icmm health and safety performance indicator definitions

Health and SafetyPerformance Indicator Definitions

Health and Safety Performance Indicator Definitions


Health and SafetyPerformanceIndicator Definitions


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Purpose 6

General Definitions 7

Safety Indicators 9

Injury Numbers 9

Calculated Indicators 12

Health Indicators 14

Definitions of Health Indicators Used in Data Entry and Reporting 14

Health Metric Definitions 16

Appendix: Further Information 18

A Definitions 18

B Health indicator criteria 20

C Health Risk Assessment 28

D Ergonomics Assessment 31

Contents

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This document contains the definitions used by ICMM for lagging (outcome) safetyand health metrics. These metrics are captured in the ICMM Benchmarkingdatabase (http://www.shecbenchmarking.com). Indicators are separated into thosecollected (and reported) and those not collected, but calculated.

The document also contains, as appendices, additional information on metrics,which may be used as a basis for improvements to benchmarking in the future. Inparticular, the appendices include information on possible leading (system/processimplementation/leadership) indicators, and improved health metric indicators whichprovides information to member companies for determining future direction forhealth management and health research.

The document has been prepared based on input from ICMM member companiesand from the International Aluminium Institute (IAI).

The intent is:• To define a core group of metrics to be used by all ICMM member companies;• To ensure that the metrics are simple to apply and are relatively general in scope;• To provide clear definition of key terms;• To provide additional metrics which may be used on a voluntary basis by

individual companies.

Purpose


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1 If you wish to register to use the ICMM Benchmarking Database, please contact the ICMM secretariat ([email protected])

Employee

Individual employed directly by the company. The preference in the database is tocount directly supervised contractors as contractors, however where companies donot separate this information from employee information, it is acceptable to countthem and their associated injuries under employee data.

Contractor

Any individual, company or other legal entity that carries out work, work-relatedactivities, or performs services pursuant to a contract for service. This includessub-contractors, and personnel working both full time and part time.

Occupational Illness

An occupational illness is any abnormal condition or disorder, other than oneresulting from an occupational injury, caused by exposures to factors associatedwith employment. It includes acute or chronic illnesses or diseases, which may becaused by inhalation, absorption, ingestion or direct contact.

Illnesses are distinguished from injuries in that the latter occur at “an instant intime”. For injury, the gap between exposure and the onset of signs or symptoms isshort (minutes to hours, but less than one shift) whereas the gap for illness islonger (days, weeks or years). If there is a known latency period for thedevelopment of illness following an acute exposure, then the condition is to beconsidered an illness. This will also apply to injuries that eventually result inoccupational diseases e.g. asthma resulting from acute high level exposure to anirritant gas.

Work-related Activities

Work-related activities are those where the employer can set safety, health andenvironmental standards, and can supervise and enforce their application.

If an event or exposure in the work environment either caused or significantlycontributed to an injury, or significantly aggravated a pre-existing condition, thenthe case is considered work-related. Work-relatedness is presumed for injuriesresulting from events or exposures occurring at the employer’s workestablishment unless an exception specifically applies.

Injuries and illnesses occurring away from the work establishment are consideredwork-related only if the worker is engaged in a work activity or is present as acondition of his or her employment or contract.

Work performed as a part of haulage of product between operated sites, whetherby directly employed or contract operators, would normally be included as work-related. Work performed at a contractor’s home base is not included as work-related unless it is clearly under the supervision and standards of the company.

General Definitions


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Injuries and illnesses that occur while the employee is travelling are work-relatedif at the time of the injury or illness the employee/contractor was engaged inwork-related activities “in the interests of the employer”. Examples of theseactivities include:

• Driving or being driven in a vehicle for work-related purposes, irrespective ofthe cause of any incident involving the vehicle.

• Flying to visit another site or customer/supplier contact.• Being transported to and from customer contacts after lodging has been

established and as part of work-related activity.• Entertaining, or being entertained to transact, discuss or promote business,

provided the entertainment is at the direction of the employer.

However when travelling employees check into a hotel, motel or other lodging,they establish a “home away from home”. Thereafter, their activities are evaluatedin the same manner as for non-travelling employees. For example, injuriessustained when commuting from a hotel to a temporary work site are not work-related, just as injuries sustained during an employee’s normal commute from apermanent residence to an office are not considered work-related.

Work Environment

The work environment is defined as the establishment and other locations whereone or more employees are working or are present as a condition of theiremployment.

Pre-existing Conditions

Pre-existing conditions are those which an individual brings with them to thecurrent employer, either caused by exposure at another workplace or by non-occupational factors.

Significant Aggravation

A significant aggravation is defined as occurring when an incident occurring atwork results in tangible consequences that go beyond those the worker wouldhave experienced as a result of the pre-existing illness/disease alone, absent theaggravating effects of the workplace.

Routine Functions

Routine Functions are work activities/assigned duties that the employee regularlyperforms at least once per week or as part of the roster cycle.


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Injury Numbers

Fatalities

Work-related injury resulting in death of employee or contractor. Fatalities arecategorised according to the following types:• Electrical• Explosions and Fires• Falls from Heights• Geotechnical• Hazardous Substances• Machinery, Equipment and Hand Tools• Mobile Equipment• Slips, Trips and Falls• Other

Lost Time Injuries

A Lost Time Injury (LTI) is a work-related injury resulting in theemployee/contractor being unable to attend work on the next calendar day afterthe day of the injury. If a suitably qualified medical professional advises that theinjured person is unable to attend work on the next calendar day after the injury,regardless of the injured person’s next rostered shift, a lost time injury is deemedto have occurred.

Restricted Work Injuries

A Restricted Work Injury (RWI) is a work-related injury which results in theemployee/contractor being unable to perform one or more of their routinefunctions for a full working day, from the day after the injury occurred. An RWIshould be certified by advice from a suitably qualified health care provider.

Lost Time + Restricted Work Injuries

Some companies do not differentiate between Lost Time and Restricted WorkInjuries. For such companies, counts of LTIs reported to the ICMM databaseinclude RWIs, and are marked as such in the database. As a result, the mainbenchmarking injury statistic that should be used is the ‘Lost Time + RestrictedWork Injury’ count (and associated frequency rate). However, the preference is thatthe ICMM database LTI count excludes RWIs and that RWIs are counted separately.

Medical Treatment Injuries

A Medical Treatment Injury (MTI) is a work-related injury resulting in themanagement and care of a patient to combat disease or disorder, including anyloss of consciousness, which does not result in lost time or restricted work.

MTIs include (for example) suturing of any wound, treatment of fractures,treatment of bruises by drainage of blood, treatment of second and third degreeburns.

Safety Indicators


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MTIs do not include:• Visits to physicians or other licensed health care professional solely for

observation or counselling.• The conduct of diagnostic procedures, such as X-rays and blood tests, including

the administration of prescription medications used solely for diagnosticpurposes (e.g. eye drops to dilate pupils etc.).

• Visits to physicians or other licensed health care professionals solely fortherapy as a preventative measure (e.g. physiotherapy or massage aspreventative therapy, tetanus or flu shots).

• First Aid Injuries (FAIs) as listed in the Appendix.

First Aid + Medical Treatment Injuries

Some companies do not differentiate between Medical Treatment and First AidInjuries. For such companies, counts of MTIs reported to the ICMM databaseinclude FAIs, and are marked as such in the database. The preference is that theICMM database MTI count excludes FAIs.

Days Lost Reporting

“Days lost” are counted as the number of calendar days2 after the day of theincident, during which the employee or contractor is unable to perform all of theirroutine functions or is temporarily assigned to a different job. This includes fulldays lost, as for a Lost Time Injury. Days lost counting ceases if the person ceasesemployment with the company, or the person is permanently reassigned to a newjob.3

Days lost are counted during the month in which the days lost occurred. Somecompanies credit days lost in the month in which the injury or illness occurredrather than the month in which the days lost are incurred. While this is notpreferred for the ICMM database, it is an option as it makes very little difference toinjury rates over time.

Time spent travelling, or waiting for diagnosis following an incident is not includedin days lost, unless the injury becomes classified as a Lost Time Injury or aRestricted Work Injury.

No lost days are recorded for fatalities.

Days lost to Lost Time Injuries

The number of calendar days during which an employee or contractor is unable toattend work during the month in which the lost days occurred.


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2 Some companies count scheduled work days instead of calendar days. Where this is done it is clearly marked as suchin the database. Companies using this practice should also indicate whether lost time/ restricted work injuries arecounted as such if the injured party is unable to attend work on the next calendar day rather than the next scheduledwork day.3 Some companies cease counting lost days after 180 lost calendar days have elapsed. The preference for the ICMMdatabase is that the full number of lost days is supplied, in other words that a 180 day limit is not applied.

Days lost to Restricted Work Injuries

The number of calendar days during which an employee or contractor is able toattend work but is unable to perform one or more of his / her routine functions,during the month in which the lost days occurred.

Days lost to Lost Time & Restricted Work Injuries

Total of calendar days lost (both restricted work and lost days) during the month inwhich the days lost occurred.

Days lost to Work-related Diseases

The number of calendar days during which an employee or contractor is eitherable to attend work but is unable to perform all his / her routine functions, or isunable to attend work, due to occupational illness which is work-related.

Days lost to Non Work-related Illnesses and Injuries

The number of calendar days during which an employee or contractor was unableto attend work due to non work-related illness or injury.4

Exposure Hours

The “exposure hours” used in injury performance calculations are the totalnumber of hours worked by employees or contractors carrying out work-relatedactivities. This includes hours worked onsite, offsite and travelling on behalf ofwork, but excludes hours spent travelling as part of normal commuting to andfrom a person's place of residence.

Exposure hours reported should reflect actual hours worked, not planned hours.


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4 Not all companies will be able to supply this statistic at this stage, and companies will not be monitored against thesupply of this statistic yet.

Calculated indicators

Total Recordable Injuries (TRIs)

TRI = Number of (Fatalities + Lost Time Injuries+ Restricted Work Injuries + Medical Treatment Injuries)

Frequency Rate (FR)

Injury frequency rates are normally expressed as the number of injuries permillion hours worked.

FR = Number of injuries * 1,000,000 / hours worked

In some jurisdictions, such rates are expressed per 200,000 hours worked. TheICMM database defaults to calculating frequency rates based on million hoursworked, but can also be set to calculate rates per 200,000 hours. Where rates aredescribed in text, the denominator used should be mentioned to avoid confusion.

Fatality Frequency Rate (FFR)

FFR = Fatalities * 1,000,000 / hours worked

Lost Time Injury Frequency Rate (LTIFR)

LTIFR = LTIs * 1,000,000 / hours worked

Total Recordable Injury Frequency Rate (TRIFR)

TRIFR = (Fatalities + LTIs + RWIs + MTIs) * 1,000,000 / hours worked


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5 2000 hours per year = 50 weeks x 40 hours and is an approximation of an average number of hours per year per personexposed

Severity Rate (SR)

SR = (Days lost to LTIs and RWIs) * 1,000,000 / hours worked

Duration Rate (DR)

DR = (Days lost to LTIs and RWIs) / Number of (Fatalities + LTIs + RWIs)

Absentee Rate (AR)

AR = Total days lost * 1,000,000 / hours worked

Total days lost = days lost to LTIs and RWIs plus days lost to work-related diseasesplus days lost to non work-related illnesses and injuries.

Number of Personnel

Total personnel = hours worked per year / 20005

Definitions of Health Indicators Used in Data Entry and Reporting

New Cases (per disease):

Only new cases are counted for lagging indicators.

New cases are counted when all of the following criteria are met:• There is a known association between the exposure(s) and the occupational

illness or disease.• There is evidence of current or previous exposure to the agent of concern

during employment with the current member company.• A dose sufficient (with respect to concentration and duration of exposure) to

cause the illness/disease has been documented through an appropriateprofessional assessment (e.g. industrial hygiene reports) or a professionalopinion that the exposure is consistent with the condition.

• There is evidence of the illness/disease as diagnosed by a medical practitioner.• The necessary (minimum) latency period exists to establish the probability of

association.• There has been no previous recorded illness of same type involving the same

body part, or the individual has had a previous recorded illness of same typeaffecting the same body part but had recovered completely (all signs andsymptoms had disappeared) from the previous illness and an event or exposurein the work environment caused the signs or symptoms to reappear (NOTE: forillnesses where the signs or symptoms may recur or continue in the absence ofan exposure in the workplace, the case must only be recorded once. Examplesinclude occupational cancer and pneumoconioses).

Significant aggravation of a pre-existing condition shall also be counted as a newcase when all of the above criteria are met.

New cases are counted separately for employees and contractors.

New cases are counted as of the date the illness/disease is diagnosed and arereported on a calendar year basis.

To ensure usability of benchmarking data, definitions of cases are provided. Thesecase definitions are not necessarily consistent across all national regulatoryframeworks, but do conform to international conventions (e.g., WHO, ISO, ILO,CDC, ATS/ERS, etc.) where possible.

Health Indicators


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Fatalities (per disease):

Number of deaths resulting from an occupational disease within the reportingyear, counted according to the date of death.

Disease Rates:

Disease rates are expressed per 1000 persons at work. The number of personnelat work is calculated as noted on the previous page based on hours worked.

Note: the calculation of meaningful statistics for diseases involving a long lagperiod prior to the development of the disease poses a definitional challenge. Nomethod is ideal. However, for comparative purposes, and to provide a standardbaseline, a disease rate is applied, even for diseases with a long lag period prior totheir manifestation. It is recognized that this rate is not a true reflection of risk tothe current working population.


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Health Metric Definitions

Health metric definitions with their associated World Health OrganizationInternational Classification of Diseases (ICD-10) identifier.

Work Related Asthma

Asthma is “work related” when there is an association over time betweensymptoms and work. A criteria for inclusion of work-related asthma can be foundin the appendix.

Work Related Chronic Obstructive Pulmonary Disease (COPD)6

Cases of COPD should be reported if they meet the following criteria:

• Recognized by a Workers’ Compensation Authority or equivalent• Recognized as an occupational disease by the physician responsible for the site

For a more detailed criteria, see appendix.

Pneumoconioses

A medical diagnosis of parenchymal lung disease with compatible radiologicalfindings related to exposures to a range of substances (see appendix).

Work Related Cancers

A medical diagnosis of cancer related to exposures to a range of agents (seeappendix for list). Specific guidelines (based on the scientific literature) on workrelatedness for bladder and lung cancer in the primary aluminium industry areprovided as appendices.

Infectious Diseases

Vector-borne diseases (e.g. malaria) in persons not originally from, or livingpermanently in, relevant disease endemic areas.

Deep Vein Thrombosis (DVT)

A medical diagnosis of DVT that has occurred as a result of work-related travel.

[ICD-10: J45, J45.1,J45.9]

[ICD-10: J42, J43,J44]

[ICD-10: J61, J62,J63, J63.0, J63.1,J63.2, J63.8 ]

[ICD-10: C67 (C67.0-C67.9), C34 (C34.0-C34.9), C45 (C45.0-C45.9)]

[ICD-10: B50-54,A90-99, and potentiallyothers in the “A” and“B” categories]

[ICD-10: I80]


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6 Sources used to develop these criteria: Quebec compensation guidelines; review of aluminium industry epidemiologystudies (e.g., Moira Chan-Yeung, Norwegian studies and Richard Martin's unpublished study)

[ICD-10: J45, J45.1,J45.9]

[ICD-10: M62.6,G56.0, G57.5, M65,M65.4, M70, M71,W43, etc.]

[ICD-10: L23 andL23.X, L24 and L24.X,L25 and L25.X]

[ICD-10: T56.9]

[ICD-10: J65]

[ICD-10: H83.3]

Silicotuberculosis

An X-Ray consistent with silicosis (see Pneumoconioses above) as well as positivesputa microscopy or culture for Mycobacterium tuberculosis.

Beryllium Related

Beryllium sensitization and chronic beryllium disease (CBD). See appendix forfurther details.

Hearing Loss7

OSHA Recordable Hearing Shift (Incidence): An age-corrected average hearingshift in either ear of greater than or equal to 10 dB at 2000, 3000 and 4000 Hzwhen compared to baseline, coupled with a greater than or equal to 25 dB averagehearing level in the same ear at 2000, 3000 and 4000 Hz. See:

www.osha.gov/recordkeeping/hearinglossflowchart.pdf

Hand-Arm Vibration Syndrome

Vibration White Finger (VWF) equal to or greater than the Stockholm grading of 2.

Musculo-Skeletal Syndrome

A medical diagnosis of disorders and diseases of the musculoskeletal systemhaving a proven causal relationship with work and associated with repetitivemotion and/or stress. Disorders arising out of single events are specificallyexcluded and are regarded as injuries.

Occupational Dermatitis

Non-infectious inflammation of the skin provoked by contact with an externalchemical or substance, accompanied by itching, cracking, blistering & ulcerations

Platinosis (Platinum Salt Sensitivity)

Allergy to complex halogenated salts of platinum is an acquired hyper-sensitivityto the complex salts of platinum which becomes manifest after a variable period ofsymptomless exposure. The clinical characteristics include one or more symptomsand signs of dermal, ocular and nasal allergy and/or asthma.


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7 Other definitions of hearing loss (Prevalence and Standard Threshold Shift) are in the Appendix and should be usedwhere applicable.

[ICD-10: J63.2,T56.7]

This appendix contains additional definitions and examples to provide furtherunderstanding of the definitions above. These definitions are not currently directlyused in ICMM benchmarking.

A Definitions

A1 First Aid Injury

A First Aid Injury is recorded when first aid treatment is required as a result of awork-related injury. OSHA determines First Aid to mean the following treatments:

• Visit(s) to a health care provider for the sole purpose of observation• Diagnostic procedures, including the use of prescription medications solely for

diagnostic purposes• Use of non prescription medications including antiseptics• Simple administration of oxygen• Administration of tetanus/diphtheria shot(s) or booster(s)• Cleaning, flushing or soaking wounds on skin surface• Use of wound coverings such as bandages, gauze pads etc.• Use of hot and cold therapy e.g. compresses, soaking, whirlpools, non

prescription creams/lotions for local relief except for musculoskeletaldisorders.

• Use of any totally non-rigid, non-immobilizing means of support e.g. elasticbandages

• Drilling of a nail to relieve pressure for subungal haematoma• Use of eye patches• Removal of foreign bodies embedded in the eye if only irrigation or removal

with cotton swab is required• Removal of splinters or foreign material from areas other than the eyes by

irrigation, tweezers, cotton swabs or other simple means.

All of the above are regarded as First Aid Injuries, regardless of the health careprovider, who may be a physician, nurse or other health care provider.

A2 Sickness

The role negotiated with society. Sickness is the external and public mode of being“unhealthy”. Sickness is the social role, a status, a negotiated position in theworld, a bargain struck between the person, henceforward called "sick", and asociety which is prepared to recognise and sustain the person.

A3 Lagging and Leading Indicators

Lagging indicators, also sometimes called trailing, downstream or ‘after-the-fact’indicators, provide historical information about health and safety performance.With lagging indicators, nothing can be changed to alter the measure of health andsafety performance, as it is history. Any changes made may influence futureperformance but cannot alter the past performance. Classic injury statistics (i.e.,

Appendix: Further Information


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injury frequency rate, lost workday rate, etc.) are examples of lagging indicators.

Leading indicators, also sometimes called ‘upstream’ indicators, are used aspredictors of health and safety performance. The advantage of using leadingindicators of performance is that actions can be taken to alter the course of healthand safety performance. If an indicator predicts poor performance, it is notnecessary to wait to see if the prediction is correct. Changes can be implementedto increase the probability of improved performance. Thus, leading indicators canprovide guidance whereby there is greater assurance of achieving good health andsafety performance.

A4 Leading Indicators for Occupational Health

Measurement of leading indicators is considered to add value to the understandingof organizational efforts to improve the management of Occupational Health in theworkplace.

Reporting of leading indicators also encourages organizations to adopt recognizedoccupational and environmental health management practices and is important tothe sustainability of the organization and its employees.

The following indicators are considered relevant to the above objectives:


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Description Measure

ManagementSystemCertification

Number of plants with recognized healthand safety management systems (e.g.OHSAS 18001 or equivalent).

IAI Objective: Implementation ofManagement Systems for Health and Safetyin 95% of Member Company plants by 2010.

Number ofplants certifiedcompared withtotal number ofplants asked.

Employee ExposureAssessment

Health risk management is essential forthe well-being of employees. This processinvolves HIRARC (Hazard Identification,Risk Assessment, Risk Control).

IAI Objective: Implementation of anEmployee Exposure Assessment 95% ofMember Company plants by 2010.

Percentage ofplants with aformal processin place thatfulfil the definedcriteria asspecified in theattached criteriadocument.

Ergonomics –Process

Is there a formal process in place toidentify AND control specific ergonomicrisks?

Percentage ofsites withprocess in place

B Health indicator criteria

B1 Asthma


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All Asthma

Non-Work-Related Asthma

No association betweensymptoms and work. Work-related Asthma

Asthma is ‘work-related’ whenthere is an association over timebetween symptoms and work.

Work-caused (true OA)

Occupational asthma (OA) isasthma caused by workplaceexposure and not by factors outsideof the workplace. OA can occur inworkers with or without priorasthma.

Work-aggravated

Work-aggravated asthma is pre-existing or coincidental new onsetasthma which is made worse byexposures in the workplace.

Irritant/Non-Immunologic*

Irritant-induced OA may occurwithin a few hours of a highconcentration exposure to anirritant, gas, fume or vapour atwork (e.g. classic acute RADS), orin response to chronic low-levelirritant exposures which maymanifest after an extended periodof time (days to years). MostAsthma in the Primary AluminiumIndustry is generally viewed tobelong in this latter category.

Allergic/Immunolgic*

Allergic OA is characterized by alatency period between firstexposure to a respiratory sensitizerat work and the development ofsymptoms; the sensitizer may bean agent of high (lgE-mediated) orlow molecular weight; latency canrange from weeks to years. Forsome agents causing this type ofOA, evidence for an immunologicmechanism is still lacking (or maynot exist).


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CRITERIA FOR WORK-RELATED ASTHMACOMMENTS

Compatible exposure history

AND Compatiblesymptoms (subjectiveevidence of airflowlimitation)

a) One or more of the following: Cough (with exertionor at rest), sputum, wheeze, chest tightness,difficulty in breathing, breathlessness

b) Symptoms are typically episodic, and often worsewhen sleeping following a work shift.

c) May occur immediately or delayed (after severalhours or during sleep) following exposure

AND Temporalrelationship to the workenvironment/exposure

a) Symptoms improve on days away from work, such asdays off, weekends, holidays; or

b) Symptoms worsen during or after the work day (lesssensitive than ‘a’); or

c) Serial pulmonary function measurements:• PEFR: at least 4 readings per day for a sufficient

period of time to quantify readings during severalcontinuous days at work as well as severalcontinuous days away from work, and showing acircadian variation of at least 20% on days atwork and showing a pattern of improvement ondays away from work

• Spirometry• Histamine or methacholine challenge testing; or

d) Cross-shift spirometry showing a fall in FEV1 of atleast 10%

Supporting Information • Daily diary: symptoms, medication use, etc.• Diffusing capacity; detailed respiratory function tests• Exclusion of alternative diagnoses

AND Objective evidenceof airflow limitation

a) Spirometry showing reduced FEV1 or FEV1/FVCvalues relative to personal baseline or appropriatepopulation predicted values, which is at leastpartially reversible either spontaneously or inresponse to treatment• Bronchodilator response must demonstrate an

increase in FEV1 of >12% and >200 ml from thebaseline value during a single testing session; or

b) non-specific bronchial hyper-responsiveness asdemonstrated by histamine or methacholineinhalation challenge (i.e., PC20 < 8mg/ml orequivalent)

B2 Work Related Chronic Obstructive Pulmonary Disease (COPD)

Definition of COPD (ATS/ERS)8

Chronic obstructive pulmonary disease (COPD) is a preventable and treatabledisease state characterised by airflow limitation that is not fully reversible. Theairflow limitation is usually progressive and is associated with an abnormalinflammatory response of the lungs to noxious particles or gases, primarily causedby cigarette smoking. Although COPD affects the lungs, it also produces significantsystemic consequences.

Diagnosis of COPD (ATS/ERS)8

The diagnosis of COPD should be considered in any patient who has the following:symptoms of cough; sputum production; or dyspnoea; or history of exposure torisk factors for the disease.

The diagnosis requires spirometry; a post-bronchodilator forced expiratory volumein one second (FEV1)/forced vital capacity (FVC) <70% confirms the presence ofairflow limitation that is not fully reversible.

Spirometry should be obtained in all persons with the following history: exposureto cigarettes; and/or environmental or occupational pollutants; and/or presence ofcough, sputum production or dyspnoea.Spirometric classification has proved useful in predicting health status, utilisationof healthcare resources, development of exacerbations and mortality in COPD.

COPD: Diagnosis and classification of severity – World Health Organization

A simple classification of disease severity into four stages is presented below. Themanagement of COPD is largely symptom-driven, and there is only an imperfectrelationship between the degree of airflow limitation and the presence ofsymptoms. The staging, therefore, is a pragmatic approach aimed at practicalimplementation and should only be regarded as an educational tool, and a verygeneral indication of the approach to management. FEV1 refers to forcedexpiratory volume in one second and values refer to measures of FEV1 taken afteruse of a bronchodilator. FVC refers to forced vital capacity.

Poorly reversible airflow limitation associated with other diseases such asbronchiectasis, cystic fibrosis, tuberculosis, or asthma is not included exceptinsofar as these conditions overlap with COPD. In many developing countries bothpulmonary tuberculosis and COPD are common. Therefore, in all subjects withsymptoms of COPD, a possible diagnosis of tuberculosis should be considered,especially in areas where this disease is known to be prevalent. In countries inwhich the prevalence of tuberculosis is greatly diminished, the possible diagnosisof this disease is sometimes overlooked.


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8 *Excerpted from: Eur Respir Jrn 2004: 23; 932-946. ATS/ERS TASK FORCE. Standards for the Diagnosis and Treatmentof Patients with COPD: a summary of the ATS/ERS position paper.

Guidelines for recognition as an occupational disease (Aluminium Industry):The epidemiological literature pertaining to COPD in the primary aluminiumindustry suggests that COPD is associated with pot-room work exposure. There isinsufficient evidence to link COPD with exposures in other areas like casting,carbon-plant operations and alumina refining.

If occupational COPD is defined as COPD that would not have arisen without workexposure, some threshold of exposure needs to be agreed upon. The literaturedoes not yield a consistent threshold. It is proposed that for the sake of simplicityin reporting, the following arbitrary criteria be used for physician-designation ofoccupational COPD:

• Non-smokers: 10 years or more of pot-room work• Ex-smokers and smokers: 20 years or more of pot-room work• All COPD cases with a prior diagnosis of pot-room asthma

These criteria should not be used to second-guess Workers’ CompensationAuthority recognized cases, all of which should be reported.


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Stage 0 AT RISK Characterized by chronic cough and sputumproduction. Lung function, as measured byspirometry, is still normal.

Stage I MILD COPD Characterized by mild airflow limitation (FEV1/FVC< 70% but FEV1 > 80% predicted values) and usually,but not always, by chronic cough and sputumproduction. At this stage, the individual may not evenbe aware that his or her lung function is abnormal.

Stage II MODERATECOPD

Characterized by worsening airflow limitation(FEV1/FVC < 70%; 50% < FEV1 < 80% predicted) andusually the progression of symptoms, with shortnessof breath typically developing on exertion. This is thestage at which patients typically seek medicalattention because of dyspnea or an exacerbation oftheir disease. The presence of repeated exacerbationshas an impact on the quality of life of patients andrequires appropriate management.

Stage III SEVERECOPD

Characterized by severe airflow limitation (FEV1/FVC< 70%; 30% < FEV1 < 50% predicted) or the presenceof respiratory failure or clinical signs of right heartfailure. Patients may have severe (Stage III) COPDeven if the FEV1 is > 30% predicted, whenever thesecomplications are present. At this stage, quality of lifeis appreciably impaired and exacerbations may belife-threatening.

Stage Severity Criteria

B3 Beryllium

Beryllium sensitization* is an “allergic” condition to beryllium that can developafter a person breathes beryllium dust or fumes. Some researchers think it mightalso occur if beryllium penetrates the skin through an open cut or from aberyllium splinter.

Diagnostic Criteria:• Sensitization requires at least 2 positive BeLPTs, performed as separate tests

(2 tests on blood, or one blood and one BAL)• No evidence of abnormal physiological, anatomical or pathological changes

consistent with CBD• No symptoms

Chronic beryllium disease9 (CBD) is a lung condition that can develop after aperson breathes beryllium dust or fumes. The immune system sees beryllium as a“foreign invader,” and builds an “army” of cells in the bloodstream that areprepared to react to beryllium wherever they see it in the body. In CBD, thereaction of the immune system against inhaled beryllium particles has resulted inscarring (called granulomas) in the lungs.

Diagnostic Criteria:• Confirmed sensitization• Plus compatible pathologic, physiologic, functional or radiographic

abnormalities• Symptoms may or may not be present

B4 Pneumoconioses – list of substances

• Asbestos• Cobalt• Refractor Ceramic Fibres• Silica• Cristobalite• Coal Workers Pneumoconiosis• Other substances known to cause pneumoconiosis.


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9 Source: National Jewish Medical Centre, Denver, Co.

B5 Cancers

B5.1 Cancer agents list:

• Asbestos• Benzidine and salts• Bichloromethyl ether (BCME)• Chromium and chromium compounds• Coal tars and coal tar pitches, soot• Beta-naphthylamine• Vinyl chloride• Benzene or its toxic homologues• Toxic nitro- and amino-derivatives of benzene or its homologues• Ionizing radiation• Pitch, bitumen, mineral oil, anthracene, or the compounds, products or

residues of these substances• Coke oven emissions• Compounds of nickel• Dust from wood• Cancer caused by any other agents not mentioned in the preceding items where

a direct link between the exposure of a worker to this agent and the cancersuffered is established.

B5.2 Bladder Cancer

The following criteria should be used to determine if a case of bladder cancer inan individual working in the primary production of aluminium is ‘work-related’:

• Pathology confirmed diagnosis of bladder cancer• Individual is currently or has previously worked in a coal tar pitch (CTP) job• CTP exposure at the industrial level is documented• Latency from first exposure to CTP until onset of symptoms or date of diagnosis

of at least 10 years• Calculated attributable risk (i.e., probability of causation) >50%, independent of

smoking.• AR% = [(RR exposed – RR unexposed)/RR exposed] X 100• AR of 50% corresponds to a relative risk (RR) of 2.0, and also toa cumulative exposure to BaP = 19µg/m3 years *

RR = Relative RiskAR = Attributable Risk

*Armstrong B, et al. Compensating Bladder Cancer Victims Employed inAluminium Reduction Plants. Journal of Occupational Medicine 1988: 30; 10. 771-775


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B5.3 Lung Cancer

The following criteria should be used to determine if a case of lung cancer in anindividual working in the primary production of aluminium is ‘work-related’:

• Pathology confirmed diagnosis of lung cancer• Individual is currently or has previously worked in a coal tar pitch (CTP) job• CTP exposure at the individual level is documented• Latency from the first exposure to CTP until onset of symptoms or date of

diagnosis of at least 10 years• Calculated “P” (i.e., probability of causation) >50%, taking into account the

smoking history of the individual.*

(0.0476)(B[a]P) x 100%

P = 1 + (0.33)(p - y) + (0.0476)(B[a]P)

P = Probability that the cancer is of occupational origin (upper 95% confidencelimit)

B[a]P = ug/m3-year B[a]P total career dose

P – y = Cumulative tobacco exposure in pack-years

* Armstrong B, Theriault G. Compensating Lung Cancer Patients OccupationallyExposed to Coal Tar Pitch Volatiles. Occupational and EnvironmentalMedicine.1996: 53: 160-167.

B6. Additional Hearing Loss Metrics

ICMM and IAI member companies are moving towards using the following hearingloss definitions. Once a reasonable number of companies have data in theseformats, the Benchmarking database will be modified to include capture of casesaccording to these definitions.

Hearing Impairment (Prevalence): As per ISO criteria and at:www.who.int/pbd/deafness/hearing_impairment_grades/en/index.html (seeopposite page)

It is recognized that organizations will require time to implement this metric. TheIAI/ICMM committee felt that if the 1000, 2000 and either 3000 or 4000 Hz datawere available, then this metric should be reported by the organization.

OSHA Standard Threshold Shift (Incidence – Early Loss Indicator): Individual sitesand organizations are encouraged to collect data on this metric. A standardthreshold shift (STS) is an age-corrected change in hearing threshold relative tothe baseline audiogram of an average of 10 dB or more at 2000, 3000, and 4000 Hzin either ear. (as per OSHA Regulations: UU1910.95(g)(10)(i)UU).


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Grades 2, 3 & 4 are classified as disabling hearing impairment

The audiometric ISO values are averages of values at 500, 1000, 2000, 4000 Hz

B7 Musculoskeletal

These may include but are not limited to:• Carpal tunnel syndrome• Rotator cuff syndrome• De Quervain's disorder• Trigger finger• Tarsal tunnel syndrome• Sciatica• Epicondylitis• Tendonitis• Raynaud's phenomenon• Whole body vibration syndrome• Herniated spinal disc• Whole Body Vibration Syndrome.


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Grade ofImpairment

CorrespondingaudiometricISO value

Performance Recommendations

0 – Noimpairment

25 dB or better(better ear)

No or very slighthearingproblems. Able tohear whispers

1 – Slightimpairment

26-40 dB(better ear)

Able to hear andrepeat wordsspoken in normalvoice at 1 metre

Counseling. Hearing aidsmay be needed.

2 – Moderateimpairment


Able to hear andrepeat wordsspoken in araisedvoice at 1 metre

Hearing aids usuallyrecommended.

3 – Severeimpairment


Able to hearsome wordswhen shoutedinto better ear.

Hearing aids needed. If nohearing aids available, lip-reading and signing shouldbe taught.

4 – Profoundimpairmentincludingdeafness

81 dB or greater(better ear)

Unable to hearand understandeven a shoutedvoice.

Hearing aids may helpunderstanding words.Additional rehabilitationneeded. Lip-reading andsometimes signing essential.

C Health Risk Assessment


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Name 3.5 Health Risk Managementa. Hazard Identification, Risk Assessment,

Risk Control (HIRARC)b. Employee Health Assessment

Definition Health risk management is essential for the well-beingof employees. This process involves HIRARC andEmployee Health Assessment.

Unit of measurement Percent of plants with a formal process in place thatfulfil the defined criteria as specified under TargetCondition.

Measurement methods Record the number of plants with a formal HIRARCprogram that meets the defined criteria as specifiedunder Target Condition.

Purpose To indicate to what degree the industry has a formalhealth risk management process in place that meets thecriteria for HIRARC and Employee Health Assessmentprocesses.•

Aggregation method Add up company data

Target Condition Each site should have implemented and update at leastannually:

A) HIRARC process that includes ALL of the followingelements:• Identification/classification of all health hazards(e.g. acceptable – significant or insignificant,uncertain health hazards

• Quantitative assessment of risk for all uncertainhealth hazards

• Control of unacceptable health risks via appropriatecounter measures (e.g. personal protectiveequipment, engineering controls, productsubstitution etc.)

• Annual reviews of effectiveness of the process.

1. Occupational Hygiene (OH) Qualitative ExposureAssessmentsThis refers to assessing all chemical and physicalagents by Similar Exposure Group (SEG) at a locationand deciding whether the SEG should be classified asinsignificant, significant, unacceptable, or uncertain.Significant risks are those which exceed 50% of theOccupational Exposure Limit (OEL). By definition,insignificant risk would be less than 50% of the OEL.Unacceptable SEGs would be those exceeding an


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Target Condition OEL. Uncertain SEGs would be those for which adecision as to exposure level is unknown. Agentsassessed also include process intermediates andbyproducts produced in the manufacturing process.

In order to state that an OH qualitative exposureassessment is in place, at least 95% of identifiedagents need to be assessed and categorized.

2. OH Quantitative AssessmentsUncertain SEGs, identified in (1) above, need to becategorized as either insignificant, significant, orunacceptable through quantitative analysis. Thenumber/percentage of uncertain SEGs should betracked. The ultimate goal is 100% assessmentscompleted (e.g. no uncertain SEGs)

In order to state that an OH quantitative exposureassessment process is in place, 95% and above of theuncertain SEGs must be quantitatively assessed viaOH sampling techniques.

3. Number of Unacceptable SEGs identified by agentand number of impacted employeesUnacceptable SEGs are those which exceed an OEL.Agent includes a description of chemical (e.g. CTP,asbestos, silica, etc.) or physical (e.g. noise, heat,radiation, etc.) agents.

4. Percentage compliance with personal protectiveequipment requirements (PPE)How many of the affected employees in unacceptableSEGs defined above are wearing required PPE (e.g.respirators, hearing protection, protective clothing,etc.)?

5. Percentage of unacceptable EGSs that have beenreduced to acceptable status via engineering,administrative, and/or substitution controls.Acceptable means the exposure is less than the OEL

B) Employee Health Assessment based on ALL of thefollowing elements:• Pre-placement physical exams covering criticalelements:• Relevant periodic health assessments for ALLidentified health risks include fitness for dutyissues as well as exposure to chemicals,physical, or biological agents.

• Fitness for duty evaluations include mobileequipment operators, respirator users and heat-exposed individuals.


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Target Condition • For chemical exposures, surveillance should beinitiated for employees exposed to >50% of theOEL.

• For noise, surveillance should be initiated fornoise exposures at 80 dbA and above (8-hourTWA)

• The above exams should be carried out on afrequency that meets accepted health surveillancepractices

• The percentage of required exams completedshould be tracked. The ultimate goal should be100% completion rate for required surveillanceexams

• A system to communicate results to employees• An annual site summary of results (withoutindividual attribution) and appropriate follow-upprocess

Examples of health assessments for relevantexposures:

• Hearing tests for noise exposure• Spirometry for exposures to respiratory irritants• Appropriate surveillance measures for exposure tocarcinogens

• General health and medication review for exposureto heat

• General health and medication review and visiontests for vehicle operators.

Data available? NO. Needs to be included in an annual survey on SDindicators.

D Ergonomics Assessment


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Name Ergonomic Process

Definition Plants with a formal ergonomic process in place toidentify AND control specific ergonomic risks whichfulfils the defined criteria as specific under TargetCondition.

Unit of measurement Percentage of plants with processes in place.

Measurement methods Record the number of plants with a formal ergonomicprocess that meets the defined criteria as specifiedunder Target Condition.

Purpose To measure the implementation of company-specificergonomic processes to favourably impact onergonomic-related injury and illness.

Aggregation method At the company level, add up the data, determine thepercentage of plants that meet the criteria.

At the IAI level, determine the overall industrynumber/percentage from reported company data.

Target condition Each site should have implemented all of the followingitems:

• Written ergonomics policies and procedure• Employee training• An effective medical management program

And at least one of the following:• Ergonomic risk factor determination (qualitative) onrelevant job tasks has been completed

• Ergonomic hazard analyses (quantitative) areperformed for tasks where ergonomic risk factorshave been identified

• Significant ergonomic risks have been prioritizedfor control

When a plant has not satisfied the above targetconditions, the plant is considered not to have met therequirements and would not be included in the final tally.

This publication contains general guidance only and should not berelied upon as a substitute for appropriate technical expertise.Whilst reasonable precautions have been taken to verify theinformation contained in this publication as at the date ofpublication, it is being distributed without warranty of any kind,either express or implied.

In no event shall the International Council on Mining and Metals("ICMM") be liable for damages or losses of any kind, howeverarising, from the use of, or reliance on this document. Theresponsibility for the interpretation and use of this publication lieswith the user (who should not assume that it is error-free or that itwill be suitable for the user's purpose) and ICMM assumes noresponsibility whatsoever for errors or omissions in this publicationor in other source materials which are referenced by thispublication.

The views expressed do not necessarily represent the decisions orthe stated policy of ICMM. This publication has been developed tosupport implementation of ICMM commitments, however the usershould note that this publication does not constitute a PositionStatement or other mandatory commitment which members ofICMM are obliged to adopt under the ICMM SustainableDevelopment Framework.

The designations employed and the presentation of the material inthis publication do not imply the expression of any opinionwhatsoever on the part of ICMM concerning the legal status of anycountry, territory, city or area or of its authorities, or concerningdelimitation of its frontiers or boundaries. In addition, the mentionof specific entities, individuals, source materials, trade names orcommercial processes in this publication does not constituteendorsement by ICMM.

This disclaimer shall be construed in accordance with the laws ofEngland.

Published by International Council on Mining and Metals (ICMM),London, UK

© 2009 International Council on Mining and Metals 2009. The ICMMlogo is a trade mark of the International Council on Mining andMetals. Registered in the United Kingdom, Australia and Japan.

Reproduction of this publication for educational or other non-commercial purposes is authorized without prior writtenpermission from the copyright holders provided the source is fullyacknowledged. Reproduction of this publication for resale or othercommercial purposes is prohibited without prior writtenpermission of the copyright holders.

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Available from: ICMM, www.icmm.com, [email protected]

This book is printed on Challenger Offset 120gsm and 250gsmpaper. A great proportion of the raw material used is the by-product from other processes i.e. saw mill waste and waste whichresults fromforest thinning. The mill holds not only ISO 2002 but also ISO 14001accreditation for their environmental management systems, whichinclude an active policy on sustainable forestry management.


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ICMM – International Council on Mining and Metals

The International Council on Mining and Metals (ICMM) is a CEO-led industrygroup that addresses key priorities and emerging issues within the industry. Itseeks to play a leading role within the industry in promoting good practice andimproved performance, and encourages greater consistency of approachnationally and across different commodities through its association membersand member companies.

ICMM’s vision is for a respected mining and metals industry that is widelyrecognized as essential for society and as a key contributor to sustainabledevelopment.

www.icmm.com

ICMM35/38 Portman SquareLondon W1H 6LRUnited Kingdom

Telephone: +44 (0) 20 7467 5070Fax: +44 (0) 20 7467 5071Email: [email protected]

icmm health and safety performance indicator definitions

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