Burden, Need and Impact

Two restaurant employees on the job

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

There are approximately six million workplaces in the U.S. that have employees. Eighty-nine percent of them have fewer than 20 employees, and 79% have fewer than 10 employees.1 Smaller firms dominate every major NORA sector (see table below). Of the 127 million plus workers employed in 2016 in the U.S., more than 53% worked in establishments with less than 100 employees.2

Size of firms by NORA Sectors


Total Firms

Firms < 20 employees (%)

Firms < 10 employees (%)

Agriculture, Forestry & Fishing












Wholesale & Retail Trade




Healthcare & Social Assistance








Transportation, Warehousing & Utilities




Oil and Gas Extraction




Source: US Census Bureau, 2015 SUSB Annual Data Tables by Establishment Size,

Although not clearly illustrated in national injury and illness statistics, several studies show the smaller a business is, the more likely workers are to experience injuries, illnesses and fatalities.3,4,5,6. Smaller businesses are recognized as having fewer human and capital resources available to devote to the prevention of workplace illnesses, injuries, and fatalities. Injury and illness incidence may appear to managers to be a minor problem because incidents are infrequent. Managers in smaller businesses often work in isolation without sufficient access to peer opinion and industry best practices. These factors not only reduce prevention activities, but may also reduce the reporting of illnesses and injuries to government agencies, insurance companies, and other organizations.

Smaller businesses engage in fewer occupational safety and health activities than larger businesses7 for the various reasons noted above. Thus, there is clearly a need for delivering OSH assistance to smaller businesses. Researchers and practitioners have observed that the use of intermediary organizations may be a useful way to overcome the difficulties associated with delivering occupational safety and health assistance to smaller businesses8.Intermediary organizations include trade associations, worker groups, insurance companies, chambers of commerce, small business development centers, professional organizations, small-business-focused media, and public health and other government agencies. The Small Business Assistance Program is currently engaged in building relationships in each of these intermediary categories. In addition, the diffusion of innovation/exchange theoretical framework9 can be used in collaboration with many other sectors, as seen in the Total Worker Health® for Small Business project.

By using intermediaries to reach small businesses, there is increased dissemination of occupational safety and health assistance. For example, a recent search of U.S. business member organizations included more than 31,000 listings10. Through increased dissemination by trusted intermediaries, there may be an increased likelihood of small businesses considering adoption of occupational safety and health interventions. Collaborations with intermediaries will also lead to better translation of products, so that highly scientific materials can be narrowed down to information that can easily be grasped and quickly applied in small business settings.

  1. S. Census Bureau [2012]. Statistics for all U.S. firms with paid employees by geographic area, industry, gender, and employment size of firm: 2012. Washington, DC: U.S. Department of Commerce, U.S. Census Bureau,
  2. S. Department of Commerce [2016]. County business patterns. Washington, DC: U.S. Department of Commerce,
  3. Buckley JP, Sestito JP, Hunting KL [2008]. Fatalities in the landscape and horticultural services industry, 1992–2001. Am J Ind Med 51:701–713.
  4. Mendeloff J, Nelson C, Ko K, Haviland A [2006]. Small business and workplace fatality risk: an exploratory analysis. Technical Report TR-371-ICJ. Santa Monica, CA: RAND.
  5. Morse T, Dillon C, Weber J, Warren N, Bruneau H, Fu R [2004]. Prevalence and reporting of occupational illness by company size: population trends and regulatory implications. Am J Ind Med 45(4):361–370.
  6. Page K [2009]. Blood on the coal: the effect of organizational size and differentiation on coal mine accidents. J Safety Res 40:85–95.
  7. Sinclair R, Cunningham TR, Schulte P. [2013]. A model for occupational safety and health intervention in small businesses. Am J Ind Med56(12):1442-1451.
  8. Hasle P, HJ Limborg [2006]. A review of the literature on preventive occupational health and safety activities in small enterprises. Ind Health 44(1):6-12.
  9. Sinclair R, Cunningham TR [2014]. Predictors of safety activities in small firms. Safety Science 64:32-38.
  10. Dunn and Bradstreet [2015]. Hoover’s business data. Short Hills, NJ: D&B Hoovers,

Page last reviewed: January 9, 2019