Federal Register / Vol. 86, No. 205 / Wednesday, October 27, 2021 / Proposed Rules 59309 

that an extension of 14 days is sufficient 

for this preliminary stage. Therefore, 

DOE is extending the comment period 

until November 15, 2021. 

Signing Authority 

This document of the Department of 

Energy was signed on October 19, 2021, 

by Kelly Speakes-Backman, Principal 

Deputy Assistant Secretary and Acting 

Assistant Secretary for Energy Efficiency 

and Renewable Energy, pursuant to 

delegated authority from the Secretary 

of Energy. That document with the 

original signature and date is 

maintained by DOE. For administrative 

purposes only, and in compliance with 

requirements of the Office of the Federal 

Register, the undersigned DOE Federal 

Register Liaison Officer has been 

authorized to sign and submit the 

document in electronic format for 

publication, as an official document of 

the Department of Energy. This 

administrative process in no way alters 

the legal effect of this document upon 

publication in the Federal Register. 

Signed in Washington, DC, on October 20, 

2021. 

Treena V. Garrett, 

Federal Register Liaison Officer, U.S. 

Department of Energy. 

[FR Doc. 2021–23229 Filed 10–26–21; 8:45 am] 

BILLING CODE 6450–01–P 

DEPARTMENT OF LABOR 

Occupational Safety and Health 

Administration 

29 CFR Parts 1910, 1915, 1917, 1918, 

1926, and 1928 

[Docket No. OSHA–2021–0009] 

RIN 1218–AD39 

Heat Injury and Illness Prevention in 

Outdoor and Indoor Work Settings 

AGENCY: Occupational Safety and Health 

Administration (OSHA), Labor. 

ACTION: Advance notice of proposed 

rulemaking (ANPRM). 

SUMMARY: OSHA is initiating 

rulemaking to protect indoor and 

outdoor workers from hazardous heat 

and is interested in obtaining additional 

information about the extent and nature 

of hazardous heat in the workplace and 

the nature and effectiveness of 

interventions and controls used to 

prevent heat-related injury and illness. 

This ANPRM provides an overview of 

the problem of heat stress in the 

workplace and of measures that have 

been taken to prevent it. This ANPRM 

also seeks information on issues that 

OSHA can consider in developing the 

standard, including the scope of the 

standard and the types of controls that 

might be required. 

DATES: Submit comments on or before 

December 27, 2021. 

ADDRESSES: You may submit comments 

and attachments, identified by Docket 

No. OSHA–2021–0009, electronically at 

www.regulations.gov, which is the 

Federal e-Rulemaking Portal. Follow the 

instructions online for making 

electronic submissions. 

Instructions: All submissions must 

include the agency’s name and the 

docket number for this ANPRM (Docket 

No. OSHA–2021–0009). When 

submitting comments or 

recommendations on the issues that are 

raised in this ANPRM, commenters 

should explain their rationale and, if 

possible, provide data and information 

to support their comments or 

recommendations. Wherever possible, 

please indicate the title of the person 

providing the information and the type 

and number of employees at your 

worksite. 

All comments, including any personal 

information you provide, will be placed 

in the public docket without change and 

will be publicly available online at 

www.regulations.gov. Therefore, OSHA 

cautions commenters about submitting 

information they do not want to be 

made available to the public or 

submitting materials that contain 

personal information (either about 

themselves or others) such as Social 

Security Numbers and birthdates. 

Docket: To read or download 

comments or other material in the 

docket, go to Docket No. OSHA–2021– 

0009 at www.regulations.gov. All 

comments and submissions are listed in 

the www.regulations.gov index; 

however, some information (e.g., 

copyrighted material) is not publicly 

available to read or download through 

that website. All submissions, including 

copyrighted material, are available for 

inspection at the OSHA Docket Office. 

Documents submitted to the docket by 

OSHA or stakeholders are assigned 

document identification numbers 

(Document ID) for easy identification 

and retrieval. The full Document ID is 

the docket number plus a unique fourdigit code. OSHA is identifying 

supporting information in this ANPRM 

by author name and publication year, 

when appropriate. This information can 

be used to search for a supporting 

document in the docket at 

www.regulations.gov. Contact the OSHA 

Docket Office at 202–693–2350 (TTY 

number: 877–889–5627) for assistance 

in locating docket submissions. 

FOR FURTHER INFORMATION CONTACT: 

Press Inquiries: Contact Frank 

Meilinger, Director, Office of 

Communications, U.S. Department of 

Labor; telephone (202) 693–1999; email 

meilinger.francis2@dol.gov. 

General and technical information: 

Contact Andrew Levinson, Acting 

Director, Directorate of Standards and 

Guidance, U.S. Department of Labor; 

telephone (202) 693–1950. 

SUPPLEMENTARY INFORMATION: This 

ANPRM on Heat Injury and Illness 

Prevention in Outdoor and Indoor Work 

Settings follows this outline: 

Table of Contents 

I. Background 

A. Occupational Illnesses, Injuries, and 

Fatalities Due to Hazardous Heat 

B. Under Reporting of Occupational 

Illnesses, Injuries, and Fatalities Due to 

Hazardous Heat 

C. Scope 

1. Industries, Occupations, and Job Tasks 

2. Structure of Work and Work 

Arrangements 

3. Business Size 

D. Geographic Region 

E. Inequality in Exposures and Outcomes 

F. Climate Change 

II. Existing Heat Illness Prevention Efforts 

A. OSHA Efforts 

1. OSHA’s Heat Illness Prevention 

Campaign and Other Guidance Efforts 

2. Stakeholder Engagement—NACOSH 

Work Group 

3. General Duty Clause 

4. Other Enforcement Efforts 

5. Applicable OSHA Standards 

B. Petitions for Rulemaking 

C. NIOSH Criteria Documents 

D. History and Requirements of State 

Standards 

E. Other Standards 

F. Employer Efforts 

III. Key Issues in Occupational Heat-Related 

Illness 

A. Determinants of Occupational Heat 

Exposure 

1. Heat Exposure 

2. Contributions to Heat Stress in the 

Workplace 

B. Strategies To Reduce Occupational HeatRelated Injury and Illness 

1. Heat Injury and Illness Prevention 

Programs 

2. Engineering Controls, Administrative 

Controls, and Personal Protective 

Equipment 

3. Acclimatization 

4. Monitoring 

5. Planning and Responding to HeatRelated Illness Emergencies 

6. Worker Training and Engagement 

IV. Costs, Economic Impacts, and Benefits 

A. Overview 

B. Impacts on Small Entities 

V. References 

I. Background 

Heat is the leading cause of death 

among all weather-related phenomena 

(NWS, September 8, 2021a; NWS, 


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September 8, 2021b). Excessive heat 

exacerbates existing health problems 

like asthma, kidney failure, and heart 

disease, and can cause heat stroke and 

even death if not treated properly and 

promptly. Workers in both outdoor and 

indoor work settings without adequate 

climate-controlled environments are at 

risk of hazardous heat exposure. In an 

evaluation of 66 heat-related illness 

enforcement investigations from 2011– 

2016, 80% of heat-related fatalities 

occurred in outdoor work environments. 

However, 61% of non-fatal heat-related 

illness cases occurred during or after 

work in an indoor work environment 

(Tustin et al., August 2018). Pregnant 

workers (NIOSH, April 20, 2017) and 

workers of color are disproportionately 

exposed to hazardous levels of heat in 

essential jobs across these work settings 

(Gubernot et al., February 2015). In 

addition, climate change is increasing 

the frequency and intensity of extreme 

heat events, as well as increasing daily 

average daytime and nighttime 

temperatures. OSHA is initiating a 

rulemaking to protect both indoor and 

outdoor workers from hazardous heat, 

and as a first step is seeking additional 

information about the extent and nature 

of hazardous heat in the workplace and 

the nature and effectiveness of 

interventions and controls used to 

prevent heat-related illness. This 

ANPRM provides an overview of the 

problem of heat stress in the workplace 

and the measures that have been taken 

to prevent it. This ANPRM also seeks 

information on issues that may be 

considered in developing a standard, 

including the scope of the standard and 

the types of controls that might be 

required. 

OSHA uses several terms related to 

excessive heat exposure throughout this 

document. Heat stress means the load of 

heat that a person experiences due to 

sources of heat or heat retention, or the 

presence of heat in a work setting. Heat 

strain means the physiological response 

to heat exposure (ACGIH, 2017). Heatrelated illness means adverse clinical 

health outcomes that occur due to 

exposure to hazardous heat. Heatrelated injury means an injury linked to 

heat exposure that is not considered one 

of the typical symptoms of heat-related 

illness, such as a fall or cut. The 

document also uses the combined terms 

of heat injury and illness when talking 

about prevention or programming to 

demonstrate that both injury and illness 

should be considered, with the 

exception of the names of existing 

programs. 

A. Occupational Illness, Injuries, and 

Fatalities Due to Hazardous Heat 

According to the Bureau of Labor 

Statistics (BLS) Census of Fatal 

Occupational Injuries, exposure to 

excessive environmental heat stress has 

killed 907 U.S. workers from 1992– 

2019, with an average of 32 fatalities per 

year during that time period (BLS, 

September 10, 2021a). In 2019, there 

were 43 work-related deaths due to 

environmental heat exposure (BLS, 

September 1, 2021). A recent analysis of 

BLS data by National Public Radio and 

Columbia Journalism Investigations 

found that the three-year average of 

heat-related fatalities among U.S. 

workers has doubled since the early 

1990s (Shipley et al., August 17, 2021). 

The BLS Annual Survey of 

Occupational Injuries and Illnesses 

estimates that 31,560 work-related heat 

injuries and illnesses involving days 

away from work have occurred from 

2011–2019, with an average of 3,507 

injuries and illnesses of this severity 

occurring per year during this period 

(BLS, September 10, 2021b). However, 

the estimates provided here on 

occupational heat-related illnesses, 

injuries, and fatalities are likely vast 

underestimates, as discussed further in 

Underreporting of occupational 

illnesses, injuries, and fatalities due to 

hazardous heat (Section I.B. of this 

ANPRM). 

In a warm environment, the human 

body maintains a healthy internal body 

temperature by getting rid of excess heat 

through mechanisms like sweating and 

increasing blood flow to the skin. This 

is especially true during physical 

activity or exertion. Briefly, if the body 

is not able to dissipate heat, the body 

temperature may rise, and symptoms of 

heat-related injury and illness can 

result. These can include heat rashes, 

heat syncope (fainting), heat cramps, 

heat exhaustion, rhabdomyolysis (a 

complex medical condition involving 

muscle breakdown), kidney injury, and 

even heat stroke (the inability of the 

body to cool which can lead to death) 

if the thermoregulatory capacity of the 

body is exceeded (Ebi et al., August 21, 

2021; NIOSH, February 2016). A multicountry meta-analysis of dozens of 

studies involving thousands of workers 

globally found that of those exposed to 

hazardous heat during a single work 

shift, 35% experienced heat strain while 

15% of those who frequently worked in 

hazardous heat experienced kidney 

disease or acute kidney injury (Flouris 

et al., December 2018). 

Exposure to hazardous heat can also 

result in the exacerbation of pre-existing 

medical conditions, such as diabetes or 

cardiovascular disease. A study of U.S. 

Army personnel demonstrated that 

those who have been hospitalized in 

U.S. hospitals for heat-related illness 

may experience organ damage that can 

persist for years afterward, even 

resulting in an increased risk of death 

from cardiovascular disease and 

ischemic heart disease compared to 

those previously hospitalized for other 

reasons (Wallace et al., 2007). Recurrent 

exposure to hazardous heat, and 

resulting dehydration, has also been 

found to be associated with acute and 

chronic kidney disease and injury in 

agricultural workers and others 

performing manual labor in outdoor 

work settings, particularly in South 

America, central America and certain 

South Asian countries. These illnesses 

appear to be unrelated to traditional 

causes of the disease (Glaser et al., 

August 8, 2016; Johnson et al., May 9, 

2019; Sorensen and Garcia-Trabanino, 

August 22, 2019). Although much of 

this research has focused on 

international populations, there is 

emerging evidence of this health hazard 

in occupational populations within the 

U.S. (Mix et al., 2019; Glaser et al., 

August 8, 2016). 

The following questions are intended 

to solicit information on the topics 

related to assessing the nature and 

magnitude of occupational illness, 

injuries, and fatalities occurring due to 

hazardous heat. 

(1) What are the occupational health 

or safety impacts of hazardous heat 

exposure? 

(2) What sources of data are important 

to consider when evaluating 

occupational heat-related illnesses, 

injuries, and fatalities? 

(3) Beyond the studies discussed in 

this ANPRM, are there other data that 

provide more information about the 

scope and magnitude of injuries, 

illnesses, and fatalities related to 

occupational heat exposure? 

B. Underreporting of Occupational 

Illnesses, Injuries, and Fatalities Due to 

Hazardous Heat 

Heat-related illnesses, injuries, and 

fatalites are underreported (EPA, April 

2021; Popovich and Choi-Schagrin, 

August 11, 2021). Occupational heatrelated illnesses, injuries, and fatalities 

may be underestimated for several 

reasons. First, the full extent of heatrelated health outcomes is 

underreported generally because heat is 

not always recognized as a contributing 

factor and the criteria for defining a 

heat-related death or illness may vary by 

state, and among physicians, medical 

examiners, and coroners. (Gubernot et 

al., October 2014). Due to the varying 


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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 OSHA’s existing injury reporting 

requirements (see 29 CFR 1904.7(a)). 

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 5–7% when comparing a 

day that was 60–65 degrees Fahrenheit 

to a day that was 85–90 degrees 

Fahrenheit. Same-day workplace injury 

risk increased 10–15% when comparing 

a day that was 60–65 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 2001–2018 (Park 

et al., July 2021). 

Third, self-reporting of health 

outcomes can result in bias which can 

lead to over- or 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 

(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? 

(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 48–49), 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, 26.3–47.0) times the risk of 


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heat-related deaths with 3.06 deaths per 

1 million workers from 2000–2010. 

Construction had 13 (95% confidence 

interval, 10.1–16.7) times the risk of 

heat-related deaths with 1.13 deaths per 

1 million workers during that time 

period (Gubernot et al., February 2015). 

Many job tasks, regardless of the 

industry in which they are performed, 

may also result in the risk of exertional 

heat stress in workers. The American 

Conference of Governmental Industrial 

Hygienists (ACGIH) has developed 

categories of work intensity based on 

their estimated metabolic rate, with the 

metabolic rate increasing across 

categories: rest (e.g., sitting), light (e.g., 

sitting, standing, light arm/handwork, 

occasional walking), moderate (e.g., 

normal walking, moderate lifting), 

heavy (e.g., heavy material handling, 

walking at a fast pace), very heavy (e.g., 

pick and shovel work) (ACGIH, 2017; 

OSHA, September 15, 2017). In an 

evaluation of 14 heat-related workplace 

fatalities that occurred from 2011–2016, 

the workload was moderate, heavy, or 

very heavy in 13 of the incidents (Tustin 

et al., July 6, 2018). Of 20 enforcement 

cases from 2012–2013 that resulted in 

heat-related citations under the 

Occupational Safety and Health Act’s 

General Duty Clause, all fatalities and 

non-fatal heat-related illnesses occurred 

under moderate or heavy workloads 

(Arbury et al., April 2016). 

The following questions are intended 

to solicit information about how 

hazardous heat exposure and risk varies 

across industries, occupations, and job 

tasks. 

(8) Are there industries, occupations, 

or job tasks that should be considered 

when evaluating the health and safety 

impacts of hazardous heat exposure in 

indoor and outdoor work environments? 

Please provide examples and data. 

(9) Are there any industries, 

occupations, or job tasks that are facing 

changes in the rate or frequency of 

occupational heat-related illness? Please 

provide examples and data. 

2. Structure of Work and Work 

Arrangements 

The structure of work and various 

work arrangements, such as the use of 

temporary, gig, or contingent workers, 

has been found in some studies, 

including of non-US workers, to be 

associated with increased health and 

safety risks to workers (Caban-Martinez 

et al., April 2018; Virtanen et al., 2005). 

This may be due to a variety of reasons, 

including workers in these work 

arrangements being assigned more 

hazardous work tasks, being less aware 

of their ability to report unsafe work 

conditions, being less acclimatized to 

the heat conditions of the work 

environment, or not receiving adequate 

personal protective equipment (PPE) or 

training for the job duties they are 

conducting. These work arrangements 

are present in a variety of industries 

where workers face hazardous heat 

exposure, such as construction, 

agriculture, and landscaping, in part 

due to outdoor work settings and 

seasonality of work. 

Additionally, multi-employer 

contexts may impact the health and 

safety of workers due to the need for 

and challenges associated with close 

coordination across employers on health 

and safety issues such as training and 

monitoring safe work practices (OSHA, 

October 6, 2021a; OSHA and NIOSH, 

October 6, 2021). OSHA recognizes that 

any rulemaking will need to consider 

the challenges for employers and 

employees related to protecting those in 

non-traditional, variable, and multiemployer work arrangements. 

The following questions are intended 

to solicit information about how unique 

and non-traditional work arrangements 

contribute to workers’ risk of heatrelated injuries and illnesses, as well as 

the best practices and challenges for 

reducing those risks in these work 

settings. 

(10) In addition to traditional work 

arrangements, are there specific types of 

work arrangements or multi-employer 

work arrangements that should be 

considered when evaluating the health 

and safety impacts of hazardous heat 

exposure in indoor and outdoor work 

environments? 

(11) What are current and best 

practices for protecting workers in 

various types of work arrangements, 

including temporary and multiemployer work arrangements, from 

hazardous heat exposure? 

(12) What are current challenges in 

and limitations of protecting workers in 

various types of work arrangements, 

including temporary and multiemployer work arrangements, from 

hazardous heat exposure? 

3. Business Size 

Heat-related illnesses can occur in 

businesses of all sizes. An evaluation of 

38 enforcement investigations involving 

66 incidents of fatal and non-fatal heatrelated illness from 2011–2016 found 

that 92% of workplaces investigated had 

less than 250 employees (Tustin et al., 

August 2018). In a different assessment 

of workplace heat-related fatalities from 

2000–2010, almost half of all fatalities 

where establishment size was known 

(244 cases out of 359 fatalities) occurred 

in what the authors termed ‘‘very small 

establishments,’’ or those with fewer 

than 10 employees (Gubernot et al., 

February 2015). However, 

approximately a quarter of fatalities 

during that time period occurred in 

‘‘very large establishments’’ with more 

than 100 employees (Gubernot et al., 

February 2015). 

The following questions are intended 

to solicit information about how 

business size may influence the 

practices and interventions 

implemented to prevent heat-related 

injuries and illnesses and the challenges 

experienced by businesses of varying 

sizes when implementing these 

prevention strategies. There are 

additional questions on the economic 

considerations for small entities 

included in Impacts on Small Entities 

(Section IV.B. of this ANPRM). 

(13) How are employers in businesses 

of various sizes currently preventing 

heat-related injury and illness in 

workers? 

(14) Are there limitations or concerns 

in preventing heat-related injury and 

illness in workers that vary among 

businesses of various sizes? 

D. Geographic Region 

Heat-related injury and illness among 

workers can occur anywhere in the 

United States. In 2015, Texas and 

California had the highest number of 

nonfatal injuries and illnesses with days 

away from work (BLS, August 30, 2017). 

Texas and California also accounted for 

a quarter of all heat-related workplace 

fatalities from 2000–2010 (Gubernot et 

al., February 2015). 

However, when the size of the worker 

populations are taken into account, 

states across the southern United States, 

including Mississippi, Arkansas, 

Nevada, West Virginia, and South 

Carolina, have been found to have the 

highest rates of heat-related workplace 

fatalities from 2000–2010 (Gubernot et 

al., February 2015). In 2015, Kansas and 

South Carolina had the highest rates of 

heat-related nonfatal injuries and 

illnesses with days away from work, at 

1.3 and 1.0 per 10,000 workers, 

respectively (BLS, August 30, 2017). 

Recent evidence also shows that the 

Southeast United States accounts for the 

most cases officially reported to OSHA. 

As discussed in Under-reporting of 

Occupational Illnesses, Injuries, and 

Fatalities due to Hazardous Heat 

(Section I.B. of this ANPRM), significant 

underreporting of workplace heatrelated injury and illness limits the 

understanding of the full geographic 

scope of outcomes. Additionally, 

populations that are less accustomed to 

hazardous heat, such as those in the 

Northeast or Midwest U.S., may be at 

increased risk of health impacts from 


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extreme heat, particularly during early 

season high heat events (Anderson and 

Bell, February 2011). 

The following questions are intended 

to solicit information, relevant data 

sources, and considerations related to 

occupational heat exposure and 

outcomes based on geographic region. 

(15) How does geographic region 

contribute to occupational heat hazards 

and the outcomes experienced by 

workers? Please provide examples and 

data. 

(16) Are there regions with improving 

or worsening occupational heat hazards 

and associated outcomes? Please 

provide examples and data. 

(17) Do regions with traditional and 

pervasive heat hazards address the 

hazard differently than regions with 

more episodic exposures (e.g., heat 

waves in a normally temperate region)? 

(18) What regional differences should 

be considered or accounted for when 

determining the appropriate 

interventions and practices to prevent 

heat-related injuries and illnesses 

among workers? 

E. Inequality in Exposures and 

Outcomes 

Disproportionate exposure to 

hazardous working conditions and their 

resulting health and safety impacts on 

workers exacerbates socioeconomic and 

racial inequalities in the U.S. In 

assessments of national work-related 

injuries, illnesses, and fatalities, 

employment in high-risk occupations 

has been disproportionately held by 

those who are Black, foreign-born, or 

low wage-earners, after adjusting for 

other demographic characteristics like 

sex and education (Steege et al., 2014). 

Non-Hispanic Black workers and 

foreign-born Hispanic workers tend to 

work in jobs with the highest injury 

risks even after adjusting for sex and 

education (Seabury et al., February 

2017). Sociodemographic disparities in 

hazardous occupational exposures to 

dust and chemicals, noise, 

musculoskeletal hazards, and strain 

have been found to persist even after 

accounting for industry and job (Quinn 

et al., 2007). 

These disparities are also present 

when focusing on health and safety 

outcomes that result from hazardous 

heat exposure. Black and Hispanic 

workers had higher relative risks of 

heat-related fatalities compared to white 

workers from 2000–2010 (Gubernot et 

al., February 2015), and one-third of 

workplace heat-related fatalities since 

2010 have occurred in Hispanic workers 

(Shipley et al., August 17, 2021). From 

1992–2006, agricultural crop workers 

were estimated to be 20 times more 

likely to suffer a heat-related fatality at 

work when compared to all other 

civilian occupations, with the majority 

of fatalities occurring among immigrant 

workers (CDC, June 20, 2008), and from 

2000–2010, agricultural workers had 35 

(95% confidence interval, 26.3–47.0) 

times the risk of dying from heat-related 

causes compared to all other industries 

(Gubernot et al., February 2015). Lowerwage workers are more likely to live and 

work in areas facing greater exposure to 

hazardous heat, to work in dangerous 

occupations, and to have limited access 

to air conditioning at home or other 

housing which may limit the ability to 

recover from occupational and nonoccupational heat exposures. In 

California, lower-wage workers 

experienced five times as many heatrelated injuries compared to the highestwage workers between 2001 and 2018 

(Park et al., July 2021). As climate 

change increases extreme heat events, 

Hispanic and Latino individuals, as well 

as American Indian and Alaska Native 

individuals, individuals with low 

income, and individuals lacking a high 

school diploma are more likely to live 

in areas with the highest projected labor 

hour losses (EPA, September 2, 2021). 

The following questions are intended 

to solicit information, relevant data 

sources, and considerations related to 

inequalities in occupational heat 

exposure and disproportionate 

outcomes experienced by vulnerable 

occupational populations. 

(19) Are there specific populations 

facing disproportionate exposure to or 

outcomes from hazardous heat in indoor 

or outdoor work settings? Please provide 

examples and data. 

(20) Are there data sources available 

to assess inequalities in exposure to or 

outcomes from hazardous heat in indoor 

or outdoor work settings? 

(21) Are there industries or employers 

who are addressing occupational heatrelated illness with an environmental 

justice approach (i.e., with a focus on 

fair treatment and meaningful 

involvement of all people regardless of 

race, color, national origin, or income) 

to appropriately address the 

disproportionate exposures and 

outcomes faced by workers of color, 

low-wage workers, immigrant workers, 

or pregnant workers (NIOSH, April 20, 

2017)? Please provide examples and 

data. 

F. Climate Change 

Climate change is increasing the 

frequency and intensity of extreme heat 

events, as well as increasing daily 

average daytime and nighttime 

temperatures. The National Climate 

Assessment, the United States’ 

quadrennial report assessing climate 

change science and impacts and 

published by the U.S. Global Change 

Research Program, states that high 

summer temperatures are linked to 

increased illness and death, that hot 

days are associated with increased heatrelated illnesses, that health risks may 

be higher earlier in warmer seasons 

before people have had time to 

acclimatize, and that workers will face 

an increased risk of heat-related illness 

due to heat exposure. This will be 

especially true in rural areas, particular 

sectors and occupations such as 

agriculture, forestry, construction, 

utilities, warehousing, manufacturing, 

and indoor workplaces producing 

additional heat or lacking adequate 

cooling, such as steel mills, dry 

cleaning, and others, and for workers of 

color, those who are older, and of lower 

socioeconomic status (USGCRP, 2016; 

USGCRP, 2018). It is estimated that 

under a high emissions scenario, 

climate change will result in the annual 

loss of almost 2 billion labor hours with 

an annual cost of an estimated $160 

billion in lost wages (in 2015 dollars) 

due to extreme temperatures alone, the 

vast majority of which is due to heat 

(EPA, May 2017; USGCRP, 2018). As the 

number of days above 90 degrees 

Fahrenheit increases due to climate 

change, so do lost hours of work. 

Nationally, the average losses are 

projected to be 14 to 34 hours annually 

per ‘‘weather-exposed’’ worker due to 

high temperature days. Weatherexposed workers in parts of the 

Southwest and Southern Great Plains 

could lose up to 84 hours per worker 

annually, depending on the level of 

temperature increases (EPA, September 

1, 2021). 

The following questions are intended 

to solicit information, relevant data 

sources, and considerations to further 

assess the impact of climate change on 

occupational heat exposure and 

outcomes. 

(22) Are there data sources available 

to assess how climate change is altering 

hazardous heat exposure in outdoor and 

indoor work environments? 

(23) How will climate change affect 

existing inequities in occupational heat 

exposure and related health outcomes? 

Please provide relevant data. 

(24) How will climate change affect 

the risk of occupational heat-related 

illness and mortality in the different 

regions of the United States? 

(25) How should climate change be 

factored into an OSHA heat illness and 

injury prevention standard? 

(26) What efforts are employers 

currently taking to prepare for and 

respond to the ways that climate change 


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is altering hazardous heat exposure in 

their workplaces? 

II. Existing Heat Injury and Illness 

Prevention Efforts 

A. OSHA Efforts 

OSHA has taken a multi-pronged 

approach to address hazardous heat 

among both indoor and outdoor 

workers. This includes efforts ranging 

from education and awareness building, 

guidance, compliance assistance, 

stakeholder engagement, and 

enforcement. 

1. OSHA’s Heat Illness Prevention 

Campaign and Other Guidance Efforts 

OSHA has a long-running Heat Illness 

Prevention Campaign (https://

www.osha.gov/heat), which was 

initiated in 2011 to build awareness of 

prevention strategies and tools for 

employers and workers to reduce 

occupational heat-related illness. 

Historically, the Campaign has utilized 

the slogan ‘‘Water. Rest. Shade.’’ The 

agency updated Campaign materials in 

2021 to recognize both indoor and 

outdoor heat hazards, as well as the 

importance of protecting new and 

returning workers from hazardous heat. 

These efforts, which are ongoing, 

incorporate stakeholder feedback and 

feature materials available in an 

increasing number of languages. Despite 

the strengths and reach of the 

Campaign, these guidance and 

communication materials are not legally 

enforceable requirements. 

In addition to the Heat Illness 

Prevention Campaign materials, OSHA 

publishes a heat specific Safety and 

Health Topics page (https://

www.osha.gov/heat-exposure), which 

provides additional information and 

resources on heat topics. The page 

provides information on planning and 

supervision in hot environments, 

identification of heat-related illness and 

first aid, information on prevention 

such as training, calculating heat stress 

and controls, personal risk factors, 

descriptions of other heat standards and 

case study examples of situations where 

workers developed heat-related illness. 

OSHA and the National Institute for 

Occupational Safety and Health 

(NIOSH) also co-developed a Heat 

Safety Tool Smartphone App for both 

Android and iPhone devices. The app 

provides outdoor location sensitive 

temperature, humidity, and heat index 

readings, as well as provides a 

corresponding risk level for ranges of 

heat index. The app is not for indoor 

use if using automatically downloaded 

data for the heat index calculation. Each 

risk level provides relevant information 

on identifying signs and symptoms of 

heat-related illness and steps that 

should be taken at that risk level to 

prevent heat-related illness. 

2. Stakeholder Engagement—NACOSH 

Work Group 

On June 22, 2021, at a meeting of the 

National Advisory Committee for 

Occupational Safety and Health 

(NACOSH), the agency announced its 

intention to form a NACOSH work 

group to engage stakeholders and better 

understand current best practices and 

challenges in occupational heat-related 

illness prevention across a variety of 

industries to inform OSHA’s response to 

this important hazard. This NACOSH 

Heat Illness Prevention Work Group 

(WG) will consist of experts who have 

extensive knowledge and experience in 

causes of, identification of, and factors 

that affect heat-related illness hazards in 

the workplace, as well as best practices 

and interventions for mitigating 

occupational heat-related illness. OSHA 

intends to initially convene the work 

group in late fall 2021. 

3. General Duty Clause 

Although OSHA does not have a 

specific standard governing hazardous 

heat conditions at workplaces, the 

agency currently enforces Section 

5(a)(1) (General Duty Clause) of the OSH 

Act against employers that expose their 

workers to this recognized hazard. 

Section 5(a)(1) states that employers 

have a general duty to furnish to each 

of their employees employment and a 

place of employment free from 

recognized hazards that cause or are 

likely to cause death or serious physical 

harm to employees (29 U.S.C. 654(a)(1)). 

To prove a violation of the General Duty 

Clause, OSHA needs to establish—in 

each individual case—that: (1) The 

employer failed to keep the workplace 

free of a hazard to which its employees 

were exposed; (2) the hazard was 

recognized; (3) the hazard was causing 

or likely to cause death or serious 

injury; and (4) a feasible means to 

eliminate or materially reduce the 

hazard existed. (See, e.g., A.H. Sturgill 

Roofing, Inc., 2019 O.S.H. Dec. (CCH) 

¶ 33712, 2019 WL 1099857, (No. 13– 

0224, 2019)). 

OSHA has relied on the General Duty 

Clause to cite employers for heat-related 

hazards for decades. Additionally, 

OSHA has issued various forms of 

guidance for employers and employees 

whose work occurs in indoor and 

outdoor heat environments and has 

addressed heat-related illness in 

Regional Emphasis Programs in an 

attempt to protect workers from heatrelated injury. (Please see OSHA Heat 

Illness Prevention Campaign and 

Guidance Efforts and Other 

Enforcement Efforts, Sections II.A.1 and 

II.A.4 of this ANPRM, respectively.) 

However, the General Duty Clause does 

not specifically prescribe hazardous 

heat exposure thresholds or provide 

specifics on how employers are to 

eliminate or reduce their employees’ 

exposure to hazardous heat. A standard 

specific to heat-related injury and 

illness prevention would more clearly 

set forth employer obligations and help 

employers to identify the measures 

necessary to more effectively protect 

employees from hazardous heat. 

OSHA’s enforcement efforts to protect 

employees from hazardous heat 

conditions using the General Duty 

Clause, although important, have been 

met with significant legal challenges, 

leaving many workers vulnerable to 

heat-related hazards. Because there are 

no specific, authoritative exposure 

thresholds for OSHA to rely on, it has 

been challenging for the agency to prove 

the existence of a recognized hazard, 

even in cases in which a heat-related 

fatality has occurred. (See, e.g., A.H. 

Sturgill Roofing, Inc., 2019 O.S.H. Dec. 

(CCH) ¶ 33712, 2019 WL 1099857, (No. 

13–0224, 2019); Aldridge Elec., Inc., 26 

BNA OSHC 1449, 2016 WL 8581709, 

(No. 13–2119, 2016)). 

Moreover, in litigated cases OSHA has 

been largely unsuccessful in relying on 

third-party scientific documents—such 

as ACGIH exposure thresholds and 

NIOSH criteria—to prove the existence 

of a recognized hazard. (See Aldridge 

Elec., Inc., 2016 WL 8581709 at *14 

(noting that ‘‘none of these documents 

is a mandatory document that 

[employers] must follow akin to an 

OSHA regulation.’’); Industrial Glass, 15 

BNA OSHC 1594, 1992 WL 88787, at 

*12 n. 10, (No. 88–348, 1992) (noting 

that the NIOSH criteria ‘‘[do] not have 

the force or effect of law.’’)). 

Additionally, because the available 

scientific information is not currently 

defined in terms of a workplace hazard 

standard, adjudicators have found that 

crucial terms and methods for 

determining the severity of risk for heatrelated illness are too vague or 

insufficiently defined to effectively 

determine the existence of a recognized 

hazard in the context of a particular 

case. (See, e.g., A.H. Sturgill Roofing, 

Inc., 2019 WL 1099857 at *4 (noting that 

the National Oceanic and Atmospheric 

Administration’s (NOAA) National 

Weather Service Heat Index chart does 

not define ‘‘prolonged exposure’’ or 

explain what factors must be considered 

to increase heat index values; only 

stating that ‘‘exposure to full sunshine 


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can increase heat index values by up to 

15 °F.’’)). 

Under the General Duty Clause, 

OSHA cannot require abatement before 

proving in an enforcement proceeding 

that specific workplace conditions are 

hazardous; whereas a standard would 

establish the existence of the hazard at 

the rulemaking stage, thus allowing 

OSHA to identify and require specific 

abatement measures without having to 

prove the existence of a hazard in each 

case. Given OSHA’s burden under the 

General Duty Clause, it is currently 

difficult for OSHA to ensure necessary 

abatement before employee lives and 

health are unnecessarily endangered. 

Moreover, under the General Duty 

Clause OSHA must largely rely on 

expert witness testimony to prove both 

the existence of a hazard and the 

availability of feasible abatement 

measures that will materially reduce or 

eliminate the hazard in each individual 

case. (See, e.g., Industrial Glass, 1992 

WL 88787 at *4–7). 

4. Other Enforcement Efforts 

In 2019, OSHA conducted 289 heatrelated inspections (OSHA, August 20, 

2021). More than 110 of these were 

initiated by complaints and 20 were due 

to the occurrence of a fatality or 

catastrophe. As a result of these 

inspections, OSHA issued 155 Hazard 

Alert Letters (HALs), which provide 

employers with information to mitigate 

hazards and resources to assist in this 

process when OSHA determines a 

formal citation cannot be issued. OSHA 

issued only 31 General Duty Clause 

citations during the same period 

(OSHA, August 20, 2021). Thus, HALs 

were issued at five times the rate of 

5(a)(1) citations in 2019. 

On September 1, 2021, OSHA’s 

Directorate of Enforcement Programs 

issued an Inspection Guidance for HeatRelated Hazards, which establishes a 

new enforcement initiative to prevent 

heat-related illnesses and fatalities 

while working in hazardous hot indoor 

and outdoor environments (OSHA, 

September 1, 2021). The guidance 

provides that days when the heat index 

exceeds 80 degrees Fahrenheit will be 

considered heat priority days. 

Enforcement efforts will be increased on 

heat priority days for a variety of indoor 

and outdoor industries, with the aim of 

identifying and mitigating potential 

hazards and preventing heat-illnesses 

before they occur. 

OSHA’s Region VI regional office, 

located in Dallas, TX, has a heat-related 

special Regional Emphasis Program 

(REP) (OSHA, October 1, 2019). This 

region covers Texas, New Mexico, 

Oklahoma, Arkansas, and Louisiana, 

which have a high number of heatrelated injuries, illnesses, and fatalities. 

This REP allows field staff to conduct 

heat illness inspections of outdoor work 

activities on days when the high 

temperature is forecast to be above 80 

degrees Fahrenheit. This REP includes 

employers with fewer than 11 

employees. Under the authority of this 

REP, Region VI conducted 78 

inspections on heat-related illness, 

which identified 89 violations, in 2019 

alone. 

Heat-related inspections are also 

initiated by heat-related complaints, 

hospitalizations or fatalities, and during 

an unrelated programmed or 

unprogrammed inspection where a heat 

hazard is identified. In addition, OSHA 

Area Offices can initiate heat 

interventions or inspections based on 

local knowledge of establishments, 

referrals from the local health 

department, or from other Federal 

agencies with joint jurisdictions, such as 

U.S. Department of Agriculture (USDA), 

Environmental Protection Agency 

(EPA), media referrals or previous 

OSHA inspection history. 

5. Applicable OSHA Standards 

OSHA currently has other existing 

standards that, while applicable to some 

issues related to hazardous heat, have 

not proven to be adequate in fully 

protecting workers. OSHA’s 

Recordkeeping standard (29 CFR 

1904.7) requires employers to record 

and report injuries and illnesses that 

meet recording criteria. If an injury or 

illness does not require medical 

treatment beyond the provision of first 

aid, it does not need to be reported. 

Some actions that a worker may be 

recommended to take when 

experiencing heat-related illness, such 

as hydration, are considered to be first 

aid, and therefore are not recordable. 

The agency’s Sanitation standards (29 

CFR 1910.141, 29 CFR 1915.88, 29 CFR 

1917.127, 29 CFR 1926.51, and 29 CFR 

1928.110) require employers to provide 

potable water readily accessible to 

workers. While these standards require 

that drinking water be made available in 

‘‘sufficient amounts,’’ it does not specify 

what those amounts are, and employers 

are only mandated to encourage workers 

to frequently hydrate on hot days. 

OSHA’s Safety Training and 

Education standard (29 CFR 1926.21) 

requires employers in the construction 

industry to train employees in the 

recognition, avoidance, and prevention 

of unsafe conditions in their 

workplaces. OSHA’s PPE standards (29 

CFR 1910.132, 29 CFR 1915.152, 29 CFR 

1917.95, and 29 CFR 1926.28) require 

employers to conduct a hazard 

assessment to determine the appropriate 

PPE to be used to protect employees 

from the hazards identified in the 

assessment. However, hazardous heat is 

not specifically identified as a hazard 

for which workers need training or PPE, 

complicating the application of these 

requirements to hazardous heat. 

The following questions are intended 

to solicit information related to the 

existing efforts OSHA has undertaken to 

prevent occupational heat-related 

illness, injuries, and fatalities. 

(27) Are OSHA’s existing efforts and 

authorities adequate or effective in 

protecting workers from hazardous heat 

in indoor and outdoor work settings? 

(28) What additional efforts or 

improvements should be undertaken by 

OSHA to protect workers from 

hazardous heat in indoor and outdoor 

work settings? 

(29) What are the gaps and limitations 

of existing applicable OSHA standards, 

as well as existing campaign, guidance, 

enforcement, and other efforts for 

preventing occupational heat-related 

illness in indoor and outdoor work 

settings? 

B. Petitions for Rulemaking 

OSHA has received three petitions 

from Public Citizen and supporting 

organizations, in 2011, 2018, and 2021, 

to implement a heat standard. The 

petitions presented data on the impacts 

of heat on workers’ morbidity and 

mortality. The 2011 petition was for an 

Emergency Temporary Standard under 

section 6(c) of the OSH Act and was 

denied for failing to meet the grave 

danger requirement of the Act. The 2018 

petition asked for an OSHA heat 

standard under section 6(b) of the OSH 

Act and was co-signed by over 130 

organizations and nearly 100 

individuals. The 2021 petition again 

requested that OSHA issue an 

Emergency Temporary Standard. The 

agency has not yet responded to the 

2018 and 2021 petitions. 

Over the last several years, many 

members of Congress have also urged 

OSHA to initiate rulemaking for a 

Federal heat standard. In 2019, OSHA 

received a request for rulemaking from 

members of the Senate (Brown et al., 

November 18, 2019). In August 2021, 

OSHA received a request for rulemaking 

from members of both the Senate and 

the House of Representatives (Padilla et 

al., August 3, 2021; Chu et al., August 

6, 2021). Both chambers of Congress 

also have pending legislation in the 

2021–2022 legislative session that 

would order OSHA to develop and 

implement a Federal heat standard (U.S. 

Senate, 117th Congress, April 12, 2021; 

U.S. House of Representatives, 117th 


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Congress, March 26, 2021). This 

legislation has also been considered in 

past legislative sessions. 

C. NIOSH Criteria Documents 

NIOSH first proposed details of a 

potential Federal heat standard in 1972 

in its Criteria for a Recommended 

Standard (NIOSH, 1972). Criteria 

documents, issued under the authority 

of section 20(a) of the Occupational 

Safety and Health Act of 1970, 

recommend occupational safety and 

health standards based on exposure 

limits and work intensity that are safe 

for various periods of employment as 

established by a critical review of 

scientific and technical information. 

NIOSH’s criteria for a recommended 

standard have since been updated in 

1986 (NIOSH, April 1986) and again in 

2016 (NIOSH, February 2016). The 2016 

criteria recommend that a Federal heat 

standard include provisions for medical 

screening and physiological monitoring, 

heat stress thresholds, rest breaks, 

hydration, shade, acclimatization plans, 

engineering controls (e.g., air 

conditioners, fans, tents), administrative 

controls (e.g., rest breaks and altered 

work schedules), PPE and auxiliary 

body cooling (e.g., cooled or iced vests, 

jackets, or other wearable garments), 

exposure and medical monitoring, 

hazard notification alerts, worker 

training and education, medical 

surveillance, and recordkeeping 

(NIOSH, February 2016). 

The 2016 criteria document 

recommends occupational exposure 

limits for heat stress, such that no 

worker be ‘‘exposed to combinations of 

metabolic and environmental heat 

greater than’’ the recommended alert 

limit (RAL, for unacclimatized workers) 

or the recommended exposure limit 

(REL, for acclimatized workers). The 

NIOSH criteria recommend that 

environmental heat should be assessed 

with hourly measurements of Wet Bulb 

Globe Temperature (WBGT) (NIOSH, 

February 2016), and metabolic heat 

should be assessed using the metabolicwork-rates set by ACGIH (ACGIH, 2017). 

There are lower recommended exposure 

limits for unacclimatized workers, 

workers who are wearing work clothing 

that minimizes heat dissipation from the 

body, and those who have underlying 

personal risk factors. These exposure 

limits were highly sensitive, meaning 

the exposure limits were met or 

exceeded, in an investigation of a subset 

of 14 cases of fatal (100% sensitivity) 

and 11 nonfatal (72% sensitivity) heatrelated illness in workers that occurred 

during outdoor work (Tustin et al., July 

6, 2018). 

D. History and Requirements of State 

Standards 

As of October 2021, four states have 

promulgated hazardous heat standards 

requiring employers in various 

industries and workplace settings to 

provide protections and abatement 

measures to reduce the risk of heatrelated illness for their employees: 

California, Minnesota, Oregon, and 

Washington. Oregon issued a temporary 

rule in July of 2021 after experiencing 

temperatures well above 100 °F for an 

extended period. Washington State also 

issued emergency heat rules during the 

summer of 2021 that provide additional 

worker protections to its previously 

promulgated heat rule. Additionally, 

since 2020, three more states, Colorado, 

Maryland, and Nevada, have passed 

laws requiring state health and safety 

administrators to promulgate rules 

related to hazardous heat in the 

workplace. Virginia’s Safety and Health 

Codes Board is also considering a 

standard on this topic. 

State standards differ in the scope of 

coverage. For example, Minnesota’s 

standard covers only indoor workplaces. 

California and Washington standards 

cover only outdoor workplaces, 

although California is engaged in 

rulemaking for a potential indoor heat 

standard. Oregon’s emergency rule 

covers both indoor and outdoor 

workplaces. California, Washington, and 

Oregon all have additional protections 

that are triggered by high heat, however, 

they differ as to the trigger for these 

additional protections: In California it is 

at a temperature reading of 95 °F (and 

only includes certain industries), in 

Washington it is at a temperature 

reading of 100 °F, and in Oregon it is at 

a heat index of 90 °F. State rules also 

differ in the methods used for triggering 

the heightened protections against 

hazardous heat. Minnesota’s standard 

considers the type of work being 

performed (light, moderate, or heavy) 

and has calculated a threshold WBGT 

for each work activity. California’s heatillness prevention protections go into 

effect at 80 °F, ambient temperature. 

Washington’s rule also relies on ambient 

temperature readings combined with 

considerations for the weight and 

breathability of workers’ clothing. 

Oregon’s emergency rule relies on the 

heat index as calculated by NOAA’s 

National Weather Service. 

All of the state standards require 

training for employees and supervisors. 

All of the state standards except for 

Minnesota require employers to provide 

at least 1 quart of water per hour for 

each employee, require some form of 

emergency response plan, mention the 

importance of acclimatization for 

workers, and require access to shaded 

break areas. Washington and Oregon 

require that employers provide training 

in a language that the workers 

understand. Similarly, California’s 

standard requires that employers create 

a written heat-illness prevention plan in 

English as well as in whatever other 

language is understood by the majority 

of workers at a given workplace. 

California has the most robust 

acclimatization program, which requires 

close monitoring of new employees for 

up to fourteen days and monitoring of 

all employees during a heat wave. Table 

II.D.1, below, highlights these and 

additional similarities and differences 

between the existing state standards on 

hazardous heat. 

TABLE II.D.1—STATE RULES ON HAZARDOUS HEAT AS OF AUGUST 2021 

Standard 

requirements CA * MN ** OR *** 

WA **** 

(emergency rule additions 

in italics) 

Worksite coverage ............. Outdoor, year-round .......... Indoor, year-round ............ Indoor and outdoor, emergency rule.Outdoor, May 1–Sept. 30. 

Thresholds triggering protection requirements.80 °F (ambient temp.) ....... Between 77 °F–86 °F 

(WBGT) based on workload.

80 °F (NOAA NWS Heat 

Index).

89 °F (ambient temp.); 

lower if wearing heavy 

clothing/PPE. 

Add’l high heat protections At 95 °F (certain industries 

only).

No ...................................... At 90 °F ............................. At 100 °F. 

Water/Hydration ................. 1 qt./hr./worker .................. No ...................................... 1 qt./hr./worker, cool or 

cold.

1 qt./hr./worker Suitably 

cool. 

Shade ................................ Yes .................................... N/A .................................... Yes .................................... Yes. 


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TABLE II.D.1—STATE RULES ON HAZARDOUS HEAT AS OF AUGUST 2021—Continued 

Standard 

requirements CA * MN ** OR *** 

WA **** 

(emergency rule additions 

in italics) 

Training .............................. Yes (new hire) ................... Yes (new hire and annual) Yes .................................... Yes (new hire and annual). 

Breaks ............................... Yes (Encouraged generally, mandatory if 

symptoms).

Yes (After two hours exposure at threshold).Yes (Mandatory if symptoms at any temp. every 

2 hours for all at 90 °F).

Yes. (Encouraged preventative and must be paid; 

Mandatory if symptoms; 

Mandatory at 100 °F). 

Acclimatization Plan .......... Yes .................................... No ...................................... Yes (in practice at 90 °F) .. No (only included in training). 

Heat Illness Prevention 

Plan.

Yes .................................... No ...................................... No ...................................... Yes (as part of accident 

prevention plan). 

Emergency Medical Response Plan.Yes .................................... No ...................................... Yes .................................... Yes. 

Medical Monitoring ............ Reactive, Proactive when 

above 95 °F.

Reactive ............................ Reactive ............................ Reactive. 

Record-keeping requirements.Yes .................................... Yes .................................... No ...................................... Yes. 

* CAL/OSHA, Title 8, section 3395. Heat Illness Prevention. https://www.dir.ca.gov/Title8/3395.html. 

** Minnesota Administrative Rules. Section 5205.0110 Indoor ventilation and temperature in places of employment. https://www.revisor.mn.gov/ 

rules/5205.0110/. 

*** Oregon Administrative Rules. 437-002-0155 Temporary Rule Heat Illness Prevention. https://osha.oregon.gov/OSHARules/div2/437-002- 

0155-temp.pdf. 

**** Washington Administrative Code (WAC) Title 296, General Occupational Health Standards. Sections 296-62-095 through 296-62-09560. 

Outdoor Heat Exposure. https://app.leg.wa.gov/WAC/default.aspx?cite=296-62&full=true#296-62-095; Emergency Rule 2125 CR103E. https://

lni.wa.gov/rulemaking-activity/AO21-25/2125CR103EAdoption.pdf. 

The following questions are intended 

to solicit information related to the 

existing efforts at the state level to 

prevent occupational heat-related 

illness, injuries, and fatalities. 

(30) What are the most effective 

aspects of existing state standards aimed 

at preventing occupational heat-related 

illness? 

(31) What are the challenges with the 

implementation of existing state 

standards aimed at preventing 

occupational heat-related illness? 

(32) Of the existing state standards, 

have any been more effective or 

challenging in their implementation 

than others? Why? 

(33) What components of a state 

standard or program should be included 

in Federal guidance or regulatory efforts 

on heat-related illness prevention? 

(34) Would any of the elements of the 

state standards not be feasible to include 

at the Federal level? 

E. Other Standards 

Various other organizations have also 

either identified the need for standards 

to prevent heat-related injury and 

illness or published their own 

standards. In 2019, the American 

National Standards Institute/American 

Society of Safety Professionals A10 

Committee (ANSI/ASSP) announced a 

proposed consensus standard on heat 

stress management. The International 

Organization for Standardization has a 

standard estimating heat stress: ISO 

7243: Hot Environments—Estimation of 

Heat Stress on Working Man, Based on 

the WBGT-Index (ISO, 2017). 

Additional standards address predicting 

sweat rate and core temperature (ISO 

7933), methods for determining 

metabolic rate (ISO 8996), physiological 

strain (ISO 9886), and thermal 

characteristics for clothing (ISO 9920) 

(NIOSH, February 2016). The ISO heat 

stress standard uses WBGT values to 

assess hot environments and assumes 

workforces to which thresholds are 

applied are healthy, physically fit, and 

are wearing standard clothing. 

ACGIH has identified Threshold Limit 

Values or TLVs for heat stress and heat 

strain (ACGIH, 2017). The TLVs utilize 

WBGT and take into consideration 

metabolic rate or work load categories: 

Light (sitting, standing, light arm/ 

handwork, occasional walking), 

moderate (normal walking, moderate 

lifting), heavy (heavy material handling, 

walking at a fast pace), very heavy (pick 

and shovel work). Additionally, ACGIH 

provides clothing adjustment factors in 

degrees Celsius that should be added to 

the assessed WBGT for certain types of 

work clothing. The TLVs range from 

WBGTs of approximately 24.5 degrees 

Celsius at the highest level of work to 

just under 34 degrees Celsius at light 

work and low metabolic rates (ACGIH, 

2017). ACGIH emphasizes that the TLVs 

are appropriate for healthy, acclimatized 

workers and they encourage screening 

of workers for potential sensitivities to 

heat and provide guidelines for 

physiological monitoring for heat strain. 

An action limit that is below the level 

of the TLV is identified for 

unacclimatized workers. 

The U.S. Armed Forces has developed 

extensive heat-related illness prevention 

and management strategies. The Warrior 

Heat and Exertion Related Events 

Collaborative is a tri-service group of 

military leaders focused on clinical, 

educational, and research efforts related 

to exercise and exertional heat-related 

illnesses and medical emergencies 

(HPRC, October 6, 2021). The U.S. Army 

has a Heat Center at Fort Benning which 

focuses on management, research, and 

prevention of heat-related illness and 

death (Galer, April 8, 2019). In 2016, the 

U.S. Army updated its Training and 

Doctrine Command (TRADOC) 

Regulation 350–29 addressessing heat 

and cold casualties. The regulation 

includes requirements for rest and water 

consumption according to specific 

WBGT levels and work intensity 

(Department of the Army, July 18, 2016). 

The U.S. Navy has developed 

Physiological Heat Exposure Limit 

curves based on metabolic and 

environmental heat load and represent 

the maximum allowable heat exposure 

limits, which were most recently 

updated in 2009. The Navy monitors 

WBGT, with physical training 

diminishing as WBGTs increase and all 

nonessential outdoor activity stopped 

when WBGTs exceed 90 degrees 

Fahrenheit (Department of the Navy, 

February 12, 2009). The U.S. Marine 

Corps follows the Navy’s guidelines for 

implementation of the Marine Corps 

Heat Injury Prevention Program 

(Commandant of the Marine Corps, June 

6, 2002). The U.S. Army and U.S. Air 


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Force issued a technical heat stress 

bulletin in 2003 with measures to 

prevent indoor and outdoor heat-related 

illness in soldiers, with recommended 

limitations of continuous work at 

‘‘moderate’’ or ‘‘hard’’ intensities, 

acclimatization planning, work-rest 

cycles, and fluid and electrolyte 

replacement (Department of the Army 

and Air Force, March 7, 2003). 

The following questions are intended 

to solicit information related to the 

existing efforts undertaken to prevent 

occupational heat-related illness, 

injuries, and fatalities by other entities. 

(35) Do any of these existing 

standards contain elements that should 

be considered for a Federal standard? 

(36) Are there other industry 

standards that contain elements that 

should be considered for a Federal 

standard? 

(37) Are there elements of these 

standards that would not be appropriate 

or feasible for a Federal heat standard? 

F. Employer Efforts 

While this section has primarily 

detailed efforts undertaken by OSHA, 

other Federal agencies, states, and 

industry trade associations, OSHA also 

recognizes that some employers may be 

engaged on this topic and implementing 

their own heat-related illness 

prevention efforts. 

The following questions are intended 

to solicit information, relevant data 

sources, and considerations to further 

assess the current employer efforts to 

prevent heat-related illness and their 

efficacy in preventing heat-related 

illnesses. 

(38) What efforts are employers 

currently taking to prevent occupational 

heat-related illness in their workplace? 

Please provide examples and data. 

(39) How effective have employers 

been in preventing occupational heatrelated illness in their workplaces, and 

how are employer-driven heat injury 

and illness prevention programs being 

evaluated? 

III. Key Issues in Occupational HeatRelated Illness 

A. Determinants of Occupational Heat 

Exposure 

1. Heat Exposure 

Workers in both indoor and outdoor 

occupations in a variety of sectors are 

exposed to heat at work through 

process, exertional, and/or 

environmental heat. Hazardous heat 

exposure can reduce the body’s ability 

to regulate physiological processes and 

can result in heat-related injury or 

illness, heat stroke, or death. 

Determining when heat becomes 

hazardous is complex. Heat exposure 

and its resultant health effects depend 

on multiple factors, such as heatgenerating practices within a workplace, 

level of exertion during work, air 

temperature, humidity, whether work is 

occurring in direct sunlight or shade, 

wind, and cloud cover (OSHA, 

September 2, 2021). Individual-level 

factors such as age, pharmaceutical use, 

underlying health conditions (such as 

cardiovascular diseases), and the ability 

to cool at night (during heat waves or 

access to night time air conditioning, for 

example) also play a role (Kilbourne, 

1997; Quandt et al., 2013; OSHA, 

October 6, 2021b). 

Multiple metrics and thresholds exist 

for measuring heat and identifying 

when it may become hazardous to a 

population. Ambient temperature, heat 

index, and WBGT are available metrics 

for measuring environmental heat and 

identifying conditions that may lead to 

heat-related injury or illness. Ambient 

temperature, which can be calculated 

using a common thermometer, is the 

most accessible and understandable 

metric that most people are familiar 

with. However, ambient temperature 

measurements alone do not take into 

consideration humidity, which is an 

important factor that influences the 

body’s ability to cool. Heat index 

combines air temperature and humidity 

and is a widely reported weather 

statistic that many people are familiar 

with and is often referred to as the 

‘‘feels like’’ or ‘‘apparent’’ temperature. 

Heat index is used for setting heat 

advisories (NWS, September 2, 2021) 

but does not take into consideration 

radiant heat or wind speed, which the 

more health-relevant WBGT does. 

WBGT is a health-relevant measurement 

that incorporates air temperature, wind, 

radiant heat, and humidity (Budd, 2008; 

OSHA, September 15, 2017; Oliveira et 

al., 2019). Measuring WBGT requires 

specialized thermometers or equipment, 

and may not always be available as a 

forecast through the National Weather 

Service. Additionally, WBGT may 

require guidance and training to avoid 

confusion with more well-known scales 

like temperature or heat index. 

Another challenge with each of these 

metrics is identifying appropriate 

thresholds for each metric that will 

prevent adverse health impacts due to 

hazardous heat exposure. There is no 

universally accepted threshold for 

ambient temperature, heat index, or 

WBGT at which heat is considered 

hazardous. Determining thresholds is 

complicated by differences in regional 

climatology, where one region’s 

population may become vulnerable to 

heat-related illness at lower heat levels 

(Grundstein et al., January 2015; NWS, 

August 25, 2021). NOAA, NIOSH, 

OSHA, the U.S. Military, and other 

organizations currently offer differing 

thresholds and metrics for the 

identification of hazardous heat 

(Department of the Army and Air Force, 

March 2007; NIOSH, 2016; NWS, 

August 25, 2021; OSHA, September 

2021; NWS, September 1, 2021). 

Existing state standards also apply 

different thresholds and metrics. 

Further, existing thresholds for various 

metrics may not be protective in the 

occupational setting because injuries 

and illnesses have been reported below 

these existing thresholds (Morris et al., 

January 28, 2019; Park et al. July 2021), 

and many of the thresholds indicating 

the potential for heat-related injury or 

illness are based on older data or studies 

that included populations that may not 

be most appropriate for evaluating heat 

stress or strain in the occupational 

setting, such as military populations 

(Steadman, April 11, 1979; Rothfusz, 

July 1, 1990; Budd, 2008). 

The following questions are intended 

to solicit information, relevant data 

sources, and considerations to further 

assess the application of various heat 

metrics and the identification and 

definition of hazardous heat using 

metric thresholds. 

(40) What metrics are currently being 

used to monitor and assess hazardous 

heat exposure in the workplace (e.g., 

heat index, ambient temperature, 

WBGT)? 

(41) What are the advantages and 

disadvantages of using each of these 

metrics (e.g., heat index, ambient 

temperature, WBGT) in indoor and 

outdoor work settings? Are there any 

challenges associated with training 

employers and employees on these 

different metrics? 

(42) Are there other metrics used to 

assess hazardous heat exposure in the 

workplace that are not discussed here? 

(43) What are current and best 

practices in defining hazardous heat 

exposure in outdoor and indoor 

workplaces, and what are the 

limitations or challenges associated 

with those practices? 

(44) Are there industries 

implementing exposure monitoring for 

heat? Please provide examples and data. 

(45) What thresholds are utilized for 

various metrics implemented in existing 

occupational heat prevention plans or 

activities? Are these thresholds effective 

for preventing heat-related illness and 

fatalities? 

(46) Which metrics and 

accompanying thresholds are both 

feasible and health-protective in both 


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indoor and outdoor occupational 

settings? 

(47) Does application of certain heat 

metrics require more training than the 

use of other heat metrics? 

2. Contributions to Heat Stress in the 

Workplace 

Air temperature, humidity, wind, and 

whether work occurs in direct sunlight 

all contribute to the potential for heat 

stress for outdoor workers. Additionally, 

physical exertion contributes to heat 

stress by increasing metabolic heat 

production. Exertion is an important 

consideration for the development of 

heat stress especially since physical 

activities may take place over prolonged 

periods of time in a work setting and in 

environmental conditions that limit the 

body’s ability to cool, such as working 

in direct sunlight or under warm and 

humid conditions. These factors that 

contribute to heat stress can lead to heat 

strain and heat-related illness when the 

body fails to lose heat. Some surfaces, 

such as asphalt, absorb heat and can add 

to heat exposure. The urban heat island 

effect is a well-studied phenomenon 

that can elevate temperatures in areas 

concentrated with heat absorbent 

surfaces. For example, dense urban 

areas may experience afternoon 

temperatures 15–20 degrees higher than 

surrounding areas with more natural 

land cover and vegetation (NIHHIS, 

August 25, 2021). PPE can also 

contribute to heat stress by interfering 

with the body’s ability to cool. PPE 

intended to protect workers from 

chemical, physical, or biological 

hazards can reduce sweat evaporation 

and subsequent cooling (i.e., limit the 

body’s ability to sweat), can trap heat 

and moisture next to the skin, and can 

increase the level of exertion required to 

complete a task (NIOSH, February 

2016). 

The factors that contribute to heat 

stress in outdoor settings contribute to 

heat stress in indoor settings as well, 

especially in buildings that lack 

adequate climate control. Additionally, 

heat-producing processes and 

equipment such as those that generate 

steam, generate heat, or use certain tools 

and combustion, can increase ambient 

temperature and contribute to heat 

stress in indoor work settings. Lack of 

adequate climate control in indoor work 

settings can also contribute to 

occupational heat stress since indoor 

settings can increase in temperature and 

humidity as outdoor temperatures 

increase, and there is no relief for 

process or task-related heat production. 

Additionally, buildings with windows 

may be further heated by sunlight that 

enters windows and warms the 

workspace. 

The vulnerability of the energy grid is 

another variable that may place many 

workers at risk of experiencing heatrelated illness. In many areas of the 

country, energy grids are vulnerable to 

brownouts and blackouts in conditions 

of high heat due to the increased 

demand and stress placed on the energy 

infrastructure (Stone, Jr., et al., 2021). 

Because of this vulnerability of a key 

cooling mechanism, more workers in 

more industries may be at risk for 

experiencing heat stress, strain, and 

heat-related illness than is currently 

realized, especially during heat waves 

or during other natural disasters that 

impact the functionality of energy grids. 

In both indoor and outdoor settings, 

individual risk factors contribute to the 

risk of heat-related illness as some 

individuals are more susceptible to the 

detrimental effects of heat. Occupational 

heat-related fatalities have been found 

to occur more frequently in men than in 

women, in those with preexisting 

conditions (e.g., obesity, diabetes, 

hypertension, cardiac disease), and in 

those with a preexisting use of certain 

medications or illicit drugs that 

predispose individuals to heat-related 

illness (Gubernot et al., February 2015; 

Tustin et al., July 6, 2018; Tustin et al., 

August 2018). Other factors, such as age, 

fitness level, alcohol consumption, prior 

heat-related illness, and lack of access to 

air conditioning in housing, also reduce 

the body’s ability to regulate heat and 

can increase individual risk of heatrelated illness. Workplace controls 

should focus on making indoor and 

outdoor work safe for all employees, 

while also complying with the 

Americans with Disabilities Act and the 

Age Discrimination in Employment Act. 

The following questions are intended 

to solicit information, relevant data 

sources, and considerations to further 

assess contributions to heat stress in 

indoor and outdoor work settings as 

well as individual risk factors that may 

contribute to heat-related illness in 

occupational settings. 

(48) What factors, beyond those 

discussed above, contribute to heat 

stress in outdoor and/or indoor 

occupational settings? 

(49) Is air conditioning provided in 

employer-provided or sponsored 

housing? 

(50) Are there existing employer 

efforts or programs to ensure that 

employees have the ability to 

adequately cool at night in order to 

recover from occupational heat 

exposure? 

(51) What factors are the most 

important contributors to heat-related 

illness risk? 

(52) Are there other individual risk 

factors that contribute to the risk of 

heat-related illness? 

(53) What individual risk factors are 

the most important contributors to heatrelated illness risk? 

(54) Are there existing employer-led 

heat prevention programs that consider 

individual-level risk factors in their 

prevention guidance? If so, how are they 

implemented? What are the challenges 

associated with this? 

B. Strategies To Reduce Occupational 

Heat-Related Injury and Illness 

Workplace heat-related injury and 

illness is preventable, and many 

effective controls can be implemented. 

The following sections provide a brief 

overview and targeted questions about 

controls that would be important to 

consider as part of an effective heat 

injury and illness prevention program. 

1. Heat Injury and Illness Prevention 

Programs 

Safety and health programs aim to 

prevent workplace injuries, illnesses, 

and fatalities by using a proactive 

approach to managing workplace safety 

and health. An effective heat injury and 

illness prevention program would 

include elements on: Assessing heat 

hazards that may occur at the 

workplace, acclimatizing new and 

returning workers, evaluating how and 

when heat will be measured, and 

determining what controls will be put 

into place and what training will be 

provided to workers and supervisors. 

Evaluations of heat-related enforcement 

cases have shown that in investigations 

of heat-related fatalities or heat-related 

illness that resulted in 5(a)(1) violations 

from 2012–2013, no employer had a 

complete heat illness prevention 

program that addressed all of the 

recommended components, and 12 of 

the 20 cases evaluated had no heat 

illness prevention program at all 

(Arbury et al., April 2016). In one study, 

the implementation of a heat illness 

prevention program was found to 

decrease workers’ compensation costs 

associated with heat-related illness 

incidents and reduce the total number 

of heat-related illnesses experienced by 

outdoor municipal workers in Texas 

(McCarthy et al., September 2019). 

The following questions are intended 

to solicit information and relevant data 

sources that OSHA should consider 

when evaluating the need for and 

elements of a heat injury and illness 

prevention program for indoor and 

outdoor work environments. 


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(55) What are the elements of a 

successful employer-led heat injury and 

illness prevention program? How are 

these programs implemented? What are 

the challenges associated with them? 

Please provide examples and data. 

(56) Are there other elements of a heat 

injury and illness prevention program 

that are important to consider? 

(57) Are there limitations associated 

with implementing a heat injury and 

illness prevention program across 

indoor or outdoor work settings, or 

across businesses of various sizes? If so, 

what are they? 

(58) Are there demonstrated 

evaluations on the successes or 

limitations of various components of 

any existing state or employer heat 

injury and illness prevention program, 

including quantitative or qualitative 

evaluations? 

2. Engineering Controls, Administrative 

Controls, and Personal Protective 

Equipment 

Engineering controls, such as air 

conditioning or increased ventilation, 

increase evaporative cooling and can 

keep body temperatures at safe levels. 

Other examples of engineering controls 

that may reduce the amount of 

hazardous heat present could include 

the use of local exhaust ventilation at 

points of high heat production, 

insulating hot surfaces or equipment 

(e.g., furnaces), and providing shade 

tents, or other building modifications 

where appropriate. 

Administrative controls, such as 

making changes to workloads or work 

schedules, can be useful in keeping 

workers cool during hazardous heat 

exposure. For example, work schedules 

may shift from the hottest parts of the 

day to cooler times of the day, like 

overnight or early in the morning. 

Employers may implement work-rest 

cycles by adding additional rest breaks 

in the shade or air conditioning away 

from heat sources as environmental and 

exertional heat increases. Some 

employers have implemented selfpacing for workers as an alternative to 

work-rest cycles, allowing employers to 

pace themselves throughout the work 

shift when heat is hazardous. Other 

examples of administrative controls 

could include reducing physical 

demands during the hottest times of the 

day or implementing buddy systems to 

ensure workers are watching out for 

signs and symptoms of heat-related 

illness in each other. 

OSHA’s Heat Illness Prevention 

Campaign has historically 

recommended the implementation of 

‘‘Water. Rest. Shade.,’’ which is a 

combination of engineering and 

administrative controls to provide 

workers with adequate amounts of 

water, rest, and shade. As discussed 

above in more detail, because the 

Campaign is not mandatory, these 

controls are not always implemented in 

workplaces. An evaluation of 38 

enforcement investigations from 2011– 

2016 found that while nearly 85% of the 

inspected employers provided 

accessible water, none of them enforced 

or required rest breaks during periods of 

hazardous heat (Tustin et al., August 

2018). In some work settings, such as in 

agricultural workplaces, workers may be 

paid piecemeal or receive wages based 

on their productivity or output. These 

payment schemes can result in workers 

making tradeoffs between reduced 

productivity and lost wages versus 

taking breaks to rest or drink water 

(Wadsworth et al., 2019). However, 

without breaks, overall productivity can 

decline during hazardous heat due to 

workers being less able to work 

efficiently, as well as from higher rates 

of accidents and heat-related illnesses 

(Ebi et al., August 21, 2021). 

In some situations, PPE and auxiliary 

body cooling methods (e.g., cooled or 

iced vests, jackets, or other wearable 

garments) may further reduce the risk of 

heat strain in those working in 

hazardous heat conditions. For example, 

reflective and breathable clothing, 

cooling neck wraps, and cooling vests or 

jackets may provide enhanced 

protection to some workers. 

The following questions seek to solicit 

additional information, data sources, 

and considerations for engineering and 

administrative controls, as well as PPE, 

and their use in preventing heat-related 

illness in indoor and outdoor work 

settings. 

(59) What engineering controls, 

administrative controls, or PPE can be 

used to prevent heat-related illness in 

indoor and outdoor work settings? Have 

the qualitative or quantitative 

effectiveness of these controls been 

evaluated? 

(60) Are there data that demonstrate 

the role of facility energy efficiency in 

maintaining optimal thermal conditions, 

optimizing worker performance, and 

cost-effectiveness of cooling strategies? 

(61) Are certain controls that are more 

effective or more feasible than others? If 

so, which ones? Do effectiveness and 

feasibility of controls differ due to 

setting (indoor/outdoor, business size, 

arrangement of work, etc.)? 

(62) What are the limitations 

associated with implementing water, 

rest, and shade effectively in indoor and 

outdoor work settings? 

(63) How are work-rest cycles 

currently implemented in indoor and 

outdoor work settings? What are the 

limitations for implementation? 

(64) Are there additional sources of 

data or evidence that describe the 

quantitative or qualitative impacts of 

work-rest cycles on productivity? 

(65) How do productivity or output 

based payment schemes affect the 

ability of workers to follow heat illness 

and injury prevention training, guidance 

or requirements? 

(66) How do productivity or output 

based payment schemes affect employer 

implementation of heat illness and 

injury prevention training, guidance or 

requirements? 

(67) Are there additional sources of 

data or evidence that describe the 

quantitative or qualitative impacts of 

self-pacing as an alternative to work-rest 

cycles to prevent occupational heatrelated illness? 

3. Acclimatization 

Acclimatization refers to the process 

of the human body becoming 

accustomed to new environmental 

conditions by gradually adapting to the 

conditions over time. Gradual exposure 

to the condition of concern (e.g., heat) 

allows the body to develop more robust 

physiological responses, such as a 

greater sweat response, to adapt to heat 

more efficiently. Workers who are new 

to working in warm environments may 

not be acclimatized to heat, and their 

bodies need time to gradually adapt to 

working in hot environments. 

Evaluations of workplace fatalities have 

shown that approximately 70% of 

deaths occur within the first few days of 

work, and upwards of 50% occur on the 

first day of work (Arbury et al., August 

8, 2014; Tustin et al., August 2018), 

highlighting the consequences of 

workers not becoming acclimatized to 

the environmental conditions of the 

workplace. Acclimatization is also 

important for those who may have been 

previously acclimatized but were out of 

the workforce or hot environment of the 

workplace for more than 2 weeks (e.g., 

due to vacation or sick leave). All 

outdoor workers may need time to 

acclimatize to heat during early season 

hazardous heat, or during particularly 

severe or long-lasting heat events, which 

are associated with higher mortality in 

the general population (Anderson and 

Bell, February 2011). During a heat 

wave, environmental conditions may 

become extremely hazardous, even to 

workers who may have been previously 

acclimatized. 

OSHA and NIOSH have historically 

recommended the ‘‘Rule of 20 Percent’’ 

for acclimatizing workers. Under this 

regimen, workers would only work 20 

percent of the normal duration of work 


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on their first day in hazardous heat 

conditions performing job tasks similar 

in intensity to their expected work, 

increasing the work duration by 20 

percent on each subsequent day until 

performing a normal work schedule. For 

example, if the normal workday lasts 8 

hours, then new workers should work 

no more than 1 hour and approximately 

40 minutes (20 percent of 8 hours) on 

their first day in the heat, and spend the 

remainder of the workday doing work 

tasks without heat stress (OSHA, 

October 7, 2021). They should be given 

at least one rest break during the period 

when they are working. Workers with 

underlying medical conditions may 

need more time to fully adapt to the 

heat. 

The following questions aim to solicit 

additional information, relevant data 

sources, and considerations on the 

design and implementation of 

acclimatization plans for workers in 

indoor and outdoor work settings. 

(68) What are current and best 

practices for implementing 

acclimatization in various industries 

and across businesses of various sizes? 

(69) What are the challenges with 

acclimatizing workers, including 

workers in non-traditional/multiemployer work arrangements (e.g., 

temporary workers)? 

(70) Are there different challenges and 

best practices for acclimatization in 

indoor work settings versus outdoor 

work settings? 

(71) Are there unique concerns or 

approaches for implementing 

acclimatization for a small versus large 

business? 

(72) Are there additional sources of 

data or evidence that describe the 

quantitative or qualitative impacts of 

acclimatization schedules on 

productivity? 

4. Monitoring 

Physiological, medical, and exposure 

monitoring of workers exposed to heat 

hazards can prevent heat strain from 

progressing to heat-related illness or 

death. Monitoring can alert both 

employees and employers when 

workers have been exposed to 

hazardous heat and are experiencing 

heat strain and should seek water, rest, 

shade, cooling, or medical attention. 

Monitoring activities may include 

monitoring environmental conditions 

regularly, self-monitoring of urine color, 

and monitoring of heart rate and core 

body temperature. Individual-level 

biomonitoring with wearable 

technologies may be an option in some 

occupational settings. Monitoring 

activities may also include buddy 

systems where workers are educated in 

signs and symptoms of heat-related 

illness and proactively look for signs 

and symptoms in fellow workers and 

encourage them to rest, hydrate, and 

find shade or seek emergency medical 

attention if the worker is experiencing 

signs of heat-related illness. 

The following questions are intended 

to solicit information, relevant data 

sources, and considerations to further 

assess heat monitoring activities or 

programs in occupational settings. 

(73) Are there industries or individual 

employers implementing exposure, 

medical, and/or physiological 

monitoring to assess workers’ health 

and safety during hazardous heat 

events? 

(74) What are the best practices for 

implementing a monitoring program? 

How effective are the monitoring 

activities in preventing heat-related 

illness in workers? 

(75) If physiological and medical 

monitoring programs are used, who 

implements these programs? Does that 

individual(s) have specialized training 

or experience? 

(76) If physiological and medical 

monitoring programs are used, are data 

protected by confidentiality or privacy 

requirements? Please describe how data 

are maintained to ensure employee 

privacy and to meet any confidentiality 

or privacy requirements. 

(77) How is exposure, medical, or 

physiological monitoring currently 

implemented or tracked across various 

time scales (e.g., hourly, daily) in an 

occupational setting? 

(78) What are the risks or challenges 

with this type of medical or 

physiological monitoring in a 

workplace? 

(79) Do you use physiological or 

medical monitoring to assist in 

identifying high risk employees? 

(80) How do you use physiological 

monitoring data (e.g., as a short term 

response to heat stress conditions, to 

address long term examination in 

protecting employees, to identify high 

risk categories of workers)? 

(81) Do you require that notification 

of monitoring results be provided to 

employees? 

(82) Do you use physiological 

monitoring to validate the effectiveness 

of recommended controls? 

(83) Are there unique concerns or 

approaches in developing a monitoring 

program for small versus large 

businesses? 

5. Planning and Responding to HeatIllness Emergencies 

A heat-illness emergency occurs when 

a worker is experiencing a health crisis 

due to over-exposure to hazardous heat. 

Workers and employers need to be able 

to identify a heat-illness emergency, 

know how to respond to an emergency 

to protect the health of the affected 

worker, to have materials on-site to 

respond to an emergency, and know 

how to contact emergency medical care 

when needed. Emergency response 

plans can ensure that workers 

understand how to respond in an 

emergency and can help prevent heatrelated illness from progressing to heat 

stroke or death. 

The following questions are intended 

to solicit information, relevant data 

sources, and considerations to further 

assess the role of heat-illness emergency 

planning and response in indoor and 

outdoor work settings in responding to 

heat stress in the workplace and 

preventing heat-related injury and 

illness from progressing to heat stroke or 

death. 

(84) How do organizations in both 

indoor and outdoor work environments 

currently deal with heat-illness 

emergencies if they arise? 

(85) What are current best practices in 

workplace response to occupational 

heat-illness emergencies? 

(86) What are the challenges with 

responding to a heat-illness emergency 

in various work environments (e.g., 

indoor settings, outdoor settings, remote 

locations)? 

(87) What should be included in an 

employer’s heat emergency response 

plan? 

(88) What materials or supplies 

should employers have on-site to 

respond to a heat emergency? 

(89) When should employers refer 

employees for medical treatment or seek 

medical treatment for an employee who 

is experiencing a heat-illness 

emergency? 

(90) When and how do employers 

refer employees for medical treatment or 

seek medical treatment for them when 

experiencing a heat-illness emergency? 

6. Worker Training and Engagement 

Employers informing employees of 

the hazards to which employees may be 

exposed while working is a cornerstone 

of occupational health and safety 

(OSHA, 2017). Training is an effective 

tool to reduce injury and illness (Burke 

et al., February 2006). Employees must 

know what protective measures are 

being utilized and be trained in their 

use so that those measures can be 

effectively implemented. Training and 

education provide employees and 

managers an increased understanding of 

existing safety and health programs. 

Training provides managers, 

supervisors, and employees with the 

knowledge and skills needed to do their 


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work safely, as well as awareness and 

understanding of workplace hazards 

and how to identify, report, and control 

them. 

Because OSHA has long recognized 

the importance of training in ensuring 

employee safety and health, many 

OSHA standards require employers to 

train employees (e.g., the Bloodborne 

Pathogen standard at 29 CFR 

1910.1030(g)(2)). When required as a 

part of OSHA standards, training helps 

to ensure that employees can conduct 

work safely and healthfully (OSHA, 

April 28, 2010). Training is essential to 

ensure that both employers and 

employees understand the sources of 

potential exposure to hazardous heat, 

control measures to reduce exposure to 

the hazard, signs and symptoms of heatrelated illness, and how to respond in 

the event of an emergency. A 2018 

analysis of OSHA enforcement 

investigations of 66 heat-related 

illnesses showed that nearly two-thirds 

of the employers did not provide 

employees with training on 

occupational heat-related illness (Tustin 

et al., August 2018). 

The following questions are intended 

to solicit information, relevant data 

sources, and considerations to further 

assess existing worker training and 

engagement programs and their 

effectiveness for preventing 

occupational heat injury and illness. 

(91) How do employers currently 

involve workers in heat injury and 

illness prevention? 

(92) What types of occupational heat 

injury and illness prevention training 

programs have been implemented and 

how effective are they? What is the 

scope and format of these training 

programs? Are workers in nontraditional/multi-employer work 

arrangements included in these training 

programs? 

(93) What are best practices in worker 

training and engagement in heat injury 

and illness prevention? 

(94) How do employers involve 

workers in the design and 

implementation of heat injury and 

illness prevention activities? 

(95) What challenges are there with 

worker training and engagement for heat 

injury and illness prevention? 

IV. Costs, Economic Impacts, and 

Benefits 

A. Overview 

OSHA also seeks information on the 

costs, economic impacts, and benefits of 

heat injury and illness prevention 

practices. In addition to information 

regarding the costs and economic 

impacts of heat injury and illness 

prevention practices, OSHA is 

interested in the benefits of such 

practices in terms of reduced injuries, 

illnesses, deaths, and compromised 

operations (i.e., emotional distress, 

staffing turnover, and unexpected 

reallocation of resources), as well as any 

other productivity effects. As discussed 

above in Part I of this ANPRM, millions 

of workers across hundreds of 

occupations are likely to be exposed to 

conditions that could lead to heatrelated injury, illness, and death. 

The effects of heat-related injury and 

illness can be significant to employers 

and workers alike. They harm workers 

financially, physically, and mentally, 

and employers also bear several costs 

and reduced revenue. A single serious 

injury or illness can lead to workers’ 

compensation losses of thousands of 

dollars, along with thousands of dollars 

in additional costs for overtime, 

temporary staffing, or recruiting and 

training a replacement. Even if a worker 

does not have to miss work, heat stress 

can still lead to higher turnover and 

deterioration of productivity and 

morale.Globally, the International 

Labour Organization (ILO) has estimated 

that increased heat stress could result in 

a productivity decline by the equivalent 

of 80 million full-time jobs by the year 

2030 (ILO, 2019). 

According to BLS, as shown below in 

Table IV.A.1, exposure to environmental 

heat results in thousands of injury and 

illness cases and dozens of deaths per 

year (BLS, December 22, 2020 and BLS, 

January 28, 2021). Note that these data 

do not provide a comprehensive 

account of the number of heat-related 

injuries and fatalities, for a variety of 

reasons, such as employee reluctance to 

report and lack of awareness of the 

contributing effects of heat to 

symptoms. 

TABLE IV.A.1—REPORTED OCCUPATIONAL INJURIES (INVOLVING DAYS

AWAY FROM WORK) AND FATALITIES

AS A RESULT OF EXPOSURE TO ENVIRONMENTAL HEAT

Year Annual injuries Annual 

fatalities 

2011 .......... 4,420 61 

2012 .......... 4,170 31 

2013 .......... 3,160 34 

2014 .......... 2,660 18 

2015 .......... 2,830 37 

2016 .......... 4,110 39 

2017 .......... 3,180 32 

2018 .......... 3,950 49 

2019 .......... 3,080 43 

Source: U.S. Bureau of Labor Statistics: Injuries, Illnesses, and Fatalities, (BLS, December 22, 2020 and BLS, January 28, 2021) 

(Accessed August 30, 2021). 

The following questions are intended 

to solicit information on the topics 

covered in this section. 

(96) OSHA requests any workers’ 

compensation data related to heatrelated injury and illness. Any other 

information on your workplace’s 

experience would also be appreciated. 

(97) Are there additional data (other 

than workers’ compensation data) from 

published or unpublished sources that 

describe or inform about the incidence 

or prevalence of heat-related injuries, 

illness, or fatalities in particular 

occupations and industries? 

(98) What are the potential economic 

impacts associated with the 

promulgation of a standard specific to 

the risk of heat-related injury and 

illness? Describe these impacts in terms 

of benefits, including reduction of 

incidents; effects on costs, revenue, and 

profit; and any other relevant impact 

measurements. 

(99) If you utilize the WBGT method 

when making your work 

determinations, what were the costs of 

any associated equipment and/or 

training to implement this measurement 

method? 

(100) If you utilize a temperature 

metric other than WBGT when making 

work determinations, what were the 

costs associated with measurement and/ 

or training to implement this 

measurement method? 

(101) Have you instituted programs or 

policies directed at mitigating heatrelated injury and illness at your 

worksite? If so, what were the resulting 

benefits? 

(102) If you have implemented a heat 

injury and illness program or policy, 

what was the cost of implementing the 

program or policy, in terms of both time 

and expenditures for supplies and 

equipment? Please describe in detail the 

resource requirements and associated 

costs expended to initiate the 

program(s) and to conduct the 

program(s) annually. If you have any 

other estimates of the costs of 

preventing or mitigating heat-related 

injury and illness, please provide them. 

It would be helpful to OSHA to learn 

both overall totals and specific 

components of the program (e.g., cost of 

equipment, equipment installation, 

equipment maintenance, training 

programs, staff time, facility redesign). 

a. What are the ongoing operating and 

maintenance costs for the program? 

b. Has your program reduced 

incidents of heat-related injury and 

illness and by how much? Can you 

identify which elements of your 

program most reduced incidents? Which 

elements did not seem effective? 


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c. Has your program reduced direct 

costs for your facility (e.g., workers’ 

compensation costs, fewer lost 

workdays)? Please quantify these 

reductions, if applicable. 

d. Has your program reduced indirect 

costs for your facility (e.g., reductions in 

absenteeism and worker turnover; 

increases in reported productivity, 

satisfaction, and level of safety in the 

workplace)? 

(103) Do you provide wearable 

devices (specific to heat) to workers? 

Does each worker get a device or only 

specific members of the crew? 

a. If wearables are provided, what 

were the associated upfront costs of the 

equipment and how often do they need 

to be replaced? 

b. Which specific wearable did you 

choose? What were your deciding 

factors (i.e., price, ease of use)? 

(104) If you are in a state with 

standards requiring programs and/or 

policies to reduce heat stress, how did 

implementing the program and/or 

policy affect the facility’s budget and 

finances? 

(105) What changes, if any, in market 

conditions would reasonably be 

expected to result from issuing a 

standard on heat stress prevention? 

Describe any changes in market 

structure or concentration, and any 

effects on the prices of products and 

services to consumers, that would 

reasonably be expected from issuing 

such a standard. 

(106) If you have implemented 

acclimatization practices in your 

workplace, were there any associated 

costs? 

(107) How does your workplace 

address the costs of any rest breaks 

necessary to prevent heat-related injury 

and illness? 

B. Impacts on Small Entities 

As part of the agency’s consideration 

of a heat stress standard, OSHA is 

concerned about whether its actions 

will have a significant economic impact 

on a substantial number of small 

entities. Small entities included small 

businesses, small non-profit 

organizations, and small governmental 

jurisdictions with a population of less 

than 50,000. These other small 

employer organizations may experience 

heat stress issues in much the same 

manner as small businesses. Injury and 

illness incidence rates are known to 

vary by establishment size. In the 

construction industry, for example, 

across all nonfatal occupational injuries 

and illnesses, establishments between 

11 and 49 employees had an average 

incidence rate of 3.3 per 100 Full Time 

Equivalent (FTE) workers, whereas 

establishments with 1,000 or more 

employees had an average incidence 

rate of 0.9 per 100 FTE workers. (BLS, 

August 31, 2021). If the agency pursues 

the development of a standard that 

would have such impacts on small 

businesses, OSHA is required to 

develop a regulatory flexibility analysis 

and convene a Small Business 

Advocacy Review panel under the 

Small Business Regulatory Enforcement 

Fairness Act (before publishing a 

proposed rule (see Regulatory 

Flexibility Act, 5 U.S.C. 601 et seq.)). 

Regardless of the significance of the 

impacts, OSHA seeks ways of 

minimizing the burdens on small 

businesses consistent with OSHA’s 

statutory and regulatory requirements 

and objectives. 

The following questions are intended 

to solicit information on the topics 

covered in this section. 

(108) How many, and what type of 

small firms, or other small entities, have 

heat-related injury and illness training, 

or a heat injury and illness program, and 

what percentage of their industry 

(NAICS code) do these entities 

comprise? Please specify the types of 

heat stress risks employees in these 

firms face. 

(109) How, and to what extent, would 

small entities in your industry be 

affected by a potential OSHA standard 

to prevent heat stress? Do special 

circumstances exist that make 

preventing heat stress more difficult or 

more costly for small entities than for 

large entities? Please describe these 

circumstances. 

(110) How many, and in what type of 

small entities, is heat-related injury and 

illness a threat, and what percentage of 

their industry (by NAICS codes) do 

these entities comprise? 

(111) Are there alternative regulatory 

or non-regulatory approaches OSHA 

could use to mitigate possible impacts 

on small entities? 

(112) For very small entities 

(historically defined by OSHA as those 

with fewer than 20 employees), what 

types of heat-related injury and illness 

threats are faced by workers? Does your 

experience with heat-related injury and 

illness reflect the lower rates reported 

by BLS? 

(113) For very small entities, what are 

the unique challenges establishments 

face in addressing heat-related injury 

and illness? 

(114) If you are in a jurisdiction with 

standards requiring programs and/or 

policies to reduce heat stress, how did 

implementing the program and/or 

policy affect your small entity or other 

small entities in your jurisdiction? 

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Authority and Signature 

James S. Frederick, Acting Assistant 

Secretary of Labor for Occupational 

Safety and Health, U.S. Department of 

Labor, 200 Constitution Avenue NW, 

Washington, DC 20210, authorized the 

preparation of this document pursuant 

to the following authorities: 29 U.S.C. 

653, 655, and 657, Secretary’s Order 8– 

2020 (85 FR 58393; Sept. 18, 2020), and 

29 CFR part 1911. 

James S. Frederick, 

Acting Assistant Secretary of Labor for 

Occupational Safety and Health. 

[FR Doc. 2021–23250 Filed 10–26–21; 8:45 am] 

BILLING CODE 4510–26–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

33 CFR Part 167 

[USCG–2018–1058] 

Port Access Route Study: Alaskan 

Arctic Coast; Reopening of Comment 

Period 

AGENCY: Coast Guard, Department of 

Homeland Security (DHS). 

ACTION: Notification of reopening of 

commend period. 

SUMMARY: The United States Coast 

Guard is reopening the comment period 

for the notice of study and request for 

comments for the Port Access Route 

Study: Alaskan Arctic Coast that we 

published on December 21, 2018. This 

action will provide the public with 

additional time and opportunity to 

provide the Coast Guard with 

information regarding the Port Access 

Route Study: Alaskan Arctic Coast. The 

comment period is reopened until 

March 31, 2022. 

DATES: The comment period for the 

document published on December 21, 

2018 (83 FR 65701), which was 

extended on September 4, 2019 (84 FR 

46501), and January 13, 2020 (85 FR 

1793), and reopened on July 6, 2020 (85 

FR 40155), is reopened again. 

Comments and related material must be 

received by the Coast Guard on or before 

March 31, 2022. 

ADDRESSES: You may submit comments 

identified by docket number USCG– 

2018–1058 using the Federal 

eRulemaking Portal at https://

www.regulations.gov. If your material 

cannot be submitted using https://

www.regulations.gov, contact the person 

in the FOR FURTHER INFORMATION

CONTACT section of this document for 

alternate instructions. 

FOR FURTHER INFORMATION CONTACT: If 

you have questions about this 

document, please contact LCDR Michael 

Newell, Seventeenth Coast Guard 

District (dpw), at telephone number 

(907) 463–2263 or email 

Michael.D.Newell@uscg.mil, or Mr. 

David Seris, Seventeenth Coast Guard 

District (dpw), at telephone number 

(907) 463–2267 or email to 

David.M.Seris@uscg.mil, or LT 

Stephanie Alvarez, Seventeenth Coast 

Guard District (dpw), at telephone 

number (907) 463–2265 or email to 

Stephanie.M.Alvarez@uscg.mil. 

SUPPLEMENTARY INFORMATION: On 

December 21, 2018, the Coast Guard 

published a notice of study and request 

for comments for the Port Access Route 

Study: Alaskan Artic Coast (83 FR 

65701). The comment period in that 

document closed September 1, 2019. On 

September 4, 2019 (84 FR 46501), the 

Coast Guard published a document 

extending the public comment period 

until January 30, 2020. On January 13, 

2020 (85 FR 1793), the Coast Guard 

published a document extending the 

public comment period until June 30, 

2020. On July 6, 2020 (85 FR 40155), the 

Coast Guard published a document 

reopening the public comment period 

until September 30, 2021. In this action, 

the Coast Guard is providing notice that 

the public comment period is reopened 

until March 31, 2022. The Coast Guard 

has reopened the comment period to 

provide adequate opportunity for public 

meetings in impacted Arctic 

communities, given COVID–19 impacts 

to travel. These discussions are vital to 

the Port Access Route Study and 

necessary to creating a well-informed 

proposal. The Port Access Route Study 

remains a high priority for the Coast 

Guard, critical to maintaining waterway 

safety in the Arctic. Documents 

mentioned in this notification, and all 

public comments, are in our online 

docket at https://www.regulations.gov 


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