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Burden, Need and Impact

man climbing a ladder

There  were approximately 9.94 million workers in Construction in 2015. Although only 6.7% of the workforce, this sector accounted for 20.4% of the fatalities for U.S. workers. It also had approximately 212,700 occupational injuries and illnesses, 5.9% of the total. Although injuries and illnesses are challenging to track and are frequently undercounted, this is the best estimate available at this time.

NIOSH strives to maximize its impact in occupational safety and health. The Construction Program identifies priorities to guide investments, and base those priorities on the evidence of burden, need and impact. Priority areas for NIOSH’s Construction Program include traumatic injuries (i.e. from falls), musculoskeletal disorders, hearing loss, respiratory exposures, non-standard work arrangements, robotics, automation and exoskeletons. Workers in the construction industry face a number of hazards, which are well-documented by the NIOSH Worker Health Charts and the NIOSH-funded National Construction Center, CPWR—The Center for Construction Research and Training in The Construction Chart Book, 5th edition.

Traumatic Injuries


Falls are the leading cause of fatalities in construction. In 2015, almost six times as many fatal falls occurred in construction compared to manufacturing, the industry with the second highest number.1 Examining 1,533 fatal falls in construction between 2011 and 2015, approximately 33% were falls from roofs, 24% were falls from ladders, and 15% were falls from scaffolding.1 Fatal and non-fatal falls in construction result in heavy economic burdens on workers, families, employers, and society. Even when workers survive, many have traumatic brain or other injuries requiring lengthy rehabilitation, placing substantial emotional, medical, and financial burdens on their families. Falls also result in significant costs to employers, including lost productivity, loss of skilled workers, and increased workers’ compensation costs.2

Construction workers are at high risk of traumatic injuries because of inherently hazardous tasks and dynamic conditions of construction sites. With recent advances in automation and robotics, novel construction approaches are being developed with the potential to reduce occupational injury risks. New and emerging types of robots (e.g., collaborative robots, aerial robots) are becoming more available, and beginning to be more widely used in the construction industry to assist workers in handling hazardous tasks that have been performed traditionally by human workers. Predicted growth of robotics in the construction industry can create new hazards to human workers who work in close proximity to or interact with these emerging technologies. This challenge can be particularly significant because of the characteristics of most construction projects: ever-changing work environments, the need for multiple skilled craftsmen, multiple employers sharing a common worksite, and the interactions of multiple pieces of automated equipment.

Sustainable construction or “green construction” is growing at a rapid rate. Jobs in green construction grew by 27.1% between 2010 and 2011, more than six times the growth rate for all industries combined (4.5%).3 Many safety professionals feel that hazards are inadvertently a part of construction projects, but could be eliminated with more focused Prevention through Design (PtD) efforts.4,5 PtD principles seek to eliminate hazards and controlling risks to workers “at the source” or as early as possible in the life cycle of items or workplaces.


Intervention and translation research addressing engineering and design, education and training, communication, and administrative issues is needed to address falls in construction and achieve meaningful results. Research to reduce falls among higher risk groups is especially needed, along with research to understand and evaluate the safety, productivity, and latent hazards of emerging work methods and technologies (e.g., advanced fall prevention and protection technologies, height access devices, drones, automation, and robots). Many causes of falls on the same level or slips, trips, and falls (STFs) are unique to construction, easily observable, and should be addressed through research.

Basic and etiologic research are needed to expand our understanding of applications of robotics and automation technologies in the construction industry and associated injury risks. Due to the rapid growth in these technologies, limited safety research addresses the efficacy and safety of collaborative robots, mobile robots, and aerial robots in construction environments. There is also an urgent need to expand occupational injury surveillance capabilities to better identify, monitor, and quantify the burden of fatal and nonfatal injury incidents involving the robotics and automation technologies in the construction industry. For instance, new source or event codes for automation and robot-related incidents need to be developed for effective surveillance.

Integrating occupational health and safety into the design of buildings helps keep workers in construction and maintenance, building occupants and demolition specialists safe and healthy. The NIOSH Construction and Prevention through Design (PtD) programs are collaborating on efforts to increase the use of building designs and construction practices that address safety and health hazards during all the stages of a building: pre-design; design; construction; occupancy and maintenance; and demolition. Additional work in this area is needed to continue the momentum that NIOSH has built, and the prospects for reducing construction illnesses and injuries using this approach are great.


The National Campaign to Prevent Falls in Construction encourages everyone in the construction industry to work safely and use the right equipment to reduce falls, especially those from roofs, ladders and scaffolds. Launched in April 2012, the Campaign grew out of multi-stakeholder discussions in the NORA Construction Sector Council, a public-private partnership co-led by NIOSH. The signature event of the Campaign is the annual National Safety Stand-Down, where companies stop work in order to give a toolbox talk on fall prevention. Over one million construction workers were reached through the National Safety Stand-Down in 2015.

NIOSH developed and saw the adoption of a pilot credit for Leadership in Energy & Environmental Design (LEED) building certification by the U.S. Green Building Council (USGBC). The pilot credit promotes the use of prevention through design (PtD) methods to design-out worker hazards during construction and subsequent building operations and maintenance. Two webinars describing the PtD pilot credit are available to LEED users through the USGBC’s website.

  1. CPWR [2017]. Quarterly data report. Fall injuries and prevention in the construction industry. Silver Spring, MD: CPWR- the Center for Construction Research and Training,
  2. OSHA [2012] Workers’ compensation costs of falls in construction. Washington, DC: U.S. Department of Labor, Occupational Safety and Health Administration,
  3. CPWR Data Center. (2014). CPWR Data Brief: Green Construction Update. Silver Spring, MD: CPWR – The Center for Construction Research and Training,
  4. Schulte PA, Rinehart R, Okun A, Geraci C, Heidel DS [2008]. National Prevention through Design (PtD) initiative. J Saf Res 39(2):115-121
  5. Toole TM, Gambatese J [2008]. The trajectories of Prevention through Design in c J Saf Res 39(2):225-230

Hearing Loss


Within the construction sector, 44% of workers are exposed to hazardous noise and about 31% of these noise-exposed workers report not wearing hearing protection.1 Thirteen percent of all construction workers have hearing difficulty and 7% have tinnitus.2 However, among noise-exposed construction workers, twenty-five percent have a material hearing impairment (average hearing threshold levels above 25 dB for 1, 2, 3, & 4 kHz) in at least one ear3 and 16% have hearing impairment in both ears.2 Hearing impairment is hearing loss that impacts day-to-day activities. Almost three-quarters (73%) of construction workers measured in a longitudinal study between (1999-2009) were exposed daily to full-shift, noise levels above the NIOSH recommended exposure level (REL) of 85 dBA.4 Many construction workers are also exposed to impulse or impact noise. Noise exposures are caused by a wide range of sources, including hand tools, larger machinery, heavy equipment, and generators.


Noise control engineering solutions are the most effective methods to reduce noise exposures and to assure the exposure levels stay below the NIOSH REL of 85 dB(A). Noise controls need to be developed and evaluated in the laboratory, followed by work with manufacturers to evaluate the feasibility of the noise control solutions through field studies. Noise hazards posed by power tools and heavy equipment in construction need to be controlled at the source. There is also a need to develop quieter powered hand tools. Researchers should continue to promote and develop “Buy Quiet” approaches that address supply and demand, in addition to development of databases of tools and the noise levels produced when operated. Noise labeling with the level of noise produced by equipment or use of Safety Data Sheets documenting the hazardous noise and the means to protect against it is also helpful. Areas in need of research include reducing impulsive noise generated by pneumatic tools and continued expansion of the ability to assess and control noise in construction.


Buy Quiet programs can play an important role in protecting workers from these dangerous noise levels. In addition to reducing the risk of hearing loss at the worksite, Buy Quiet programs help minimize the impact of noise on communities and help companies comply with OSHA and other noise regulation requirements. Buy Quiet may also reduce the long-term costs of audiometric testing, personal protective equipment, and workers’ compensation. NIOSH has led efforts to promote Buy Quiet, such as developing a NIOSH Power Tools Database to make noise data available to tool buyers, users, and manufacturers of powered hand tools. This area targets the top of the hierarchy of controls and is likely to have significant impact in reducing noise induced hearing loss.

  1. Tak S, Davis RR, Calvert GM [2009]. Exposure to hazardous workplace noise and use of hearing protection devices among US workers — NHANES, 1999-2004. Am J Ind Med 52(5):358-371.
  2. Masterson EA, Themann CL, Luckhaupt SE, Li J, Calvert GM [2016]. Hearing difficulty and tinnitus among U.S. workers and non-workers in 2007. Am J Ind Med 59:290-300.
  3. Masterson EA, Deddens JA, Themann CL, Bertke S, Calvert GM [2015]. Trends in worker hearing loss by industry sector, 1981-2010. Am J Ind Med 58:392-401.
  4. CPWR (The Center for Construction Research and Training) [2010]. The construction chart book. Silver Spring, MD: The Center for Construction Research and Training,

Musculoskeletal Disorders


Musculoskeletal disorders (MSDs) are common among construction workers due to the nature of the work, which is physically demanding [Schneider et al. 1998]. In 2014, “sprains and strains” represented 27.3% of all construction injuries and illnesses1,2 while another 17.3% of injuries and illnesses were from “soreness, pain,” related to MSDs. Lifetime risk of “overexertion” injuries in construction is about 21%, so more than 1 in 5 construction workers might be expected to get an overexertion injury during their career.3 Some of the trades that have elevated rates of overexertion injuries include masonry, concrete, drywall, plumbing, and flooring among others.4 Back injuries are another concern among construction workers. In 2010, the rate of back injuries among construction workers was 24.5 per 10,000 FTEs compared to 21.4 for all industries combined.4 Construction trades with the highest rates of back injuries include masonry, roofing, drywall, plumbing, and glass and glazing. Many of these workers have an elevated or disproportionate risk including Hispanic workers, foreign-born workers, workers in small businesses, contingent workers, and older (55 and over) workers.4


Prevention of work-related Musculoskeletal disorders (MSDs) has been a major focus of NIOSH research for many years, especially ergonomic interventions.4,5 Ergonomic interventions often pay for themselves by improving productivity as well as reducing injuries.6 MSDs are a primary cause of occupational injuries and represent the largest portion of workers compensation costs. However, contractors may not understand the return on investment that comes from making ergonomics changes. Research is needed effectively transfer knowledge and intervention into workplace practices.

With changes in technology, novel approaches to risk reduction are being developed. For example, robotics, automation, and exoskeletons (or human augmentation devices) can be used to improve safety and reduce MSD risk factors that can cause back injuries, strains, and sprains. These devices are rapidly appearing in the workplace despite limited research on their effectiveness in reducing MSDs. When new technologies enter the workplace, their impact needs to be studied. Research is needed to identify the costs and benefits of the intervention (including any productivity gains).


NIOSH has played a leading role in defining and attempting to reduce ergonomic risks to workers for decades.  The 1981 NIOSH Work Practices Guide for Manual Lifting (WPG) and the documentation for the revised lifting equations are both intended to address back injuries and were two significant early contributions to this effort.

More recently, NIOSH has published two documents that provide easy to understand information about simple and readily available work practices and equipment to prevent injuries: Simple Solutions for Home Building Workers: A Basic Guide for Preventing Manual Material Handling Injuries and Simple Solutions: Ergonomics for Construction Workers. NIOSH maintains effective partnerships with key stakeholders who have adopted and disseminated previous research outputs. Members of the NORA Construction Sector Council have helped to disseminate NIOSH research throughout the industry.

  1. BLS [2016a]. TABLE R1. Number of nonfatal occupational injuries and illnesses involving days away from work by industry and selected natures of injury or illness, private industry, 2014. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics,
  2. BLS [2016b]. TABLE R113. Percent distribution of nonfatal occupational injuries and illnesses involving days away from work by industry and selected natures of injury or illness, private industry, 2014. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics,
  3. Dong X, Ringen K, Welch L, Dement J. [2014]. Risks of a lifetime in construction, part I: traumatic injuries. Am J of Ind Med 57(9):973-83. doi: 10.1002/ajim.22363. Epub 2014 Jul 24
  4. CPWR [2013]. The Construction Chartbook. Fifth Ed. Silver Spring, MD: CPWR- the Center for Construction Research and Training,
  5. NIOSH [2007]. Simple Solutions: Ergonomics for Construction Workers. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2007–122,
  6. Hendricks H [1996]. Good ergonomics is good economics,

Respiratory Exposures


Many construction tasks generate complex airborne hazards. Exposure to mineral dusts occurs during many different construction activities, notably abrasive blasting, jack hammering, rock or well drilling, concrete drilling, tuck-pointing, cement finishing, brick and concrete block cutting and sawing, excavating, and highway work. A 2010 study revealed that over 50% of construction workers reported occupational exposure to vapors, gas, dust, or fumes at least twice a week, which was twice as likely as workers from all industries.1 These activities and subsequent exposures can result in respiratory diseases (e.g., silicosis, asbestosis, chronic obstructive pulmonary disease [COPD], and lung cancer), and reduce a worker’s length and quality of life. Mixed exposures of particular current concern are welding fumes, those associated with abrasive blasting and those associated with the use of emerging advanced materials such as nanomaterials. Construction workers continue to be exposed from previously-installed asbestos containing materials in old buildings that is disturbed by renovation or demolition. An emerging issue potentially affecting construction workers is exposure to noncommercial elongate mineral particles (EMPs) with potential for asbestos-like health effects. These materials can be encountered by disturbing natural deposits during construction activities, or by using materials such as crushed stone products contaminated with EMPs.2


Workers and contractors need to recognize the hazards posed by complex airborne exposures, understand the risk factors, and take appropriate precautions. The research needed varies by agent and exposure. There is a need for basic/etiologic research to identify potential health hazards of new and emerging agents (such as nanomaterials, advanced manufacturing materials, and abrasive blasting agents); and improve understanding of dose-response relationships and use that information to better determine how much of a reduction in exposure is needed to prevent adverse health effects from these fibers. Surveillance research is needed to develop novel approaches for health and hazard surveillance that will improve the ability to track the burden of work-related illnesses. Intervention research is needed to improve the existence and performance of control technologies (engineering controls, personal protective equipment [PPE], etc.). There is also a need to evaluate the effectiveness of interventions.


As a member of the Silica/Asphalt Milling Machine Partnership, the Construction Program contributed to the groundbreaking Best Practice Engineering Control Guidelines to Control Worker Exposure to Respirable Silica during Asphalt Paving Milling. It was the culmination of more than ten years of collaborative research by labor, industry, and government to reduce respirable crystalline silica exposure during asphalt pavement milling in highway construction. Members of the Partnership have formally agreed to begun installing NIOSH-recommended silica dust controls on all new half-lane and larger cold-milling machines by as of January 2017. Two milling machine manufacturers with 80% of the U.S. market began putting controls on new milling machines in 2014, nearly three years ahead of the agreed-upon deadline. Additionally, NIOSH has published a range of document with information and recommendations to reduce hazardous respiratory exposures based on its research, such as a NIOSH/OSHA alert on exposure to silica during countertop manufacturing, finishing and installation.

  1. CPWR [2013]. The construction chartbook. Fifth Ed. Silver Spring, MD: CPWR- the Center for Construction Research and Training.
  2. NIOSH [2011]. Asbestos fibers and other elongate mineral particles: state of the science and roadmap for research [Revised April 2011]. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2011-159,

Non-Standard Work Arrangements


During the last recession, the construction sector saw a 23% decrease in the number of construction workers.1 Many of the workers displaced during the recession are not returning to construction, and an influx of new workers is entering the sector. In 2013, about 1.3 million temporary workers were employed in construction, accounting for nearly 14% of the construction workforce.2 A growing number of these new entrants have non-standard work arrangements and are new immigrants, or contingent workers. This means that they may belong to one or more groups of workers at disproportionate risk for occupational injury or illness. The construction sector has one of the highest shares of workers in non-standard arrangements.3


Non-standard work arrangements are understudied but increasingly prevalent, and their determinants and health and safety consequences are poorly understood. Surveillance research is needed to better characterize and track risk factors for construction workers in non-standard work arrangements, as well as the burden suffered by the workers and their families, employers, and society. Translation research is needed to identify and disseminate barriers and aids to implementation of proven effective interventions to reduce health and safety hazards for workers in non-standard work arrangements. Intervention research is needed to evaluate the determinants and consequences of existing and new work arrangements.


Many temporary workers in construction are employed through staffing agencies. These workers have two employers—a staffing company and a host employer— so there is sometimes confusion regarding which aspects of health and safety each employer has responsibility. To help address this, NIOSH and OSHA released Protecting Temporary Workers, a document of recommended practices. The Construction Program will continue to develop recommendations to help reduce injuries and illnesses among workers in non-standard work arrangements.

  1. CPWR [2013]. The construction chartbook. Fifth Ed. Silver Spring, MD: CPWR- the Center for Construction Research and Training.
  2. CPWR [2015]. Quarterly data report: temporary workers in the construction industry. Second Quarter. Silver Spring, MD: CPWR- the Center for Construction Research and Training.
  3. Katz LF, Krueger AB [2016]. The rise and nature of alternative work arrangements in the United States, 1995-2015. Washington D.C.: National Bureau of Economic Research No. w22667.