Residential frame carpenters are at high risk of falls. (Washington University photo)

Construction Fall Fatalities Can Be Prevented

Our new training curriculum for residential frame carpenters proved the skeptics wrong.

The statistics are grim. Falls are the number one killer of construction workers, accounting for approximately one-third of construction fatalities. A typical day sees one construction worker fall to his or her death on the job, with several more hurt and hospitalized.

Most studies suggest residential construction is even more hazardous than commercial construction. That's why OSHA has launched a campaign to prevent falls in construction and why OSHA has a new, stringent fall protection policy for residential construction sites.

Too often, our research team at Washington University in St. Louis has heard residential contractors express a fatalistic attitude about this deadly problem; they tell us the work is dangerous, the workers take foolish risks, and these things will never change. But we have been studying falls and fall prevention among one of the highest-risk groups –- residential frame carpenters -– for years and have learned otherwise.

Fall Risks and Frame Carpenters
The carpenters who frame single-family homes -– raising walls, placing joists, and setting trusses -– experience shockingly high injury and death rates in falls. In 2007, an astonishing 55 percent of occupational fatalities in residential framing were attributed to "falls to a lower level." These men and women work in small groups and must repeatedly access areas well above the ground in structures marked by gaps and leading edges; they typically work for small firms and seldom see on-site safety professionals.

At first glance, they would seem to be among the most difficult groups to reach with effective interventions against falls. Of course, if they could be reached, they would offer an especially rich opportunity to save lives and limbs.

Unlike many areas of the country, the residential frame carpenters of the St. Louis area are largely union members, which presented a remarkable opportunity for our research team. We found an enthusiastic partner in the apprenticeship program jointly administered by the Carpenters' union and the contractors who employ their members. With the help training center staff and participating framing contractors, we developed and tested a measurement tool we called SAFR -– the St. Louis Audit of Fall Risks. SAFR is a checklist of more than 52 different safety practices: Is everyone wearing hard hats? Do those installing roof sheathing have personal fall arrest systems? Are workers maintaining three points of contact when on a ladder?

Using SAFR, two master carpenters spent a year auditing a total of 197 work sites, observing nearly 800 carpenters at work and interviewing most of them afterward, at least briefly. The average site's SAFR score was 59 percent. Some dangerous practices –- standing on the top plate of exterior walls, working around uncovered floor openings -– were alarmingly common.

From SAFR to Safer: A New Curriculum on Fall Prevention
Our next challenge was to develop a fall prevention curriculum that would address such problems. Doing so was no small task. We had to begin with a review of the existing training programs administered by the Carpenters' Joint Apprenticeship Program (CJAP) of St. Louis to identify gaps where problems identified by SAFR had not been addressed or were not sufficiently addressed. We also surveyed more than 1,000 apprentices and organized several focus groups among them to explore their current knowledge, beliefs, attitudes, and training and to find out what factors made training effective.

The findings highlighted several shortcomings of existing fall prevention training. The apprentices had only about two hours of fall prevention work in the course of their training, and despite their preference for participatory learning, this largely meant sitting in a classroom watching videos. Perhaps this explained why apprentices routinely underestimated the fall risks created when working on ladders, why they believed unprotected floor openings as big as a foot across were permitted by OSHA, and why they felt the job required them to "get over their fear" of working unprotected on steeply pitched roofs.

The new curriculum was greatly expanded, with 17 hours of fall prevention training delivered in the course of their apprenticeship. But perhaps even more importantly, we improved the way this training was delivered, incorporating hands-on practice and problem-solving activities. We also included role-playing exercises designed to give apprentices the confidence to say "no" when asked to work under unsafe conditions.

After implementation of the curriculum, 207 work sites were audited in a follow-up exercise. We found their SAFR scores had climbed significantly, from 59 percent to 75 percent. Carpenters who participated in our training program:

1) were less likely to stand on the top plate of the wall and be at risk for a fall

2) were more likely to wear fall arrest gear

3) were more likely to install guardrails around floor openings and leading edges

4) were more likely to keep three points of contact on a ladder while climbing, and

5) were less likely to experience a fall accident.

In other words, we had proven the skeptics wrong. Contractors, union or nonunion, can take action to reduce the rate of fall accidents on their construction sites. If it can be done in the high-risk world of residential framing, it can be done everywhere -– if there is a will to do so.

Fall Prevention Technology: Lending to Learn
Much of our team's current work revolves around evaluation of fall prevention technologies, new and old. Personal fall arrest systems have become routine in the commercial building world, but they are often absent in residential construction and seldom used even when they are. (Fall arrest systems were in use at only 8 percent of the sites we audited!) There are technical reasons for this: It can be highly challenging to find secure anchor points for a fall arrest system during framing, especially before trusses are set and secured.

But that can't be an excuse; it needs to be a push to action as we explore fall prevention alternatives. That's why our next step has been to work with the CJAP to establish a technology lending program. The apprenticeship school has collected a variety of cutting-edge tools and equipment designed to keep workers safe. These are loaned out in turn to participating contractors. Contractors get a chance to try them in action before committing funds to a purchase, and in return they provide feedback on their quality and ease of use.

Contractors, journeymen, and apprentices alike have given high marks to a device called a safety boot, a sturdy plastic footing for temporary guardrails. This tool made it simple to establish secure temporary railings to prevent falls off leading edges or through unprotected floor openings. They expressed similar enthusiasm for a new hanging scaffold that is mounted on clips that hang over the top plates of an exterior wall. Installing the temporary walkway proved quick and easy, and it offered a solid alternative to balancing on ladders. Both of these devices were relatively unfamiliar to the contractors and workers, and some of the firms have moved on to purchase them.

You may say that's well and good, but you don't have access to a technology lending program. Have you considered approaching your apprenticeship fund or trade association to establish one? Have you asked your rental company to acquire a set of safety boots or the hanging scaffold? Once you have taken the decision to reduce fall injuries, there are many ways forward -– it's a matter of being committed and creative.

It's time for us all to put to rest the attitude that "accidents happen" and take action to make sure deadly fall accidents don't happen. The National Institute for Occupational Safety and Health and CPWR – The Center for Construction Research and Training have come together to create a website full of resources on fall prevention in construction. For creative ideas, check it out at www.stopconstructionfalls.com.

For More Information
1. Kaskutas V, Dale AM, Lipscomb H, and Evanoff B [2008]. Development of the St. Louis Audit of Fall Risks at Residential Construction Sites. International Journal of Occupational and Environmental Health 14: 243-9.
2. Kaskutas V, Dale AM, Nolan J, Patterson D, Lipscomb H, and Evanoff B [2009]. Fall hazard control observed on residential construction sites. American Journal of Industrial Medicine 52:491-99.
3. Kaskutas V, Dale AM, Lipscomb H, Gaal J, Fuchs M, Evanoff B, and Carpenters Joint Apprenticeship Program Instructor Team [2010]. Changes in fall prevention training for apprentice carpenters based on a comprehensive needs assessment. Journal of Safety Research 41: 221-7.
4. Evanoff B, Kaskutas V, Dale AM, Gaal J, Fuchs M, Lipscomb H [2012]. Outcomes of a revised apprentice carpenter fall prevention training curriculum. Work 41:3806-8.

This article originally appeared in the January 2013 issue of Occupational Health & Safety.

About the Authors

Bradley Evanoff, M.D., MPH, is a professor of Medicine at Washington University in St. Louis, where he is active as a clinician, teacher, and researcher. His research focus is preventing injuries and musculoskeletal disorders among construction and health care workers. Dr. Evanoff believes that most work injuries can be avoided and that employers can improve their bottom lines through increased attention to worker health and safety.

Vicki Kaskutas, OTD, MHS, is an assistant professor of Occupational Therapy at Washington University. Her current research focuses on preventing falls from height by residential construction workers. She also performs work rehabilitation research and teaches occupational therapy graduate students. Prior to joining Washington University, she provided ergonomic and injury prevention programs for the manufacturing, construction, and transportation industries. She believes if individuals are well-matched with their work site and work duties, they can enjoy long, productive careers while maintaining their health and well-being.

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