Services Program

Burden, Need and Impact

There were over 73 million workers in the Services sector in 2018 (46.9% of the workforce).1 In 20172 this sector accounted for 1,471 fatal occupational injuries (28.6% of the fatalities for all U.S. workers) and over 1.13 million3 non-fatal occupational injuries and illnesses (32.6% of the total for all U.S. workers).4-5 Although injuries and illnesses are challenging to track and are frequently undercounted, this is the best estimate available at this time.

worker health charts logo

Data related to some health outcomes of concern may be available in the NIOSH Worker Health Charts (WHC). WHC is a web application that uses data from various sources to visualize worker health data that may be difficult to find or not charted elsewhere. Note that some industries may not be represented in this tool due to small sample size.

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


Occupational hearing loss is one of the most common U.S. work-related illnesses1 and approximately 11% of the U.S. working population has hearing difficulty.2 About 19% of noise-exposed tested workers have a material hearing impairment, which is hearing loss that impacts day-to-day activities.3 It is estimated that 22 million of workers in the U.S. are exposed to hazardous noise each year.4-5

According to an analysis of 2014 National Health Interview Survey data, approximately 11-34% of all service workers are exposed to hazardous noise and approximately 8-15% of all service workers have hearing difficulty, depending on the sub-sector.5 Service occupations with the highest percentage of workers with hearing difficulty include: Installation, Maintenance, and Repair (22%); Architecture and Engineering (14.6%); and Building and Grounds Cleaning and Maintenance (12.8%). An analysis of 1999-2004 National Health and Nutrition Examination Survey data showed that 22-56% of noise-exposed service workers report not wearing hearing protection, depending on sub-sector.4

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 among service workers, particularly those in the Maintenance and Repair, Architecture and Engineering, and Building and Grounds Cleaning and Maintenance occupational groups.


The noise controls developed in other sectors (Manufacturing and Construction), have direct application to workers in similar occupations (such as Building and Grounds Cleaning and Maintenance) in the Services sector. NIOSH can apply known effective noise control methods within and develop specific educational materials for the Services sector, such as Workplace Solutions and NIOSH Hazard Alerts, where necessary. Given the size of the Services sector and the prevalence of hazardous noise exposure among service workers, hearing loss prevention efforts in this sector have the potential to significantly reduce the burden of occupational hearing loss among U.S. workers.

  1. 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. icon
  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. 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.
  5. Kerns E, Masterson EA, Themann CL, Calvert GM [2018]. Cardiovascular conditions, hearing difficulty, and occupational noise exposure within US industries and occupations. A J Ind Med 61, 477-491.


The restaurant industry employs 6.1% of the nation’s workforce1 and is among the most burdened by slip, trip and fall injuries. Specifically, in the Accommodation and Food Services sub-sector, 13% of the fatalities in 2017 were due to slips, trips, and falls.2 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.


The number of workers in this sub-sector is expected to increase in coming years,3 as are the number of older workers4 who  have been found to have higher slip, trip, and fall injury rates.5 Because of this, 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 [2018]. Household data annual averages: Employed persons detailed by industry, sex, race, and Hispanic or Latino ethnicity (Table 18). Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey, icon
  2. BLS [2018] 2017 Fatal occupational injuries by industry and event or exposure, all United States, 2017 (Table A-1). Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, Census of Fatal Occupational Injuries, icon
  3. BLS [2019] Occupational Outlook Handbook, Food and Beverage Serving and Related Workers. U.S. Bureau of Labor Statistics, U.S. Department of Labor, Bureau of Labor Statistics, icon
  4. Toossi M, Torpey E [2017] Older workers: Labor force trends and career options. Career Outlook, U.S. Bureau of Labor Statistics, May 2017. icon
  5. Bell JL, Collins JW, Chiou S [2019]. Effectiveness of a no-cost-to-workers, slip-resistant footwear program for reducing slipping-related injuries in food service workers: A cluster randomized trial. Scan J Work Environ Health, 45(2), 194-202.


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 2017, 811 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 temporary agency 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 Training programs tailored for the unique needs of temporary agency workers are needed.


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 [2018]. Contracted workers as a percentage of all fatally-injured workers in selected occupation groups, 2017. 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, iconexternal icon
  8. Boden LI, Spieler EA, Wagner GR [2016]. The changing structure of work: Implications for workplace safety in the US. Available from: iconexternal icon
  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 [2018]. Household data annual averages: Employed persons detailed by industry, sex, race, and Hispanic or Latino ethnicity (Table 18). Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey, icon
  2. CFOI (fatal injury data) covers not only private, state government, and local government wage and salary workers covered in SOII (non-fatal injury data), but also workers on small farms, the self-employed, family workers, and federal government workers not covered by SOII. For more details regarding the differences in coverage between CFOI and SOII, visit iconexternal icon.
  3. This estimate does not include non-fatal injuries to state and local government workers in the Public Administration (NAICS #92) sector. State and local government workers in the Justice, Public Order, and Safety Activities sub-sector (NAICS #922) of the Public Administration sector are part of the NIOSH Public Safety Program and therefore need to be subtracted from injury estimates for the NIOSH Services Program. However, injury estimates for this sub-sector did not meet BLS reporting requirements and, as such, were not available to be subtracted. Instead, state and local government workers from the entire Public Administration (NAICS #92) sector were subtracted, which was an estimated 292,200 injuries in 2017.
  4. BLS [2018]. Fatal occupational injuries by industry and event or exposure, all United States, 2017 (Table A-1). Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, Census of Fatal Occupational Injuries, icon
  5. BLS [2018]. Numbers of nonfatal occupational injuries and illnesses by industry and case types, 2017 (Table 2). Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses, icon
  6. BLS [2016]. An update on SOII undercount research activities. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, icon

Page last reviewed: November 8, 2019