Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings, 59309-59326 [2021-23250]

Agencies

• DEPARTMENT OF LABOR
• Occupational Safety and Health Administration

[Federal Register Volume 86, Number 205 (Wednesday, October 27, 2021)]
[Proposed Rules]
[Pages 59309-59326]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-23250]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF LABOR

Occupational Safety and Health Administration

29 CFR Parts 1910, 1915, 1917, 1918, 1926, and 1928

[Docket No. OSHA-2021-0009]
RIN 1218-AD39


Heat Injury and Illness Prevention in Outdoor and Indoor Work 
Settings

AGENCY: Occupational Safety and Health Administration (OSHA), Labor.

ACTION: Advance notice of proposed rulemaking (ANPRM).

-----------------------------------------------------------------------

SUMMARY: OSHA is initiating rulemaking to protect indoor and outdoor 
workers from hazardous heat and is interested in obtaining additional 
information about the extent and nature of hazardous heat in the 
workplace and the nature and effectiveness of interventions and 
controls used to prevent heat-related injury and illness. This ANPRM 
provides an overview of the problem of heat stress in the workplace and 
of measures that have been taken to prevent it. This ANPRM also seeks 
information on issues that OSHA can consider in developing the 
standard, including the scope of the standard and the types of controls 
that might be required.

DATES: Submit comments on or before December 27, 2021.

ADDRESSES: You may submit comments and attachments, identified by 
Docket No. OSHA-2021-0009, electronically at www.regulations.gov, which 
is the Federal e-Rulemaking Portal. Follow the instructions online for 
making electronic submissions.
    Instructions: All submissions must include the agency's name and 
the docket number for this ANPRM (Docket No. OSHA-2021-0009). When 
submitting comments or recommendations on the issues that are raised in 
this ANPRM, commenters should explain their rationale and, if possible, 
provide data and information to support their comments or 
recommendations. Wherever possible, please indicate the title of the 
person providing the information and the type and number of employees 
at your worksite.
    All comments, including any personal information you provide, will 
be placed in the public docket without change and will be publicly 
available online at www.regulations.gov. Therefore, OSHA cautions 
commenters about submitting information they do not want to be made 
available to the public or submitting materials that contain personal 
information (either about themselves or others) such as Social Security 
Numbers and birthdates.
    Docket: To read or download comments or other material in the 
docket, go to Docket No. OSHA-2021-0009 at www.regulations.gov. All 
comments and submissions are listed in the www.regulations.gov index; 
however, some information (e.g., copyrighted material) is not publicly 
available to read or download through that website. All submissions, 
including copyrighted material, are available for inspection at the 
OSHA Docket Office. Documents submitted to the docket by OSHA or 
stakeholders are assigned document identification numbers (Document ID) 
for easy identification and retrieval. The full Document ID is the 
docket number plus a unique four-digit code. OSHA is identifying 
supporting information in this ANPRM by author name and publication 
year, when appropriate. This information can be used to search for a 
supporting document in the docket at www.regulations.gov. Contact the 
OSHA Docket Office at 202-693-2350 (TTY number: 877-889-5627) for 
assistance in locating docket submissions.

FOR FURTHER INFORMATION CONTACT: 
    Press Inquiries: Contact Frank Meilinger, Director, Office of 
Communications, U.S. Department of Labor; telephone (202) 693-1999; 
email [email protected].
    General and technical information: Contact Andrew Levinson, Acting 
Director, Directorate of Standards and Guidance, U.S. Department of 
Labor; telephone (202) 693-1950.

SUPPLEMENTARY INFORMATION: This ANPRM on Heat Injury and Illness 
Prevention in Outdoor and Indoor Work Settings follows this outline:

Table of Contents

I. Background
    A. Occupational Illnesses, Injuries, and Fatalities Due to 
Hazardous Heat
    B. Under Reporting of Occupational Illnesses, Injuries, and 
Fatalities Due to Hazardous Heat
    C. Scope
    1. Industries, Occupations, and Job Tasks
    2. Structure of Work and Work Arrangements
    3. Business Size
    D. Geographic Region
    E. Inequality in Exposures and Outcomes
    F. Climate Change
II. Existing Heat Illness Prevention Efforts
    A. OSHA Efforts
    1. OSHA's Heat Illness Prevention Campaign and Other Guidance 
Efforts
    2. Stakeholder Engagement--NACOSH Work Group
    3. General Duty Clause
    4. Other Enforcement Efforts
    5. Applicable OSHA Standards
    B. Petitions for Rulemaking
    C. NIOSH Criteria Documents
    D. History and Requirements of State Standards
    E. Other Standards
    F. Employer Efforts
III. Key Issues in Occupational Heat-Related Illness
    A. Determinants of Occupational Heat Exposure
    1. Heat Exposure
    2. Contributions to Heat Stress in the Workplace
    B. Strategies To Reduce Occupational Heat-Related Injury and 
Illness
    1. Heat Injury and Illness Prevention Programs
    2. Engineering Controls, Administrative Controls, and Personal 
Protective Equipment
    3. Acclimatization
    4. Monitoring
    5. Planning and Responding to Heat-Related Illness Emergencies
    6. Worker Training and Engagement
IV. Costs, Economic Impacts, and Benefits
    A. Overview
    B. Impacts on Small Entities
V. References

I. Background

    Heat is the leading cause of death among all weather-related 
phenomena (NWS, September 8, 2021a; NWS,

[[Page 59310]]

September 8, 2021b). Excessive heat exacerbates existing health 
problems like asthma, kidney failure, and heart disease, and can cause 
heat stroke and even death if not treated properly and promptly. 
Workers in both outdoor and indoor work settings without adequate 
climate-controlled environments are at risk of hazardous heat exposure. 
In an evaluation of 66 heat-related illness enforcement investigations 
from 2011-2016, 80% of heat-related fatalities occurred in outdoor work 
environments. However, 61% of non-fatal heat-related illness cases 
occurred during or after work in an indoor work environment (Tustin et 
al., August 2018). Pregnant workers (NIOSH, April 20, 2017) and workers 
of color are disproportionately exposed to hazardous levels of heat in 
essential jobs across these work settings (Gubernot et al., February 
2015). In addition, climate change is increasing the frequency and 
intensity of extreme heat events, as well as increasing daily average 
daytime and nighttime temperatures. OSHA is initiating a rulemaking to 
protect both indoor and outdoor workers from hazardous heat, and as a 
first step is seeking additional information about the extent and 
nature of hazardous heat in the workplace and the nature and 
effectiveness of interventions and controls used to prevent heat-
related illness. This ANPRM provides an overview of the problem of heat 
stress in the workplace and the measures that have been taken to 
prevent it. This ANPRM also seeks information on issues that may be 
considered in developing a standard, including the scope of the 
standard and the types of controls that might be required.
    OSHA uses several terms related to excessive heat exposure 
throughout this document. Heat stress means the load of heat that a 
person experiences due to sources of heat or heat retention, or the 
presence of heat in a work setting. Heat strain means the physiological 
response to heat exposure (ACGIH, 2017). Heat-related illness means 
adverse clinical health outcomes that occur due to exposure to 
hazardous heat. Heat-related injury means an injury linked to heat 
exposure that is not considered one of the typical symptoms of heat-
related illness, such as a fall or cut. The document also uses the 
combined terms of heat injury and illness when talking about prevention 
or programming to demonstrate that both injury and illness should be 
considered, with the exception of the names of existing programs.

A. Occupational Illness, Injuries, and Fatalities Due to Hazardous Heat

    According to the Bureau of Labor Statistics (BLS) Census of Fatal 
Occupational Injuries, exposure to excessive environmental heat stress 
has killed 907 U.S. workers from 1992-2019, with an average of 32 
fatalities per year during that time period (BLS, September 10, 2021a). 
In 2019, there were 43 work-related deaths due to environmental heat 
exposure (BLS, September 1, 2021). A recent analysis of BLS data by 
National Public Radio and Columbia Journalism Investigations found that 
the three-year average of heat-related fatalities among U.S. workers 
has doubled since the early 1990s (Shipley et al., August 17, 2021). 
The BLS Annual Survey of Occupational Injuries and Illnesses estimates 
that 31,560 work-related heat injuries and illnesses involving days 
away from work have occurred from 2011-2019, with an average of 3,507 
injuries and illnesses of this severity occurring per year during this 
period (BLS, September 10, 2021b). However, the estimates provided here 
on occupational heat-related illnesses, injuries, and fatalities are 
likely vast underestimates, as discussed further in Underreporting of 
occupational illnesses, injuries, and fatalities due to hazardous heat 
(Section I.B. of this ANPRM).
    In a warm environment, the human body maintains a healthy internal 
body temperature by getting rid of excess heat through mechanisms like 
sweating and increasing blood flow to the skin. This is especially true 
during physical activity or exertion. Briefly, if the body is not able 
to dissipate heat, the body temperature may rise, and symptoms of heat-
related injury and illness can result. These can include heat rashes, 
heat syncope (fainting), heat cramps, heat exhaustion, rhabdomyolysis 
(a complex medical condition involving muscle breakdown), kidney 
injury, and even heat stroke (the inability of the body to cool which 
can lead to death) if the thermoregulatory capacity of the body is 
exceeded (Ebi et al., August 21, 2021; NIOSH, February 2016). A multi-
country meta-analysis of dozens of studies involving thousands of 
workers globally found that of those exposed to hazardous heat during a 
single work shift, 35% experienced heat strain while 15% of those who 
frequently worked in hazardous heat experienced kidney disease or acute 
kidney injury (Flouris et al., December 2018).
    Exposure to hazardous heat can also result in the exacerbation of 
pre-existing medical conditions, such as diabetes or cardiovascular 
disease. A study of U.S. Army personnel demonstrated that those who 
have been hospitalized in U.S. hospitals for heat-related illness may 
experience organ damage that can persist for years afterward, even 
resulting in an increased risk of death from cardiovascular disease and 
ischemic heart disease compared to those previously hospitalized for 
other reasons (Wallace et al., 2007). Recurrent exposure to hazardous 
heat, and resulting dehydration, has also been found to be associated 
with acute and chronic kidney disease and injury in agricultural 
workers and others performing manual labor in outdoor work settings, 
particularly in South America, central America and certain South Asian 
countries. These illnesses appear to be unrelated to traditional causes 
of the disease (Glaser et al., August 8, 2016; Johnson et al., May 9, 
2019; Sorensen and Garcia-Trabanino, August 22, 2019). Although much of 
this research has focused on international populations, there is 
emerging evidence of this health hazard in occupational populations 
within the U.S. (Mix et al., 2019; Glaser et al., August 8, 2016).
    The following questions are intended to solicit information on the 
topics related to assessing the nature and magnitude of occupational 
illness, injuries, and fatalities occurring due to hazardous heat.
    (1) What are the occupational health or safety impacts of hazardous 
heat exposure?
    (2) What sources of data are important to consider when evaluating 
occupational heat-related illnesses, injuries, and fatalities?
    (3) Beyond the studies discussed in this ANPRM, are there other 
data that provide more information about the scope and magnitude of 
injuries, illnesses, and fatalities related to occupational heat 
exposure?

B. Underreporting of Occupational Illnesses, Injuries, and Fatalities 
Due to Hazardous Heat

    Heat-related illnesses, injuries, and fatalites are underreported 
(EPA, April 2021; Popovich and Choi-Schagrin, August 11, 2021). 
Occupational heat-related illnesses, injuries, and fatalities may be 
underestimated for several reasons. First, the full extent of heat-
related health outcomes is underreported generally because heat is not 
always recognized as a contributing factor and the criteria for 
defining a heat-related death or illness may vary by state, and among 
physicians, medical examiners, and coroners. (Gubernot et al., October 
2014). Due to the varying

[[Page 59311]]

nature of heat-related illness symptoms, some of which (e.g., headache, 
fatigue) may have other causes, not all cases of illness or injury are 
reported. Further, if the illness or injury does not require medical 
treatment beyond first aid, or result in restrictions or days away from 
work, loss of consciousness, diagnosis by a healthcare professional as 
a significant injury, or death, an employer is not required to report 
the incident under OSHA's existing injury reporting requirements (see 
29 CFR 1904.7(a)). There may also be situations where an illness, 
injury, or fatality is deemed to be unrelated to work, but heat 
exposure at work may have contributed to that incident (Gubernot et 
al., October 2014; Shipley et al., August 17, 2021).
    Second, hazardous heat can impair job tasks related to complex 
cognitive function (Ebi et al., August 21, 2021), and also reduce 
decision-making abilities and productivity. A recent global meta-
analysis showed that 30% of workers who experienced hazardous heat 
during a single shift reported productivity losses (Flouris et al., 
December 2018). Additionally, a growing body of evidence has 
demonstrated that these heat-induced impairments may result in 
significant occupational injuries that are not currently factored into 
assessments of the health hazards resulting from occupational heat 
exposure (Park et al., July 2021). In California, the likelihood of 
same-day workplace injury risk significantly increased by approximately 
5-7% when comparing a day that was 60-65 degrees Fahrenheit to a day 
that was 85-90 degrees Fahrenheit. Same-day workplace injury risk 
increased 10-15% when comparing a day that was 60-65 degrees Fahrenheit 
to a day that was above 100-degrees Fahrenheit. These increased risks 
were demonstrated in certain indoor and outdoor work environments, 
contributing to approximately 360,000 additional workplace injuries in 
California alone from 2001-2018 (Park et al., July 2021).
    Third, self-reporting of health outcomes can result in bias which 
can lead to over- or under-estimates of health outcomes (Althubaiti, 
May 4, 2016). In 2009, the Government Accountability Office (GAO) 
reported that the BLS Survey of Occupational Injuries and Illnesses, 
which relies heavily on employer self-report of non-fatal injuries and 
illnesses, may underreport employer-reported injury and illness data 
(GAO, October 2009). This underreporting of non-fatal illnesses and 
injuries may be particularly present in some industries, like 
agriculture, where some employers (e.g., employers with 10 or fewer 
employees) are excluded from reporting requirements (Leigh et al., 
April 2014). While there may be multiple factors influencing 
underreporting, BLS investigations of this issue have found that 
employers and employees may face disincentives for reporting injuries 
and illnesses (BLS, December 8, 2020). By reporting injuries and 
illness, employers may increase their workers' compensation costs and 
jeopardize their reputation. Employees may also face disincentives for 
reporting if they are reluctant to report for fear of retaliation or 
may not realize an illness or injury is heat-related. Employees may 
decide to continue working for economic incentives and to avoid losing 
wages. Employee fear of retaliation, including the potential loss of 
employment, may be of particular concern with heat-related illness and 
injuries given the disproportionate number of undocumented, migrant, 
low-wage, or other vulnerable workers that make up sectors that are at 
high risk of hazardous heat exposure such as agriculture and 
construction. These workers may lack the awareness of their right to, 
and perceived ability to, speak out about workplace conditions. 
Additional concerns related to the inequalities in hazardous heat 
exposure and resulting health outcomes are discussed below in more 
detail. Despite potential underreporting, these datasets are important 
indicators of occupational safety and health, and through the questions 
below, OSHA seeks additional information and data to better assess the 
fullest extent of occupational illnesses, injuries, and fatalities due 
to hazardous heat exposure in the workplace.
    Finally, there are some health conditions associated with 
occupational heat exposure that may take many years to manifest in 
workers previously exposed to hazardous heat due to the latency period 
between exposure and symptom onset (Gubernot et al., October 2014). For 
these illnesses that develop over time, it is unlikely that the current 
national datasets of occupational illnesses and injuries associate 
those outcomes with hazardous heat exposure.
    The following questions are intended to solicit information on the 
topics related to assessing and addressing underreporting of 
occupational illness, injuries, and fatalities occurring due to 
hazardous heat.
    (4) Are there quantitative estimates of the magnitude of 
occupational illnesses, injuries, and fatalities related to hazardous 
heat, beyond what is described in this ANPRM?
    (5) Are there quantitative estimates or other quantitative or non-
quantitative examinations of the magnitude of underreporting of 
occupational illnesses, injuries, and fatalities related to hazardous 
heat?
    (6) What factors lead to the underreporting of occupational heat-
related illness, injuries, and fatalities of which OSHA should be 
aware?
    (7) What datasets are available to address some of the limitations 
associated with the underreporting of occupational heat-related 
illnesses, injuries, and fatalities?

C. Scope

1. Industries, Occupations, and Job Tasks
    Workers across hundreds of industries are at risk for hazardous 
heat exposure and resulting health impacts. Since 2018, 789 heat-
related hospitalizations and 54 heat-related fatalities across nearly 
275 unique industries have been documented by OSHA through workplace 
inspections and violations . During this time, hospitalizations 
occurred most frequently in postal and delivery service, landscaping, 
and commercial building, as well as highway, street, and bridge 
construction workers. Fatalities were reported in landscaping, masonry, 
and highway, street, and bridge construction workers (OSHA, August 20, 
2021).
    Also since 2018, over 230 unique industries (as identified by 6-
digit NAICS codes) across indoor and outdoor work settings have had at 
least one heat-related inspection by OSHA. During 2019, for example, 
OSHA heat-related inspections occurred most often in industries and 
workplaces such as roofing, postal and delivery service, construction 
and contracting, masonry, landscaping, restaurants, and warehousing and 
storage (OSHA, August 20, 2021).
    Further, multiple analyses of OSHA enforcement investigations and 
the Census of Fatal Occupational Injuries have found that Agriculture 
(NAICS code 11), Construction (NAICS code 23), Transportation and 
Warehousing (NAICS codes 48-49), and Administrative and Support and 
Waste Management and Remediation Services (NAICS code 56) experience 
the highest rates of heat-related mortality (Gubernot et al., February 
2015; Tustin et al., August 2018). Compared to the average annual heat-
related workplace fatality rate in all other industries of 0.09 deaths 
per 1 million workers, Agriculture, Forestry, Fishing, and Hunting was 
found to have 35 (95% confidence interval, 26.3-47.0) times the risk of

[[Page 59312]]

heat-related deaths with 3.06 deaths per 1 million workers from 2000-
2010. Construction had 13 (95% confidence interval, 10.1-16.7) times 
the risk of heat-related deaths with 1.13 deaths per 1 million workers 
during that time period (Gubernot et al., February 2015).
    Many job tasks, regardless of the industry in which they are 
performed, may also result in the risk of exertional heat stress in 
workers. The American Conference of Governmental Industrial Hygienists 
(ACGIH) has developed categories of work intensity based on their 
estimated metabolic rate, with the metabolic rate increasing across 
categories: rest (e.g., sitting), light (e.g., sitting, standing, light 
arm/handwork, occasional walking), moderate (e.g., normal walking, 
moderate lifting), heavy (e.g., heavy material handling, walking at a 
fast pace), very heavy (e.g., pick and shovel work) (ACGIH, 2017; OSHA, 
September 15, 2017). In an evaluation of 14 heat-related workplace 
fatalities that occurred from 2011-2016, the workload was moderate, 
heavy, or very heavy in 13 of the incidents (Tustin et al., July 6, 
2018). Of 20 enforcement cases from 2012-2013 that resulted in heat-
related citations under the Occupational Safety and Health Act's 
General Duty Clause, all fatalities and non-fatal heat-related 
illnesses occurred under moderate or heavy workloads (Arbury et al., 
April 2016).
    The following questions are intended to solicit information about 
how hazardous heat exposure and risk varies across industries, 
occupations, and job tasks.
    (8) Are there industries, occupations, or job tasks that should be 
considered when evaluating the health and safety impacts of hazardous 
heat exposure in indoor and outdoor work environments? Please provide 
examples and data.
    (9) Are there any industries, occupations, or job tasks that are 
facing changes in the rate or frequency of occupational heat-related 
illness? Please provide examples and data.
2. Structure of Work and Work Arrangements
    The structure of work and various work arrangements, such as the 
use of temporary, gig, or contingent workers, has been found in some 
studies, including of non-US workers, to be associated with increased 
health and safety risks to workers (Caban-Martinez et al., April 2018; 
Virtanen et al., 2005). This may be due to a variety of reasons, 
including workers in these work arrangements being assigned more 
hazardous work tasks, being less aware of their ability to report 
unsafe work conditions, being less acclimatized to the heat conditions 
of the work environment, or not receiving adequate personal protective 
equipment (PPE) or training for the job duties they are conducting. 
These work arrangements are present in a variety of industries where 
workers face hazardous heat exposure, such as construction, 
agriculture, and landscaping, in part due to outdoor work settings and 
seasonality of work.
    Additionally, multi-employer contexts may impact the health and 
safety of workers due to the need for and challenges associated with 
close coordination across employers on health and safety issues such as 
training and monitoring safe work practices (OSHA, October 6, 2021a; 
OSHA and NIOSH, October 6, 2021). OSHA recognizes that any rulemaking 
will need to consider the challenges for employers and employees 
related to protecting those in non-traditional, variable, and multi-
employer work arrangements.
    The following questions are intended to solicit information about 
how unique and non-traditional work arrangements contribute to workers' 
risk of heat-related injuries and illnesses, as well as the best 
practices and challenges for reducing those risks in these work 
settings.
    (10) In addition to traditional work arrangements, are there 
specific types of work arrangements or multi-employer work arrangements 
that should be considered when evaluating the health and safety impacts 
of hazardous heat exposure in indoor and outdoor work environments?
    (11) What are current and best practices for protecting workers in 
various types of work arrangements, including temporary and multi-
employer work arrangements, from hazardous heat exposure?
    (12) What are current challenges in and limitations of protecting 
workers in various types of work arrangements, including temporary and 
multi-employer work arrangements, from hazardous heat exposure?
3. Business Size
    Heat-related illnesses can occur in businesses of all sizes. An 
evaluation of 38 enforcement investigations involving 66 incidents of 
fatal and non-fatal heat-related illness from 2011-2016 found that 92% 
of workplaces investigated had less than 250 employees (Tustin et al., 
August 2018). In a different assessment of workplace heat-related 
fatalities from 2000-2010, almost half of all fatalities where 
establishment size was known (244 cases out of 359 fatalities) occurred 
in what the authors termed ``very small establishments,'' or those with 
fewer than 10 employees (Gubernot et al., February 2015). However, 
approximately a quarter of fatalities during that time period occurred 
in ``very large establishments'' with more than 100 employees (Gubernot 
et al., February 2015).
    The following questions are intended to solicit information about 
how business size may influence the practices and interventions 
implemented to prevent heat-related injuries and illnesses and the 
challenges experienced by businesses of varying sizes when implementing 
these prevention strategies. There are additional questions on the 
economic considerations for small entities included in Impacts on Small 
Entities (Section IV.B. of this ANPRM).
    (13) How are employers in businesses of various sizes currently 
preventing heat-related injury and illness in workers?
    (14) Are there limitations or concerns in preventing heat-related 
injury and illness in workers that vary among businesses of various 
sizes?

D. Geographic Region

    Heat-related injury and illness among workers can occur anywhere in 
the United States. In 2015, Texas and California had the highest number 
of nonfatal injuries and illnesses with days away from work (BLS, 
August 30, 2017). Texas and California also accounted for a quarter of 
all heat-related workplace fatalities from 2000-2010 (Gubernot et al., 
February 2015).
    However, when the size of the worker populations are taken into 
account, states across the southern United States, including 
Mississippi, Arkansas, Nevada, West Virginia, and South Carolina, have 
been found to have the highest rates of heat-related workplace 
fatalities from 2000-2010 (Gubernot et al., February 2015). In 2015, 
Kansas and South Carolina had the highest rates of heat-related 
nonfatal injuries and illnesses with days away from work, at 1.3 and 
1.0 per 10,000 workers, respectively (BLS, August 30, 2017). Recent 
evidence also shows that the Southeast United States accounts for the 
most cases officially reported to OSHA.
    As discussed in Under-reporting of Occupational Illnesses, 
Injuries, and Fatalities due to Hazardous Heat (Section I.B. of this 
ANPRM), significant underreporting of workplace heat-related injury and 
illness limits the understanding of the full geographic scope of 
outcomes. Additionally, populations that are less accustomed to 
hazardous heat, such as those in the Northeast or Midwest U.S., may be 
at increased risk of health impacts from

[[Page 59313]]

extreme heat, particularly during early season high heat events 
(Anderson and Bell, February 2011).
    The following questions are intended to solicit information, 
relevant data sources, and considerations related to occupational heat 
exposure and outcomes based on geographic region.
    (15) How does geographic region contribute to occupational heat 
hazards and the outcomes experienced by workers? Please provide 
examples and data.
    (16) Are there regions with improving or worsening occupational 
heat hazards and associated outcomes? Please provide examples and data.
    (17) Do regions with traditional and pervasive heat hazards address 
the hazard differently than regions with more episodic exposures (e.g., 
heat waves in a normally temperate region)?
    (18) What regional differences should be considered or accounted 
for when determining the appropriate interventions and practices to 
prevent heat-related injuries and illnesses among workers?

E. Inequality in Exposures and Outcomes

    Disproportionate exposure to hazardous working conditions and their 
resulting health and safety impacts on workers exacerbates 
socioeconomic and racial inequalities in the U.S. In assessments of 
national work-related injuries, illnesses, and fatalities, employment 
in high-risk occupations has been disproportionately held by those who 
are Black, foreign-born, or low wage-earners, after adjusting for other 
demographic characteristics like sex and education (Steege et al., 
2014). Non-Hispanic Black workers and foreign-born Hispanic workers 
tend to work in jobs with the highest injury risks even after adjusting 
for sex and education (Seabury et al., February 2017). Sociodemographic 
disparities in hazardous occupational exposures to dust and chemicals, 
noise, musculoskeletal hazards, and strain have been found to persist 
even after accounting for industry and job (Quinn et al., 2007).
    These disparities are also present when focusing on health and 
safety outcomes that result from hazardous heat exposure. Black and 
Hispanic workers had higher relative risks of heat-related fatalities 
compared to white workers from 2000-2010 (Gubernot et al., February 
2015), and one-third of workplace heat-related fatalities since 2010 
have occurred in Hispanic workers (Shipley et al., August 17, 2021). 
From 1992-2006, agricultural crop workers were estimated to be 20 times 
more likely to suffer a heat-related fatality at work when compared to 
all other civilian occupations, with the majority of fatalities 
occurring among immigrant workers (CDC, June 20, 2008), and from 2000-
2010, agricultural workers had 35 (95% confidence interval, 26.3-47.0) 
times the risk of dying from heat-related causes compared to all other 
industries (Gubernot et al., February 2015). Lower-wage workers are 
more likely to live and work in areas facing greater exposure to 
hazardous heat, to work in dangerous occupations, and to have limited 
access to air conditioning at home or other housing which may limit the 
ability to recover from occupational and non-occupational heat 
exposures. In California, lower-wage workers experienced five times as 
many heat-related injuries compared to the highest-wage workers between 
2001 and 2018 (Park et al., July 2021). As climate change increases 
extreme heat events, Hispanic and Latino individuals, as well as 
American Indian and Alaska Native individuals, individuals with low 
income, and individuals lacking a high school diploma are more likely 
to live in areas with the highest projected labor hour losses (EPA, 
September 2, 2021).
    The following questions are intended to solicit information, 
relevant data sources, and considerations related to inequalities in 
occupational heat exposure and disproportionate outcomes experienced by 
vulnerable occupational populations.
    (19) Are there specific populations facing disproportionate 
exposure to or outcomes from hazardous heat in indoor or outdoor work 
settings? Please provide examples and data.
    (20) Are there data sources available to assess inequalities in 
exposure to or outcomes from hazardous heat in indoor or outdoor work 
settings?
    (21) Are there industries or employers who are addressing 
occupational heat-related illness with an environmental justice 
approach (i.e., with a focus on fair treatment and meaningful 
involvement of all people regardless of race, color, national origin, 
or income) to appropriately address the disproportionate exposures and 
outcomes faced by workers of color, low-wage workers, immigrant 
workers, or pregnant workers (NIOSH, April 20, 2017)? Please provide 
examples and data.

F. Climate Change

    Climate change is increasing the frequency and intensity of extreme 
heat events, as well as increasing daily average daytime and nighttime 
temperatures. The National Climate Assessment, the United States' 
quadrennial report assessing climate change science and impacts and 
published by the U.S. Global Change Research Program, states that high 
summer temperatures are linked to increased illness and death, that hot 
days are associated with increased heat-related illnesses, that health 
risks may be higher earlier in warmer seasons before people have had 
time to acclimatize, and that workers will face an increased risk of 
heat-related illness due to heat exposure. This will be especially true 
in rural areas, particular sectors and occupations such as agriculture, 
forestry, construction, utilities, warehousing, manufacturing, and 
indoor workplaces producing additional heat or lacking adequate 
cooling, such as steel mills, dry cleaning, and others, and for workers 
of color, those who are older, and of lower socioeconomic status 
(USGCRP, 2016; USGCRP, 2018). It is estimated that under a high 
emissions scenario, climate change will result in the annual loss of 
almost 2 billion labor hours with an annual cost of an estimated $160 
billion in lost wages (in 2015 dollars) due to extreme temperatures 
alone, the vast majority of which is due to heat (EPA, May 2017; 
USGCRP, 2018). As the number of days above 90 degrees Fahrenheit 
increases due to climate change, so do lost hours of work. Nationally, 
the average losses are projected to be 14 to 34 hours annually per 
``weather-exposed'' worker due to high temperature days. Weather-
exposed workers in parts of the Southwest and Southern Great Plains 
could lose up to 84 hours per worker annually, depending on the level 
of temperature increases (EPA, September 1, 2021).
    The following questions are intended to solicit information, 
relevant data sources, and considerations to further assess the impact 
of climate change on occupational heat exposure and outcomes.
    (22) Are there data sources available to assess how climate change 
is altering hazardous heat exposure in outdoor and indoor work 
environments?
    (23) How will climate change affect existing inequities in 
occupational heat exposure and related health outcomes? Please provide 
relevant data.
    (24) How will climate change affect the risk of occupational heat-
related illness and mortality in the different regions of the United 
States?
    (25) How should climate change be factored into an OSHA heat 
illness and injury prevention standard?
    (26) What efforts are employers currently taking to prepare for and 
respond to the ways that climate change

[[Page 59314]]

is altering hazardous heat exposure in their workplaces?

II. Existing Heat Injury and Illness Prevention Efforts

A. OSHA Efforts

    OSHA has taken a multi-pronged approach to address hazardous heat 
among both indoor and outdoor workers. This includes efforts ranging 
from education and awareness building, guidance, compliance assistance, 
stakeholder engagement, and enforcement.
1. OSHA's Heat Illness Prevention Campaign and Other Guidance Efforts
    OSHA has a long-running Heat Illness Prevention Campaign (https://www.osha.gov/heat), which was initiated in 2011 to build awareness of 
prevention strategies and tools for employers and workers to reduce 
occupational heat-related illness. Historically, the Campaign has 
utilized the slogan ``Water. Rest. Shade.'' The agency updated Campaign 
materials in 2021 to recognize both indoor and outdoor heat hazards, as 
well as the importance of protecting new and returning workers from 
hazardous heat. These efforts, which are ongoing, incorporate 
stakeholder feedback and feature materials available in an increasing 
number of languages. Despite the strengths and reach of the Campaign, 
these guidance and communication materials are not legally enforceable 
requirements.
    In addition to the Heat Illness Prevention Campaign materials, OSHA 
publishes a heat specific Safety and Health Topics page (https://www.osha.gov/heat-exposure), which provides additional information and 
resources on heat topics. The page provides information on planning and 
supervision in hot environments, identification of heat-related illness 
and first aid, information on prevention such as training, calculating 
heat stress and controls, personal risk factors, descriptions of other 
heat standards and case study examples of situations where workers 
developed heat-related illness. OSHA and the National Institute for 
Occupational Safety and Health (NIOSH) also co-developed a Heat Safety 
Tool Smartphone App for both Android and iPhone devices. The app 
provides outdoor location sensitive temperature, humidity, and heat 
index readings, as well as provides a corresponding risk level for 
ranges of heat index. The app is not for indoor use if using 
automatically downloaded data for the heat index calculation. Each risk 
level provides relevant information on identifying signs and symptoms 
of heat-related illness and steps that should be taken at that risk 
level to prevent heat-related illness.
2. Stakeholder Engagement--NACOSH Work Group
    On June 22, 2021, at a meeting of the National Advisory Committee 
for Occupational Safety and Health (NACOSH), the agency announced its 
intention to form a NACOSH work group to engage stakeholders and better 
understand current best practices and challenges in occupational heat-
related illness prevention across a variety of industries to inform 
OSHA's response to this important hazard. This NACOSH Heat Illness 
Prevention Work Group (WG) will consist of experts who have extensive 
knowledge and experience in causes of, identification of, and factors 
that affect heat-related illness hazards in the workplace, as well as 
best practices and interventions for mitigating occupational heat-
related illness. OSHA intends to initially convene the work group in 
late fall 2021.
3. General Duty Clause
    Although OSHA does not have a specific standard governing hazardous 
heat conditions at workplaces, the agency currently enforces Section 
5(a)(1) (General Duty Clause) of the OSH Act against employers that 
expose their workers to this recognized hazard. Section 5(a)(1) states 
that employers have a general duty to furnish to each of their 
employees employment and a place of employment free from recognized 
hazards that cause or are likely to cause death or serious physical 
harm to employees (29 U.S.C. 654(a)(1)). To prove a violation of the 
General Duty Clause, OSHA needs to establish--in each individual case--
that: (1) The employer failed to keep the workplace free of a hazard to 
which its employees were exposed; (2) the hazard was recognized; (3) 
the hazard was causing or likely to cause death or serious injury; and 
(4) a feasible means to eliminate or materially reduce the hazard 
existed. (See, e.g., A.H. Sturgill Roofing, Inc., 2019 O.S.H. Dec. 
(CCH) ] 33712, 2019 WL 1099857, (No. 13-0224, 2019)).
    OSHA has relied on the General Duty Clause to cite employers for 
heat-related hazards for decades. Additionally, OSHA has issued various 
forms of guidance for employers and employees whose work occurs in 
indoor and outdoor heat environments and has addressed heat-related 
illness in Regional Emphasis Programs in an attempt to protect workers 
from heat-related injury. (Please see OSHA Heat Illness Prevention 
Campaign and Guidance Efforts and Other Enforcement Efforts, Sections 
II.A.1 and II.A.4 of this ANPRM, respectively.) However, the General 
Duty Clause does not specifically prescribe hazardous heat exposure 
thresholds or provide specifics on how employers are to eliminate or 
reduce their employees' exposure to hazardous heat. A standard specific 
to heat-related injury and illness prevention would more clearly set 
forth employer obligations and help employers to identify the measures 
necessary to more effectively protect employees from hazardous heat.
    OSHA's enforcement efforts to protect employees from hazardous heat 
conditions using the General Duty Clause, although important, have been 
met with significant legal challenges, leaving many workers vulnerable 
to heat-related hazards. Because there are no specific, authoritative 
exposure thresholds for OSHA to rely on, it has been challenging for 
the agency to prove the existence of a recognized hazard, even in cases 
in which a heat-related fatality has occurred. (See, e.g., A.H. 
Sturgill Roofing, Inc., 2019 O.S.H. Dec. (CCH) ] 33712, 2019 WL 
1099857, (No. 13-0224, 2019); Aldridge Elec., Inc., 26 BNA OSHC 1449, 
2016 WL 8581709, (No. 13-2119, 2016)).
    Moreover, in litigated cases OSHA has been largely unsuccessful in 
relying on third-party scientific documents--such as ACGIH exposure 
thresholds and NIOSH criteria--to prove the existence of a recognized 
hazard. (See Aldridge Elec., Inc., 2016 WL 8581709 at *14 (noting that 
``none of these documents is a mandatory document that [employers] must 
follow akin to an OSHA regulation.''); Industrial Glass, 15 BNA OSHC 
1594, 1992 WL 88787, at *12 n. 10, (No. 88-348, 1992) (noting that the 
NIOSH criteria ``[do] not have the force or effect of law.'')). 
Additionally, because the available scientific information is not 
currently defined in terms of a workplace hazard standard, adjudicators 
have found that crucial terms and methods for determining the severity 
of risk for heat-related illness are too vague or insufficiently 
defined to effectively determine the existence of a recognized hazard 
in the context of a particular case. (See, e.g., A.H. Sturgill Roofing, 
Inc., 2019 WL 1099857 at *4 (noting that the National Oceanic and 
Atmospheric Administration's (NOAA) National Weather Service Heat Index 
chart does not define ``prolonged exposure'' or explain what factors 
must be considered to increase heat index values; only stating that 
``exposure to full sunshine

[[Page 59315]]

can increase heat index values by up to 15 [deg]F.'')).
    Under the General Duty Clause, OSHA cannot require abatement before 
proving in an enforcement proceeding that specific workplace conditions 
are hazardous; whereas a standard would establish the existence of the 
hazard at the rulemaking stage, thus allowing OSHA to identify and 
require specific abatement measures without having to prove the 
existence of a hazard in each case. Given OSHA's burden under the 
General Duty Clause, it is currently difficult for OSHA to ensure 
necessary abatement before employee lives and health are unnecessarily 
endangered. Moreover, under the General Duty Clause OSHA must largely 
rely on expert witness testimony to prove both the existence of a 
hazard and the availability of feasible abatement measures that will 
materially reduce or eliminate the hazard in each individual case. 
(See, e.g., Industrial Glass, 1992 WL 88787 at *4-7).
4. Other Enforcement Efforts
    In 2019, OSHA conducted 289 heat-related inspections (OSHA, August 
20, 2021). More than 110 of these were initiated by complaints and 20 
were due to the occurrence of a fatality or catastrophe. As a result of 
these inspections, OSHA issued 155 Hazard Alert Letters (HALs), which 
provide employers with information to mitigate hazards and resources to 
assist in this process when OSHA determines a formal citation cannot be 
issued. OSHA issued only 31 General Duty Clause citations during the 
same period (OSHA, August 20, 2021). Thus, HALs were issued at five 
times the rate of 5(a)(1) citations in 2019.
    On September 1, 2021, OSHA's Directorate of Enforcement Programs 
issued an Inspection Guidance for Heat-Related Hazards, which 
establishes a new enforcement initiative to prevent heat-related 
illnesses and fatalities while working in hazardous hot indoor and 
outdoor environments (OSHA, September 1, 2021). The guidance provides 
that days when the heat index exceeds 80 degrees Fahrenheit will be 
considered heat priority days. Enforcement efforts will be increased on 
heat priority days for a variety of indoor and outdoor industries, with 
the aim of identifying and mitigating potential hazards and preventing 
heat-illnesses before they occur.
    OSHA's Region VI regional office, located in Dallas, TX, has a 
heat-related special Regional Emphasis Program (REP) (OSHA, October 1, 
2019). This region covers Texas, New Mexico, Oklahoma, Arkansas, and 
Louisiana, which have a high number of heat-related injuries, 
illnesses, and fatalities. This REP allows field staff to conduct heat 
illness inspections of outdoor work activities on days when the high 
temperature is forecast to be above 80 degrees Fahrenheit. This REP 
includes employers with fewer than 11 employees. Under the authority of 
this REP, Region VI conducted 78 inspections on heat-related illness, 
which identified 89 violations, in 2019 alone.
    Heat-related inspections are also initiated by heat-related 
complaints, hospitalizations or fatalities, and during an unrelated 
programmed or unprogrammed inspection where a heat hazard is 
identified. In addition, OSHA Area Offices can initiate heat 
interventions or inspections based on local knowledge of 
establishments, referrals from the local health department, or from 
other Federal agencies with joint jurisdictions, such as U.S. 
Department of Agriculture (USDA), Environmental Protection Agency 
(EPA), media referrals or previous OSHA inspection history.
5. Applicable OSHA Standards
    OSHA currently has other existing standards that, while applicable 
to some issues related to hazardous heat, have not proven to be 
adequate in fully protecting workers. OSHA's Recordkeeping standard (29 
CFR 1904.7) requires employers to record and report injuries and 
illnesses that meet recording criteria. If an injury or illness does 
not require medical treatment beyond the provision of first aid, it 
does not need to be reported. Some actions that a worker may be 
recommended to take when experiencing heat-related illness, such as 
hydration, are considered to be first aid, and therefore are not 
recordable.
    The agency's Sanitation standards (29 CFR 1910.141, 29 CFR 1915.88, 
29 CFR 1917.127, 29 CFR 1926.51, and 29 CFR 1928.110) require employers 
to provide potable water readily accessible to workers. While these 
standards require that drinking water be made available in ``sufficient 
amounts,'' it does not specify what those amounts are, and employers 
are only mandated to encourage workers to frequently hydrate on hot 
days.
    OSHA's Safety Training and Education standard (29 CFR 1926.21) 
requires employers in the construction industry to train employees in 
the recognition, avoidance, and prevention of unsafe conditions in 
their workplaces. OSHA's PPE standards (29 CFR 1910.132, 29 CFR 
1915.152, 29 CFR 1917.95, and 29 CFR 1926.28) require employers to 
conduct a hazard assessment to determine the appropriate PPE to be used 
to protect employees from the hazards identified in the assessment. 
However, hazardous heat is not specifically identified as a hazard for 
which workers need training or PPE, complicating the application of 
these requirements to hazardous heat.
    The following questions are intended to solicit information related 
to the existing efforts OSHA has undertaken to prevent occupational 
heat-related illness, injuries, and fatalities.
    (27) Are OSHA's existing efforts and authorities adequate or 
effective in protecting workers from hazardous heat in indoor and 
outdoor work settings?
    (28) What additional efforts or improvements should be undertaken 
by OSHA to protect workers from hazardous heat in indoor and outdoor 
work settings?
    (29) What are the gaps and limitations of existing applicable OSHA 
standards, as well as existing campaign, guidance, enforcement, and 
other efforts for preventing occupational heat-related illness in 
indoor and outdoor work settings?

B. Petitions for Rulemaking

    OSHA has received three petitions from Public Citizen and 
supporting organizations, in 2011, 2018, and 2021, to implement a heat 
standard. The petitions presented data on the impacts of heat on 
workers' morbidity and mortality. The 2011 petition was for an 
Emergency Temporary Standard under section 6(c) of the OSH Act and was 
denied for failing to meet the grave danger requirement of the Act. The 
2018 petition asked for an OSHA heat standard under section 6(b) of the 
OSH Act and was co-signed by over 130 organizations and nearly 100 
individuals. The 2021 petition again requested that OSHA issue an 
Emergency Temporary Standard. The agency has not yet responded to the 
2018 and 2021 petitions.
    Over the last several years, many members of Congress have also 
urged OSHA to initiate rulemaking for a Federal heat standard. In 2019, 
OSHA received a request for rulemaking from members of the Senate 
(Brown et al., November 18, 2019). In August 2021, OSHA received a 
request for rulemaking from members of both the Senate and the House of 
Representatives (Padilla et al., August 3, 2021; Chu et al., August 6, 
2021). Both chambers of Congress also have pending legislation in the 
2021-2022 legislative session that would order OSHA to develop and 
implement a Federal heat standard (U.S. Senate, 117th Congress, April 
12, 2021; U.S. House of Representatives, 117th

[[Page 59316]]

Congress, March 26, 2021). This legislation has also been considered in 
past legislative sessions.

C. NIOSH Criteria Documents

    NIOSH first proposed details of a potential Federal heat standard 
in 1972 in its Criteria for a Recommended Standard (NIOSH, 1972). 
Criteria documents, issued under the authority of section 20(a) of the 
Occupational Safety and Health Act of 1970, recommend occupational 
safety and health standards based on exposure limits and work intensity 
that are safe for various periods of employment as established by a 
critical review of scientific and technical information. NIOSH's 
criteria for a recommended standard have since been updated in 1986 
(NIOSH, April 1986) and again in 2016 (NIOSH, February 2016). The 2016 
criteria recommend that a Federal heat standard include provisions for 
medical screening and physiological monitoring, heat stress thresholds, 
rest breaks, hydration, shade, acclimatization plans, engineering 
controls (e.g., air conditioners, fans, tents), administrative controls 
(e.g., rest breaks and altered work schedules), PPE and auxiliary body 
cooling (e.g., cooled or iced vests, jackets, or other wearable 
garments), exposure and medical monitoring, hazard notification alerts, 
worker training and education, medical surveillance, and recordkeeping 
(NIOSH, February 2016).
    The 2016 criteria document recommends occupational exposure limits 
for heat stress, such that no worker be ``exposed to combinations of 
metabolic and environmental heat greater than'' the recommended alert 
limit (RAL, for unacclimatized workers) or the recommended exposure 
limit (REL, for acclimatized workers). The NIOSH criteria recommend 
that environmental heat should be assessed with hourly measurements of 
Wet Bulb Globe Temperature (WBGT) (NIOSH, February 2016), and metabolic 
heat should be assessed using the metabolic-work-rates set by ACGIH 
(ACGIH, 2017). There are lower recommended exposure limits for 
unacclimatized workers, workers who are wearing work clothing that 
minimizes heat dissipation from the body, and those who have underlying 
personal risk factors. These exposure limits were highly sensitive, 
meaning the exposure limits were met or exceeded, in an investigation 
of a subset of 14 cases of fatal (100% sensitivity) and 11 nonfatal 
(72% sensitivity) heat-related illness in workers that occurred during 
outdoor work (Tustin et al., July 6, 2018).

D. History and Requirements of State Standards

    As of October 2021, four states have promulgated hazardous heat 
standards requiring employers in various industries and workplace 
settings to provide protections and abatement measures to reduce the 
risk of heat-related illness for their employees: California, 
Minnesota, Oregon, and Washington. Oregon issued a temporary rule in 
July of 2021 after experiencing temperatures well above 100 [deg]F for 
an extended period. Washington State also issued emergency heat rules 
during the summer of 2021 that provide additional worker protections to 
its previously promulgated heat rule. Additionally, since 2020, three 
more states, Colorado, Maryland, and Nevada, have passed laws requiring 
state health and safety administrators to promulgate rules related to 
hazardous heat in the workplace. Virginia's Safety and Health Codes 
Board is also considering a standard on this topic.
    State standards differ in the scope of coverage. For example, 
Minnesota's standard covers only indoor workplaces. California and 
Washington standards cover only outdoor workplaces, although California 
is engaged in rulemaking for a potential indoor heat standard. Oregon's 
emergency rule covers both indoor and outdoor workplaces. California, 
Washington, and Oregon all have additional protections that are 
triggered by high heat, however, they differ as to the trigger for 
these additional protections: In California it is at a temperature 
reading of 95 [deg]F (and only includes certain industries), in 
Washington it is at a temperature reading of 100 [deg]F, and in Oregon 
it is at a heat index of 90 [deg]F. State rules also differ in the 
methods used for triggering the heightened protections against 
hazardous heat. Minnesota's standard considers the type of work being 
performed (light, moderate, or heavy) and has calculated a threshold 
WBGT for each work activity. California's heat-illness prevention 
protections go into effect at 80 [deg]F, ambient temperature. 
Washington's rule also relies on ambient temperature readings combined 
with considerations for the weight and breathability of workers' 
clothing. Oregon's emergency rule relies on the heat index as 
calculated by NOAA's National Weather Service.
    All of the state standards require training for employees and 
supervisors. All of the state standards except for Minnesota require 
employers to provide at least 1 quart of water per hour for each 
employee, require some form of emergency response plan, mention the 
importance of acclimatization for workers, and require access to shaded 
break areas. Washington and Oregon require that employers provide 
training in a language that the workers understand. Similarly, 
California's standard requires that employers create a written heat-
illness prevention plan in English as well as in whatever other 
language is understood by the majority of workers at a given workplace. 
California has the most robust acclimatization program, which requires 
close monitoring of new employees for up to fourteen days and 
monitoring of all employees during a heat wave. Table II.D.1, below, 
highlights these and additional similarities and differences between 
the existing state standards on hazardous heat.

                          Table II.D.1--State Rules on Hazardous Heat as of August 2021
----------------------------------------------------------------------------------------------------------------
                                                                                              WA **** (emergency
      Standard requirements              CA *                MN **              OR ***         rule additions in
                                                                                                   italics)
----------------------------------------------------------------------------------------------------------------
Worksite coverage...............  Outdoor, year-      Indoor, year-round  Indoor and          Outdoor, May 1-
                                   round.                                  outdoor,            Sept. 30.
                                                                           emergency rule.
Thresholds triggering protection  80 [deg]F (ambient  Between 77 [deg]F-  80 [deg]F (NOAA     89 [deg]F (ambient
 requirements.                     temp.).             86 [deg]F (WBGT)    NWS Heat Index).    temp.); lower if
                                                       based on workload.                      wearing heavy
                                                                                               clothing/PPE.
Add'l high heat protections.....  At 95 [deg]F        No................  At 90 [deg]F......  At 100 [deg]F.
                                   (certain
                                   industries only).
Water/Hydration.................  1 qt./hr./worker..  No................  1 qt./hr./worker,   1 qt./hr./worker
                                                                           cool or cold.       Suitably cool.
Shade...........................  Yes...............  N/A...............  Yes...............  Yes.

[[Page 59317]]

 
Training........................  Yes (new hire)....  Yes (new hire and   Yes...............  Yes (new hire and
                                                       annual).                                annual).
Breaks..........................  Yes (Encouraged     Yes (After two      Yes (Mandatory if   Yes. (Encouraged
                                   generally,          hours exposure at   symptoms at any     preventative and
                                   mandatory if        threshold).         temp. every 2       must be paid;
                                   symptoms).                              hours for all at    Mandatory if
                                                                           90 [deg]F).         symptoms;
                                                                                               Mandatory at 100
                                                                                               [deg]F).
Acclimatization Plan............  Yes...............  No................  Yes (in practice    No (only included
                                                                           at 90 [deg]F).      in training).
Heat Illness Prevention Plan....  Yes...............  No................  No................  Yes (as part of
                                                                                               accident
                                                                                               prevention plan).
Emergency Medical Response Plan.  Yes...............  No................  Yes...............  Yes.
Medical Monitoring..............  Reactive,           Reactive..........  Reactive..........  Reactive.
                                   Proactive when
                                   above 95 [deg]F.
Record-keeping requirements.....  Yes...............  Yes...............  No................  Yes.
----------------------------------------------------------------------------------------------------------------
* CAL/OSHA, Title 8, section 3395. Heat Illness Prevention. https://www.dir.ca.gov/Title8/3395.html.
** Minnesota Administrative Rules. Section 5205.0110 Indoor ventilation and temperature in places of employment.
  https://www.revisor.mn.gov/rules/5205.0110/.
*** Oregon Administrative Rules. 437-002-0155 Temporary Rule Heat Illness Prevention. https://osha.oregon.gov/OSHARules/div2/437-002-0155-temp.pdf.
**** Washington Administrative Code (WAC) Title 296, General Occupational Health Standards. Sections 296-62-095
  through 296-62-09560. Outdoor Heat Exposure. https://app.leg.wa.gov/WAC/default.aspx?cite=296-62&full=true#296-62-095; Emergency Rule 2125 CR103E. https://lni.wa.gov/rulemaking-activity/AO21-25/2125CR103EAdoption.pdf.

    The following questions are intended to solicit information related 
to the existing efforts at the state level to prevent occupational 
heat-related illness, injuries, and fatalities.
    (30) What are the most effective aspects of existing state 
standards aimed at preventing occupational heat-related illness?
    (31) What are the challenges with the implementation of existing 
state standards aimed at preventing occupational heat-related illness?
    (32) Of the existing state standards, have any been more effective 
or challenging in their implementation than others? Why?
    (33) What components of a state standard or program should be 
included in Federal guidance or regulatory efforts on heat-related 
illness prevention?
    (34) Would any of the elements of the state standards not be 
feasible to include at the Federal level?

E. Other Standards

    Various other organizations have also either identified the need 
for standards to prevent heat-related injury and illness or published 
their own standards. In 2019, the American National Standards 
Institute/American Society of Safety Professionals A10 Committee (ANSI/
ASSP) announced a proposed consensus standard on heat stress 
management. The International Organization for Standardization has a 
standard estimating heat stress: ISO 7243: Hot Environments--Estimation 
of Heat Stress on Working Man, Based on the WBGT-Index (ISO, 2017). 
Additional standards address predicting sweat rate and core temperature 
(ISO 7933), methods for determining metabolic rate (ISO 8996), 
physiological strain (ISO 9886), and thermal characteristics for 
clothing (ISO 9920) (NIOSH, February 2016). The ISO heat stress 
standard uses WBGT values to assess hot environments and assumes 
workforces to which thresholds are applied are healthy, physically fit, 
and are wearing standard clothing.
    ACGIH has identified Threshold Limit Values or TLVs for heat stress 
and heat strain (ACGIH, 2017). The TLVs utilize WBGT and take into 
consideration metabolic rate or work load categories: Light (sitting, 
standing, light arm/handwork, occasional walking), moderate (normal 
walking, moderate lifting), heavy (heavy material handling, walking at 
a fast pace), very heavy (pick and shovel work). Additionally, ACGIH 
provides clothing adjustment factors in degrees Celsius that should be 
added to the assessed WBGT for certain types of work clothing. The TLVs 
range from WBGTs of approximately 24.5 degrees Celsius at the highest 
level of work to just under 34 degrees Celsius at light work and low 
metabolic rates (ACGIH, 2017). ACGIH emphasizes that the TLVs are 
appropriate for healthy, acclimatized workers and they encourage 
screening of workers for potential sensitivities to heat and provide 
guidelines for physiological monitoring for heat strain. An action 
limit that is below the level of the TLV is identified for 
unacclimatized workers.
    The U.S. Armed Forces has developed extensive heat-related illness 
prevention and management strategies. The Warrior Heat and Exertion 
Related Events Collaborative is a tri-service group of military leaders 
focused on clinical, educational, and research efforts related to 
exercise and exertional heat-related illnesses and medical emergencies 
(HPRC, October 6, 2021). The U.S. Army has a Heat Center at Fort 
Benning which focuses on management, research, and prevention of heat-
related illness and death (Galer, April 8, 2019). In 2016, the U.S. 
Army updated its Training and Doctrine Command (TRADOC) Regulation 350-
29 addressessing heat and cold casualties. The regulation includes 
requirements for rest and water consumption according to specific WBGT 
levels and work intensity (Department of the Army, July 18, 2016). The 
U.S. Navy has developed Physiological Heat Exposure Limit curves based 
on metabolic and environmental heat load and represent the maximum 
allowable heat exposure limits, which were most recently updated in 
2009. The Navy monitors WBGT, with physical training diminishing as 
WBGTs increase and all nonessential outdoor activity stopped when WBGTs 
exceed 90 degrees Fahrenheit (Department of the Navy, February 12, 
2009). The U.S. Marine Corps follows the Navy's guidelines for 
implementation of the Marine Corps Heat Injury Prevention Program 
(Commandant of the Marine Corps, June 6, 2002). The U.S. Army and U.S. 
Air

[[Page 59318]]

Force issued a technical heat stress bulletin in 2003 with measures to 
prevent indoor and outdoor heat-related illness in soldiers, with 
recommended limitations of continuous work at ``moderate'' or ``hard'' 
intensities, acclimatization planning, work-rest cycles, and fluid and 
electrolyte replacement (Department of the Army and Air Force, March 7, 
2003).
    The following questions are intended to solicit information related 
to the existing efforts undertaken to prevent occupational heat-related 
illness, injuries, and fatalities by other entities.
    (35) Do any of these existing standards contain elements that 
should be considered for a Federal standard?
    (36) Are there other industry standards that contain elements that 
should be considered for a Federal standard?
    (37) Are there elements of these standards that would not be 
appropriate or feasible for a Federal heat standard?

F. Employer Efforts

    While this section has primarily detailed efforts undertaken by 
OSHA, other Federal agencies, states, and industry trade associations, 
OSHA also recognizes that some employers may be engaged on this topic 
and implementing their own heat-related illness prevention efforts.
    The following questions are intended to solicit information, 
relevant data sources, and considerations to further assess the current 
employer efforts to prevent heat-related illness and their efficacy in 
preventing heat-related illnesses.
    (38) What efforts are employers currently taking to prevent 
occupational heat-related illness in their workplace? Please provide 
examples and data.
    (39) How effective have employers been in preventing occupational 
heat-related illness in their workplaces, and how are employer-driven 
heat injury and illness prevention programs being evaluated?

III. Key Issues in Occupational Heat-Related Illness

A. Determinants of Occupational Heat Exposure

1. Heat Exposure
    Workers in both indoor and outdoor occupations in a variety of 
sectors are exposed to heat at work through process, exertional, and/or 
environmental heat. Hazardous heat exposure can reduce the body's 
ability to regulate physiological processes and can result in heat-
related injury or illness, heat stroke, or death. Determining when heat 
becomes hazardous is complex. Heat exposure and its resultant health 
effects depend on multiple factors, such as heat-generating practices 
within a workplace, level of exertion during work, air temperature, 
humidity, whether work is occurring in direct sunlight or shade, wind, 
and cloud cover (OSHA, September 2, 2021). Individual-level factors 
such as age, pharmaceutical use, underlying health conditions (such as 
cardiovascular diseases), and the ability to cool at night (during heat 
waves or access to night time air conditioning, for example) also play 
a role (Kilbourne, 1997; Quandt et al., 2013; OSHA, October 6, 2021b).
    Multiple metrics and thresholds exist for measuring heat and 
identifying when it may become hazardous to a population. Ambient 
temperature, heat index, and WBGT are available metrics for measuring 
environmental heat and identifying conditions that may lead to heat-
related injury or illness. Ambient temperature, which can be calculated 
using a common thermometer, is the most accessible and understandable 
metric that most people are familiar with. However, ambient temperature 
measurements alone do not take into consideration humidity, which is an 
important factor that influences the body's ability to cool. Heat index 
combines air temperature and humidity and is a widely reported weather 
statistic that many people are familiar with and is often referred to 
as the ``feels like'' or ``apparent'' temperature. Heat index is used 
for setting heat advisories (NWS, September 2, 2021) but does not take 
into consideration radiant heat or wind speed, which the more health-
relevant WBGT does. WBGT is a health-relevant measurement that 
incorporates air temperature, wind, radiant heat, and humidity (Budd, 
2008; OSHA, September 15, 2017; Oliveira et al., 2019). Measuring WBGT 
requires specialized thermometers or equipment, and may not always be 
available as a forecast through the National Weather Service. 
Additionally, WBGT may require guidance and training to avoid confusion 
with more well-known scales like temperature or heat index.
    Another challenge with each of these metrics is identifying 
appropriate thresholds for each metric that will prevent adverse health 
impacts due to hazardous heat exposure. There is no universally 
accepted threshold for ambient temperature, heat index, or WBGT at 
which heat is considered hazardous. Determining thresholds is 
complicated by differences in regional climatology, where one region's 
population may become vulnerable to heat-related illness at lower heat 
levels (Grundstein et al., January 2015; NWS, August 25, 2021). NOAA, 
NIOSH, OSHA, the U.S. Military, and other organizations currently offer 
differing thresholds and metrics for the identification of hazardous 
heat (Department of the Army and Air Force, March 2007; NIOSH, 2016; 
NWS, August 25, 2021; OSHA, September 2021; NWS, September 1, 2021). 
Existing state standards also apply different thresholds and metrics. 
Further, existing thresholds for various metrics may not be protective 
in the occupational setting because injuries and illnesses have been 
reported below these existing thresholds (Morris et al., January 28, 
2019; Park et al. July 2021), and many of the thresholds indicating the 
potential for heat-related injury or illness are based on older data or 
studies that included populations that may not be most appropriate for 
evaluating heat stress or strain in the occupational setting, such as 
military populations (Steadman, April 11, 1979; Rothfusz, July 1, 1990; 
Budd, 2008).
    The following questions are intended to solicit information, 
relevant data sources, and considerations to further assess the 
application of various heat metrics and the identification and 
definition of hazardous heat using metric thresholds.
    (40) What metrics are currently being used to monitor and assess 
hazardous heat exposure in the workplace (e.g., heat index, ambient 
temperature, WBGT)?
    (41) What are the advantages and disadvantages of using each of 
these metrics (e.g., heat index, ambient temperature, WBGT) in indoor 
and outdoor work settings? Are there any challenges associated with 
training employers and employees on these different metrics?
    (42) Are there other metrics used to assess hazardous heat exposure 
in the workplace that are not discussed here?
    (43) What are current and best practices in defining hazardous heat 
exposure in outdoor and indoor workplaces, and what are the limitations 
or challenges associated with those practices?
    (44) Are there industries implementing exposure monitoring for 
heat? Please provide examples and data.
    (45) What thresholds are utilized for various metrics implemented 
in existing occupational heat prevention plans or activities? Are these 
thresholds effective for preventing heat-related illness and 
fatalities?
    (46) Which metrics and accompanying thresholds are both feasible 
and health-protective in both

[[Page 59319]]

indoor and outdoor occupational settings?
    (47) Does application of certain heat metrics require more training 
than the use of other heat metrics?
2. Contributions to Heat Stress in the Workplace
    Air temperature, humidity, wind, and whether work occurs in direct 
sunlight all contribute to the potential for heat stress for outdoor 
workers. Additionally, physical exertion contributes to heat stress by 
increasing metabolic heat production. Exertion is an important 
consideration for the development of heat stress especially since 
physical activities may take place over prolonged periods of time in a 
work setting and in environmental conditions that limit the body's 
ability to cool, such as working in direct sunlight or under warm and 
humid conditions. These factors that contribute to heat stress can lead 
to heat strain and heat-related illness when the body fails to lose 
heat. Some surfaces, such as asphalt, absorb heat and can add to heat 
exposure. The urban heat island effect is a well-studied phenomenon 
that can elevate temperatures in areas concentrated with heat absorbent 
surfaces. For example, dense urban areas may experience afternoon 
temperatures 15-20 degrees higher than surrounding areas with more 
natural land cover and vegetation (NIHHIS, August 25, 2021). PPE can 
also contribute to heat stress by interfering with the body's ability 
to cool. PPE intended to protect workers from chemical, physical, or 
biological hazards can reduce sweat evaporation and subsequent cooling 
(i.e., limit the body's ability to sweat), can trap heat and moisture 
next to the skin, and can increase the level of exertion required to 
complete a task (NIOSH, February 2016).
    The factors that contribute to heat stress in outdoor settings 
contribute to heat stress in indoor settings as well, especially in 
buildings that lack adequate climate control. Additionally, heat-
producing processes and equipment such as those that generate steam, 
generate heat, or use certain tools and combustion, can increase 
ambient temperature and contribute to heat stress in indoor work 
settings. Lack of adequate climate control in indoor work settings can 
also contribute to occupational heat stress since indoor settings can 
increase in temperature and humidity as outdoor temperatures increase, 
and there is no relief for process or task-related heat production. 
Additionally, buildings with windows may be further heated by sunlight 
that enters windows and warms the workspace.
    The vulnerability of the energy grid is another variable that may 
place many workers at risk of experiencing heat-related illness. In 
many areas of the country, energy grids are vulnerable to brownouts and 
blackouts in conditions of high heat due to the increased demand and 
stress placed on the energy infrastructure (Stone, Jr., et al., 2021). 
Because of this vulnerability of a key cooling mechanism, more workers 
in more industries may be at risk for experiencing heat stress, strain, 
and heat-related illness than is currently realized, especially during 
heat waves or during other natural disasters that impact the 
functionality of energy grids.
    In both indoor and outdoor settings, individual risk factors 
contribute to the risk of heat-related illness as some individuals are 
more susceptible to the detrimental effects of heat. Occupational heat-
related fatalities have been found to occur more frequently in men than 
in women, in those with preexisting conditions (e.g., obesity, 
diabetes, hypertension, cardiac disease), and in those with a 
preexisting use of certain medications or illicit drugs that predispose 
individuals to heat-related illness (Gubernot et al., February 2015; 
Tustin et al., July 6, 2018; Tustin et al., August 2018). Other 
factors, such as age, fitness level, alcohol consumption, prior heat-
related illness, and lack of access to air conditioning in housing, 
also reduce the body's ability to regulate heat and can increase 
individual risk of heat-related illness. Workplace controls should 
focus on making indoor and outdoor work safe for all employees, while 
also complying with the Americans with Disabilities Act and the Age 
Discrimination in Employment Act.
    The following questions are intended to solicit information, 
relevant data sources, and considerations to further assess 
contributions to heat stress in indoor and outdoor work settings as 
well as individual risk factors that may contribute to heat-related 
illness in occupational settings.
    (48) What factors, beyond those discussed above, contribute to heat 
stress in outdoor and/or indoor occupational settings?
    (49) Is air conditioning provided in employer-provided or sponsored 
housing?
    (50) Are there existing employer efforts or programs to ensure that 
employees have the ability to adequately cool at night in order to 
recover from occupational heat exposure?
    (51) What factors are the most important contributors to heat-
related illness risk?
    (52) Are there other individual risk factors that contribute to the 
risk of heat-related illness?
    (53) What individual risk factors are the most important 
contributors to heat-related illness risk?
    (54) Are there existing employer-led heat prevention programs that 
consider individual-level risk factors in their prevention guidance? If 
so, how are they implemented? What are the challenges associated with 
this?

B. Strategies To Reduce Occupational Heat-Related Injury and Illness

    Workplace heat-related injury and illness is preventable, and many 
effective controls can be implemented. The following sections provide a 
brief overview and targeted questions about controls that would be 
important to consider as part of an effective heat injury and illness 
prevention program.
1. Heat Injury and Illness Prevention Programs
    Safety and health programs aim to prevent workplace injuries, 
illnesses, and fatalities by using a proactive approach to managing 
workplace safety and health. An effective heat injury and illness 
prevention program would include elements on: Assessing heat hazards 
that may occur at the workplace, acclimatizing new and returning 
workers, evaluating how and when heat will be measured, and determining 
what controls will be put into place and what training will be provided 
to workers and supervisors. Evaluations of heat-related enforcement 
cases have shown that in investigations of heat-related fatalities or 
heat-related illness that resulted in 5(a)(1) violations from 2012-
2013, no employer had a complete heat illness prevention program that 
addressed all of the recommended components, and 12 of the 20 cases 
evaluated had no heat illness prevention program at all (Arbury et al., 
April 2016). In one study, the implementation of a heat illness 
prevention program was found to decrease workers' compensation costs 
associated with heat-related illness incidents and reduce the total 
number of heat-related illnesses experienced by outdoor municipal 
workers in Texas (McCarthy et al., September 2019).
    The following questions are intended to solicit information and 
relevant data sources that OSHA should consider when evaluating the 
need for and elements of a heat injury and illness prevention program 
for indoor and outdoor work environments.

[[Page 59320]]

    (55) What are the elements of a successful employer-led heat injury 
and illness prevention program? How are these programs implemented? 
What are the challenges associated with them? Please provide examples 
and data.
    (56) Are there other elements of a heat injury and illness 
prevention program that are important to consider?
    (57) Are there limitations associated with implementing a heat 
injury and illness prevention program across indoor or outdoor work 
settings, or across businesses of various sizes? If so, what are they?
    (58) Are there demonstrated evaluations on the successes or 
limitations of various components of any existing state or employer 
heat injury and illness prevention program, including quantitative or 
qualitative evaluations?
2. Engineering Controls, Administrative Controls, and Personal 
Protective Equipment
    Engineering controls, such as air conditioning or increased 
ventilation, increase evaporative cooling and can keep body 
temperatures at safe levels. Other examples of engineering controls 
that may reduce the amount of hazardous heat present could include the 
use of local exhaust ventilation at points of high heat production, 
insulating hot surfaces or equipment (e.g., furnaces), and providing 
shade tents, or other building modifications where appropriate.
    Administrative controls, such as making changes to workloads or 
work schedules, can be useful in keeping workers cool during hazardous 
heat exposure. For example, work schedules may shift from the hottest 
parts of the day to cooler times of the day, like overnight or early in 
the morning. Employers may implement work-rest cycles by adding 
additional rest breaks in the shade or air conditioning away from heat 
sources as environmental and exertional heat increases. Some employers 
have implemented self-pacing for workers as an alternative to work-rest 
cycles, allowing employers to pace themselves throughout the work shift 
when heat is hazardous. Other examples of administrative controls could 
include reducing physical demands during the hottest times of the day 
or implementing buddy systems to ensure workers are watching out for 
signs and symptoms of heat-related illness in each other.
    OSHA's Heat Illness Prevention Campaign has historically 
recommended the implementation of ``Water. Rest. Shade.,'' which is a 
combination of engineering and administrative controls to provide 
workers with adequate amounts of water, rest, and shade. As discussed 
above in more detail, because the Campaign is not mandatory, these 
controls are not always implemented in workplaces. An evaluation of 38 
enforcement investigations from 2011-2016 found that while nearly 85% 
of the inspected employers provided accessible water, none of them 
enforced or required rest breaks during periods of hazardous heat 
(Tustin et al., August 2018). In some work settings, such as in 
agricultural workplaces, workers may be paid piecemeal or receive wages 
based on their productivity or output. These payment schemes can result 
in workers making tradeoffs between reduced productivity and lost wages 
versus taking breaks to rest or drink water (Wadsworth et al., 2019). 
However, without breaks, overall productivity can decline during 
hazardous heat due to workers being less able to work efficiently, as 
well as from higher rates of accidents and heat-related illnesses (Ebi 
et al., August 21, 2021).
    In some situations, PPE and auxiliary body cooling methods (e.g., 
cooled or iced vests, jackets, or other wearable garments) may further 
reduce the risk of heat strain in those working in hazardous heat 
conditions. For example, reflective and breathable clothing, cooling 
neck wraps, and cooling vests or jackets may provide enhanced 
protection to some workers.
    The following questions seek to solicit additional information, 
data sources, and considerations for engineering and administrative 
controls, as well as PPE, and their use in preventing heat-related 
illness in indoor and outdoor work settings.
    (59) What engineering controls, administrative controls, or PPE can 
be used to prevent heat-related illness in indoor and outdoor work 
settings? Have the qualitative or quantitative effectiveness of these 
controls been evaluated?
    (60) Are there data that demonstrate the role of facility energy 
efficiency in maintaining optimal thermal conditions, optimizing worker 
performance, and cost-effectiveness of cooling strategies?
    (61) Are certain controls that are more effective or more feasible 
than others? If so, which ones? Do effectiveness and feasibility of 
controls differ due to setting (indoor/outdoor, business size, 
arrangement of work, etc.)?
    (62) What are the limitations associated with implementing water, 
rest, and shade effectively in indoor and outdoor work settings?
    (63) How are work-rest cycles currently implemented in indoor and 
outdoor work settings? What are the limitations for implementation?
    (64) Are there additional sources of data or evidence that describe 
the quantitative or qualitative impacts of work-rest cycles on 
productivity?
    (65) How do productivity or output based payment schemes affect the 
ability of workers to follow heat illness and injury prevention 
training, guidance or requirements?
    (66) How do productivity or output based payment schemes affect 
employer implementation of heat illness and injury prevention training, 
guidance or requirements?
    (67) Are there additional sources of data or evidence that describe 
the quantitative or qualitative impacts of self-pacing as an 
alternative to work-rest cycles to prevent occupational heat-related 
illness?
3. Acclimatization
    Acclimatization refers to the process of the human body becoming 
accustomed to new environmental conditions by gradually adapting to the 
conditions over time. Gradual exposure to the condition of concern 
(e.g., heat) allows the body to develop more robust physiological 
responses, such as a greater sweat response, to adapt to heat more 
efficiently. Workers who are new to working in warm environments may 
not be acclimatized to heat, and their bodies need time to gradually 
adapt to working in hot environments. Evaluations of workplace 
fatalities have shown that approximately 70% of deaths occur within the 
first few days of work, and upwards of 50% occur on the first day of 
work (Arbury et al., August 8, 2014; Tustin et al., August 2018), 
highlighting the consequences of workers not becoming acclimatized to 
the environmental conditions of the workplace. Acclimatization is also 
important for those who may have been previously acclimatized but were 
out of the workforce or hot environment of the workplace for more than 
2 weeks (e.g., due to vacation or sick leave). All outdoor workers may 
need time to acclimatize to heat during early season hazardous heat, or 
during particularly severe or long-lasting heat events, which are 
associated with higher mortality in the general population (Anderson 
and Bell, February 2011). During a heat wave, environmental conditions 
may become extremely hazardous, even to workers who may have been 
previously acclimatized.
    OSHA and NIOSH have historically recommended the ``Rule of 20 
Percent'' for acclimatizing workers. Under this regimen, workers would 
only work 20 percent of the normal duration of work

[[Page 59321]]

on their first day in hazardous heat conditions performing job tasks 
similar in intensity to their expected work, increasing the work 
duration by 20 percent on each subsequent day until performing a normal 
work schedule. For example, if the normal workday lasts 8 hours, then 
new workers should work no more than 1 hour and approximately 40 
minutes (20 percent of 8 hours) on their first day in the heat, and 
spend the remainder of the workday doing work tasks without heat stress 
(OSHA, October 7, 2021). They should be given at least one rest break 
during the period when they are working. Workers with underlying 
medical conditions may need more time to fully adapt to the heat.
    The following questions aim to solicit additional information, 
relevant data sources, and considerations on the design and 
implementation of acclimatization plans for workers in indoor and 
outdoor work settings.
    (68) What are current and best practices for implementing 
acclimatization in various industries and across businesses of various 
sizes?
    (69) What are the challenges with acclimatizing workers, including 
workers in non-traditional/multi-employer work arrangements (e.g., 
temporary workers)?
    (70) Are there different challenges and best practices for 
acclimatization in indoor work settings versus outdoor work settings?
    (71) Are there unique concerns or approaches for implementing 
acclimatization for a small versus large business?
    (72) Are there additional sources of data or evidence that describe 
the quantitative or qualitative impacts of acclimatization schedules on 
productivity?
4. Monitoring
    Physiological, medical, and exposure monitoring of workers exposed 
to heat hazards can prevent heat strain from progressing to heat-
related illness or death. Monitoring can alert both employees and 
employers when workers have been exposed to hazardous heat and are 
experiencing heat strain and should seek water, rest, shade, cooling, 
or medical attention. Monitoring activities may include monitoring 
environmental conditions regularly, self-monitoring of urine color, and 
monitoring of heart rate and core body temperature. Individual-level 
biomonitoring with wearable technologies may be an option in some 
occupational settings. Monitoring activities may also include buddy 
systems where workers are educated in signs and symptoms of heat-
related illness and proactively look for signs and symptoms in fellow 
workers and encourage them to rest, hydrate, and find shade or seek 
emergency medical attention if the worker is experiencing signs of 
heat-related illness.
    The following questions are intended to solicit information, 
relevant data sources, and considerations to further assess heat 
monitoring activities or programs in occupational settings.
    (73) Are there industries or individual employers implementing 
exposure, medical, and/or physiological monitoring to assess workers' 
health and safety during hazardous heat events?
    (74) What are the best practices for implementing a monitoring 
program? How effective are the monitoring activities in preventing 
heat-related illness in workers?
    (75) If physiological and medical monitoring programs are used, who 
implements these programs? Does that individual(s) have specialized 
training or experience?
    (76) If physiological and medical monitoring programs are used, are 
data protected by confidentiality or privacy requirements? Please 
describe how data are maintained to ensure employee privacy and to meet 
any confidentiality or privacy requirements.
    (77) How is exposure, medical, or physiological monitoring 
currently implemented or tracked across various time scales (e.g., 
hourly, daily) in an occupational setting?
    (78) What are the risks or challenges with this type of medical or 
physiological monitoring in a workplace?
    (79) Do you use physiological or medical monitoring to assist in 
identifying high risk employees?
    (80) How do you use physiological monitoring data (e.g., as a short 
term response to heat stress conditions, to address long term 
examination in protecting employees, to identify high risk categories 
of workers)?
    (81) Do you require that notification of monitoring results be 
provided to employees?
    (82) Do you use physiological monitoring to validate the 
effectiveness of recommended controls?
    (83) Are there unique concerns or approaches in developing a 
monitoring program for small versus large businesses?
5. Planning and Responding to Heat-Illness Emergencies
    A heat-illness emergency occurs when a worker is experiencing a 
health crisis due to over-exposure to hazardous heat. Workers and 
employers need to be able to identify a heat-illness emergency, know 
how to respond to an emergency to protect the health of the affected 
worker, to have materials on-site to respond to an emergency, and know 
how to contact emergency medical care when needed. Emergency response 
plans can ensure that workers understand how to respond in an emergency 
and can help prevent heat-related illness from progressing to heat 
stroke or death.
    The following questions are intended to solicit information, 
relevant data sources, and considerations to further assess the role of 
heat-illness emergency planning and response in indoor and outdoor work 
settings in responding to heat stress in the workplace and preventing 
heat-related injury and illness from progressing to heat stroke or 
death.
    (84) How do organizations in both indoor and outdoor work 
environments currently deal with heat-illness emergencies if they 
arise?
    (85) What are current best practices in workplace response to 
occupational heat-illness emergencies?
    (86) What are the challenges with responding to a heat-illness 
emergency in various work environments (e.g., indoor settings, outdoor 
settings, remote locations)?
    (87) What should be included in an employer's heat emergency 
response plan?
    (88) What materials or supplies should employers have on-site to 
respond to a heat emergency?
    (89) When should employers refer employees for medical treatment or 
seek medical treatment for an employee who is experiencing a heat-
illness emergency?
    (90) When and how do employers refer employees for medical 
treatment or seek medical treatment for them when experiencing a heat-
illness emergency?
6. Worker Training and Engagement
    Employers informing employees of the hazards to which employees may 
be exposed while working is a cornerstone of occupational health and 
safety (OSHA, 2017). Training is an effective tool to reduce injury and 
illness (Burke et al., February 2006). Employees must know what 
protective measures are being utilized and be trained in their use so 
that those measures can be effectively implemented. Training and 
education provide employees and managers an increased understanding of 
existing safety and health programs. Training provides managers, 
supervisors, and employees with the knowledge and skills needed to do 
their

[[Page 59322]]

work safely, as well as awareness and understanding of workplace 
hazards and how to identify, report, and control them.
    Because OSHA has long recognized the importance of training in 
ensuring employee safety and health, many OSHA standards require 
employers to train employees (e.g., the Bloodborne Pathogen standard at 
29 CFR 1910.1030(g)(2)). When required as a part of OSHA standards, 
training helps to ensure that employees can conduct work safely and 
healthfully (OSHA, April 28, 2010). Training is essential to ensure 
that both employers and employees understand the sources of potential 
exposure to hazardous heat, control measures to reduce exposure to the 
hazard, signs and symptoms of heat-related illness, and how to respond 
in the event of an emergency. A 2018 analysis of OSHA enforcement 
investigations of 66 heat-related illnesses showed that nearly two-
thirds of the employers did not provide employees with training on 
occupational heat-related illness (Tustin et al., August 2018).
    The following questions are intended to solicit information, 
relevant data sources, and considerations to further assess existing 
worker training and engagement programs and their effectiveness for 
preventing occupational heat injury and illness.
    (91) How do employers currently involve workers in heat injury and 
illness prevention?
    (92) What types of occupational heat injury and illness prevention 
training programs have been implemented and how effective are they? 
What is the scope and format of these training programs? Are workers in 
non-traditional/multi-employer work arrangements included in these 
training programs?
    (93) What are best practices in worker training and engagement in 
heat injury and illness prevention?
    (94) How do employers involve workers in the design and 
implementation of heat injury and illness prevention activities?
    (95) What challenges are there with worker training and engagement 
for heat injury and illness prevention?

IV. Costs, Economic Impacts, and Benefits

A. Overview

    OSHA also seeks information on the costs, economic impacts, and 
benefits of heat injury and illness prevention practices. In addition 
to information regarding the costs and economic impacts of heat injury 
and illness prevention practices, OSHA is interested in the benefits of 
such practices in terms of reduced injuries, illnesses, deaths, and 
compromised operations (i.e., emotional distress, staffing turnover, 
and unexpected reallocation of resources), as well as any other 
productivity effects. As discussed above in Part I of this ANPRM, 
millions of workers across hundreds of occupations are likely to be 
exposed to conditions that could lead to heat-related injury, illness, 
and death.
    The effects of heat-related injury and illness can be significant 
to employers and workers alike. They harm workers financially, 
physically, and mentally, and employers also bear several costs and 
reduced revenue. A single serious injury or illness can lead to 
workers' compensation losses of thousands of dollars, along with 
thousands of dollars in additional costs for overtime, temporary 
staffing, or recruiting and training a replacement. Even if a worker 
does not have to miss work, heat stress can still lead to higher 
turnover and deterioration of productivity and morale.Globally, the 
International Labour Organization (ILO) has estimated that increased 
heat stress could result in a productivity decline by the equivalent of 
80 million full-time jobs by the year 2030 (ILO, 2019).
    According to BLS, as shown below in Table IV.A.1, exposure to 
environmental heat results in thousands of injury and illness cases and 
dozens of deaths per year (BLS, December 22, 2020 and BLS, January 28, 
2021). Note that these data do not provide a comprehensive account of 
the number of heat-related injuries and fatalities, for a variety of 
reasons, such as employee reluctance to report and lack of awareness of 
the contributing effects of heat to symptoms.

 Table IV.A.1--Reported Occupational Injuries (Involving Days Away From
   Work) and Fatalities as a Result of Exposure to Environmental Heat
------------------------------------------------------------------------
                                              Annual          Annual
                  Year                       injuries       fatalities
------------------------------------------------------------------------
2011....................................           4,420              61
2012....................................           4,170              31
2013....................................           3,160              34
2014....................................           2,660              18
2015....................................           2,830              37
2016....................................           4,110              39
2017....................................           3,180              32
2018....................................           3,950              49
2019....................................           3,080              43
------------------------------------------------------------------------
Source: U.S. Bureau of Labor Statistics: Injuries, Illnesses, and
  Fatalities, (BLS, December 22, 2020 and BLS, January 28, 2021)
  (Accessed August 30, 2021).

    The following questions are intended to solicit information on the 
topics covered in this section.
    (96) OSHA requests any workers' compensation data related to heat-
related injury and illness. Any other information on your workplace's 
experience would also be appreciated.
    (97) Are there additional data (other than workers' compensation 
data) from published or unpublished sources that describe or inform 
about the incidence or prevalence of heat-related injuries, illness, or 
fatalities in particular occupations and industries?
    (98) What are the potential economic impacts associated with the 
promulgation of a standard specific to the risk of heat-related injury 
and illness? Describe these impacts in terms of benefits, including 
reduction of incidents; effects on costs, revenue, and profit; and any 
other relevant impact measurements.
    (99) If you utilize the WBGT method when making your work 
determinations, what were the costs of any associated equipment and/or 
training to implement this measurement method?
    (100) If you utilize a temperature metric other than WBGT when 
making work determinations, what were the costs associated with 
measurement and/or training to implement this measurement method?
    (101) Have you instituted programs or policies directed at 
mitigating heat-related injury and illness at your worksite? If so, 
what were the resulting benefits?
    (102) If you have implemented a heat injury and illness program or 
policy, what was the cost of implementing the program or policy, in 
terms of both time and expenditures for supplies and equipment? Please 
describe in detail the resource requirements and associated costs 
expended to initiate the program(s) and to conduct the program(s) 
annually. If you have any other estimates of the costs of preventing or 
mitigating heat-related injury and illness, please provide them. It 
would be helpful to OSHA to learn both overall totals and specific 
components of the program (e.g., cost of equipment, equipment 
installation, equipment maintenance, training programs, staff time, 
facility redesign).
    a. What are the ongoing operating and maintenance costs for the 
program?
    b. Has your program reduced incidents of heat-related injury and 
illness and by how much? Can you identify which elements of your 
program most reduced incidents? Which elements did not seem effective?

[[Page 59323]]

    c. Has your program reduced direct costs for your facility (e.g., 
workers' compensation costs, fewer lost workdays)? Please quantify 
these reductions, if applicable.
    d. Has your program reduced indirect costs for your facility (e.g., 
reductions in absenteeism and worker turnover; increases in reported 
productivity, satisfaction, and level of safety in the workplace)?
    (103) Do you provide wearable devices (specific to heat) to 
workers? Does each worker get a device or only specific members of the 
crew?
    a. If wearables are provided, what were the associated upfront 
costs of the equipment and how often do they need to be replaced?
    b. Which specific wearable did you choose? What were your deciding 
factors (i.e., price, ease of use)?
    (104) If you are in a state with standards requiring programs and/
or policies to reduce heat stress, how did implementing the program 
and/or policy affect the facility's budget and finances?
    (105) What changes, if any, in market conditions would reasonably 
be expected to result from issuing a standard on heat stress 
prevention? Describe any changes in market structure or concentration, 
and any effects on the prices of products and services to consumers, 
that would reasonably be expected from issuing such a standard.
    (106) If you have implemented acclimatization practices in your 
workplace, were there any associated costs?
    (107) How does your workplace address the costs of any rest breaks 
necessary to prevent heat-related injury and illness?

B. Impacts on Small Entities

    As part of the agency's consideration of a heat stress standard, 
OSHA is concerned about whether its actions will have a significant 
economic impact on a substantial number of small entities. Small 
entities included small businesses, small non-profit organizations, and 
small governmental jurisdictions with a population of less than 50,000. 
These other small employer organizations may experience heat stress 
issues in much the same manner as small businesses. Injury and illness 
incidence rates are known to vary by establishment size. In the 
construction industry, for example, across all nonfatal occupational 
injuries and illnesses, establishments between 11 and 49 employees had 
an average incidence rate of 3.3 per 100 Full Time Equivalent (FTE) 
workers, whereas establishments with 1,000 or more employees had an 
average incidence rate of 0.9 per 100 FTE workers. (BLS, August 31, 
2021). If the agency pursues the development of a standard that would 
have such impacts on small businesses, OSHA is required to develop a 
regulatory flexibility analysis and convene a Small Business Advocacy 
Review panel under the Small Business Regulatory Enforcement Fairness 
Act (before publishing a proposed rule (see Regulatory Flexibility Act, 
5 U.S.C. 601 et seq.)). Regardless of the significance of the impacts, 
OSHA seeks ways of minimizing the burdens on small businesses 
consistent with OSHA's statutory and regulatory requirements and 
objectives.
    The following questions are intended to solicit information on the 
topics covered in this section.
    (108) How many, and what type of small firms, or other small 
entities, have heat-related injury and illness training, or a heat 
injury and illness program, and what percentage of their industry 
(NAICS code) do these entities comprise? Please specify the types of 
heat stress risks employees in these firms face.
    (109) How, and to what extent, would small entities in your 
industry be affected by a potential OSHA standard to prevent heat 
stress? Do special circumstances exist that make preventing heat stress 
more difficult or more costly for small entities than for large 
entities? Please describe these circumstances.
    (110) How many, and in what type of small entities, is heat-related 
injury and illness a threat, and what percentage of their industry (by 
NAICS codes) do these entities comprise?
    (111) Are there alternative regulatory or non-regulatory approaches 
OSHA could use to mitigate possible impacts on small entities?
    (112) For very small entities (historically defined by OSHA as 
those with fewer than 20 employees), what types of heat-related injury 
and illness threats are faced by workers? Does your experience with 
heat-related injury and illness reflect the lower rates reported by 
BLS?
    (113) For very small entities, what are the unique challenges 
establishments face in addressing heat-related injury and illness?
    (114) If you are in a jurisdiction with standards requiring 
programs and/or policies to reduce heat stress, how did implementing 
the program and/or policy affect your small entity or other small 
entities in your jurisdiction?

V. References

Althubaiti A. (2016, May 4). Information bias in health research: 
definition, pitfalls, and adjustment methods. Journal of 
Multidisciplinary Healthcare, 9, 211-217. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862344/pdf/jmdh-9-211.pdf. 
(Althubaiti, May 4, 2016)
American Conference of Governmental Industrial Hygienists (ACGIH). 
(2017). Heat Stress and Strain: TLV[supreg] Physical Agents 7th 
Edition Documentation. https://mhssn.igc.org/2017%20ACGIH%20-%20Heat%20Stress%20TLV.pdf. (ACGIH, 2017)
Anderson GB and ML Bell. (2011, February). Heat waves in the United 
States: mortality risk during heat waves and effect modification by 
heat wave characteristics in 43 U.S. communities. Environmental 
Health Perspectives, 119, 210-218. doi:10.1289/ehp.1002313. 
(Anderson and Bell, February 2011)
Arbury S et al. (2014, August 8). Heat illness and death among 
workers--United States, 2012-2013. Centers for Disease Control and 
Prevention, Morbidity and Mortality Weekly Report, 63(31). (Arbury 
et al., August 8, 2014)
Arbury S et al. (2016, April). A critical review of OSHA heat 
enforcement cases: lessons learned. Journal of Occupational and 
Environmental Medicine, 58(4). doi:10.1097/JOM.0000000000000640. 
(Arbury et al., April 2016)
Brown S, Baldwin T, Murray P, Whitehouse S, Warren E, Schatz B, Wood 
Hassan M, Blumenthal R, Casey, Jr. RP, Rosen J, Hirono MK, Reed J. 
(2019, November 18). Correspondence from members of the U.S. Senate 
to the Honorable Eugene Scalia, Secretary, United States Department 
of Labor. (Brown et al., November 18, 2019)
Budd G. (2008). Wet-bulb globe temperature (WBGT)--its history and 
limitations. Journal of Science and Medicine and Sport, 11, 20-32. 
2008. doi:10.1016/j.jsams.2007.07.003. (Budd, 2008)
Bureau of Labor Statistics (BLS). (2017, August 30). Work injuries 
in the heat in 2015. The Economics Daily. https://www.bls.gov/opub/ted/2017/work-injuries-in-the-heat-in-2015.htm. (BLS, August 30, 
2017)
Bureau of Labor Statistics (BLS). (2020, December 8). Survey of 
Occupational Injuries and Illnesses Data Quality Research. https://www.bls.gov/iif/data-quality.htm. (BLS, December 8, 2020)
Bureau of Labor Statistics (BLS). (2020, December 22). Census of 
Fatal Occupational Injuries. https://www.bls.gov/iif/oshcfoi1.htm. 
(BLS, December 22, 2020)
Bureau of Labor Statistics (BLS). (2021, January 28). Survey of 
Occupational Injuries and Illnesses Data. https://www.bls.gov/iif/soii-data.htm. (BLS, January 28, 2021)
Bureau of Labor Statistics (BLS). (2021, August 31). Injuries, 
Illnesses, and Fatalities. Table Q1. Incidence rates of total 
recordable cases of nonfatal occupational injuries and illnesses by 
quartile distribution and employment

[[Page 59324]]

size, 2019. Accessed August 31, 2021. (BLS, August 31, 2021)
Bureau of Labor Statistics (BLS). (2021, September 1). 43 work-
related deaths due to environmental heat exposure in 2019. The 
Economics Daily. https://www.bls.gov/opub/ted/2021/43-work-related-deaths-due-to-environmental-heat-exposure-in-2019.htm. (BLS, 
September 1, 2021)
Bureau of Labor Statistics (BLS). (2021a, September 10). Fatal 
occupational injuries by selected worker characteristics and 
selected event or exposure, All U.S., all ownerships, 1992-2019. 
https://data.bls.gov/gqt/InitialPage. Accessed September 10, 2021. 
(BLS, September 10, 2021a)
Bureau of Labor Statistics (BLS). (2021b, September 10). Databases, 
Tables & Calculators by Subject. Nonfatal cases involving days away 
from work: selected characteristics (2011 forward). https://data.bls.gov/PDQWeb/cs. Accessed September 10, 2021. (BLS, September 
10, 2021b)
Burke MJ et al. (2006, February). Relative effectiveness of worker 
safety and health training methods. American Journal of Public 
Health, 96, 315-324. (Burke et al., February 2006)
Caban-Martinez AJ et al. (2018, April). Physical exposures, work 
tasks, and OSHA-10 training among temporary and payroll construction 
workers. Journal of Occupational and Environmental Medicine, 60(4), 
e159-e165. doi:10.1097/JOM.0000000000001267. (Caban-Martinez et al., 
April 2018)
CAL/OSHA, Title 8, Section 3395. Heat Illness Prevention. https://www.dir.ca.gov/Title8/3395.html. (CAL/OSHA)
Centers for Disease Control and Prevention (CDC). (2008, June 20). 
Heat-related deaths among crop workers--United States, 1992-2006. 
Centers for Disease Control and Prevention, Morbidity and Mortality 
Weekly Report, 57(24), 649-653. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5724a1.htm. (CDC, June 20, 2008)
Chu J, Grijalva RM, Levin A, Schakowsky J, Takano M, Hayes J, Pocan 
M, Bonamici S, Lowenthal A, Davis DK, Adams AS, Scott RC, Lee B, 
Blumenauer E, Jaypal P, Moore G, McGovern JP, Panetta J, Carson A, 
Dingell D, Carbajal S, Pressley A, Watson Colman B, Sanchez L. 
(2021, August 6). Correspondence from members of the U.S. House of 
Representatives to The Honorable Martin J. Walsh, Secretary, U.S. 
Department of Labor. (Chu et al., August 6, 2021)
Commandant of the Marine Corps. (2002, June 6). Marine Corps Order 
6200.1E W/CH1: Marine Corps heat injury prevention program. https://www.imef.marines.mil/Portals/68/Docs/IMEF/Surgeon/MCO_6200.1E_W_CH_1_Heat_Injury_Prevention.pdf. (Commandant of the 
Marine Corps, June 6, 2002)
Department of the Army (2016, July 18). Training Prevention of Heat 
and Cold Casualties. TRADOC Regulation 350-29. https://adminpubs.tradoc.army.mil/regulations/TR350-29.pdf. (Department of 
the Army, July 18, 2016)
Department of the Army and Air Force. (2003, March 7). Technical 
bulletin: Heat stress control and heat casualty management. https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=46205. 
(Department of the Army and Air Force, March 7, 2003)
Department of the Navy, Bureau of Medicine and Surgery. (2009, 
February 12). Manual of Naval Preventive Medicine, Chapter 3: 
Prevention of heat and cold stress injuries (ashore, afloat, and 
ground forces). NAVMED P-5010-3 (Rev. 2-2009) 0510-LP-108-2696. 
https://www.med.navy.mil/Portals/62/Documents/BUMED/Directives/All%20Pubs/5010-3.pdf?ver=yohnSL5ixr0E8pzXCJLhCw%3d%3d. (Department 
of the Navy, February 12, 2009)
Ebi KL et al. (2021, August 21). Hot weather and heat extremes: 
health risks. The Lancet, 398, 698-708. (Ebi et al., August 21, 
2021)
Environmental Protection Agency (EPA). (2017, May). Multi-Model 
Framework for Quantitative Sectoral Impacts Analysis: A Technical 
Report for the Fourth National Climate Assessment. U.S. 
Environmental Protection Agency, EPA 430-R-17-001. https://cfpub.epa.gov/si/si_public_record_Report.cfm?Lab=OAP&dirEntryId=335095. (EPA, May 
2017)
Environmental Protection Agency (EPA). (2021, April). Climate Change 
Indicators: Heat-Related Deaths. https://www.epa.gov/climate-indicators/climate-change-indicators-heat-related-deaths. (EPA, 
April 2021)
Environmental Protection Agency (EPA). (2021, September 2). Climate 
Change and Social Vulnerability in the United States: A Focus on Six 
Impacts. EPA 430-R-21-003. www.epa.gov/cira/social-vulnerability-report. (EPA, September 2, 2021)
Flouris AD et al. (2018, December). Workers' health and productivity 
under occupational heat strain: a systematic review and meta-
analysis. Lancet Planetary Health, 2, e521-31. (Flouris et al., 
December 2018)
Galer M. (2019, April 8). The heat center initiative: heat illness 
awareness. https://www.army.mil/article/218736/the_heat_center_initiative_heat_illness_awareness. (Galer, April 8, 
2019)
Glaser J et al. (2016, August 8). Climate change and the emergent 
epidemic of CKD from heat stress in rural communities: the case for 
heat stress nephropathy. Clinical Journal of the American Society of 
Nephrology, 11(8), 1472-1483. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974898/?report=printable. (Glaser et al., August 8, 
2016)
Government Accountability Office (GAO). (2009, October). Enhancing 
OSHA's records audit process could improve the accuracy of worker 
injury and illness data. https://www.gao.gov/assets/gao-10-10.pdf. 
(GAO, October 2009)
Grundstein A, et al. (2015, January). Regional heat safety 
thresholds for athletics in the contiguous United States. Applied 
geography, 56 (2015), 55-60. https://doi.org/10.1016/j.apgeog.2014.10.014. (Grundstein et al., January 2015)
Gubernot DM et al. (2014, October). The epidemiology of occupational 
heat-related morbidity and mortality in the United States: a review 
of the literature and assessment of research needs in a changing 
climate. International Journal of Biometeorology, 58(8), 1779-1788. 
doi:10.1007/s00484-013-0752-x. (Gubernot et al., October 2014)
Gubernot DM et al. (2015, February). Characterizing occupational 
heat-related mortality in the United States, 2000-2010: An analysis 
using the census of fatal occupational injuries database. American 
Journal of Industrial Medicine, 58(2), 203-211. doi:10.1002/
ajim.22381. (Gubernot et al., February 2015)
Human Performance Resources by Consortium for Health and Military 
Performance (HPRC). (2021, October 6). Warrior heat- and exertion-
related events collaborative. https://www.hprc-online.org/resources-partners/whec. Accessed October 6, 2021. (HPRC, October 6, 2021)
International Labour Organization (ILO). (2019). Working on a warmer 
planet: The impact of heat stress on labour productivity and decent 
work. 13. (ILO, 2019)
International Organization for Standardization (ISO). (2017). 
Ergonomics of the thermal environment--Assessment of heat stress 
using the WBGT (wet bulb globe temperature) index. Third Edition. 
ISO 7243:2017(E). 2017. (ISO, 2017)
Johnson RJ et al. (2019, May 9). Chronic kidney disease of unknown 
cause in agricultural communities. The New England Journal of 
Medicine, 380, 1843-1852. doi:10.1056/NEJMra1813869. (Johnson et 
al., May 9, 2019)
Kilbourne, EM. (1997). Heat waves and hot environments. The public 
health consequences of disasters. (1997). (Kilbourne, 1997)
Leigh JP et al. (2014, April). An estimate of the US government's 
undercount of nonfatal occupational injuries and illnesses in 
agriculture. Ann Epidemiology, 24(4). 254-259. doi:10.1016/
j.annepidem.2014.01.006. (Leigh et al., April 2014)
McCarthy RB et al. (2019, September). Outcomes of a heat stress 
awareness program on heat-related illness in municipal outdoor 
workers. Journal of Occupational and Environmental Medicine, 61(9), 
724-728. doi:10.1097/JOM.0000000000001639. (McCarthy et al., 
September 2019)
Minnesota Administrative Rules. Section 5205.0110 Indoor ventilation 
and temperature in places of employment. https://www.revisor.mn.gov/rules/5205.0110/. (Minnesota Administrative Rules)
Mix J et al. (2019). Hydration status, kidney function, and kidney 
injury in Florida

[[Page 59325]]

agricultural workers. Journal of Occupational and Enviornmental 
Medicine, 60(5), e253-e260. DOI: https://doi.org/10.1097/JOM.000000000000126. (Mix et al., 2019)
Morris CE et al. (2019, January 28). Actual and simulated weather 
data to evaluate wet bulb globe temperature and heat index as alerts 
for occupational heat-related illness. Journal of Occupational and 
Environmental Hygiene, 16(1), 54-65. https://www.tandfonline.com/doi/full/10.1080/15459624.2018.1532574. (Morris et al., January 28, 
2019)
National Weather Service (NWS). (2021, August 25). Wet Bulb Globe 
Temperature: Guidelines-Charts. https://www.weather.gov/arx/wbgt#guidelines. Accessed August 25, 2021. (NWS, August 25, 2021)
National Weather Service (NWS). (2021, September 1). What is the 
heat index?. https://www.weather.gov/ama/heatindex. Accessed 
September 1, 2021. (NWS, September 1, 2021)
National Weather Service (NWS). (2021, September 2). Heat watch vs. 
warning. https://www.weather.gov/safety/heat-ww. Accessed on 
September 2, 2021. (NWS, September 2, 2021)
National Weather Service (NWS). (2021a, September 8). 80-year list 
of severe weather fatalities. https://www.weather.gov/media/hazstat/80years_2020.pdf. 2020. Accessed September 8, 2021. (NWS, September 
8, 2021a)
National Weather Service (NWS). (2021b, September 8). Weather 
related fatality and injury Statistics: weather fatalities 2020. 
https://www.weather.gov/hazstat/2020. Accessed September 8, 2021. 
(NWS, September 8, 2021b)
National Institute for Occupational Safety and Health (NIOSH). 
(1972). NIOSH criteria for a recommended standard: occupational 
exposure to hot environments. Publication 72-10269. https://www.cdc.gov/niosh/docs/72-10269/default.html. (NIOSH, 1972)
National Institute for Occupational Safety and Health (NIOSH). 
(1986, April). NIOSH criteria for a recommended standard: 
occupational exposure to hot environments. Publication 86-113. 
https://www.cdc.gov/niosh/docs/86-113/86-113.pdf?id=10.26616/NIOSHPUB86113. (NIOSH, April 1986)
National Institute for Occupational Safety and Health (NIOSH). 
(2016, February). NIOSH criteria for a recommended standard: 
occupational exposure to heat and hot environments. Publication 
2016-106. https://www.cdc.gov/niosh/docs/2016-106/default.html. 
(NIOSH, February 2016)
National Institute for Occupational Safety and Health (NIOSH). 
(2017, April 20). Reproductive health and the workplace: Heat. 
https://www.cdc.gov/niosh/topics/repro/heat.html. (NIOSH, April 20, 
2017)
National Integrated Heat Health Information System (NIHHIS). (2021, 
August 25). Understand Urban Heat Islands. https://nihhis.cpo.noaa.gov/Urban-Heat-Island-Mapping/Understand-Urban-Heat-Islands. Accessed August 25, 2021. (NIHHIS, August 25, 2021)
Occupational Safety and Health Administration (OSHA). (2010, April 
28).Training standards policy statement.https://www.osha.gov/dep/standards-policy-statement-memo-04-28-10.html.(OSHA, April 28, 2010)
Occupational Safety and Health Administration (OSHA). 
(2017).Workers' rights.https://www.osha.gov/sites/default/files/publications/osha3021.pdf.(OSHA, 2017)
Occupational Safety and Health Administration (OSHA). (2017, 
September 15). OSHA Technical Manual. Section III: Chapter 4--Heat 
Stress. https://www.osha.gov/otm/section-3-health-hazards/chapter-4. 
(OSHA, September 15, 2017)
Occupational Safety and Health Administration (OSHA). (2019, October 
1). Region VI: Regional Emphasis Program for Heat Illnesses. https://www.osha.gov/sites/default/files/enforcement/directives/CPL_2_02-00-027A.pdf. (OSHA, October 1, 2019)
Occupational Safety and Health Administration (OSHA). (2021, August 
20). Federal OSHA Heat-Related Inspections and Violations, Jan 2018-
August 19, 2021. (OSHA, August 20, 2021)
Occupational Safety and Health Administration (OSHA). (2021, 
September). A Selection of Agency Heat Exposure Guidelines Tables. 
(OSHA, September 2021)
Occupational Safety and Health Administration (OSHA). (2021, 
September 1). Inspection Guidance for Heat-Related Hazards. (OSHA, 
September 1, 2021)
Occupational Safety and Health Administration (OSHA). (2021, 
September 2). Heat: Prevention>>Hazard Recognition. https://www.osha.gov/heat-exposure/hazards. Accessed September 2, 2021. 
(OSHA, September 2, 2021)
Occupational Safety and Health Administration (OSHA). (2021, October 
6). Protecting Temporary Workers. https://www.osha.gov/temporaryworkers. Accessed October 6, 2021. (OSHA, October 6, 2021a)
Occupational Safety and Health Administration (OSHA). (2021, October 
6). Safety and Health Topics>>Heat>>Personal risk factors. https://www.osha.gov/heat-exposure/personal-risk-factors. Accessed October 
6, 2021. (OSHA, October 6, 2021b)
Occupational Safety and Health Administration (OSHA). (2021, October 
7). Heat: Prevention--Protecting New Workers. https://www.osha.gov/heat-exposure/protecting-new-workers. Accessed October 7, 2021. 
(OSHA, October 7, 2021)
Occupational Safety and Health Administration (OSHA and National 
Istitute for Occupational Safety and Health (NIOSH). (2021, October 
6). Recommended Practices: Protecting Temporary Workers. https://www.osha.gov/sites/default/files/publications/OSHA3735.pdf. Accessed 
October 6, 2021. (OSHA and NIOSH, October 6, 2021)
Oliveira AVM et al. (2019, August). Globe temperature and its 
measurement: requirements and limitations. Annals of Work Exposure 
sand Health, 63(7), 743-758. doi:10.1093/annweh/wxz042. (Oliveira et 
al., August 2019)
Oregon Administrative Rules. 437-002-0155 Temporary Rule Heat 
Illness Prevention. https://osha.oregon.gov/OSHARules/div2/437-002-0155-temp.pdf. (Oregon Administrative Rules)
Padilla A, Brown S, Warren E, Wyden R, Sanders B, Cortez Masto C, 
Gillibrand K, Geinstein D, Blumenthal R, Baldwin T, Smith T, Markey 
EJ, Booker C. (2021, August 3). Correspondence from members of the 
U.S. Senate to The Honorable Martin Walsh, Secretary, United States 
Department of Labor. (Padilla et al., August 3, 2021)
Park RJ et al. (2021, July). Temperature, workplace safety, and 
labor market inequality. Institute of Labor Economics, Discussion 
Paper Series. https://ftp.iza.org/dp14560.pdf. (Park et al., July 
2021)
Popovich N and Choi-Schagrin W. (2021, August 11). Hidden toll of 
the northwest heat wave: hundreds of extra deaths. The New York 
Times. https://www.nytimes.com/interactive/2021/08/11/climate/deaths-pacific-northwest-heat-wave.html. (Popovich and Choi-
Schagrin, August 11, 2021)
Quandt SA et al. (2013, August). Heat index in migrant farmworker 
housing: implications for rest and recovery from work-related heat 
stress. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723406/. 
(Quandt et al., August, 2013)
Quinn MM et al. (2007). Social disparities in the burden of 
occupational exposures: results of a cross-sectional study. American 
Journal of Industrial Medicine, 50, 861-875. doi:10.1002/ajim.20529. 
(Quinn et al., 2007)
Rothfusz. (1990, July 1). National Weather Service Technical 
Attachment: The heat index ``equation'' (or, more than you ever 
wanted to know about heat index). https://www.weather.gov/media/ffc/ta_htindx.PDF. (Rothfusz, July 1, 1990)
Seabury AS et al. (2017, February). Racial and ethnic differences in 
the frequency of workplace injuries and prevalence of work-related 
disability. Health Affairs, 36(2), 266-273. doi:10.1377/
hlthaff.2016.1185. (Seabury et al., February 2017)
Shipley J et al. (2021, August 17). Heat is killing workers in the 
U.S.--and there are no federal rules to protect them. National 
Public Radio. https://www.npr.org/2021/08/17/1026154042/hundreds-of-workers-have-died-from-heat-in-the-last-decade-and-its-getting-worse. (Shipley et al., August 17, 2021)
Sorensen C and R Garcia-Trabanino. (2019, August 22). Perspective 
essay: A new era of climate medicine--addressing heat-triggered 
renal disease. The New England Journal of Medicine, 381, 693-

[[Page 59326]]

696. https://www.nejm.org/doi/pdf/10.1056/NEJMp1907859?articleTools=true. (Sorensen and Garcia-Trabanino, 
August 22, 2019)
Steadman. (1979, April 11). The assessment of sultriness. Part 1. A 
temperature-humidity index based on human physiology and clothing 
science. https://journals.ametsoc.org/view/journals/apme/18/7/1520-0450_1979_018_0861_taospi_2_0_co_2.xml?tab_body=pdf. (Steadman, 
April 11, 1979)
Steege AL et al. (2014). Examining occupational health and safety 
disparities using national data: a cause for continuing concern. 
American Journal of Industrial Medicine, 57, 527-538. doi:10.1002/
ajim.22297. (Steege et al., 2014)
Stone, Jr., B et al. (2021). Compound climate and infrastructure 
events: how electrical grid failure alters heat wave risk. 
Environmental Science and Technology, 55, 6957-6964. https://doi.org/10.1021/acs.est.1c00024. (Stone, Jr., et al., 2021)
Tustin A et al. (2018, July 6). Evaluation of occupational exposure 
limits for heat stress in outdoor workers--United States, 2011-2016. 
Centers for Disease Control and Prevention, Morbidity and Mortality 
Weekly Report, 67(26). (Tustin et al., July 6, 2018)
Tustin A et al. (2018, August). Risk factors for heat-related 
illness in U.S. workers: an OSHA case series. Journal of 
Occupational and Environmental Medicine, 60(8). (Tustin et al., 
August 2018)
U.S. Global Change Research Program (USGCRP). (USGCRP, 2016). The 
Impacts of Climate Change on Human Health in the United States: A 
Scientific Assessment. https://health2016.globalchange.gov/low/ClimateHealth2016_FullReport_small.pdf. (USGCRP, 2016)
U.S. Global Change Research Program (USGCRP). (USGCRP, 2018). 
USGCRP, 2018: Impacts, Risks, and Adaptation in the United States: 
Fourth National Climate Assessment, Volume II: 1515 pp. https://nca2018.globalchange.gov/downloads/NCA4_2018_FullReport.pdf. 
(USGCRP, 2018)
U.S. House of Representatives, 117th Congress. (2021, March 26). 
H.R. 2193, Asuncion Valdivia Heat Illness and Fatality Prevention 
Act of 2021. https://www.congress.gov/bill/117th-congress/house-bill/2193?s=1&r=4. (U.S. House of Representatives, March 26, 2021)
U.S. Senate, 117th Congress. (2021, April 12) S. 1068, Asuncion 
Valdivia Heat Illness and Fatality Prevention Act of 2021. https://www.congress.gov/bill/117th-congress/senate-bill/1068/text?r=5&s=1. 
(U.S. Senate, 117th Congress, April 12, 2021)
Virtanen M et al. (2005). Temporary employment and health: a review. 
International Journal of Epidemiology, 34, 610-622. doi:10.1093/ije/
dyi024. (Virtanen et al., 2005)
Wadsworth G et al. (2019). Pay, power, and health: HRI and the 
agricultural conundrum. Labor Studies Journal, 44(3), 214-235. 
https://doi.org/10.1177/0160449X18767749. (Wadsworth et al., 2019)
Wallace RF et al. (2007). Prior heat illness hospitalization and 
risk of early death. Environmental Research, 104, 290-295. 
doi:10.1016/j.envres.2007.01.003. (Wallace et al., 2007)
Washington Administrative Code (WAC) Title 296, General Occupational 
Health Standards. Sections 296-62-095 through 296-62-09560. Outdoor 
Heat Exposure. https://app.leg.wa.gov/WAC/default.aspx?cite=296-62&full=true#296-62-095; Emergency Rule 2125 CR103E. https://lni.wa.gov/rulemaking-activity/AO21-25/2125CR103EAdoption.pdf. 
(Washington Administrative Code)

Authority and Signature

    James S. Frederick, Acting Assistant Secretary of Labor for 
Occupational Safety and Health, U.S. Department of Labor, 200 
Constitution Avenue NW, Washington, DC 20210, authorized the 
preparation of this document pursuant to the following authorities: 29 
U.S.C. 653, 655, and 657, Secretary's Order 8-2020 (85 FR 58393; Sept. 
18, 2020), and 29 CFR part 1911.

James S. Frederick,
Acting Assistant Secretary of Labor for Occupational Safety and Health.
[FR Doc. 2021-23250 Filed 10-26-21; 8:45 am]
BILLING CODE 4510-26-P