardous materials of which the general contractor has no knowledge. Additionally, workers employed by one subcontractor using a certain material may have been trained, but the crew working for another subcontractor in the same area but doing something entirely different may know nothing about the material and yet could be as much at risk as those using the material directly.

Another factor which emerges regarding contractor-contractor relationships relates to the bidding process. A subcontractor who bids too low may take shortcuts that compromise health and safety. In these cases, the general contractor must ensure that subcontractors adhere to the standards, specifications and statutes pertaining to health and safety. It is not uncommon on projects where everyone has bid very low to observe continuing health and safety problems coupled with excessive passing of responsibility, until regulatory authorities step in to impose a solution.

A further problem relates to the scheduling of work and the impact this can have on health and safety. With several different subcontractors on the site at one time, competing interests may create problems. Each contractor wants to get his or her work done as quickly as possible. When two or more contractors want to occupy the same space, or when one has to perform work overhead of another, problems can occur. This is typically a much more common problem in construction than in fixed industry, where the main competing interests tend to involve only operations versus maintenance.

Employer-Employee Relationships

The several employers on a particular project may have somewhat different relationships with their employees than those common at most fixed industrial workplaces. For example, unionized workers at a manufacturing facility tend to belong to one union. When the employer needs additional workers, it interviews and hires them and the new employees join the union. Where there are former unionized workers on layoff, they are rehired generally on a seniority basis.

In the unionized part of the construction industry, a completely different system is used. Employers form collective associations which then enter into agreements with building and construction trade unions. The majority of the non-salaried direct-hire employees in the industry work through their union. When, for example, a contractor needs five additional carpenters at a project, he or she would call the local Carpenters’ Union and place a request for five carpenters to show up for work at the project on a certain day. The union would notify the five members at the top of the employment list that they are to report to the project to work for the particular firm. Depending on the provisions of the collective agreement between the employers and the union, the contractor may be able to “name hire” or select some of these workers. If there are no union members available to fill the employment call, the employer may be able to hire temporary workers who would join the union, or the union may bring in skilled workers from other locals to help fill the demand.

In non-unionized situations, employers use different processes to obtain additional staff. Prior employment lists, local employment centres, word of mouth and advertising in local newspapers are the principal methods used.

It is not uncommon for workers to be employed by several different employers in the course of a year. The employment duration varies with the nature of the project and the amount of work to be done. This places a large administrative load on the construction contractors compared with their fixed-industry counterparts (e.g., recordkeeping for income taxes, workers’ compensation, unemployment insurance, union dues, pensions, licensing and other regulatory or contractual issues).

This situation presents some unique challenges compared to the typical fixed-industry workplace. Training and qualifications must not only be standardized but portable from one job or sector to another. These important issues affect the construction industry much more profoundly than fixed industries. Construction employers expect workers to come to the project with certain skills and capabilities. In most trades, this is accomplished by a comprehensive apprenticeship program. If a contractor places a call for five carpenters, he or she expects to see five qualified carpenters at the project on the day they are needed. If health and safety regulations require special training, the employer needs to be able to access a pool of workers with this training, since the training may not be readily available at the time the work is scheduled to start. An example of this is the Certified Worker Program required at larger construction projects in Ontario, Canada, which involves having joint health and safety committees. Since this training is not currently part of the apprenticeship program, alternative training systems had to be put in place to create a pool of trained workers.

With growing emphasis on specialized training or at least confirmation of skill level, training program conducted in conjunction with the building and construction trades unions will likely grow in importance, number and variety.

Inter-union Relationships

The structure of organized labor mirrors the way in which contractors have specialized within the industry. On a typical construction project, five or more trades may be represented onsite at any one time. This involves many of the same problems posed by multiple employers. Not only are there competing interests to deal with, but lines of authority and communication are more complex and sometimes blurred when compared with a single-employer, single-union workplace. This influences many aspects of health and safety. For example, which worker from which union will represent all workers on the project if there is a regulatory requirement for a health and safety representative? Who gets trained in what and by whom?

In the case of rehabilitation and reinstatement of injured workers, the options for skilled construction workers are much more limited than those of their fixed-industry counterparts. For example, an injured worker at a factory may be able to return to some other job at that workplace without crossing important jurisdictional boundaries between one union and another, because there is typically only one union in the factory. In construction, each trade has fairly clearly defined jurisdiction over the types of work its members can perform. This greatly limits the options for injured workers who may not be able to perform their normal pre-injury job functions but could none the less perform some other related work at that workplace.

Occasionally, jurisdictional disputes arise over which union should perform certain types of work which have health and safety implications. Examples include scaffold erection, boom truck operation, asbestos removal and rigging. Regulations in these areas need to consider jurisdictional concerns, especially with respect to licensing and training.

The Dynamic Nature of Construction

Construction workplaces are in many respects quite different from fixed industry. Not only are they different, they tend to be constantly changing. Unlike a factory which operates at a given location day after day, with the same equipment, the same workers, the same processes and generally the same conditions, construction projects evolve and change from day to day. Walls are erected, new workers from different trades arrive, materials change, employers change as they complete their portions of the work, and most projects are affected to some degree just by the changes in the weather.

When one project is completed, workers and employers move on to other projects to start all over again. This indicates the dynamic nature of the industry. Some employers work in several different cities, provinces, states or even countries. Similarly, many skilled construction workers move with the work. These factors influence many aspects of health and safety, including workers’ compensation, health and safety regulations, performance measurement and training.

Summary

The construction industry is presented with some very different conditions from those in fixed industry. These conditions must be considered when control strategies are being contemplated and may help to explain why things are done differently in the construction industry. Solutions developed with the input from both construction labor and construction management, who know these conditions and how to deal effectively with them, offer the best chance for improving health and safety performance.

Integrating Prevention and Quality Management

Rudolf Scholbeck, Head
International Labour Office

Improving Occupational Health and Safety

Construction companies are increasingly adopting the quality management systems spelled out by the International Organization for Standardization (ISO), such as the ISO 9000 series and the subsequent regulations that have been based on it. Although no recommendations on occupational health and safety are specified in this set of standards, there are cogent reasons for including preventive measures when implementing a management system such as that required by the ISO 9000.

Occupational health and safety regulations are written and implemented and are continuously being adapted to technological progress as well as to new safety techniques and to advances in occupational medicine. All too often, however, they are not followed, either deliberately or out of ignorance. When this occurs, models for safety management, such as the ISO 9000 series, assist in integrating the structure and content of preventive measures into management. The advantages of such a comprehensive approach are obvious.

Integrated management means that occupational health and safety regulations are no longer looked at in isolation, but gain relevance from the corresponding sections of a quality management handbook, as well as in process and work instructions, thus creating a fully integrated system. This integral approach can improve the chances of greater attention to accident prevention measures in daily construction practice and, thereby, reduce the number of workplace accidents and injuries. Dissemination of a handbook that integrates occupational health and safety procedures into the processes it describes is crucial for this process.

New management methods are aimed at putting people closer to the centre of the processes. Coworkers are being more actively involved. Information, communication and cooperation are promoted across hierarchical barriers. The reduction of absences due to illness or workplace accidents enhances the implementation of the principles of quality management in construction.

With the development of new building methods and equipment, safety requirements increase steadily in number. The increasing concern with environmental protection makes the problem even more complex. Coping with the demands of modern prevention is difficult without appropriate regulations and a centrally directed articulation of the process and work instructions. Clear divisions of responsibility and effective coordination for the prevention plan should, therefore, be written into the quality management system.

Improving Competitiveness

Documentation of the existence of an occupational safety management system is increasingly required when contractors submit bids for work, and its effectiveness has become one of the criteria for awarding a contract.

The pressure of international competition could become even greater in the future. It seems prudent, therefore, to integrate preventive measures into the quality management system now, rather than waiting and being forced by increasing competitive pressure to do so later, when the pressure of time and the costs of personnel and financing will be much greater. Furthermore, a not inconsiderable benefit of an integrated prevention/quality management system is that having such a well-documented program in place is likely to reduce the costs of coverage, not only for workers’ compensation, but also for product liability.

Company Management

Company management must be committed to the integration of occupational health and safety into the management system. Goals specifying the content and time-frame of this effort should be defined and included in the basic statement of company policy. The necessary resources should be made available and appropriate personnel assigned to accomplish the project goals. Specialized safety personnel are generally required in large and mid-sized construction companies. In smaller companies, the employer must take the responsibility for the preventive aspects of the quality management system.

A periodic company management review closes the circle. The collective experiences in utilizing the integrated prevention/ quality management system should be examined and assessed, and plans for revision and for subsequent review should be formulated by company management.

Assessing Results

Assessment of results of the occupational safety management system that has been instituted is the second step in the integration of preventive measures and quality management.

The dates, kinds, frequency, causes and costs of accidents should be compiled, analyzed and shared with all those in the company with relevant responsibilities. Such an analysis enables the company to set priorities in formulating or modifying process and work instructions. It also makes clear the extent to which occupational health and safety experience affects all divisions and all processes in the construction company. For this reason, defining the interface between company processes and preventive aspects takes on great importance. During bid preparation, the resources in time and money needed for comprehensive preventive measures, such as those incurred in clearing debris, can be precisely calculated.

When purchasing construction materials, attention should be paid to the availability of substitutes for potentially dangerous materials. From the beginning of a project responsibility for occupational health and safety should be assigned for particular aspects and each phase of the construction project. The need and availability for special training in occupational health and safety as well as the relative risks of injury and disease should be compelling considerations in the adoption of particular construction processes. These conditions must be recognized early on so that appropriately qualified workers can be selected and the courses of instruction can be arranged in a timely manner.

The responsibilities and authorities of the personnel assigned to safety and how they fit into the daily work should be documented in writing and collated with the onsite task descriptions. The construction company’s occupational safety staff should appear shown in its organizational chart, which, along with a clear responsibility matrix and schematic flowcharts of processes, should appear in the quality management handbook.

An Example from Germany

In practice, there are four formal procedures and their combinations for integrating occupational health and safety into a quality management system that have been implemented in Germany:

1. A quality management handbook and a separate occupational safety management handbook are developed. Each has its own procedures and work instructions. In extreme cases, this creates ineffective, insular organizational solutions, which require twice the amount of work and in practice do not accomplish the desired results.
2. An additional section is inserted into the quality management handbook with the heading “Occupational health and safety”. All statements on occupational health and safety are organized in this section. This path is chosen by some construction companies. Positioning a health and safety problem in a separate section may well highlight the importance of prevention, but it entails the risk being ignored as a “fifth wheel” and serves more as an evidence of intent rather than a command for appropriate action.
3. All aspects of occupational health and safety are worked directly into the quality management system. This is the most systematic implementation of the basic idea of integration. The integrated and flexible structuring of the presentation models of the German DIN EN ISO 9001-9003 permits such an inclusion.
4. The Underground Construction Trade Organization (Berufs-genossenschaft) favors a modular integration. This concept is explained below.

Major Sectors

Jeffrey Hinksman, Health and Safety Consultant

The term construction industry is used worldwide to cover what is a collection of industries with very different practices, brought together temporarily on the site of a building or civil engineering job. The scale of operations ranges from a single worker carrying out a job lasting minutes only (e.g., replacing a roof tile with equipment consisting of a hammer and nails and possibly a ladder) to vast building and civil engineering projects lasting many years that involve hundreds of different contractors, each with their own expertise, plant and equipment. However, despite the enormous variation in scale and complexity of operations, the major sectors of the construction industry have a great deal in common. There is always a client (known sometimes as the owner) and a contractor; except for the very smallest jobs, there will be a designer, either an architect or engineer, and if the project involves a range of skills, it will inevitably require additional contractors working as subcontractors to the main contractor (see also the article “Organizational factors affecting health and safety” [CCE05AE] in this chapter). While small-scale domestic or agricultural buildings may be built on the basis of an informal agreement between the client and builder, the vast majority of building and civil engineering work will be carried out under the terms of a formal contract between the client and contractor. This contract will set out details of the structure or other work that the contractor is to provide, the date by which it is to be built and the price. Contracts may contain a great deal besides the job, the time and the price, but those are the essentials.

The two broad categories of construction projects are building and civil engineering. Building applies to projects involving houses, offices, shops, factories, schools, hospitals, power and railway stations, churches and so on—all those kinds of structures that in everyday speech we describe as “buildings”. Civil engineering applies to all the other built structures in our environment, including roads, tunnels, bridges, railways, dams, canals and docks. There are structures that appear to fall into both categories; an airport involves extensive buildings as well as civil engineering in the creation of the airfield proper; a dock may involve warehouse buildings as well excavation of the dock and raising of the dock walls.

Whatever the type of structure, building and civil engineering both involve certain processes such as building or erection of the structure, its commissioning, maintenance, repair, alteration and ultimately its demolition. This cycle of processes occurs regardless of the type of structure.

Small Contractors and the Self-employed

While there are variations from country to country, construction is typically an industry of small employers. As many as 70 to 80% of contractors employ less than 20 workers. This is because many contractors start out as a single tradesperson working alone on small-scale jobs, probably domestic ones. As their business expands, such tradespeople start to employ a few workers themselves. The workload in construction is rarely consistent or predictable, as some jobs finish and others start up at different times. There is a need in the industry to be able to move groups of workers with particular skills from job to job as the work requires. Small contractors fulfill this role.

Alongside the small contractors there is a population of self-employed workers. Like agriculture, construction has a very high proportion of self-employed workers. These again are usually tradespeople, such as carpenters, painters, electricians, plumbers and bricklayers. They are able to find a place in either small-scale domestic work or as part of the workforce on bigger jobs. In the boom construction period of the late 1980s, there was an increase in workers claiming to be self-employed. This was partly because of tax incentives for the individuals concerned and use by contractors of so-called self-employed who were cheaper than employees. Contractors were not faced with the same level of social security costs, were not required to train self-employed persons and could get rid of them more easily at the end of jobs.

The presence in construction of so many small contractors and self-employed individuals tends to militate against effective management of health and safety for the job as a whole and, with such a transitory workforce, certainly makes it more difficult to provide proper safety training. Analysis of fatal accidents in the United Kingdom over a 3-year period showed that about half the fatal accidents happened to workers who had been onsite for a week or less. The first few days on any site are especially hazardous to construction workers because, however experienced they may be as tradespeople, each site is a unique experience.

Public and Private Sectors

Contractors may be part of the public sector (e.g., the works department of a city or district council) or they are part of the private sector. A considerable amount of maintenance used to be done by such public works departments, especially on housing, schools and roads. Recently there has been a move to encourage greater competition in such work, partly as a result of pressures for better value for money. This has led firstly to a reduction in the size of public works departments, even their total disappearance in some places, and to the introduction of mandatory competitive tendering. Jobs previously done by public works departments are now done by private-sector contractors under severe “lowest tender wins” conditions. In their need to cut costs, contractors may be tempted to reduce what are seen as overheads such as safety and training.

The distinction between public and private sectors may also apply to clients. Central and local government (along with transportation and public utilities if under the control of central or local government) may all be clients for construction. As such they would generally be thought to be in the public sector. Transportation and utilities run by corporations would usually be considered to be in the private sector. Whether a client is in the public sector sometimes influences attitudes towards inclusion of some items of safety or training in the cost of construction work. Recently public- and private-sector clients have been under similar constraints as regards competitive tendering.

Work across National Boundaries

An aspect of public-sector contracts of increasing importance is the need for tenders to be invited from beyond national boundaries. In the European Union, for example, large-scale contracts beyond a value set out in Directives, must be advertised within the Union so that contractors from all member countries may tender. The effect of this is to encourage contractors to work across national boundaries. They are then required to work in accordance with the local national health and safety laws. One of the aims of the European Union is to harmonize standards between member states in health and safety laws and their application. Major contractors working in parts of the world subject to similar regimes must therefore be familiar with health and safety standards in those countries where they carry out work.

Designers

In buildings, the designer is usually an architect, although on small-scale domestic housing, contractors sometime provide such design expertise as is necessary. If the building is large or complex, there may be architects dealing with design of the overall scheme as well as structural engineers concerned with design of, for example, the frame, and specialist engineers involved with design of the services. The architect for the building will ensure that sufficient space is provided in the right places in the structure to permit installation of plant and services. Specialist designers will be concerned to ensure that the plant and services are designed to operate to the required standard when installed in the structure in the places provided by the architect.

In civil engineering, the lead in design is more likely to be taken by a civil or structural engineer, although in high-profile jobs where visual impact may be an important factor, an architect may have an important role in the design team. In tunneling, railways and highways, the lead in design is likely to be taken by structural or civil engineers.

The role of the developer is to seek to improve the utilization of land or buildings and profit from that improvement. Some developers simply sell the improved land or buildings and have no further interest; others may retain ownership of land or even buildings and reap a continuing interest in the form of rents that are greater than before the improvements.

The skill of the developer is to identify sites either as empty land or underutilized and out-of-date buildings where application of construction skills will improve their value. The developer may use his or her own finances, but perhaps more often exercises further skills in identifying and bringing together other sources of finance. Developers are not a modern phenomenon; the expansion of cities over the last 200 years owes a great deal to developers. Developers may themselves be clients for the construction work, or they may simply act as agents for other parties who provide finance.

Types of Contract

In the traditional contract, the client arranges for a designer to prepare a full design and specifications. Contractors are then invited by the client to tender or bid for doing the job in accordance with the design. The role of the contractor is largely confined to construction proper. The contractor’s involvement in questions of design or specification is then mainly a matter of seeking such changes as will make it easier or more efficient to build—to improve “buildability”.

The other common arrangement in construction is the design and build contract. The client requires a building (perhaps an office block or shopping development) but has no firm ideas on detailed aspects of its design other than the size of site, number of persons to be accommodated or scale of activities to be carried out in it. The client then invites tenders from either designers or contractors to submit both design and construction proposals. Contractors working in design and build either have their own design organization or have close links with an external designer who will work for them on the job. Design and build may involve two stages in design: an initial stage where a designer prepares an outline scheme which is then put out to tender; and a second stage where the successful design and build contractor will then carry out further design on detailed aspects of the job.

Maintenance and emergency contracts cover a wide variety of arrangements between clients and contractors and represent a significant proportion of the work of the construction industry. They generally run for a fixed period, require the contractor to do certain types of work or to work on a “call-off” basis (i.e., work that the client calls the contractor in to do). Emergency contracts are widely used by public authorities who are responsible for providing a public service that ought not to be interrupted; government agencies, public utilities and transportation systems make wide use of them. Operators of factories, particularly those with continuous processes such as petrochemicals, also make wide use of emergency contracts to deal with problems in their facilities. Having entered such a contract, the contractor undertakes to make available suitable workers and plant to carry out the work, often at very short notice (e.g., in the case of emergency contracts). The advantage to the client is that he or she does not need to retain workers on payroll or have plant and equipment that may only occasionally be used to deal with maintenance and emergencies.

Pricing of maintenance and emergency contracts may be on the basis of a fixed sum per annum, or on the basis of time spent carrying out work, or some combination.

Perhaps the most common publicly known example of such contractors is maintenance of roads and emergency repairs to gas main or power supplies that have either failed or been accidentally damaged.

Whatever the form of contract, the same possibilities arise for clients and designers to influence the health and safety of contractors by decisions made in the early stage of the job. Design and build perhaps permits closer liaison between the designer and contractor on health and safety.

Price

Price is always an element in a contract. It may simply be a single sum for the cost of doing the job, such as building a house. Even with a single lump sum, the client may have to pay part of the price in advance of the job starting, to enable the contractor to buy materials. The price may, however, be on a cost-plus basis, where the contractor is to recover his or her costs plus an agreed amount or percentage for profit. This arrangement tends to work to the disadvantage of the client, since there is no incentive for the contractor to keep costs down. The price may also have bonuses and penalties attached to it, so that the contractor will receive more money if, for example, the job is completed earlier than the agreed time. Whatever form the price takes for the job, it is usual for payments to be made in stages as the work progresses, either on completion of certain parts of the job by agreed dates or on the basis of some agreed method of measuring the work. At the end of construction proper, it is common for an agreed proportion of the price to be kept back by the clients until “snags” have been put right or the structure has been commissioned.

During the course of the job, the contractor may encounter problems that were not foreseen when the contract was made with the client. These might require changes to the design, the construction method or the materials. Usually such changes will create extra costs for the contractor, who then seeks to recover from the client on the basis that these items become agreed “variations” from the original contract. Sometimes recovery of the cost of variations can make the difference for the contractor between doing the job at a profit or loss.

The pricing of contracts can affect health and safety if inadequate provision is made in the contractor’s tender to cover the costs of providing safe access, lifting equipment and so on. This becomes even more difficult where, in an attempt to ensure that they obtain value for money from contractors, clients pursue a vigorous policy of competitive tendering. Governments and local authorities apply policies of competitive tendering to their own contracts, and indeed there may be laws requiring that contracts can be awarded only on the basis of competitive tendering. In such a climate, there is always a risk that the health and safety of construction workers will suffer. In cutting costs, clients may resist a reduction in the standard of construction materials and methods, but at the same time be totally unaware that in accepting the lowest tender, they have accepted working methods that are more likely to endanger construction workers. Even in a situation of competitive tendering, contractors submitting tenders should have to make clear to the client that their bid adequately covers the cost of health and safety involved in their proposals.

Developers can influence health and safety in construction in ways similar to clients, firstly by using contractors who are competent in health and safety and architects who take health and safety into account in their designs, and secondly in not automatically accepting the lowest tenders. Developers generally want to be associated only with successful developments, and one measure of success ought to be projects where there are no major health and safety problems during the construction process

Building Standards and Planning

In the case of buildings, whether housing, commercial or industrial, projects are subject to planning laws that dictate where certain types of development may take place (e.g., that a factory may not be built among houses). Planning laws may be very specific about the appearance, materials and size of buildings. Typically areas identified as industrial zones are the only places where factory buildings may be erected.

Often there are also building regulations or similar standards that specify in precise detail many aspects of the design and specification of buildings—for example, the thickness of walls and timbers, depth of foundations, insulation characteristics, size of windows and rooms, layout of electrical wiring and earthing, layout of plumbing and pipework and many other issues. These standards have to be followed by clients, designers, specifiers and contractors. They limit their choices but at the same time ensure that buildings are built to an acceptable standard. Planning laws and building regulations thus affect the design of buildings and their cost.

Housing

Projects to build housing may consist of a single house or vast estates of individual houses or flats. The client may be each individual householder, who will then normally be responsible for maintenance of his or her own house. The contractor will usually remain responsible for correcting defects in construction for a period of months after building is finished. However, if the project is for many houses, the client may be a public body, either in local or national government, with responsibility for providing housing. There are also large private bodies like housing associations for whom numbers of houses may be built. Public or private bodies with responsibilities for providing housing generally rent the finished houses to occupants, retaining a greater or lesser degree of responsibility for maintenance also. Building projects involving blocks of flats usually have a client for the block as a whole, who then lets out individual flats under a leasing arrangement. In this situation the owner of the block has responsibility for carrying out maintenance but passes on the cost to the tenants. In some countries ownership of individual flats in a block can rest with the occupants of each flat. There has to be some arrangement, sometimes through an estate management contractor, whereby maintenance can be carried out and the necessary costs raised among the occupants.

Often houses are built on a speculative basis, by a developer. Specific clients or occupants of those houses may not have been identified at the outset but come on the scene after construction has begun and purchase or rent the property like any other article. Houses are usually fitted out with electrical, plumbing and drainage services and heating systems; a gas supply may also be laid on. Sometimes in an attempt to cut costs, houses are only partially finished, leaving it to the purchaser to install some of the fittings and to paint or decorate the building.

Commercial Buildings

Commercial buildings include offices, factories, schools, hospitals, shops—an almost endless list of different types of buildings. In most cases these buildings are constructed for a particular client. However, offices and shops are often built on a speculative basis like housing, with the hope of attracting buyers or tenants. Some clients require an office or shop to be totally fitted out to their requirements, but very often the contract is for the structure and main services, with the client making arrangements to fit out the premises using specialist contractors in office and shop fitting.

Hospitals and schools are built for clients who have a clear idea of precisely what they want, and the clients often provide design input into the project. Plant and equipment in hospitals may cost more than the structure and involve a great deal of design that has to satisfy stringent medical standards. National or local government may also play a part in the design of schools by laying down very detailed requirements on space standards and equipment as part of its wider role in education. National governments usually have very detailed standards as to what is acceptable in hospital buildings and plant. Fitting out of hospitals and similarly complex buildings is a form of construction work usually carried out by specialist subcontractors. Such contractors not only require knowledge of health and safety in construction in general, but also need expertise in ensuring that their operations do not adversely affect the hospital’s own activities.

Industrial Construction

Industrial building or construction involves use of the mass- production techniques of manufacturing industry to produce parts of buildings. The ultimate example is the house brick, but normally the expression is applied to building using concrete parts or units that are assembled onsite. Industrial construction expanded rapidly after the Second World War to meet the demand for cheap housing, and it is more commonly found in mass housing developments. Under factory conditions it is possible to mass produce cast units that are consistently accurate in a way that would be virtually impossible under normal site conditions.

Sometimes units for industrial construction are manufactured away from the construction site in factories that may supply a wide area; sometimes, where the individual development is itself very large, a factory is set up onsite to serve that sole site.

Units designed for industrial construction must be structurally strong enough to stand up to being moved, lifted and lowered; they must incorporate anchorage points, or slots to permit safe attachment of lifting tackle, and must also include appropriate lugs or recesses to permit the units to fit together both easily and strongly. Industrial construction demands plant for transporting and lifting units into position and space and arrangements to store units safely when delivered to site, so that units are not damaged and workers are not injured. This technique of building tends to produce visually unattractive buildings, but on a large scale it is cheap; a whole room can be assembled from six cast units with window and door openings in place.

Similar techniques are used to produce concrete units for civil engineering structures like elevated motorways and tunnel linings.

Turn-key Projects

Some clients for industrial or commercial buildings containing extensive complex plant wish simply to walk into a facility that will be up and running from their first day in the premises. Laboratories are sometimes constructed and fitted out on this basis. Such an arrangement is a “turnkey” project, and here the contractor will ensure that all aspects of plant and services are fully operational before handing the project over. The job may be done under a design and build contract so that, in effect, the turnkey contractor deals with everything from design to commissioning.

Civil Engineering and Heavy Construction

The civil engineering of which the public is most aware is work on highways. Some highway work is the creation of new roads on virgin land, but much of it is the extension and repair of existing highways. Contracts for highway work are usually for state or local government agencies, but sometimes roads remain under the control of contractors for some years after completion, during which time they are permitted to charge tolls. If civil engineering structures are being financed by government, then both the design and actual construction will be subject to a high degree of supervision by officials on behalf of government. Contracts for construction of highways are usually let to contractors on the basis of a contractor being responsible for a section of so many kilometers of the highway. There will be a main contractor for each section; but highway construction involves a number of skills, and aspects of the job such as steel work, concrete, shuttering and surfacing may be subcontracted by the main contractor to specialist firms. Highway construction is also sometimes carried out under management contract arrangements, where a civil engineering consultancy will provide management for the job, with all the work being done by subcontractors. Such a management contractor may also have been involved in design of the highway.

Construction of highways requires the creation of a surface whose gradients are suitable for the sort of traffic that will use it. In a generally level terrain, creation of the foundation of the highway may involve earthmoving—that is, shifting soil from cuttings to create embankments, building bridges across rivers and drivi