Burden, Need and Impact

There were approximately 74.8 million workers in Services in 2017 (48.8% of the workforce).1 In 2016, this sector accounted for 1,459 fatal occupational injuries, 28.1% of the fatalities for all U.S. workers.2 It also had approximately 1.26 million occupational injuries and illnesses, 37.7% of the total.3 Although injuries and illnesses are challenging to track and are frequently undercounted, this is the best estimate available at this time.4

NIOSH strives to maximize its impact in occupational safety and health. The Services Program identifies priorities to guide investments, and base those priorities on the evidence of burden, need and impact. Below are three of the priority areas for the Services Program.


Hearing loss is the one of the most common chronic physical conditions in the United States1 and approximately 11% of the U.S. working population has hearing difficulty2. About 19% of noise-exposed tested workers have a material hearing impairment that affects day-to-day activities. Hearing impairment is hearing loss that impacts day-to-day activities3. Occupational hearing loss is the one of the most common U.S. work-related illnesses4 as about 22 million (17%) of workers in the United States are exposed to hazardous noise each year5.

Approximately 6-45% of all workers in Services are exposed to hazardous noise, depending on sub-sector5. Most sub-sectors have fewer than 13% exposed, except: Repair and Maintenance (45%); and Arts, Entertainment, and Recreation (22%). Furthermore, about 22-56% of noise-exposed Services workers report not wearing hearing protection, depending on sub-sector. The sub-sectors with the most workers exposed include the following: Educational Services (56%); Finance, Insurance and Real Estate (54%); and Repair and Maintenance (43%)5.

For the most up-to-date statistics focusing on the Services Sector, please visit the Occupational Hearing Loss (OHL) Surveillance page.


Many of the workers in the Services Sector do not wear hearing protection although workers in similar jobs in Construction and Manufacturing are routinely required to do so. Research and outreach are needed to inform companies, workers, and associations about methods to reduce noise exposures in these industries.


The noise controls developed in other sectors (Manufacturing and Construction), have direct application to workers in similar occupations in the Services Sector. NIOSH can apply known effective noise control methods in the Services Sector. NIOSH can develop specific educational materials for the Services Sector such as Workplace Solutions, and NIOSH Hazard Alerts where necessary.

  1. Blackwell DL, Lucas JW, Clarke TC [2014]. Summary health statistics for U.S. adults: National Health Interview Survey, 2012. Hyattsville, MD: Centers for Disease Control and prevention, National Center for Health Statistics. Vital Health Stat 10(260). DHHS Publication No. 2014-1588.
  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(4):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(4):392-401.
  4. Themann CL, Suter AH, Stephenson MR [2013]. National research agenda for the prevention of occupational hearing loss—part 1. Semin Hear 34(3):145–207.
  5. 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.


The restaurant industry employs 6.1% of the nation’s workforce and is among the most burdened by slip, trip and fall injuries. Specifically, in the Food Service and Drinking Places subsector, 13% of the fatalities in 2016 were due to slips, trips, and falls1. Services consists of a large number of small businesses that are recognized as having fewer human and capital resources available to devote to the prevention of workplace illnesses, injuries, and fatalities.


Fast-paced work, liquids on floors, other debris, and tight working conditions are risk factors for a slip, trip, or fall injury in food service. NIOSH and various industrial partners have conducted state-of-the-art research related to falls, and have developed numerous prevention-through-design suggestions for fall controls. There is a need to develop effective and practical strategies to design out fall risk, craft engineering solutions, and implement organizational interventions to reduce fall incidents and prevent fall injuries in the services sector.


Because the number of workers in this subsector is expected to increase in coming years, especially older workers who generally have higher slip, trip, and fall injury rates. Because of this potential increase in older workers and the already large number of workers, research in this area could have a large impact on workplace safety. Focusing on small businesses by using intermediaries like trade organizations will increase the dissemination of occupational safety and health information.

  1. BLS [2017] 2016 Census of Fatal Occupational Injuries: Industry by event or exposure, 2016. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics,


Contingent workers, defined as those with a job that they do not expect to last, include temporary agency workers (i.e., those who are employed by staffing companies). Temporary agency workers are included in the Services Sector but work in jobs across many industries and are exposed to a variety of hazards. In 2017, temporary agency workers were heavily concentrated in the manufacturing sector and in production, transportation, and material moving occupations.1 Temporary agency workers accounted for 0.9% of the workforce, a number that is projected to continue growing.2 Burden data for temporary agency workers is sparse due to the limitations of existing safety and health surveillance systems. In 2016, 856 fatal injuries occurred among contract workers, which includes those hired by temporary staffing companies, accounting for 16% of all fatal injuries.3 In Washington State, temporary agency workers experienced higher rates of workers compensation claims compared to non-temporary agency workers in similar jobs.4-5 There is also evidence suggesting a relationship between temporary employment and psychological morbidity.6 Temporary agency workers are more likely than non-temporary agency workers to earn a lower hourly wage and be younger, Hispanic, less educated, and members of low-income families.1,7

Many factors may contribute to the increased risk of occupational injuries and illnesses among temporary agency workers. They may be assigned to more hazardous jobs, have less work experience, and be unfamiliar with work operations, associated hazards, and protective practices.8-10 There is evidence that newly hired employees are more likely to experience a work-related injury compared to employees with longer job tenure,11-12 and temporary agency workers are likely to be new hires multiple times a year. Given temporary agency workers have two employers—a staffing company and a host employer—there may be confusion regarding which aspects of safety and health each employer has responsibility for.8 Insufficient supervision, safety training, and personal protective equipment may also contribute to increased risk.13-14 Temporary agency workers may be less likely to request additional training or report safety concerns to their staffing company, host employer, or OSHA out of fear of retribution and/or uncertainty regarding to whom they should report these concerns.2,15-16


Given the growth and disproportionate burden of occupational injuries and illnesses among agency temporary workers, surveillance, economic analysis, small business research, and other types of intervention research are needed to assist both staffing companies and host employers in creating a safe and healthy workplace and improving well-being for temporary agency workers. Joint guidance from OSHA and NIOSH calls for the provision of general and job-specific workplace safety and health training for temporary agency workers prior to starting a new job.17


Determining the extent of the problem and the economic burden will assist policy makers, researchers and employers in determining effective interventions to reduce workplace injuries and illnesses among this group of high-risk workers.

  1. BLS [2018]. Contingent and alternative employment arrangements—May 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics.
  2. Foley M, Ruser J, Shor G, Shuford H, Sygnatur E [2014]. Contingent workers: workers’ compensation data analysis strategies and limitations. Am J Ind Med 57(7):764–75.
  3. BLS [2017]. Contracted workers as a percentage of all fatally-injured workers in selected occupation groups, 2016. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics,
  4. Smith CS, Silverstein BA, Bonauto DK, Adams D, Fan ZJ [2010]. Temporary workers in Washington state. Am J Ind Med 53:135-145.
  5. Foley M [2017]. Factors underlying observed injury rate differences between temporary workers and permanent peers. Am J Ind Med 60:841-851.
  6. Virtanen M, Kivimaki M, Joensuu M, Virtanen P, Elovainio M, Vahtera J [2005]. Temporary employment and health: a review. Intl J Epi 34(3):610-622.
  7. GAO [2015]. Contingent workforce: Size, characteristics, earnings, and benefits. Washington, DC: Government Accountability Office, GAO-15-168R,
  8. Boden LI, Spieler EA, Wagner GR [2016]. The changing structure of work: Implications for workplace safety in the US. Available from:
  9. Rousseau DM, Libuser C [1997]. Contingent workers in high risk environments. Cal Manag Rev 39(12):103-123.
  10. Thebaud-Mony A [1999]. Contracting and subcontracting by the French nuclear power industry. Int J Occup Environ Health 5(4):296-299.
  11. Bena A, Giraudo M, Leombruni R, Costa G [2013]. Job tenure and work injuries: A multivariate analysis of the relation with previous experience and differences by age. BMC Public Health 13:869.
  12. Breslin FC, Smith P [2006]. Trial by fire: A multivariate examination of the relation between job tenure and work injuries. J Occup Environ Med 63(1):27-32.
  13. Rebitzer JB [1995]. Job safety and contract workers in the petrochemical industry. Ind Rel 34(1):40-57.
  14. Cummings KJ, Kreiss K [2008]. Contingent workers and contingent health: Risks of a modern economy. J Am Med Assoc 299(4):448-450.
  15. Benavides FG, Benach J, Muntaner C, Delclos GL, Catot N, Amable M [2006]. Associations between temporary employment and occupational injury: what are the mechanisms? J Occup Environ Med 63(6):416–21.
  16. Estill CF, Morata T, Schnorr T, Materna B [2015]. Addressing the hazards of temporary employment. NIOSH Science Blog, June 16,
  17. OSHA/NIOSH [2014]. OSHA-NIOSH Recommended Practices Protecting Temporary Workers. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, OSHA-3735-2014.

1. BLS [2017]. Household data annual Averages: Employed persons detailed by industry and age (18b). Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics,

2. BLS [2016]. Fatal occupational injuries by industry and event or exposure. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics

3. BLS [2016]. Incidence rate and number of nonfatal occupational injuries by industry and ownership, 2016 (Table SNR05). Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics,

4. BLS [2016]. An update on SOII undercount research activities. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics,

Page last reviewed: January 3, 2019