Breaking the Cycle of Slips, Trips, and Falls

It's not that we can't figure out or prevent these incidents. It's that the same mistakes are made over and over, and solutions aren't carried out sufficiently.

THE night he fell, Gary was working as a line cook at the signature restaurant of a newly opened, 5-star resort hotel. With more than 10 years of experience in restaurants, he had never experienced an injury on the job beyond some occasional cuts and burns--those all minor and mostly when he was learning the ropes. He was glad to have a nice assignment in this prestigious restaurant; the spacious kitchen and gleaming new equipment made for a very pleasant work environment.

Dinner service was set to begin in less than an hour, and he was getting the last few items together to prepare his station for the evening. The pace in the kitchen was brisk that night, but this was a popular place, always full for dinner, and a busy kitchen was the norm. Gary walked back to the walk-in refrigerator and retrieved a box of mushrooms. He was halfway back to his station with the box in his hands, and next thing he knew he had slipped, he lost his footing, and his head had bounced back off the hard tile floor. As he fell, he had tried to keep the box from tipping, as the mushrooms were pretty pricey. Gary had slipped on some ice cubes on the floor in front of the ice machine, which he hadn't seen as he briskly headed back to his station. Though he tried to get up, he knew right away that he had sustained a serious injury. When he was seen at a clinic later, the doctor said Gary had suffered a concussion and a broken elbow. The general manager and the head chef conferred on the accident scene, remarking to each other that it was a "freak accident." They didn't consider that what had happened was about as far from a freak accident as you can get.

People responsible for safety in hotels, restaurants, manufacturing, and many other industries face the ever-present issue of slips, trips, and falls in their workplaces. Unfortunately, if you look at the accident reports from five (or even 10) years ago in some of these organizations, you'll see very similar incidents to those happening right now. The problem isn't that slip, trip, and fall prevention can't be "figured out" or is awaiting technological advances for prevention to be possible; the problem is that the same mistakes are made over and over, and solutions that are understood are often not implemented thoroughly enough or are not sustained after implementation. It's possible to turn things around with some focused attention to the right things and to achieve lasting results. 

Common Errors in Slip, Trip, and Fall Prevention

Error #1 Not being systematic in prevention approaches

Error #2 Having the wrong floor for your environment

Error #3 Improper cleaning

Error #4 Ineffective spill and contaminant response

Error #5 The wrong shoes

Error #6 Inadequate maintenance

Error #7 Ineffective warnings

Error #8 Segregate prevention efforts from everyday activities

Error #9 Neglecting follow-up

Examining some of the common mistakes that are made and repeated can help us take steps to eliminate slip, trip, miss-step, and fall injuries in our workplaces. Presented below are 10 common mistakes made in slip, trip, and fall prevention, along with the keys to avoiding these mistakes.

Error #1: Not Being Systematic in Prevention Approaches
During planning for the new restaurant at the hotel where Gary worked, there was no shortage of thought about the look, the feel, the food preparation needs, and even the guest experience of the both the dining area and the kitchen. Unfortunately, no specific time was taken to consider the most prevalent risks in the environment being designed and how to reduce or eliminate them. When it came to safety, the architects and owners were confident their new restaurant would meet all building codes and have a design that complied with OSHA, environmental, and health regulations.

For many risks, especially slips, trips, and falls, ensuring code and regulatory compliance is the beginning, not the end. In our example, the ice machine was placed alongside a busy walkway between the front portion of the kitchen and the storeroom area. This placement was certainly great for easy access, but it also meant that spilled ice was likely to end up directly in the path of travel. It would have been relatively simple in the early phases of the design process to locate the ice machine in an area that was both easily accessible and set up to keep spilled ice away from walkways. Preventing slips and falls isn't about having a great floor, putting great shoes on workers' feet, or teaching people to walk with better balance; it's about all of those factors, and others as well, done in concert.

Error #2: Having the Wrong Floor for Your Environment
Sometimes the decision about what flooring material to use is based on what looks good, what fits the budget, or what is in use in similar places. These criteria might lead to a decent floor for your application, but it's much better to begin with a simple question: "How will this floor be used and under what conditions?"

Flooring that works wonderfully in one environment might provide dismal performance in another, which is why it is essential to select a floor that will perform well under all expected conditions. Additionally, it is important to remember that there are many differences in published specifications for the slip resistance of flooring materials, due to differing test methods and conditions. Quoted specifications may be useful, but you need to go further and see which test method was used, whether there are expected differences in the floor performance when viewed as an installed system or after it has been sealed or finished. If you need a floor that performs well when it is wet, be sure to evaluate the flooring material's performance in as close to installed condition as possible with a test method that is valid for wet testing--and many popular test methods are not. It is worth it to go to through the extra effort required to be confident that you have the right flooring because floors are usually not replaced for years, and the right one will save a great deal of administrative effort.

Specifics to look at include:

What activities will be performed on this floor?
Will visitors, vendors, or anyone outside your workers be walking on this floor? (If yes, what footwear do we expect them to be wearing?)
What contaminants are foreseen?
Will the area be exposed to weather?
What sort of monitoring and maintenance will the floor experience?
How much maintenance and upkeep will this flooring need?
Will mats, rugs, or runners be used?
Does any equipment need to be pushed or driven over the floor?

Error #3 Improper Cleaning
There needs to be provision made for cleaning floors during and after operational days and for deeper occasional cleaning to remove residues and ensure that all the edges and out-of-the way spots are thoroughly cleaned. Even for routine cleaning, there are several things that need to be done properly by the cleaning crew, including knowing which cleaners to use and in what mixture, what equipment to use, and the process in terms of applying solution to the floor, letting it dwell on the surface, scrubbing or agitation to remove deposits, and removal of the cleaning solution, possibly followed by rinsing.

In industrial and petrochemical environments, this gains added importance due to the special challenges of cleaning certain substances and the possible environmental and health issues in the cleaning process. Millions of floors around the world have contaminant or cleaning solution residue or buildup that is untouched, even added to, by the daily cleaning routines used.

Error #4 Ineffective Spill and Contaminant Response
This was perhaps the second most prominent issue in Gary's situation, after the placement of the ice machine relative to the walkway. Some spills and contaminants are unexpected, such as a fluid leak in a usually reliable piece of equipment, and other contaminants are expected, such as ice near an ice machine. It's important that there are means in place to detect and correct spills and other contaminants before they linger on a walkway. Just as important, recurrent contaminants need to be identified and reduced or eliminated.
Was the ice machine out of adjustment and overfull? Were the employees using the wrong bucket for ice, resulting in spillage? Did the employees filling the ice buckets get out of control and then fail to clean up the spilled ice? Was there a dustpan nearby to take care of spilled ice quickly? The same questioning process can easily be followed for construction sites, manufacturing, or other industries, considering the source of contaminants and the equipment and procedures available to respond to them.

Error #5 The Wrong Shoes
Better shoes wouldn't have helped much in Gary's situation, but for most employee slips, proper slip-resistant shoes can make the most difference in the shortest time among all prevention methods. There have been many advances in slip-resistant footwear in recent years, but it not sufficient to just look for soles marked or advertised as "slip resistant" because that label can't be depended on to predict the performance of the shoe.

Test results (using appropriate test methods) and pilot tests are two ways to gain confidence in the performance of the shoes you are considering. Additionally, there need to be administrative means to ensure employees wear their shoes, take good care of them, and replace them when they are excessively worn. It's also important to remember that the best shoes for a smooth floor wouldn't be the best for other surfaces such as loose gravel--and the other way around.

Error #6 Inadequate Maintenance
A thorough and regular program of physical inspections is the starting point for a well-maintained facility, supplemented by frequent, informal checks during the course of operations. When employees report hazards, those must be checked out, as well.

After hazards are identified, prompt maintenance must be the norm. Fixes do not need to be expensive or sophisticated, but they do need to be effective. The best way to determine the effectiveness of maintenance is through regular checks of the fixes after they've been performed. Not only does this help ensure the facility is in the best shape possible, it also helps operating management get a better understanding of persistent trouble spots.

Error #7 Ineffective Warnings
Warnings, of course, are what you do after you have done everything else possible to reduce or eliminate the hazards in your environment, but they still play an important role in accident prevention. You want to make it hard to miss the hazards that remain, and that is the goal of your warning systems. For slip, trip, and fall prevention, warnings can include cones, signs, taped or painted markings, or lighting. For some public spaces, even audible warnings, activated by proximity sensors, have gained popularity. Sometimes the best place for a warning isn't directly on the hazard; it might be best positioned above, below, or to the side, so it best catches the pedestrian's attention before he approaches the hazard.

Error #8 Segregating Prevention Efforts from Everyday Activities
Sometimes the mark of a good safety program is mistakenly interpreted to be a pretty binder on a shelf filled with a lengthy and detailed series of forms and procedures. There is nothing wrong with a detailed program; rather, the problem comes when the program is developed, documented, and maintained separately from the operating procedures that are used daily in the operation. It's certainly a good idea to have your slip and fall prevention program highlighted in some way, but that should only be as a supplement to inclusion in the regular operating policies, procedures, and training materials. The best programs are thoroughly integrated into the operation. Well-integrated programs are also easier to sustain.

Error #9 Neglecting Follow-Up
It's a natural tendency to think that after a problem gets fixed, the job is done. Actually, the important part of the job has just begun. Many issues take a few iterations to fix properly, which can be discovered only with thorough follow-up. Careful oversight is needed for more than just repairs, including monitoring, spill cleanup, maintenance, and even incident response and documentation.

When incidents do happen, we need to learn from them and take the time to consider the issues that lead to even the small incidents. Every close call and minor incident should be viewed as a chance to learn how to avoid a more serious incident in the future.

Conclusion
What Gary's executive chef and manager didn't realize was that there was nothing "freak" about the accident he suffered. The fact is, the ice on the floor, the slow cleanup, the obstructed view, and the hurried pace were all well-known factors not just in that kitchen, but in many of the previous kitchens that the managers and staff had worked in for years. The disconnect came from the fact that there had been a whole lot of close calls, a lot of slips without falls, and a few falls here and there with no injury. That one of those falls eventually resulted in a serious injury was what surprised them, but as we can now see, they already had all of the information they needed to keep Gary's accident from ever happening.

This article originally appeared in the October 2007 issue of Occupational Health & Safety.

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