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Federal Register / Vol. 86, No. 205 / Wednesday, October 27, 2021 / Proposed Rules nature of heat-related illness symptoms, some of which e.g., headache, fatigue may have other causes, not all cases of illness or injury are reported. Further, if the illness or injury does not require medical treatment beyond first aid, or result in restrictions or days away from work, loss of consciousness, diagnosis by a healthcare professional as a significant injury, or death, an employer is not required to report the incident under OSHAs existing injury reporting requirements see 29 CFR 1904.7a.
There may also be situations where an illness, injury, or fatality is deemed to be unrelated to work, but heat exposure at work may have contributed to that incident Gubernot et al., October 2014;
Shipley et al., August 17, 2021.
Second, hazardous heat can impair job tasks related to complex cognitive function Ebi et al., August 21, 2021, and also reduce decision-making abilities and productivity. A recent global meta-analysis showed that 30%
of workers who experienced hazardous heat during a single shift reported productivity losses Flouris et al., December 2018. Additionally, a growing body of evidence has demonstrated that these heat-induced impairments may result in significant occupational injuries that are not currently factored into assessments of the health hazards resulting from occupational heat exposure Park et al., July 2021. In California, the likelihood of same-day workplace injury risk significantly increased by approximately 57% when comparing a day that was 6065 degrees Fahrenheit to a day that was 8590 degrees Fahrenheit. Same-day workplace injury risk increased 1015% when comparing a day that was 6065 degrees Fahrenheit to a day that was above 100-degrees Fahrenheit. These increased risks were demonstrated in certain indoor and outdoor work environments, contributing to approximately 360,000
additional workplace injuries in California alone from 20012018 Park et al., July 2021.
Third, self-reporting of health outcomes can result in bias which can lead to overor under-estimates of health outcomes Althubaiti, May 4, 2016. In 2009, the Government Accountability Office GAO reported that the BLS Survey of Occupational Injuries and Illnesses, which relies heavily on employer self-report of nonfatal injuries and illnesses, may underreport employer-reported injury and illness data GAO, October 2009.
This underreporting of non-fatal illnesses and injuries may be particularly present in some industries, like agriculture, where some employers
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e.g., employers with 10 or fewer employees are excluded from reporting requirements Leigh et al., April 2014.
While there may be multiple factors influencing underreporting, BLS
investigations of this issue have found that employers and employees may face disincentives for reporting injuries and illnesses BLS, December 8, 2020. By reporting injuries and illness, employers may increase their workers compensation costs and jeopardize their reputation. Employees may also face disincentives for reporting if they are reluctant to report for fear of retaliation or may not realize an illness or injury is heat-related. Employees may decide to continue working for economic incentives and to avoid losing wages.
Employee fear of retaliation, including the potential loss of employment, may be of particular concern with heatrelated illness and injuries given the disproportionate number of undocumented, migrant, low-wage, or other vulnerable workers that make up sectors that are at high risk of hazardous heat exposure such as agriculture and construction. These workers may lack the awareness of their right to, and perceived ability to, speak out about workplace conditions. Additional concerns related to the inequalities in hazardous heat exposure and resulting health outcomes are discussed below in more detail. Despite potential underreporting, these datasets are important indicators of occupational safety and health, and through the questions below, OSHA seeks additional information and data to better assess the fullest extent of occupational illnesses, injuries, and fatalities due to hazardous heat exposure in the workplace.
Finally, there are some health conditions associated with occupational heat exposure that may take many years to manifest in workers previously exposed to hazardous heat due to the latency period between exposure and symptom onset Gubernot et al., October 2014. For these illnesses that develop over time, it is unlikely that the current national datasets of occupational illnesses and injuries associate those outcomes with hazardous heat exposure.
The following questions are intended to solicit information on the topics related to assessing and addressing underreporting of occupational illness, injuries, and fatalities occurring due to hazardous heat.
4 Are there quantitative estimates of the magnitude of occupational illnesses, injuries, and fatalities related to hazardous heat, beyond what is described in this ANPRM?

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5 Are there quantitative estimates or other quantitative or non-quantitative examinations of the magnitude of underreporting of occupational illnesses, injuries, and fatalities related to hazardous heat?
6 What factors lead to the underreporting of occupational heatrelated illness, injuries, and fatalities of which OSHA should be aware?
7 What datasets are available to address some of the limitations associated with the underreporting of occupational heat-related illnesses, injuries, and fatalities?
C. Scope 1. Industries, Occupations, and Job Tasks Workers across hundreds of industries are at risk for hazardous heat exposure and resulting health impacts. Since 2018, 789 heat-related hospitalizations and 54 heat-related fatalities across nearly 275 unique industries have been documented by OSHA through workplace inspections and violations .
During this time, hospitalizations occurred most frequently in postal and delivery service, landscaping, and commercial building, as well as highway, street, and bridge construction workers. Fatalities were reported in landscaping, masonry, and highway, street, and bridge construction workers OSHA, August 20, 2021.
Also since 2018, over 230 unique industries as identified by 6-digit NAICS codes across indoor and outdoor work settings have had at least one heat-related inspection by OSHA.
During 2019, for example, OSHA heatrelated inspections occurred most often in industries and workplaces such as roofing, postal and delivery service, construction and contracting, masonry, landscaping, restaurants, and warehousing and storage OSHA, August 20, 2021.
Further, multiple analyses of OSHA
enforcement investigations and the Census of Fatal Occupational Injuries have found that Agriculture NAICS
code 11, Construction NAICS code 23, Transportation and Warehousing NAICS codes 4849, and Administrative and Support and Waste Management and Remediation Services NAICS code 56 experience the highest rates of heat-related mortality Gubernot et al., February 2015; Tustin et al., August 2018. Compared to the average annual heat-related workplace fatality rate in all other industries of 0.09 deaths per 1 million workers, Agriculture, Forestry, Fishing, and Hunting was found to have 35 95% confidence interval, 26.347.0 times the risk of
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