A Risk Manager's Roadmap

Your best chance at reducing slip-and-fall accidents is during your facility's design phase, when choosing floor materials.

SLIPS and falls are a leading cause of unintentional injury in the United States. National Safety Council statistics noted in 2003 that 14,200 deaths from the previous year were caused by falls from one level to another or falls on the same level--the leading non-vehicular cause of death in public places. In 2000, falls were the leading cause of accidental injuries treated in hospital emergency rooms, with more than 7 million cases.

Slips and falls totaled $5.6 billion in worker's compensation costs in 2003 (LM Workplace Safety Index). According to OSHA, this ranks second only after motor vehicle crashes. In fact, slips and falls typically account for as much as 40 percent of an employer's worker's compensation costs (OSHA).

Slips and falls can result in many types of injuries, including serious head injuries, back problems, and various strains. Many injuries occur from pedestrians attempting to prevent falls, such as rotator cuff tears from grabbing a handrail during a fall. However, slips and falls are significantly controllable through a strong safety prevention program.

Recognize Primary Slip and Fall Causes
Slips are caused by a lack of friction or traction between the pedestrian's foot and the walking surface. In his guide "Pedestrian Slip Resistance: How to Measure It, How to Improve It," William English notes three controllable factors that affect traction: the floor surface, contaminants on the floor, and the footwear itself. The interaction between these variables results in the dangerous heel slide that causes most slip-and-fall accidents.

Floor surfaces. Texture determines a floor's slip resistance. Smooth floors made of glazed ceramic tile or terrazzo can be dangerously slippery when wet under typical footwear. Other floors with abrasives in their surface or specially textured metal plates can be quite slip resistant, even when wet or contaminated. Your best chance at reducing slip-and-fall accidents is during your facility's design phase, when choosing floor materials. Some problem floors can be made safer by surface treatments, but others may need to be replaced or carpeted over, if possible.

Contaminants. Ensure the walkway surface of your floors stays free of slippery agents. Excellent maintenance and/or process changes can control and even eliminate this problem. Simple requirements to keep refreshments in the breakroom, rather than bringing them into the work area, can help. Contaminants aren't limited to the obvious problems of leaks and spills, either. Even using the wrong kind or combination of cleaning/waxing agents can cause risks.

Footwear. Both shoe bottom material and tread pattern affect traction performance. Although you can't control the shoes worn by the general public, you can require your employees to wear slip-resistant footwear. Certain shoe styles have been demonstrated in lab testing to have the best traction in the presence of certain contaminants. Know what works best for your industry. A shoe that performs well on petroleum oil may not achieve the same results on cooking grease. There are a variety of vendors who specialize in slip-resistant footwear. Your insurer should be able to provide you with a listing.

Implement a Proactive Prevention Program
The relationship between floor surfaces, contaminants, and footwear demonstrates the need for a proactive slip-and-fall prevention strategy. Such accidents can be controlled, if not eliminated, through a program that includes a review of the premises to note any potential problems, corrective action to address possible hazards, good routine housekeeping and maintenance programs, and regular audits to observe walking surface conditions.

The following is a basic strategy for slip-and-fall prevention:

  • Review and analyze accident statistics. Determine what types of accidents are happening, where they are happening, and who is involved. Determine whether slips are occurring on clear floor surfaces or from contact with floor contaminants. Look for trends in day and time of accidents, precise location of accidents, and weather conditions at the time of the accidents. Your insurer can provide significant assistance in obtaining this information. If this information isn't readily available, develop a method for investigating slips and falls and documenting details of the incidents. All incidents should be promptly investigated. Keep written records of investigation results. Remember that slips and falls tend to be underreported. Many people walk away from a slip without injury and without reporting it; the hazardous condition then goes unreported.
  • Check the condition of walking surfaces. Inspect walking surfaces for condition and maintenance. Repair any unstable surfaces, such as loose tiles or torn carpet. Secure any mats, rugs, or carpet that doesn't lie flat. Provide adequate clearances for doors, walkways, and aisles. Keep floors clean and dry and remove any obstructions or tripping hazards. Conduct routine monitoring of any walking surface that is periodically wet or icy, such as sidewalks, building entrances, or food coolers.
  • Equip your stairs. Provide handrails for both sides of stairs. Handrails provide not only support for the pedestrian, but also a visual indication of the incline. Watch stair geometry: Keeping the tread (the horizontal portion of the step) and risers (the vertical section) of your steps uniform is critical to fall prevention. Check your local building code for requirements in your area. Keep risers around 7 inches high and tread at about 11 inches deep. Did you ever notice how uncomfortable it is to walk on a stationary escalator? The riser height is very different in that situation than what we are accustomed to. Highlight tread nosing with a contrasting color to accent the steps. Yellow is a commonly used color for highlighting changes in walkway elevation. If an elevator is available, provide signs to direct pedestrians from stairs to the elevator.
  • Examine the visibility. Good visibility is essential for the prevention of accidental slips, trips, and falls. Review your facility and grounds during different times of the day and seasons of the year to determine whether lighting is adequate. Consider the earliest and latest times when visitors, pedestrians, or employees are on your premises. Provide additional lighting for walking surfaces, as needed.
  • Clean up spills. Monitor any walking surfaces that are susceptible to periodic spills. Provide cleanup tools and materials in a nearby location so they are readily accessible. Train employees to clean up spills promptly. Use warning signs to mark areas that have not been cleaned and surfaces that are wet from mopping and cleaning. Remove signage once the floor is dry; leaving "Wet Floor" signs where floors are dry discourages pedestrians from taking the warning seriously. Follow instructions for all cleaners or floor treatments used in the facility. Proper use of cleaning agents and proper application of floor treatments are vital for good floor maintenance.
  • Assist shoe selection. While you cannot control the selection of the general public's footwear, there can be requirements for employee footwear. You can assist employees in the selection of appropriate footwear. Some employers participate in programs to provide periodic reimbursement to employees for proper footwear. Specific tread types can increase shoe traction on wet surfaces. Involving employees in the shoe selection process helps ensure buy-in.
  • Test floor surfaces. Slip resistance of floor surfaces can be measured by using a number of devices, but the only one credible for use in wet and dry environments is a device called a vertical incidence tribometer (VIT). VIT can measure the slip resistance of the floor surface under dry and wet conditions. This information will help you determine whether the floor surface or surface treatment contributes to slips and whether the floor provides adequate traction. Determining the slip resistance provides a quantifiable assessment for traction of walking surfaces. Use this information in selecting the optimal flooring in new installations.
  • Audit. Conduct periodic audits of facility and grounds conditions. Monitor any area where slip and fall accidents occurred in the past. Develop a system to note any problems or defects, and assign corrective actions to appropriate personnel. Document defects and corrective actions taken to correct problems. Follow up to be certain that controls remain in place. Conduct routine assessments of walking surface conditions. Replacement of surfaces in disrepair could be less costly than a slip-and-fall accident.

Understand Your Industry's Inherent Risks
Certain industries have more exposure to slip-and-fall accidents than others do. Hospitality, health care, and food processing are fields that are particularly susceptible to these types of losses. The chart in this article lists several specific challenges and explains how to address them.



Control Measure

Building lobbies

Outside moisture; highly polished, slick floor surfaces

Welcome mats at each entrance long enough to catch several footsteps' worth of moisture; umbrella holders; vigilant monitoring for hazards such as spills and precipitation moisture; floor finishes with slip-resistant characteristics.

Public restrooms

Soap, water, other contaminants

Immediate response to spills by employees; warning signs; blocking off wet areas until dry; periodic routine inspections.

Commercial kitchens

Polymerized grease

Daily cleaning after hours with an effective cleaning solution because simple wet mopping may only distribute grease; slip-resistant shoe program for employees.

Pool and spa areas

Standing water; mineral residue and biological growth

Thorough, regular cleaning and removal of any deposit that may form. Check manufacturer's recommendations for appropriate disinfectant.

Meat processing facility

Blood, fats, meat juices

Thorough cleaning at pre-determined intervals; harsher cleaning agents; slip-resistant footwear for employees.

Hospital halls/ patient rooms

Blood, food, water, bodily fluids, medications

Regular cleaning schedule; prompt response to contaminants; slip-resistant footwear for employees. Enlist visitors' aid in reporting spills.

Regardless of your industry, slips and falls are a costly problem that puts both your employees and the general public at risk. Although your best chance for reducing these accidents is at the design phase when choosing floor materials, planning and implementing a proactive risk prevention program can target problem areas, lower accident frequency, and decrease costs.

This article appeared in the September 2005 issue of Occupational Health & Safety.

This article originally appeared in the September 2005 issue of Occupational Health & Safety.

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