Overview

The Occupational Safety and Health Act of 1970 requires employers to track injuries and illnesses sustained on the job and gives the Occupational Safety and Health Administration (OSHA) authority to set the tracking and recording parameters. These parameters are outlined in the Code of Federal Regulations (Standard – 29 CFR) as outlined below:

• Part Number: 1904
• Part Title: Recording and Reporting Occupational Injuries and Illness
• Subpart: C
• Subpart Title: Recordkeeping Forms and Recording Criteria
• Standard Number: 1904.7 – Recording and Reporting Occupational Injuries and Illnesses

OSHA Injury and Illness Recordkeeping and Reporting Requirements: www.osha.gov./recordkeeping

OSHA Rules & Regulations

OSHA defines the basic requirement on what constitutes a recordable injury or illness for recordkeeping purposes here:

1904.7(a)

Basic requirement. You must consider an injury or illness to meet the general recording criteria, and therefore to be recordable, if it results in any of the following: death, days away from work, restricted work or transfer to another job, medical treatment beyond first aid, or loss of consciousness. You must also consider a case to meet the general recording criteria if it involves a significant injury or illness diagnosed by a physician or other licensed health care professional, even if it does not result in death, days away from work, restricted work or job transfer, medical treatment beyond first aid, or loss of consciousness.

So, for our purpose here we need to remember the guidelines state that an MSD would be recordable if medical treatment beyond first aid takes place. Which begs the question, what constitutes medical treatment beyond first aid?

Medical Treatment

In order to comply with the OSHA rules and regulations, we need to understand OSHA’s definition of medical treatment and what medical treatment under OSHA guidelines does NOT include.

1904.7(b)(5)(i)

What is the definition of medical treatment? “Medical treatment” means the management and care of a patient to combat disease or disorder. For the purposes of Part 1904, medical treatment does not include (NOT Recordable):

Visits to a physician or other licensed health care professional solely for observation or counseling; The conduct of diagnostic procedures, such as x‐rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes (e.g., eye drops to dilate pupils); or “First aid” as defined in paragraph (b)(5)(ii) of this section.

Note that an evaluation by a physician, licensed physical therapist or certified athletic trainer, in and of itself, does not trigger a recordable injury or illness. In addition, application and use of first aid measures as defined by OSHA also does not trigger a recordable injury or illness.

Section 1904.7(b)(5)(ii) defines first aid, the applicable definitions to early MSD intervention are outlined below:

First Aid

Within the context of early MSD intervention, applicable first aid measures as defined by OSHA include:

• Using a non‐prescription medication at nonprescription strength. (Exception: for medications available in both prescription and non‐prescription form, a recommendation by a physician or other licensed health care professional to use a non‐prescription medication at prescription strength is considered medical treatment for recordkeeping purposes)
• Using hot or cold therapy
• Using any non‐rigid means of support, such as elastic bandages, wraps, non‐rigid back belts, etc. (Exception: devices with rigid stays or other systems designed to immobilize parts of the body are considered medical treatment for recordkeeping purposes)
• Using massages (Exception: physical therapy or chiropractic treatment are considered medical treatment for recordkeeping purposes)

OSHA considers the first aid treatments listed above to be first aid regardless of the professional status of the person providing the treatment. Even when these treatments are provided by a physician or other licensed health care professional like an athletic trainer, they are considered first aid for the purposes of Part 1904.

Work Restrictions

Under the OSHA recording guidelines, work restrictions do not necessarily trigger an OSHA recordable injury or illness.

The Recordkeeping Policies and Procedures Manual states, “A case would not be recorded under section 1904.7(b)(4) if, 1) the employee experiences minor musculoskeletal discomfort, and 2) a health care professional determines that the employee is fully able to perform all of his or her routine job functions, and 3) the employer assigns a work restriction to that employee for the purpose of preventing a more serious condition from developing.”

Note that if a case is or becomes recordable under any other general recording criteria contained in section 1904.7, the case would be recordable regardless of having any work restrictions.

Exercise

Although “therapeutic exercise” is considered “physical therapy” and therefore treatment beyond first aid under the OSHA definition, recommending exercise as a part of a proactive wellness initiative such as early MSD intervention does not trigger a recordable injury or illness. Preventive and counteractive exercises used as a part of an MSD prevention and early intervention program are not the same as “therapeutic exercise”.

OSHA’s clarification regarding exercise states, “Please be aware that if a treatment is administered as a purely precautionary measure to an employee who does not exhibit any signs or symptoms of an injury or illness, the case is not recordable. For a case to be recordable, an injury or illness must exist. For example, if, as part of an employee wellness program, an ATC recommends exercise to employees that do not exhibit signs or symptoms of an abnormal condition, there is no case to record. Furthermore, if an employee has an injury or illness that is not work‐related, (e.g., the employee is experiencing muscle pain from home improvement work) the administration of exercise does not make the case recordable either.”

Note that if “therapeutic exercise” is recommended by a health care professional for a serious injury or illness with specific instructions over an extended period of time, OSHA considers this form of therapeutic exercise to be “physical therapy” treatment beyond first aid and therefore would be considered an OSHA recordable injury or illness.