# State Occupational Safety & Health Surveillance Program

Minus

              - Background
              - Purpose
              - State Program Descriptions
              - NIOSH State Surveillance Program Focus on Timely COVID-19 Related Projects
              - Program Performance One-Pagers
              - Fiscal Year (FY) Extramural Research Program Highlights
              - Funding Opportunity Announcements
              - Additional Resources

## Background

Each year, millions of workers in the United States are injured on the job or become ill because of exposure to health hazards at work. In 2019 there were 5,333 fatal work injuries recorded in the United States, a 2 percent increase from the 5,250 in 2018, according to the Census of Fatal Occupational Injuries Summary. Although deaths from work-related illnesses are more difficult to count, a 2011 publication estimated that 53,445 work-related deaths occur annually.

In 2020, the U.S. Bureau of Labor Statistics indicated that employers reported approximately 2.7 million nonfatal work-related injuries and illnesses to private industry workers. Work-related injuries and illnesses result in substantial human and economic costs for workers, families, employers, and society. A 2011 publication estimated that the direct and indirect costs of work-related injuries and illnesses exceed $250 billion annually.

Work-related injuries and illnesses can be prevented, and successful approaches to making workplaces safer and healthier begin with having the data necessary to understand the problem. As part of its mission to prevent work-related injuries, illnesses, disabilities, and fatalities caused by hazards in the workplace, NIOSH funds states and other jurisdictions to conduct occupational safety and health (OSH) surveillance to assess the extent and severity of workplace injury, illness, disability, and death and identify worker populations and occupations at greater risk.  This information can be used to: 1) set program priorities to address new and emerging issues, 2) develop workplace interventions, and 3) create links to policy initiatives that may improve worker safety and health in their state and measure the effectiveness of those actions.

## State Role in Occupational Safety and Health Surveillance

For more than 40 years, NIOSH has recognized the key importance of state public health approaches to addressing occupational health problems. The institute began funding pilot surveillance programs in a limited number of state health departments in the 1970’s. State public health agencies have a critical and complementary role in the prevention of occupational injuries, illnesses, disabilities, and fatalities, and these agencies are uniquely positioned to use state-specific data sources and link surveillance findings with intervention outreach activities within their jurisdictions.

NIOSH has funded a variety of approaches to build state capacity in OSH, ranging from the development of population-based and case-based surveillance systems, to creating focused public health interventions that address the OSH needs of high-risk populations such as minorities and teen workers. State programs demonstrate that effective surveillance of occupational injuries, illnesses, disabilities, and death embraces the concept of “information for action” by ensuring that collection, analysis, interpretation, and dissemination of health data are linked to prevention and control activities. In addition, state surveillance systems and activities provide a vital foundation for several federal surveillance systems and augment others.

NIOSH has used cooperative research agreements to fund approximately 10 state surveillance programs since 2000, and by 2009, the number of funded states increased from 15 to 23. NIOSH has provided financial and technical assistance to state health and labor agencies to develop or expand state surveillance program capacity and technical infrastructure. Examples include the addition of epidemiologists and other technical staff, training and continuing education, informatics or methods improvements, contracting for specialized statistical and communications expertise, and purchase of statistical software.

## Purpose

The primary purpose of NIOSH’s state surveillance program is to provide financial and technical support to states and other eligible jurisdictions for the development or expansion of an OSH surveillance program. Through this program, NIOSH seeks to strengthen OSH surveillance within states and other eligible jurisdictions that will provide information that will help drive actions to improve the health of workers in the United States.

NIOSH supports the use of existing surveillance data and the collection of new surveillance data to better define the current health of the state’s workforce, target relevant worker populations at risk, develop relevant interventions, and initiate and enhance partnerships within, and beyond, the state’s surveillance community. NIOSH also supports the advancement of state surveillance systems to enable the future use of new or newly emerging electronic surveillance data sources and to participate in the development of the data sources and data exchange methods. NIOSH strongly encourages state surveillance programs to engage directly in activities and initiatives related to the collection, exchange, and use of electronic health data.

States are expected to be innovative in the dissemination and communication of products that they develop. Whenever possible, communication products should inform measurable surveillance data findings and related public health actions that include recommendations for prevention, interventions, policies, and communications that advance the integration of proven health and safety strategies into targeted workplaces by organizations both within and outside of traditional occupational health. A key goal is to build partnerships among surveillance programs and health agencies, and other organizations and stakeholders that engage in OSH surveillance or can be leveraged to improve surveillance.

NIOSH expects state surveillance programs to do the following:
          - Identify, access, and analyze data that can be used to conduct surveillance of work-related injuries, illnesses, exposures, and fatalities.
          - Use findings for the calculation of incidence and/or prevalence of occupational injuries, illnesses, exposures, and fatalities, including calculation of occupational health indicators (OHIs).
          - Be resourceful and proactive in identifying and accessing untapped data sources for surveillance, which may include creating linkages between data sources.
          - Identify surveillance trends, emerging issues and diseases, high-risk occupations, industries, and worker populations.
          - Establish and address state priorities for follow-up activities, including more in-depth data surveillance and outreach, prevention, and intervention programs.
          - Establish and maintain an advisory committee, or other process(es) to obtain stakeholder input and identify relevant state-specific issues and priorities.
          - Apply current technologies to develop and communicate audience-specific educational materials, outreach, and other resources for optimizing their uptake, adoption, or adaptation for protecting workers.
          - Find ways to foster the integration of OSH into broader public health goals and objectives (such as infectious and chronic disease).
          - Develop workplace interventions and create links to policy initiatives that may improve worker health and safety in their state.

### Current Funding Cycle

The program’s current funding cycle includes 22 awards, funded from 2021-2026, and consists of 3 Fundamental, 6 Fundamental-Plus, and 13 Expanded Programs. Additional rounds of competition in 2022 and 2023 may add more programs.

Fundamental Programs establish and maintain “fundamental” OSH surveillance capacity and conduct activities to do the following:
          - Use available data sources to generate a state employment profile of the employed workers in the state.
          - Collect, analyze, and interpret a minimum of 15 of 25 OHIs annually.
          - Use OHIs to identify and prioritize the state’s occupational health burden and needs and conduct follow-up prevention activities such as investigations, interventions, or policy/rule changes for high priority issues in their state.
          - Participate in the NIOSH Adult Blood Lead Epidemiology Surveillance System to conduct annual follow-back/intervention/communication activities for work-related adult blood lead cases based in case load.
          - Engage in activities and initiatives related to the collection, exchange, and use of electronic health data by promoting inclusion and analysis of industry and occupation work variables in existing data collection and maintaining awareness of the status of electronic case reporting within the state.
          - Build and maintain meaningful collaborations and partnerships that will improve state surveillance activities.
          - Include efforts to address worker groups that are underserved in their state.
          - Identify intended audiences and stakeholders for dissemination of surveillance findings and tailor communication products to those groups.

Fundamental-Plus Programs conduct all fundamental activities (mentioned above) plus two projects: (1) an in-depth or follow-back investigation activity based on findings from surveillance data analyses or OHIs; and (2) a policy or intervention activity in collaboration with state partners, other state grantees, or other external partners that can impact the surveillance of an identified occupation, industry, or population.

Expanded Programs conduct all fundamental activities (mentioned above) plus they conduct in-depth surveillance activities in up to four priority areas of their choosing. Expanded Programs are expected to identify and access data beyond those available from national OSH surveillance systems and to articulate the need for proposed activities for each of the proposed priority areas.

These 22 state surveillance programs are managed by 13 state health departments (59%), 2 state Departments of Labor (9%), and 7 bona fide agents (32%), which involve partnerships between state health departments and universities. These programs reside in states that contain about 64% of the civilian labor force and include 18 of the 29 most populated states in the United States. The portfolio includes approximately 37 surveillance projects that include topics such as respiratory diseases, pesticide poisonings, worker fatalities, opioids, heat-related illnesses, motor vehicle injuries, infectious diseases, and healthcare workers.

### State Program Descriptions

**Institution:** Public Health Institute (CA)**Program Title:** California Occupational Health and Safety Surveillance**Program Type:** Expanded Program

Since 1987, the Occupational Health Branch (OHB) in the California Department of Public Health (CDPH) has collaborated with NIOSH, other state occupational health programs, and partners within California to promote worker safety and health through public health prevention activities. The Public Health Institute is a bona fide agent of the CDPH OHB and provides general administrative functions and support for the California Occupational Health and Safety Surveillance Program. Through this Expanded Program, the CHPH OHB maintains and enhances its capacity to identify state priorities and guide efforts to improve and protect worker safety and health, monitor statistical and other trends and progress over time, and develop and distribute prevention and intervention recommendations. The fundamental component and three expanded projects under this program share the same aims: (1) sustain and enhance science by using multiple data sources to conduct surveillance; (2) develop and implement health informatics systems; (3) establish a communication and translation plan with materials and methods that reach all populations; (4) build and maintain partnerships and collaboration; (5) address populations that are underserved; and (6) establish an evaluation and performance management plan.

For the fundamental component, the CHPH OHB will also generate the state employment profile for the state and collect, analyze, interpret, and publicize 20 of the occupational health indicators, one of which is state-specific – Hispanic/Latino fatal injuries. Additionally, CHPH OHB staff perform in-depth analyses of selected health outcomes, exposures, or worker populations and identify and investigate emerging issues while also mentoring students and early-career professionals contributing to the future OSH workforce. They also conduct surveillance and follow-up of laboratory-reported blood lead levels and provide data to NIOSH. To develop and implement health informatics systems, they maintain ongoing relations with existing providers of electronic data on health outcomes and occupational hazards (e.g., workers’ compensation claims, death records, cancer registry, and emergency department visits, etc.) and explore new methods including the Reportable Conditions Knowledge Management System. Under this component, the CHPH OHB also works with infectious disease colleagues to improve the capture of industry, occupation, and other work variables in its infectious disease reporting system.

The three expanded projects in this program are: 1) Occupational Respiratory Disease Surveillance, 2) Occupational Pesticide Illness, and 3) Fatality Assessment and Control Evaluation. Research to practice activities in these projects include: (1) completing the surveillance loop by translating findings from surveillance data analyses, case ascertainment, and field investigations into practical interventions, prevention strategies, and policy recommendations; (2) tailoring prevention messages to each target audience using stakeholder input during product development; (3) gathering evaluation feedback to ensure that the guidance is useful; and (4) continually improving the program’s performance and effectiveness.

*Occupational Respiratory Disease Surveillance*The California Occupational Respiratory Disease Surveillance expanded project identifies, characterizes, and prevents occupational respiratory disease, with an emphasis on work-related asthma (WRA) and silicosis. Through this project, CHPH OHB targets industries with high rates of WRA, including agriculture, construction, transportation, manufacturing, utilities, and others with emerging exposures of concern, along with the use of asthma-causing disinfectants in multiple industries, particularly related to COVID-19 and other infectious disease prevention. The project also continues to focus on silica exposures and disease outcomes in the engineered stone countertop fabrication industry. Addressing populations that are underserved and at greater risk of occupational respiratory disease also continues to be a focus of surveillance, case follow-up, and prevention efforts. These populations include non-English speaking and immigrant workers in agriculture, engineered stone countertop fabrication, construction, temporary workers in manufacturing, “gig”/online platform workers in transportation, and employees of small businesses that lack OSH resources.

*Occupational Pesticide Illness*The Occupational Pesticide Illness Project identifies, characterizes, and prevents occupational pesticide exposure and illness in California. The project performs selected case-based investigations based on review of data and perform targeted worksite investigations in industries with high rates of occupational pesticide illness including agriculture, landscaping, janitorial services, food manufacturing, pest control, and other industries of concern.

*Fatality Assessment and Control Evaluation*The Fatality Assessment and Control Evaluation (FACE) project identifies, characterizes, and prevents work-related fatalities in California. Through FACE, CHPH OHB performs selected case-based investigations based on review of data among industries, causes, and workers of special interest in California. These include the following: (1) healthcare worker fatalities from workplace violence; (2) agricultural machine and heat-related fatalities and fatalities among landscaping/tree workers and construction workers (priority on Hispanic worker falls); (3) energy production workers (oil and gas & solar energy); and (4) temporary workers and firefighters (medical and heat-related). Priorities for onsite investigations include robot-related machinery, law enforcement motor vehicles, powered industrial trucks and warehousing, tow truck drivers, and waste collection/sanitation.

**Institution:** Connecticut State Department of Public Health**Program Title:** Occupational Health Fundamental-Plus Surveillance Program in Connecticut**Program Type:** Fundamental-Plus Program

The major objectives of this Fundamental-Plus Program are to maintain continuity and increase capacity for enhanced occupational injury and illness surveillance in Connecticut. The Connecticut Department of Public Health’s specific goals include: (1) continuing annual analysis of all 25 nationally-recognized occupational health indicators and creating a state employment  profile for Connecticut; (2) continuing surveillance and exposure investigations for mercury and adult lead poisonings and education as needed; and (3) maintaining collaboration with the Connecticut Occupational Health Clinics Workgroup, which acts as its advisory committee, as well as with regional occupational health partners from other Northeast states (such as MA, NJ, NH, NY, PA and VT) on specific surveillance activities. For 30 years, Connecticut has hosted, and will continue to host, the Northeast Occupational Health Network Conference which is supported in part through this Fundamental-Plus Program and the NIOSH-funded state surveillance program at the Massachusetts Department of Public Health. The meeting is held each spring and brings together occupational health program partners from the Northeast states, partners from other state and federal agencies, research partners, and advocacy groups from the region to collaborate on various multi-state surveillance projects.

In addition, the Connecticut Department of Public Health conducts two Fundamental-Plus Projects. The first project maintains and expands traditional surveillance systems and activities in Connecticut by: (1) conducting longitudinal analysis of occupational illness and injury underreporting through comparison of existing data sources; and (2) conducting sentinel event surveillance for chemical inhalation and non-inhalation exposure incidents. The second project assesses the occupational health impacts of COVID-19 and develops effective workplace risk-mitigation strategies by: (1) conducting population-based surveillance to identify at-risk workers, employment characteristics, and the differential application of remote work during the COVID-19 pandemic; (2) using targeted information gathered with stakeholders in the Education Industry Sector to identify and address gaps in COVID-19 workplace policies and procedures; and (3) performing retrospective analysis of workplace outbreak data during the COVID-19 pandemic to identify workplaces with groups that have been marginalized and evaluate variables related to policies, procedures, and/or infrastructure affecting outbreak experiences.

**Institution:** Georgia Department of Public Health**Program Title:** Georgia Occupational Health Surveillance Program**Program Type:** Fundamental-Plus Program

The Georgia Occupational Safety and Health Surveillance Program (GA-OHS) aims to strengthen its current occupational safety and health surveillance and build upon its capacity through this Fundamental-Plus Program. GA-OHS systematically collects, analyzes, interprets, and disseminates data for the 25 occupational health indicators (OHIs) that have been recommended by NIOSH and the Council of State and Territorial Epidemiologists, and GA-OHS creates the state employment profile. Additionally, the GA Behavioral Risk Factor Surveillance System will be analyzed annually to obtain data for two identified state specific OHIs – workplace secondhand smoke exposure and arthritis among employees. The GA Violent Death Reporting System data will also be analyzed annually for a new state-specific indicator on work-related violent deaths to determine the magnitude of workplace and work-related homicides and suicides in Georgia. GA-OHS conducts in-depth analyses and surveillance of OHIs with rates that have increased over time in GA, OHIs that have rates above the national average, and those identified as emerging issues. These priority OHIs and emerging conditions include work-related transportation incidents, work-related pesticide-associated illness and injury, and work-related COVID-19 cases. In collaboration with the GA Department of Public Health Environmental Health Section, the GA-OHS implements follow-back investigations of cases involving persons age 16 years and older with elevated blood lead levels (BLLs) of ≥ 25 μg/dL. GA-OHS maintains an Advisory Committee including representatives of key partners and stakeholder organizations and agencies.

GA-OHS maintains and builds upon its current capacity to conduct fundamental occupational health surveillance through two new in-depth surveillance activities (Fundamental-Plus Projects). For the first project, GA-OHS conducts in-depth assessment and follow-back activities for work-related and workplace suicides. Follow-back activities are conducted with employers who would like to receive mental health trainings or resources available for their employees. For the second project, GA-OHS is planning to collaborate with the GA Council on Respiratory Health Promotion and the GA Department of Public Health Asthma Control and Prevention Program to create a policy and intervention program for work-related asthma.

**Institution:** University of Illinois at Chicago**Program Title:** Illinois Occupational Surveillance Program**Program Type:** Expanded Program

The Illinois (IL) Occupational Surveillance Program, now in its 11th year of funding from NIOSH, has an Expanded Program that continues to improve safety and health across the entire workforce, while also focusing on the groups that have been significantly marginalized in the state. As the bona fide agent of the Illinois Department of Public Health, the research team at the University of Illinois Chicago, School of Public Health, has taken on the role of building occupational health surveillance capacity in Illinois via this program. The program has a fundamental component and two expanded projects.

The fundamental component has five aims, which include conducting active surveillance of occupational injuries and illnesses in IL, utilizing recognized data systems with a particular focus on high-risk industries, as well as underserved and precarious workers. For Aim 1, the program conducts analyses, and case call-backs for adult lead poisonings, provides the state demographic employment profile, and analyzes 24 occupational health indicators to identify emerging hazards, high-risk industries and occupations, target precarious workers who are underserved, plan investigations and recommend policy changes. Other aims include the following:  (1) expand health informatics capacity by analyzing under-utilized data systems, identifying and integrating novel data systems into the current occupational surveillance program, improving exchange of data, and linking multiple data systems in order to enhance occupational surveillance (i.e., expand use of BRFSS for analyses of risk factors associated with industry and occupation, expand use of outpatient hospitalization records/emergency department visits and link data systems such as workers’ compensation data to identify high risk, populations that are underserved, etc.); (2) organize statewide communication of occupational health surveillance data and coordinate translation of surveillance findings into improved public health practice and advancement of policies that will reduce the burden of workplace injuries and illnesses; (3) enhance partnerships and collaborations with occupational health stakeholders in IL, the Midwest, and nationally (i.e., their Advisory Committee, other Centers for Disease Control and Prevention (CDC) funded programs in IL, Education and Research Centers, Centers for Agricultural Safety and Health, Centers of Excellence for *Total Worker Health®*, and NIOSH); and (4) intensify evaluation of the program and performance management plan to improve program capacity.

*Linking Occupational Surveillance Data, Work Practices and OSHA Enforcement Activities in IL (OSHA Region 5)*This first expanded project has four aims. Overall, it creates a real-time surveillance program to inform Occupational Safety and Health Administration (OSHA) unprogrammed inspections and analyzes occupational injury and illness data captured in data systems not available to OSHA (i.e., workers’ compensation data) to identify high risk industries and employers with recurring severe injuries and characterize emerging hazards to inform OSHA’s programmed inspections. The project also assesses the reliability of employer reporting of severe injuries and strategically coordinates efforts between OSHA and other stakeholders. As part of this effort, they will systematically screen medical examiner and hospital data to identify injuries and illnesses that are targets of the following OSHA emphasis programs:  grain handling facilities, high rise building construction, powered industrial vehicles, wood pallet manufacturing, general falls, amputations, hexavalent chromium, lead, silica, and work-related deaths. Guidance materials will also be developed for employers and worker advocacy groups on workplace hazards based on the above analyses and build occupational surveillance capacity by embedding students in OHSA and other stakeholder agencies.

*Pesticide Related Illness Surveillance*This second expanded project has three aims that propose to use data and statewide stakeholders to guide action that prevents pesticide-related illness (PRI) in IL among general and farmworker populations and contributes to national prevention efforts. The project’s first aim creates a new, robust surveillance program in IL to reduce the burden of PRI and produces reports framed in an actionable way for industry, occupational groups, government entities, clinicians, non-profits, and individual businesses. Aim 2 establishes a state-wide task force of federal, state, community, and university experts to prevent PRI by evaluating current policies and practices and uses data to drive planning, implementation, and evaluation of prevention/intervention activities. The last aim proposes to protect 55,000 migrant and seasonal farmworkers who are exposed to pesticides in IL by using surveillance data and task force feedback to do the following: (1) plan preventive actions that protect farmworkers and their families; (2) partner with a migrant clinic system to develop an outreach program for counting, training, and triaging migrant and seasonal farmworkers and their families; (3) work with rural health departments to engage in PRI prevention for farmworkers; and (4) train healthcare providers to recognize, report, and care for pesticide-exposed farmworkers.

**Institution:** University of Kentucky**Program Title:** Kentucky Occupational Safety and Health Surveillance (KOSHS) Program**Program Type:** Expanded Program

The Kentucky (KY) Occupational Safety and Health Surveillance Program (KOSHS), now in its 16th year of NIOSH funding, has an Expanded Program that includes a fundamental component and two expanded projects. As the bona fide agent of the Kentucky Cabinet for Health and Family Services, Department for Public Health, the research team at the University of Kentucky Research Foundation strives to reduce occupational injuries and hazards in KY and the nation through this program. These researchers implement surveillance strategies, epidemiological analyses, surveillance quality improvement, targeted interventions, dissemination, and evaluation.

The KOSHS fundamental component aims to: (1) identify and access comprehensive, multisource OSH data and evaluate new occupational injury and illness surveillance data sources for the occupational health indicators (OHIs); (2) manage and perform quality control and surveillance quality improvement of OSH surveillance data; (3) calculate, analyze, and interpret 20 OHIs (13 are KY-specific OHIs) and the state employment profile, along with incidence and prevalence rates and trends to describe KY’s burden of work-related injuries, illnesses, exposures, and fatalities, including novel KY-specific OHIs on and interventions related to occupational motor vehicle crashes (MVC) for light, medium, and heavy vehicles, substance misuse, and workplace deaths by suicide; (4) perform case follow-up public health interventions for persons age 16 or older with blood lead levels (BLL) of ≥ 10 μg/dL and conduct referrals to KY OSHA for follow-back site investigations of cases with BLL ≥ 20 μg/dL; (5) conduct epidemiological analyses of OSH surveillance data or other data sources using innovative methodologic approaches such as machine learning and data linkage to inform MVC prevention outreach, prevention, and intervention activities and to advance heavy, medium and light vehicle injury research; (6) disseminate public health recommendations for workplace interventions and policies; and (7) perform a process, impact, and outcome evaluation of the fundamental component.

*Fatality Assessment Control and Evaluation (FACE)*For the first expanded project, KOSHS works to reduce fatal occupational injuries in KY and the nation through the following: (1) identifying industries, occupations, and worker populations at high risk for fatal occupational injuries; (2) identifying risk factors, trends, and emerging issues and informing work-related interventions and policies; and (3) advancing usefulness of surveillance data at federal, state, and local levels for the prevention of fatal occupational injuries and hazards. The project has six aims: (1) identify and collect comprehensive, multisource data on all occupational injuries and fatalities occurring in KY, using timely data collection, processing, and reporting to inform intervention and prevention activities, determine priority areas and populations, identify potential cases for on-site investigations, conduct epidemic analyses, and collaborate on state, regional, and national (i.e., NIOSH) studies; (2) manage and perform quality control of FACE surveillance data; and (3) select occupational fatality cases to investigate and conduct on-site investigations within the following priority areas – workplace deaths by suicide, occupational medium and heavy vehicle crash fatalities, construction industry injury fatalities, pedestrian worker injury fatalities, NIOSH prior areas for occupational injury fatalities (robot-related, law enforcement motor vehicles, arborist, powered industrial trucks/warehousing, tow truck drivers, waste collection), and cases amenable to engineering and process change recommendations. For its fourth aim, KOSHS plans to develop recommendations to control or eliminate occupational fatality risks through FACE investigation report recommendations and conduct epidemiological analyses of occupational fatality surveillance and investigation data using innovative methodologic approaches (e.g., machine learning, narrative test analyses, data linkage on FACE surveillance data, etc.) and other fatal occupational injury related data sources in novel priority focus areas of occupational motor vehicle crashes, workplace deaths by suicide, pedestrian worker fatalities, and drug-involved worker deaths and fatal worker drug overdoses. For its fifth aim, KOSHS will prepare FACE data findings and disseminate FACE surveillance and research findings through new and existing collaborations, state agencies, organizations, NIOSH, and others, and it will perform a process, impact, and outcome evaluation of the FACE Project as its sixth aim.

*Occupational Motor Vehicle (OMV) Injury Surveillance (OMVIS)*Through the second expanded project, KOSHS utilizes multisource data (e.g., emergency department, inpatient hospitalization, trauma registry, workers’ compensation, emergency medical services, crash reports, and demographic mapping software, etc.) and uses probabilistic data linkages and text narrative mining to conduct comprehensive surveillance of work-related motor vehicle crashes and resulting injuries. KOSHS’s goal is the reduce OMV injuries in KY and the nation through identifying industries and environments at high risk for OMV injuries, identifying risk factors, trends, and emerging issues, informing OMV injury prevention-related interventions and policies, and advancing usefulness of OMV injury surveillance data at federal, state, and local levels for the prevention of OMV injuries. The project’s five aims are:  (1) identify, collect, and describe current and potential comprehensive, multisource surveillance data on all OMV injury crashes (fatal and nonfatal) in KY using timely data collection, processing, and reporting; (2) perform quality control of OMVIS surveillance data following the National Highway Traffic Safety Administration approach; (3) conduct epidemiological analyses of OMVIS data to identify patterns and trends of OMV injuries in workers that have been marginalized and specific industry populations at risk, identify risk behaviors and vehicle and road factors associated with OMV injuries, inform intervention, prevention, and surveillance improvement activities, improve OMVIS system operation, generate hypotheses, and stimulate future research; (4) prepare and disseminate OMV injury research findings; and (5) perform a process, impact, and outcome evaluation to assess OMVIS program effectiveness and impact.

**Institution:** Louisiana Department of Health**Program Title:** Occupational Health & Injury Surveillance in Louisiana**Program Type:** Expanded Program

This Expanded Program is housed in the Louisiana (LA) Department of Health, Office of Public Health, and has been in existence for 16 years with the long-term objective of improving the health and well-being of LA workers. Some of the state’s most dangerous industries are also some of its most economically important, including agriculture, oil and gas extraction, construction, chemical and petrochemical manufacturing, and transportation. The state is a national leader in both natural gas and crude oil production and reserves, and it has more than 100 major chemical plants and one of the largest concentrations of petrochemical manufacturing facilities in the country. The seafood industry in LA is the second largest in the United States, leading the nation in crawfish, oyster, and alligator sales.  It is among the top five producing states for sugarcane, rice, and sweet potatoes. This program tracks the extent of work-related injuries, illnesses, and fatalities in LA and develops and disseminates prevention strategies to reduce their impact. The LA Department of Health plans to strengthen and expand its occupational health surveillance capacity through its Expanded Program which consists of a fundamental component and two expanded projects.

The fundamental component includes the following: (1) expanded compilation, analysis, and interpretation of OSH surveillance data from multiple data sources (i.e., developing new data sources, utilizing health informatics) to identify high-risk industries and occupations; (2) ongoing emergency response activities; (3) continued collaboration with a diverse range of local and state agencies and other organizations; (4) translation of findings from surveillance data analyses and case investigations into practical interventions, prevention strategies, and policy recommendations by presenting findings in a variety of formats using various communication channels; and (5) implementing an evaluation plan to determine the effectiveness and efficiency  of program activities and efforts. This state continues to collect analyze and interpret 23 of the occupational health indicators and develop the state employment profile, as well as continue to conduct surveillance and follow up/case investigation and review if needed for heavy metals (lead, arsenic, cadmium, mercury) and carbon monoxide exposures. Using workers’ compensation claims data, LA expands its efforts by exploring nonfatal work-related injuries in seafood processing and aquaculture industry workers, an industry that is heavily composed of foreign temporary workers. Other topics of interest for LA include the collection, exchange, and use of electronic health data, work-related COVID-19 and opioid-related incidence and fatalities, pesticide exposures, chronic conditions (e.g., cardiovascular disease and diabetes, etc.) and health risk factors (e.g., smoking, obesity, physical inactivity, and binge drinking, etc.) among LA workers, and inclusion of industry/occupation in the LA electronic case reporting forms in the Reportable Condition Knowledge Management System. LA identifies and develops two new occupational health data sources: a trauma registry data for work-related traumatic injuries and work-related motor-vehicle associated fatalities and injuries.

*Fatality Assessment and Control Evaluation Program (FACE)*Additionally, the first expanded project has five aims: (1) use pre-existing data sharing arrangements with key state sources to establish a state-wide, multisource work-related injury fatality system; (2) perform selected case-based investigations, using recommended procedures, for NIOSH FACE targeted cases including machine-related, foreign-born workers, energy production (oil and gas industry), and falls in the construction industry, along with state-level targets determined by surveillance data; (3) engage a network of agencies and organizations to develop and implement prevention strategies for work-related fatalities, with stakeholders that include employers, academia, labor organizations, trade associations, public health professionals, healthcare providers, and community-based organizations; (4) collaborate with partners to develop appropriate methods for communicating occupational safety and health messages to target audiences; and (5) routinely evaluate the LA Department of Health’s surveillance system in order to assess and improve their methods for case ascertainment, fatality investigations, outreach, and dissemination.

*Occupational Heat-Related Illness (HRI) Prevention Program*The second project has six aims. One includes expanding and maintaining a state-wide multi-source occupational HRI surveillance system of heat-related morbidity and mortality data and conducting case follow-back investigations to capture exposure and work-related information about worker activities, environmental conditions, risk factors, and health impacts. Current data sources to be used include emergency department inpatient hospitalizations and death certificates while new data sources will include emergency medical services, the Trauma Registry, and Syndromic Surveillance. The remaining five project aims include: (1) collaborating with local climate agencies and research centers to develop methods to access, analyze, and interpret climate data and integrate with health outcome data; (2) conducting and supporting innovative and novel data analysis projects that leverage surveillance data, subject matter expertise, and unique partnerships; (3) convening and facilitating education and training opportunities for target audiences including healthcare providers, employers, workers, and community members; (4) maintaining an active advisory committee and stakeholder engagement to promote surveillance findings and inform policies, recommendations, and practices that protect workers; and (5) developing and implementing an evaluation plan to determine the effectiveness and efficiency of their program, as well as utilize findings to make program adjustments and improvements.

**Institution:** Maryland Department of Health**Program Title:** Maryland Occupational Health and Safety Surveillance Project**Program Type:** Expanded Program

As an Expanded Program, the Maryland (MD) Occupational Health and Safety Surveillance Program provides data, technical assistance, education, and outreach and collaborates with other entities in the state to improve worker health and safety in Maryland. Their Fundamental component has four aims, which include advancing occupational epidemiology public health research in occupational health through continued analysis and reporting on the 21 occupational health indicators from existing sources of data and expansion of data sources. This will also include creation of a state employment profile and collection and investigation of elevated blood lead in adults and working with the MD Department of the Environment for follow-up of elevated blood lead levels in adults and with the MD Children’s Health Insurance Program for follow-up in children in cases that may be due to secondary occupational exposures. Other program aims include: (1) broadening the utility of other state surveillance systems by the inclusion of industry and occupation in the Maryland Violent Death Reporting System (homicides and suicides related to occupation), the State Unintentional Drug Overdose Reporting System or SUDORS (improving management of opioids in the workplace), the Maryland Behavioral Risk Factor Surveillance System (BRFSS) to identify industries and occupations that can be prioritized for interventions based on state priorities for specific health outcomes (i.e., diabetes, opioid use, and asthma), and the National Electronic Disease Surveillance System and/or electronic health records; (2) utilizing data and input from their Technical Advisory Group to inform prevention activities in Maryland and external stakeholders through increased outreach and prevention activities; and (3) providing focus on improvement of asthma in migrant teenage workers through an innovative collaboration with local health departments, employers, and healthcare providers, focused on the worker’s total environment.

*Opioids in the Workplace Surveillance Project*This program’s one expanded project builds upon work from the previous project periods to address the state’s opioid crisis as it occurs in Maryland workplaces. There are four aims for this expanded project. Aim 1 seeks to improve surveillance of opioids in the workplace through the BRFSS, SUDORS, and the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (“ESSENCE”) by collecting industry/occupation data systematically in the BRFSS and SUDORS and exploring methods to improve information about workplace and opioid-related emergency department visits in the ESSENCE system. The additional three project aims include: (1) develop toolkits on improving opioids management in Maryland workplaces; (2) recruit employers and workplaces in which to implement and disseminate toolkits to improve opioids management in Maryland workplaces by engaging their Technical Advisory Group and with Healthiest Maryland businesses (MD’s statewide worksite wellness initiative comprised of 500+ employers); and (3) evaluate the effectiveness of the toolkits in altering policies and practices, shifting resources, and improving outcomes for individuals with substance use disorders who are in or entering the workplace.

**Institution:** Massachusetts Department of Public Health**Program Title:** Expanded Occupational Health Surveillance in Massachusetts**Program Type:** Expanded Program

The Massachusetts (MA) Occupational Health Surveillance Program (OHSP) has worked for over 30 years with partners within and outside the Massachusetts Department of Public Health (MDPH) to make workplaces safer for MA workers. The overarching aim of this Expanded Program is to reduce the incidence and severity of work-related injuries and illnesses and improve worker health in MA. The program seeks to enhance its internal coordination on cross-cutting and complex initiatives and expand collaboration with its public health partners to promote integration of occupational health into the work of other public health programs. The MA program also builds upon its commitment to workers who are underserved by using a health and racial equity framework, that aligns with the MDPH Bureau of Community Health and Prevention’s and MDPH’s priorities to guide its work. The program also plans to expand its ability to use electronic health records and other data sources and tools to increase the availability, timeliness, and accessibility of surveillance data. MA also maintains a strong network of partners who can use their data for action. This Expanded Program has a fundamental component and three expanded projects: 1) Occupational Respiratory Disease Surveillance, 2) Fatality Assessment and Control Evaluation (FACE), and 3) Healthcare Workers Project.

The fundamental component has seven aims: (1) generate 30 occupational health indicators (OHIs), with 5 being MA-specific OHIs, and the state demographic employment profile annually to track the occupational status of the MA population and disseminate findings; (2) use existing state data sources and explore using new data sources to characterize work-related injuries and illnesses and enhance surveillance capacity and disseminate findings; (3) continue case-based surveillance and referral of select serious occupational health conditions that require immediate public health response and selected young worker injuries to assure that hazards are controlled; (4) collaborate with other public health programs to foster integration of occupational health surveillance into ongoing public health activities at the state and local levels; (5) continue and enhance working relationships with partners to obtain input on program priorities, increase surveillance capacity, and promote use of surveillance findings to improve worker safety and health; (6) promote regional collaboration to enhance state capacity to conduct occupational health surveillance and prevention activities; and (7) conduct annual intervention and communication activities for adults with an elevated blood lead reported through the MA Occupational Lead Poisoning Registry to reduce occupational exposures to lead. MA also promotes collaboration among the Northeastern states to enhance state capacity to conduct occupational health surveillance and prevention activities. OHSP also co-hosts the annual Northeast Regional Occupational Health Surveillance Meeting, also known as “NEON”, which is a 28-year long collaboration that promotes regional collaboration to enhance state surveillance capacity by sharing surveillance information, prevention strategies, methodologies, and materials to maximize the use of surveillance and intervention resources.

While OHSP works to ensure worker protections for all MA workers, some groups face greater risk for work-related illnesses and injuries due to their occupations, industries, and demographic factors such as race, age, or gender. OHSP has selected the following worker groups for priority attention: workers of color and foreign-born workers, teens and young adult workers including those workers in temporary employment agencies, hospital workers and workers in long-term care facilities, workers who are exposed to cleaners and disinfectants, workers employed in tree service landscaping, as well as gig workers and the self-employed.

*Occupational Respiratory Disease Surveillance*The first expanded project has five aims: (1) case ascertainment including continuing to focus on work-related asthma (WRA) and expand to other priority work-related respiratory diseases (WRRDs) – inhalation injuries due to chemicals, chronic obstructive pulmonary disease exacerbations, and silicosis; (2) case follow up which includes conducting timely follow up of WRA and initiating follow up of other priority WRRDs to characterize cases and target worksite interventions; (3) data analysis and communication of findings which includes analyzing sentinel and population-based surveillance data on asthma and other respiratory disease, including COVID-19, and communication of findings to increase awareness of WRRDs and inform intervention; (4) intervention which includes conducting intervention and prevention activities to reduce the risk of WRA and other WRRDs in targeted workplaces, industries, and in worker populations that are underserved; and (5) collaboration which includes partnering with government and community stakeholders at the local, state, regional, and national levels to promote WRRDs surveillance and intervention.

*FACE Project*The second expanded project has five aims: (1) surveillance which includes continuing to enhance the current surveillance system for timely identification and collection of data on all fatal occupational injuries to identify high-risk workplaces and populations, as well as high priority events in MA; (2) FACE investigations which include conducting a minimum of nine investigations of priority fatalities per year, using FACE investigative methods to identify risk factors and developing recommended countermeasures to control or eliminate identified hazards; (3) communication and translation which include communicating information on hazardous work environments and recommending injury prevention measures to those who can intervene in MA workplaces; (4) focused prevention which includes planning, conducting, and fostering prevention and intervention activities focused on priority industries, groups of workers, and hazards to reduce the incidence of fatal occupational injuries in MA; and (5) collaboration which includes collaborating with government and community partners at the local, state, regional, and national levels to promote fatal occupational injury surveillance and prevention.

OHSP FACE investigation priorities include falls in construction, machine-related events including robotics, public sector including law enforcement motor vehicle events, workers performing tasks on roadways, chemical-related deaths, workplace suicides and overdoses, green energy, work-related asthma deaths, and fatalities related to powered industrial trucks and warehousing, tow trucks, and waste collection. Higher-risk workforce priorities for OHSP include immigrant workers less than 25 years of age, temporary workers, tree and landscaping workers, self-employed workers, gig workers, day laborers, and commercial fishing.

*Healthcare Workers Project – Surveillance and Prevention of Work-related Conditions*This last expanded project focuses on reducing and eliminating sharps injuries, musculoskeletal disorders related to patient handling and mobilization, and infectious disease in healthcare workers, which is the largest industry sector in MA. This project has five aims which include: (1) continuing to collect case level de-identified data on sharps injuries among hospital workers from all MDPH licensed hospitals annually, enhance data collection methods, and assess underreporting of sharps injuries among hospital workers; (2) continuing to use administrative data sets to characterize musculoskeletal disorders related to patient handling and mobilization among healthcare workers in MA, and communicate findings to partners; (3) providing guidance to and fostering information sharing among healthcare facilities, healthcare workers, and others regarding successful approaches to surveillance and prevention of sharps and injuries and patient handling and mobilization related to musculoskeletal disorders; (4) exploring the use of MDPH infectious disease data to describe the distribution of certain infectious diseases among healthcare workers by occupation; and (5) continuing collaboration with partners in the healthcare industry and internal MDPH partners to promote the use of data to prevent sharps injuries and patient handling and mobilization related to musculoskeletal disorders and extend this collaboration to address infectious diseases.

**Institution:** Michigan State University **Program Title:** Expanded Program in Occupational Injury and Illness Surveillance**Program Type:** Expanded Program

Michigan State University, in conjunction with the Michigan Occupational Safety and Health Administration (MIOSHA) and the Michigan Department of Health and Human Services, has been conducting state-based occupational injury and illness surveillance since 1988. This program continues and expands occupational injury and illness surveillance and addresses all three-core functions in public health through the collection and analysis of data, building partnerships to promote the goal of tracking, and using the data to prevent occupational injuries and illnesses. The program uses a variety of strategies to ensure that surveillance data are of high quality and that stakeholders and the public are aware and have access to the data, and that the data drive prevention activities. The overall goal of Michigan’s Expanded Occupational Injury and Illness Surveillance Program is the reduction of occupational injuries and illnesses. This Expanded Program consists of a fundamental component and three expanded projects: 1) Occupational Lung Disease, 2) Occupational Pesticide Injuries and Illness, and 3) Fatality Assessment and Control Evaluation (FACE). The five overall aims in this program are: (1) compile and disseminate data on magnitude and trends in occupational illnesses and injuries in Michigan using 25 occupational health indicators (OHIs) and promote and evaluate the impact of Michigan’s OHIs on the generation of prevention and intervention activities; (2) conduct laboratory-based surveillance for elevated blood lead and conduct, promote and evaluate follow-up interventions to eliminate exposures in worksites; (3) conduct multisource surveillance with case follow-back for selected work-related injuries and for blood and urine test results for arsenic, mercury and cadmium; (4) develop and expand new and emerging electronic data sources and data linkages for occupational health surveillance; and (5) conduct case-based surveillance for three NIOSH “legacy” programs focused on occupational lung disease, pesticides, and work-related fatalities.

This program is expanding its educational outreach and addressing the hazards of worker populations that have been marginalized and racial and ethnic minority groups, as well as temporary workers and youth follow back. The program is also expanding surveillance to include exposure surveillance, additional nonfatal traumatic injuries, projects on underreporting, evaluation of MIOSHA inspections for following up reported cases, and projects on special populations and industrial sectors.

*Occupational Lung Disease (OLD) Surveillance*The first expanded project has the overall goal of reducing the occurrence and burden of occupational lung disease (OLD), including work-related asthma (WRA) and silicosis, and identifies emerging work-related lung diseases. This project has four aims: (1) continue and expand surveillance for occupational lung disease through the collection, analysis and dissemination of data on occupational lung disease in Michigan; (2) continue and expand ongoing enforcement and consultative industrial hygiene activity for occupational allergens and respiratory hazards to prevent additional OLD in Michigan; (3) continue to develop, disseminate, and expand educational materials on occupational disease (OD) reporting and OLD; and (4) continue and expand on occupational health surveillance collaborative activities within Michigan, among surveillance states, and with NIOSH (i.e., work with states and NIOSH to compile and share information on emerging issues and explore new partnerships and collaborations with stakeholders, such as unions and other groups that represent professional affiliations).

Based on their more than 30 years of surveillance data on the burden of WRA, silicosis and other OLD, the Michigan surveillance program staff is conducting three subprojects under the OLD Surveillance project: 1) underreporting and under-recognition of OLD, 2) changing and emerging industries and exposures associated with OLD, and 3) the burden of OLD among populations that have been marginalized and are underserved (i.e., temporary employees and working youth). This project conducts multisource case-based surveillance (including case reporting and case confirmation) and data compilation and dissemination through a variety of media, and links the lessons learned to prevention and intervention activities to reduce the burden of injury and illness among Michigan workers. The project also shares current trends and useful data findings along with recommendations to allow companies and their employees and other stakeholders such as healthcare providers, unions, and safety and health professionals to take actions to improve the safety and health in the workforce, which continues to be a priority.

*Occupational Pesticide Illness*The second expanded project has the overall goal of reducing the occurrence and burden of acute or short-term, work-related pesticide illnesses and injuries. This project has three aims: (1) collect, analyze, and disseminate data on acute, work-related pesticide illnesses and injuries in Michigan; (2) prioritize and expand ongoing compliance, consultative, and educational activities to prevent and reduce work-related pesticide exposure in Michigan, in collaboration with partner agencies and stakeholders; and (3) support the NIOSH vision of a comprehensive nationwide occupational health surveillance system through integration of acute, work-related pesticide illness and injury surveillance and prevention into occupational health surveillance within Michigan, among states, and with NIOSH.

*Acute Traumatic Work-Related Fatalities*This third expanded project conducts in-depth investigations of the following: (1) fatal incidents that are either targeted nationally by NIOSH or are of special significance to Michigan (i.e., agriculture, homicides, and suicides); (2) construction, which has the highest number of fatalities overall; and (3) industries and individual circumstances not covered by MIOSHA (e.g., self-employed, etc.). The project conducts approximately 10 on-site investigation reports per year. Based on the NIOSH FACE model, these reports of on-site investigations continue to include recommendations that identify prevention strategies for mitigating or preventing the frequency and severity of incidents and reducing the risk of fatal incidents at that employer and others in the same or similar industries. This project has four aims: (1) continue to identify work situations in Michigan at increased risk for work-related fatal injuries; (2) continue to identify the underlying causes of work-related fatal injuries in Michigan; (3) continue to formulate and disseminate prevention strategies to reduce work-related fatal injuries; and (4) continue collaborative activities among the states with funded FACE programs and NIOSH. The Michigan FACE program has been active in providing leadership for an annual state surveillance meeting held with other NIOSH-funded state surveillance programs, NIOSH, the Council of State and Territorial Epidemiologists and other persons or groups who have an interest or concern in surveillance. The program also trains new FACE investigators in other states and disseminates educational materials developed by NIOSH and other FACE states and targets investigation of fatalities jointly agreed upon by the states and NIOSH. The Michigan FACE collaborates with other FACE programs to integrate data for special projects, including trends and factors in fatalities involving stone slab manufacturing, warehousing, and transportation. On-site investigation reports, other reports, and educational materials are routinely disseminated to those involved in the fatal injuries, including families of the deceased, employers, worker representatives, police, and medical examiners. The project also disseminates materials widely to trade associations, employers who perform similar work or have similar hazard potential, unions, advocacy groups and industry representatives, as appropriate. For each on-site investigation report, a dissemination plan is developed. The project also identifies additional outreach activities specific to the fatality for each death investigated.

**Institution:** Minnesota Department of Health**Program Title:** Minnesota Occupational Health and Safety Surveillance Program**Program Type:** Fundamental-Plus Program

The Minnesota (MN) Fundamental-Plus Program promotes occupational health and safety through surveillance of a core set of occupational health indicators (OHIs) and dissemination of the findings to appropriate stakeholders for use in setting priorities for education and prevention activities. This program expands the use of industry and occupation reporting in established datasets and explores new sources of data to include previously underserved worker populations in surveillance of occupational health and safety.

This program aims to: (1) collect, analyze, disseminate, and utilize MN data for 24 OHIs and create a state employment profile; (2) collaborate with the MN Department of Health Lead and Healthy Homes Program to participate in the Adult Blood Lead Epidemiology and Surveillance program; (3) advance the inclusion and use of industry and occupation information in health informatics; (4) disseminate surveillance findings to appropriate audiences; (5) build and maintain collaborations and partnerships to improve state surveillance activities; (6) develop and use new data sources to address worker populations that are underserved, including agricultural workers, gig workers, and salon workers; (7) evaluate the MN Occupational Health and Safety Surveillance Program using CDC guidelines to continuously improve the program; (8) assess COVID-19 outcomes and experience by industry and occupation sector by comparing risk of infection, comparing case outcomes (symptoms, hospitalization, and mortality), measuring and comparing the rate of COVID-19 workers’ compensation by claims, and studying the impact of COVID-19 safety measures and business closures by comparing the timeline of business sector closures, remote work status, and implementation of safety measures with COVID-19 case rates by business sector; and (9) measure the impact of statewide agricultural safety policies and rural mental health interventions by developing indicators of farm-related injuries that can be consistently tracked using health datasets to measure general farm injuries, tractor rollover injuries, and grain bin injuries and by developing indicators of mental health status in farmers and the agricultural community that can be tracked using health datasets to measure the impact of suicide prevention efforts.

The two Fundamental-Plus projects under this program relate to aims 8 and 9 and focus on COVID-19 outcomes by industry and occupation sector and the impact of agricultural safety policies and rural mental health interventions across Minnesota.

**Institution:**Montana Department of Labor & Industry**Program Title:** Montana Occupational Health and Safety Surveillance Program**Program Type:** Fundamental-Plus Program

The Montana (MT) Fundamental-Plus Program has the major goal of increasing the capacity and quality of occupational surveillance in the state by adding occupational data collection to other surveillance systems, linking existing sources (e.g., workers’ compensation, etc.), and creating new data through surveys of special projects. In addition to collecting data for reporting 20 of the occupational health indicators (OHIs) to NIOSH annually, the program also creates a state employment profile. Existing datasets include MT Department of Labor and Industry data, the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior Surveillance System, and blood lead concentrations and infectious disease surveillance data. Through the OHIs collected on an annual basis, this program analyzes trends and uses the OHIs to monitor MT’s occupational safety and health landscape, reveal areas in need of more in-depth surveillance, and guide prevention efforts. To improve the quantity and quality of occupational health data collected and used for surveillance and explore new data sources, MT collaborates with other agencies and bureaus within the state to take advantage of the large variety of surveillance systems already in place. These include the MT Department of Public Health and Human Services, MT Department of Transportation, MT Department of Environmental Quality, MT university system, and other outside organizations. These collaborations allow for research on emerging issues such as COVID-19 and new occupational safety and health topics like *Total Worker Health*®.

The program includes two Fundamental-Plus projects – one focused on COVID-19 surveillance and the other on the collection of *Total Worker Health (TWH)* data with a focus on mental health. The aims of the COVID-19 surveillance project are the following: (1) develop a surveillance system for workplace-related COVID-19 using data from workers’ compensation, communicable disease, and any other relevant sources; (2) create guidance documents for workers and employers on safe workplace procedures to reduce COVID-19 transmission and reduce injuries from changes in the workplace; and (3) inform workplace policies and legislation for reducing the spread of communicable diseases. The aims of the TWH project are the following: (1) increase collaboration with MT’s Worksite Wellness Program; (2) study mental health and suicides in MT by industry, occupation, and other workplace factors; and (3) develop strong ties with the TWH Community throughout the country.

**Institution:** Nebraska Department of Health and Human Services**Program Title:** Nebraska Occupational Safety and Health Surveillance Program**Program Type:** Expanded Program

This Expanded Program in Nebraska monitors the status of worker health and safety, tracks injury and illness trends, identifies priorities for prevention strategies, reaches worker populations, and evaluates interventions. This Program will have a fundamental component and one expanded project. For the fundamental component, one program aim includes collecting, analyzing, and interpreting injury and illness burden and trends using existing state-based data sources. As part of Aim 1, Nebraska continues annual analysis of 16 occupational health indicators (OHI) and compiles a state employment profile. In each of the five years, the program conducts a “deeper dive” analysis on at least one new OHI each year, as well as collects, analyzes and interprets data pertaining to issues that impact priority injuries/illnesses, special working populations (e.g., racial, and ethnic minority groups, youth workers, older workers, etc.), and workers in high-risk industries and occupations (e.g., meatpacking, etc.) in 10 state databases (e.g., cancer registry, trauma registry, and worker compensation claims, etc.). Geographic information systems will also be used to produce maps that will highlight this local level data. Nebraska is also planning to promote the inclusion and use of industry and occupational variables in additional systems, such as syndromic surveillance, infectious disease, trauma registry, BRFSS (CDC Behavioral Risk Factor Surveillance System), EMS (emergency medical services) data, Parkinson’s Disease registry, and others as needed. Other program aims include: (1) conducting surveillance and investigation for adults with elevated blood lead levels; (2) developing and disseminating surveillance data, findings, reports, presentations, factsheets, prevention recommendations, and best practices to workers, program partners and the occupational health community; (3) building and maintaining partnerships and collaborations with state and federal agencies, local public health departments, non-profit organizations, and other health and safety stakeholders to integrate occupational health into mainstream public health; and (4) enhancing and expanding occupational health surveillance through using health informatics.

*Health Informatics – Infectious Disease and Poisonings*This expanded project has the following aims: (1) collect, analyze, and report on occupational data involving poisonings and infectious diseases, including COVID-19 cases and vaccinations; (2) participate in informatics and electronic case reporting initiatives which include participating in pilot testing of message mapping guides in collaboration with the state and CDC, and participating in the Reportable Conditions Knowledge Management System and trigger codes development; and (3) enhance occupational health surveillance using syndromic surveillance data by developing syndrome definitions for occupational-related patient encounters and conditions and by developing reports and dashboards.

**Institution:** University of New Hampshire**Program Title:** Expansion of the New Hampshire Occupational Health Surveillance Program**Program Type:** Expanded Program

This Expanded Program aims to increase the state-based capacity for occupational health surveillance in New Hampshire (NH) through in-depth analysis with the goal of the following:  (1) assessing the extent and severity of workplace injuries, illnesses, disabilities, fatalities, hazards and exposures; (2) addressing state and NIOSH program priorities for follow-up activities, including more in-depth surveillance and outreach, prevention, and intervention focused on adult lead surveillance, opioid overdose and suicide mortality surveillance, infectious disease health informatics, and productive aging and work; (3) expanding surveillance activities to include analysis of unconventional data sources from other agencies and organizations, including commercial motor vehicle crash data and U.S. Department of Labor first reports of injury; (4) identifying workers and occupations at greatest risk through data collection of industry, occupation, and work status in the Behavioral Risk Factor Surveillance System, death data, cancer incidence data, Youth Risk Behavior Survey, occupational poisoning data, and asthma surveillance; (5) developing partnerships with public health and non-public health organizations to assist in developing recommendations for workplace interventions and policies, including the NH area Occupational Safety and Health Administration office, NH nonprofits and the NH Health Department focused on prevention of substance use disorders and suicides in the workplace and lactation support programs for breastfeeding mothers returning to work; and (6) expanding methodologies and capacity for expanded occupational health surveillance, including the development of a core disability demographic profile and indicators. For Aim 1 identified above, the program staff collects, analyzes, and interprets 15 occupational health indicators annually, utilizes all data sources to determine priority areas in the state for prevention, and generates a state employment profile.

*Employment Demographic Profile Resources for Workers with Disabilities*For the one expanded project under this program, there are three aims: (1) further investigate the precariousness and work arrangements of workers with disabilities, in comparison to other worker populations that have been marginalized based on gender, race (White persons, Black or African American persons, and Asian persons), and ethnicity (Hispanic or Latino persons); (2) support the use of national, regional, and state employment demographic profiles of workers with disabilities by creating and distributing national, regional, and state employment demographic profiles of workers with disabilities; and (3) support the use of national, regional, and state employment demographic profiles of workers with disabilities. Under Aim 3, the program will create an annual infographic depicting the employment demographic profile for workers with disabilities, both nationally and for each Census region and state, so that other NIOSH-funded grantees may use the infographic for their given areas. The program will also create a corresponding presentation, using the national profile, that describes the profile and the importance of considering the occupational safety and health of workers with disabilities.  One goal is for state programs and employers to use these data for the design of training materials, workplace accommodations, and alternative work arrangements that meet the needs of workers with disabilities related to occupational safety risks. Through this project, the University of New Hampshire hopes that NIOSH and its grantees will join federal efforts to improve employment opportunities of people with disabilities.

**Institution:** New Jersey Department of Health**Program Title:** New Jersey Occupational Health Surveillance**Program Type:** Fundamental-Plus Program

Since 1985, the New Jersey (NJ) Department of Health (NJDOH) has conducted OSH surveillance to estimate and characterize the burden of specific work-related injuries and illnesses and compare rates to national estimates and evaluate trends over time in order to protect NJ workers. In this Fundamental-Plus Program, the NJDOH Occupational Health Surveillance (OSH) Unit enhances and evaluates its surveillance system to expand data collection, prevention, and intervention activities. The specific aims of the program’s fundamental component are to: (1) maintain and analyze data collected for 23 specified occupational health indicators (OHIs); create a state employment profile, and conduct an education and outreach effort focused on reducing exposure to asbestos; (2) analyze specified OHIs to characterize occupational health injuries and illnesses among populations that have been marginalized to formulate strategies for interventions, including a specific project focused on youth injuries and a general focus on worker populations that have been marginalized such as essential critical infrastructure workers; and (3) maintain data collection of adult blood lead and other heavy metals and conduct surveillance of exposed individuals to identify at-risk workplaces for further targeted interventions, such as education and outreach and referral to regulatory authorities. Through this program, the NJDOH is enhancing existing relationships with Rutgers University, the regional NIOSH Education and Research Center, the NJ Poison Control Center, and other key partners within NJDOH, including the Public Employee Occupational Safety and Health program and the Communicable Disease Service. These continued collaborations with current partners and potential new partners and stakeholders will improve future response efforts to work-related injuries and illnesses in the state.

The NJDOH OHS Unit has two fundamental plus projects to enhance occupational health surveillance by using and evaluating new data sources and translating real-time data to public health action. During the current funding cycle, the NJDOH OHS will develop a framework for occupational health surveillance of emergent infectious diseases by including workplace variables in non-traditional datasets to improve surveillance and mitigate workplace transmission of COVID-19 in the current pandemic. The NJDOH OHS Unit will conduct trainings for the collection of industry and occupation information in these nontraditional surveillance systems, including communicable diseases, contact tracing, and poison control inquiries.

For the first Fundamental-Plus Project, the NJDOH OHS promotes inclusion and analysis of industry and occupation variables in nontraditional data sources, through existing and new partnerships to enhance surveillance of emergent diseases and hazards. The objectives of this project are the following: (1) conduct retrospective analyses of COVID-19 data in the Communicable Disease Reporting Surveillance System (CDRSS) to evaluate the system’s ability to capture workplace information during an emerging infectious disease outbreak with gaps in the data being noted; (2) collaborate with the NJDOH infectious disease partners to promote and assess inclusion of industry and occupation variables in current state data collection systems; (3) conduct training for the collection of industry and occupational data in unique surveillance systems not traditionally used for occupational health, including CDRSS, contact tracing, and poison control inquiries with data gaps being noted; (4) summarize workplace COVID-19 outbreaks identified through public health investigations in public and private facilities and report to policy makers on populations that have been marginalized and worksites; and (5) implement surveillance using the COVID-19 workplace violation complaint database mandated by the governor’s Executive Order 192 to identify and characterize occupations and industries with possible compliance deficiencies.

The second project aims to enhance the EpiCenter syndromic surveillance system as a real-time surveillance system for work-related nonfatal injuries and poisonings. This project has three objectives: (1) expand the EpiCenter syndromic surveillance system to create fields to capture workplace information that is being sent by NJ emergency departments; (2) use EpiCenter and the poison control center work-related poisonings real-time surveillance systems to develop public health prevention strategies; and (3) evaluate the ability of the poison control center work-related poisonings real-time surveillance system (New Jersey Poison Information and Education System) to identify occupational poisonings among NJ workers by comparing the cases identified through this mechanism with the traditional hospitalization and emergency department discharge data.

**Institution:** New Mexico Department of Health**Program Title:** New Mexico Occupational Health Surveillance Program**Program Type:** Fundamental-Plus Program

The New Mexico (NM) Occupational Health Surveillance Program (NMOHSP) has been in existence for over 17 years. This Fundamental-Plus Program continues its activities with a specific focus on standardizing protocols and providing clear documentation and planning that allows the program to increase capacity and effectiveness with careful planning, organization, and evaluation. The program has four aims: (1) evaluate and inventory current data and data access and develop guidance documents to streamline data collection and analysis; (2) develop specific case investigation protocols and report forms to standardize data collection and intervention policies; (3) improve data dissemination and utility of NMOHSP data for education and prevention; and (4) generate and implement a long-term outreach plan to prioritize and target partnership and education in efficient and meaningful ways. The NMOHSP also maintains and analyzes data collected for 21 specified occupational health indicators and creates a state employment profile. NM’s Healthy Homes and Lead Poisoning Surveillance System notifies the program about elevated adult blood lead so program staff can report them to the NIOSH Adult Blood Lead Epidemiology and Surveillance Program and conduct case investigations and follow up as needed for further targeted interventions. Program staff evaluates how many occupational health clinics in the state use electronic case reporting and then focuses efforts to encourage reporting on occupational injuries and illnesses. The NMOHSP will also make a targeted effort over the next 5 years towards creating successful and beneficial partnerships with sovereign indigenous nations within New Mexico and will work with NM’s Office of the Tribal Liaison to create a culturally sensitive plan for occupational health surveillance and intervention work with New Mexico’s Pueblos, Tribes, and Navajo Nation. NM is the location of 19 recognized Pueblos, 3 Apache Tribes, and a portion of the Navajo Nation; each Pueblo, Tribe, Nation, and Band has its own government, traditions, and culture. The NMOHSP also plans to revitalize the Advisory Committee which is made up of representatives from organizations involved in worker health and safety, such as NM Occupational Safety and Health Administration (OSHA), the Mining Safety and Health Administration, NM Poison and Drug Information Center, and the NM Tumor Registry. The program will strengthen existing partnerships to obtain data on drug overdoses and acts of violence in the workplace, and other partnerships will be reestablished with the NM Department of Transportation and NM Department of Public Safety to obtain data on road deaths and injuries.

For the first fundamental-plus project under this program, NM has three aims: (1) identify industries and occupations with substantial burden of COVID-19 in the state of New Mexico; (2) evaluate the outcomes of COVID-19 cases within industries/occupations to identify any worker populations disproportionately represented among poor outcomes such as hospitalization, need for mechanical ventilation, and death; and (3) generate and disseminate a report detailing the industry and occupation characteristics of employed COVID-19 cases in New Mexico and illness outcomes. In close partnership with NM OSHA, this report will be used to develop industry and occupational specific guidance on the prevention of respiratory infectious disease spread in the workplace.

For the second project, NM also has three aims: (1) generate broadly applicable recommendations for prevention of infectious disease spread in the workplace with clear guidance for policy makers, regulators, employers, and employees; (2) create a series of publicly available digital tool kits tailored to specific industries and/or occupations to aid regulators and employers in preventing, interrupting, and learning from infectious disease outbreaks in the workplace; and (3) evaluate the number and nature of complaints filed with NM OSHA related to infectious disease spread to determine effectiveness of the tool kits and revise as needed.

**Institution:** Health Research, Inc. (New York State)**Program Title:** Occupational Safety and Health Surveillance in New York State (NYS)**Program Type:** Expanded Program

Housed within the NYS Department of Health, Bureau of Occupational Health and Injury Prevention, this program, expands and improves upon its current Expanded Program, with a fundamental component and one expanded project.  Recognizing that many occupational hazards and adverse health outcomes overlap with other public health programs, the Occupational Safety and Health Surveillance in NYS Program plans to continue to incorporate data into other public health tracking systems and explore potential opportunities to get industry and occupational variables included in their infectious disease surveillance databases. The program evaluates data to identify high-risk industries and occupations and populations at high-risk and directs prevention strategies and dissemination of information towards these populations. As part of the fundamental component, the program has seven aims: (1) address all aspects of worker health to improve the culture of worker health and safety by integrating occupational health into public health practice; (2) identify relevant priority areas for surveillance in NYS and raise awareness of worker health and safety in NYS by utilizing the NYS Occupational Health Clinic Network and its advisory boards to develop multidisciplinary partnerships and expand dissemination of surveillance information; (3) develop and disseminate materials that will increase both awareness and prevention strategies for occupational diseases and injuries among workers, employers, and healthcare providers in NYS; (4) collect, analyze, disseminate 24 occupational health indicators and create the state demographic employment profile; (5) identify, evaluate, and analyze occupational health data available in NYS as identified through surveillance data to determine the magnitude and distribution of occupational injuries and illnesses and identify high-risk and disparate worker populations; (6) collect data on all adult blood lead levels through the NYS Department of Health Heavy Metals Registry and submit information to NIOSH’s Adult Blood Lead Epidemiology and Surveillance program, as well as review elevated blood lead level data and follow back, monitor and use cases with high levels for worksite investigations and intervention activities; and (7) continue the pregnant women collaborative program with the NYS Childhood Lead Program and county health departments to ensure timely identification of lead poisoned pregnant women and follow-up of their at-risk newborn babies.

*NYS Fatality Assessment and Control Evaluation (FACE) Program*For the first expanded project in this program, the Occupational Safety and Health Surveillance in NYS has the goal of reducing the occurrence of work-related, non-fatal and fatal injuries by establishing a strong workplace safety culture through changing the knowledge, attitudes, and behaviors of individuals within the NYS working community. The FACE Program targets fatal injuries among self-employed workers, older workers (>65 years of age), Hispanic or Latino workers, agricultural workers, and construction workers. The program has five aims: (1) conduct active surveillance to collect accurate and complete workplace fatal injury data to lay a foundation for intervention; (2) investigate work-related deaths with the NIOSH and NYS Department of Health, Bureau of Occupational Health and Injury Prevention targets to identify etiology and prevention measures; (3) transform research findings into practical intervention products through developing new products and adopting existing products; (4) disseminate intervention products to NYS working populations and promote adaptation and implementation through collaboration with multiple partners; and (5) conduct priority intervention projects to target fatal injuries involving young Amish and Mennonite family-farm workers and solid waste collection workers, with a focus on the cases associated with victims using the side riding steps on garbage trucks.

**Institution:** North Carolina Department of Health and Human Services**Program Title:** North Carolina Occupational Health and Safety Surveillance Program**Program Type:** Fundamental Program

The North Carolina (NC) Occupational Health and Safety Surveillance Program maintains and enhances current occupational health surveillance capacity by identifying and addressing emergent public health issues in the state and promoting employment and work-related exposure information. The program also addresses gaps in NC occupational health surveillance capacity and aims to reduce the disproportionate burden from workplace injury and illness for worker populations that have been marginalized through leveraging more comprehensive, collaborative partnerships and resources for workplace interventions and policy changes.

NC is the ninth largest state in the country and has experienced an 11.5% population growth from 2010 to 2020, with another 11.3% growth projected for the next 10 years. A major factor contributing to this growth is a marked increase of migration from other states or from outside the United States.  Migration presents unique safety and health challenges as many workers born outside the state or country may be unaware of local laws or received little training in their native language regarding worker safety and health and protection. Manufacturing remains one of the top three employers in the state, and 5 of the 10 largest private manufacturing employers in NC are swine and poultry product processing plants, with meat processing facilities having some of the highest rates of occupational injuries and illness of any manufacturing sector. NC has a robust agricultural economy, ranking first in the nation for production of tobacco, and second for hogs/pigs, cut Christmas trees, and poultry/eggs. These industries expose workers to risks such as traumatic and/or fatal injuries from farm equipment or machinery, pesticide exposures, and puts outdoor workers (e.g., farm workers, etc.) at risk for heat-related injury and illness.

This Fundamental Program has three aims: (1) monitor state occupational health through integrated public health surveillance and use established surveillance systems to report trends in work-related injuries, illnesses, and fatalities which includes collecting, analyzing, and interpreting occupational health surveillance data for 19 Occupational Health Indicators, creating the state employment profile, and reporting summarized results annually to NIOSH; (2) deploy an occupational health consultation team to protect NC’s workforce from existing and emerging threats to worker health and safety, including COVID-19 transmission and workplace exposures identified as state priorities such as lead, pesticides, carbon monoxide, and opioids; and (3) promote occupational health policy and program development through enhanced partnerships.

The program also maintains data collection of adult blood lead and conducts surveillance of exposed individuals to identify at-risk workplaces for further targeted interventions. Additional priorities for the state include using additional occupational surveillance data sources to investigate: 1) the aging workforce and contingent workforce (people who do not expect their jobs to last or report their jobs are temporary and tend to be concentrated in high-risk industry sectors, such as manufacturing and warehousing), 2) farmworker injuries, 3) climate change, and 4) employment patterns for migrant farmworkers related to heat-related illness and death and occupational COVID-19 surveillance. NC promotes the inclusion of employment and work-related exposure information into additional data sources for priorities such as traumatic work-related injury surveillance (e.g., heat-related illness, and injuries caused by tractors, farm equipment, or farm machinery, etc.), transportation-related injury surveillance, and use of workers’ compensation data to investigate trends.

**Institution:** Oregon Health & Science University**Program Title:** Improving Occupational Health in Oregon: Turning Data to Action**Program Type:** Expanded Program

With continuous funding from NIOSH since 1992, the Oregon (OR) Occupational Public Health Program (OPHP) has developed robust surveillance systems and effective partnerships with stakeholders in occupation health for impactful education and outreach to safety professionals who can take actions to promote workplace health and save lives. Since 2002, this Expanded Program has operated as a unique university-government collaboration between the Oregon Health & Science University (OHSU), Oregon Institute of Occupational Health Sciences and the Oregon Health Authority (OHA).

Building upon past accomplishments, this Expanded Program continues in the current funding cycle with its fundamental component and one expanded project, which is the Oregon Fatality Assessment Control & Evaluation (OR-FACE) Project. The fundamental component has four aims which are: (1) maintaining and improving fundamental occupational surveillance systems through occupational health indicator (OHI) activities including the analysis of data collected for 25 OHIs and the creation of the state employment profile; (2) investigating emerging issues, occupational illnesses and injuries; (3) placing worker populations that have been marginalized and underserved at the center of occupational health surveillance; and (4) promoting collaboration, communications, workforce development and translation of science into action. For this final aim, the program develops and implements a comprehensive communications plan, and its Steering Team meets monthly to drive program projects and priorities. Additionally, the OPHP Advisory Committee meets twice annually to advise on projects and coordinate and discuss state-level initiates and policies. The program continues to support training of future occupational health professionals through graduate student field placements which will result in nearly 900 hours of “person power” on surveillance projects, and the program supports the OR Healthy Workforce Center – a NIOSH-funded Center of Excellence for Total*Worker Health®* – by providing data for populations in new center research projects.

Through its fundamental component, OPHP continues to bring new databases and information systems into use and improves linkage and utility of these databases. For instance, OPHP continues to innovatively tap Oregon- Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE), which provides near real-time data from the state’s emergency departments and associated urgent care clinics, as well as access to OR Poison Center data. The OPHP continues to refine use of OR’s reportable condition surveillance system (ORPHEUS) to manage and report cases of lead, cadmium, and pesticide exposure. The program also continues piloting and refining the use of Application Programming Interfaces (APIs) to improve interoperability or the ability of computer systems to connect with each other. This includes interoperability between ORPHEUS, Oregon Pandemic Emergency Response Application which is Oregon’s COVID surveillance system, and ESSENCE, as well as between ORPHEUS and the Pesticide Information Center OnLine. The OPHP will complete work on the API linking the NIOSH Industry and Occupation Computerized Coding System to ORPHEUS cases, potentially also for nationally notifiable conditions where occupational fields can be informative like tuberculosis. Long-standing collaborations continue between OHSU, OHA, the NIOSH Center of Excellence for *Total Worker Health* (TWH) in OR, the State Bureau of workers’ compensation, Oregon OSHA, and trade associations.

*OR-FACE*Through OR-FACE, the OPHP leverages its surveillance and prevention program to influence safety professionals and leaders in high-risk industries to implement preventive safety controls, and ultimately save lives at work. In response to prior surveillance and research findings, the project’s focus includes crosscutting themes on young and inexperienced workers and on racial and ethnic minority groups that have been marginalized. The OR-FACE project targets the four most hazardous industries in Oregon based on total deaths – Transportation, Logging, Construction, and Agriculture. OPHP plans to complete 4-6 investigations each year, and the project’s four aims are the following: (1) maintain and evaluate core processes of occupational fatality surveillance, investigation and outreach; (2) conduct epidemiological surveillance research with disabling workers’ compensation injury claims to inform fatality surveillance and prevention; (3) partner with established training series to disseminate fatality prevention information in high-risk industries; and (4) implement targeted outreach through intermediary organizations based on OPHP’s prior field research.

The OR-FACE project continues investigation of selected fatalities with special emphasis on young and new workers, and workers from minority backgrounds. The project also evaluates serious disabling workers’ compensation injury claims to inform fatality surveillance and prevention, as well as critical and emerging issues which include work-related musculoskeletal disorders, injuries related to wildfire response and mitigation (smoke and heat exposure), opioid impacts, pesticide exposures, and unique occupational lead exposures in commercial fishing. OPHP plans to center race/ethnicity and young worker status in investigation and intervention recommendations, including cultural and language tailoring.  Fatality prevention outreach will leverage training series and intermediary organizations to reach Hispanic or Latino workers that have been marginalized in agriculture and construction industries.

The project continues successful partnerships with the State Accident Insurance Fund (SAIF) Corporation’s (Oregon’s largest workers’ compensation insurer who also has provided safety-specific Spanish language translation support) Agricultural Safety Seminar Series and the Oregon Trucking Associations’ regional safety council meetings. New partnerships with the Associated Oregon Loggers and the Oregon Institute of Occupational Health Sciences at OHSU addresses fatality prevention among young and new workers and workers from minority backgrounds. The project also targets new partner organizations such as the Salud Medical Clinic, which serves seasonal farm workers, with deep ties to working populations from minority backgrounds and the Oregon Tradeswomen to support women entering high-risk construction trades.

**Institution:** Pennsylvania Department of Health**Program Title:** Pennsylvania Occupational Safety and Health Surveillance Program**Program Type:** Fundamental Program

As a new state surveillance program, the Pennsylvania Occupational Safety and Health Surveillance Program (PennOSHS), which is a Fundamental Program, aims to build a sustainable public health infrastructure in Pennsylvania (PA) to reduce occupational morbidity and mortality and eliminate occupational health disparities. The PennOSHS has two major aims: (1) collect, compile, and analyze occupational health data to identify areas that require targeted actions by public health practitioners and other stakeholders; and (2) disseminate relevant information to these stakeholders to improve health outcomes.

PennOSHS develops, analyzes, and interprets 19 occupational health indicators, including the state employment profile, as well as improves data collection for occupational lead exposure, analyzes and interprets the resulting data and promotes the importance of collecting work-related variables, such as industry and occupation in exiting data collection efforts by the PA Department of Health (DOH) and its partners. The program also identifies potentially new sources of data to support the concept of *Total Worker Health®* in PA. PennOSHS also participates in the Adult Blood Lead Epidemiology Surveillance System and collaborates with the PA DOH to maintain data collection of adult blood lead and conduct surveillance of exposed individuals to identify at-risk workplaces for further targeted interventions, such as education and outreach and referral to regulatory authorities and provide follow up for families if relevant. The program also uses workers’ compensation data to explore risk factors for pneumoconiosis.  Lastly, in partnership with the PA Behavioral Risk Factor Surveillance System and using industry/occupation information in the survey, the program also works to identify PA workers who were disproportionately impacted by COVID-19, estimating the burden, demographic/socio-economic characteristics, and potentially adverse health outcomes. Other areas to be explored include emerging health disparities, mental health issues, the gig economy, and prevention of workplace and non-occupational (i.e., hobbies) lead exposure.

**Institution:** Texas Department of State Health Services**Program Title:** Texas Occupational Safety and Health Surveillance Program**Program Type:** Fundamental Program

The Environmental Surveillance and Toxicology Branch (ESTB) at the Texas (TX) Department of State Health Services (DSHS) has more than 30 years of experience with occupational health surveillance including surveillance of acute or short-term occupational pesticide-related illness and injury, elevated blood lead levels, asbestosis, silicosis, and other injuries and illnesses.  As a Fundamental Program, they have seven aims: (1) collect, analyze, and interpret occupational health surveillance data for 25 occupational health indicators, create the state employment profile, and report summarized results annually to NIOSH; (2) pilot new and enhanced data sources to explore their capacity for occupational health surveillance and identify priority worker populations for interventions; (3) conduct in-depth investigation and case follow-up activities for adult lead poisoning surveillance and prevention in TX; (4) integrate adult and childhood blood lead surveillance to improve case identification and intervention efforts; (5) conduct external collaborative-enhancing activities to optimize investigations and intervention efforts to prevent adult blood lead poisonings in TX; (6) collaborate with external partners to design and implement targeted educational interventions for priority occupational safety and health issues, such as adult blood lead poisoning (for the Adult Blood Lead Epidemiology and Surveillance), work-related motor vehicle crashes, and heat-related illness prevention; and (7) provide training and consultation to high-risk occupational groups and their employers to enhance safety awareness. At this time, targeted interventions will focus on transportation incidents, heat-related illness prevention in outdoor workers, and those at risk for occupational exposures to lead, including young workers (15-24 years of age), as identified through discussions with the program’s strategic planning group and based upon previous surveillance data analyses.

**Institution:** Washington State Department of Labor & Industries**Program Title:** Washington Occupational Injury and Illness Surveillance Program**Program Type:** Expanded Program

The Washington (WA) Occupational Injury and Illness Surveillance Program has a 30-year history of applied public health research aimed at the prevention of workplace injury and illness. This Expanded Program leverages opportunities to integrate its research and surveillance findings into the operations of the WA State Occupational Safety and Health Administration (OSHA) program and WA’s single payer state workers’ compensation insurance program. The program will base its research and surveillance actions on available data, input from multiple advisory groups, and opportunities to take advantage of emerging interest from the public, press, or others in OSH.

WA’s Expanded Program will have a fundamental component and two expanded projects. The fundamental component has the following aims: (1) identify emerging occupational safety and health issues for surveillance, research, and prevention opportunities through advisory committee input, occupational injury and illness data, and community input; (2) use 22 occupational health indicators to describe occupational injuries and illnesses in Washington, and create a state  employment profile; (3) create an occupational amputations surveillance system, then use the system to evaluate state OSHA actions to prevent such injuries and streamline a system of improved reporting of amputations to regulatory authorities; (4) create a surveillance system to describe workplace contributions to notifiable infectious disease and lead efforts to improve industry and occupation coding on notifiable infectious diseases and identify workplace infectious disease clusters; (5) continue WA’s Adult Blood Lead Epidemiology and Surveillance program and evaluate changes to workplace lead exposure policies; and (6) implement two expanded projects that address fatal occupational injuries and occupational respiratory disease. As their research is put into practice, the program staff will monitor for evidence that their work has influenced the safety and health actions of others and contributed to the ultimate goal of reducing workplace injuries and illnesses.

*Washington Fatality Assessment Control & Evaluation (FACE) Program*The first expanded project strives to prevent work-related traumatic injury fatalities via four components: 1) surveillance, 2) investigation, 3) prevention activities/information dissemination, and 4) evaluation. The FACE Program collects detailed surveillance data on all work-related fatalities in WA State. It uses the data to prioritize and focus incident investigations, describe incidents and associated hazards and guide development of prevention resources. The FACE Program is committed to using surveillance data and working with its partners to expand program activities and achieve reductions in workplace fatalities and promote safer, more productive workplaces. There are five specific aims of the FACE Program. For Aim 1, program staff maintain and enhance their timely multisource surveillance system to identify and track all traumatic occupational fatalities that occur in WA State. They frequently share data directly with stakeholders and use these data to set priorities and as the basis of single case and case series reports. For Aim 2, the program staff investigates select fatal incidents as defined in these four state priority areas: 1) youth fatalities, 2) fatalities due to falls in residential construction, 3) fatalities associated with machinery, especially construction machinery, and 4) fatalities among workers in agriculture crop production and logging. They will also investigate the following NIOSH priorities: 1) law enforcement motor vehicle fatalities, and fatalities in the following workers, 2) tree care/arborist, 3) powered industrial trucks/warehousing, 4) tow truck drivers, and 5) waste collection/sanitation. For Aim 3, the program identifies and characterizes hazardous workplaces, activities, and contributing factors using multiple data sources and epidemiological, safety engineering, and human factors/ergonomics methods to focus and promote prevention strategies. For Aim 4, the FACE team develops and communicates prevention resources that can be used to reduce the risk of fatal occupational injuries. Prevention resources characterize fatal incidents, detail risk factors, and effectively communicate recommendations for the prevention of traumatic injuries and fatalities. Aim 5 focuses on evaluating FACE Program prevention activities and resources by centering on impacts and outcomes that are measured using online surveys, targeted employer surveys, website activity tracking, and surveys from outreach efforts, including the annual National Stand-Down to Prevent Falls in Construction.

*Occupational Respiratory Disease Surveillance in Washington State*The second expanded project continues its current surveillance for occupational respiratory disease, toxic inhalation injury, hazardous exposures, and work-related COVID-19 exposure and disease. The project also establishes respiratory disease injury and trends by industry and occupation and identifies emerging respiratory hazards. This program will have four components: 1) surveillance; 2) intervention and prevention efforts; 3) communication and dissemination activities; and 4) evaluation. The five specific aims of this project include: (1) conducting surveillance of occupational respiratory disease; (2) conducting surveillance of toxic inhalation injury and hazardous exposure; (3) conducting surveillance of work-related suspected or known exposure or disease for COVID-19; (4) conducting industry and case-based investigations aimed at disease prevention by conducting an employer health and safety needs assessment survey and worker assessment for respirable crystalline silica in the countertop fabrication industry and by conducting case-based investigations for disease and inhalation injury prevention; and (5) evaluating case capture, programmatic function, and feasibility of new surveillance data sources.

**Institution:** Wisconsin Department of Health Services**Program Title:** Occupational Health and Safety Surveillance Program**Program Type:** Expanded Program

Since 1984, the Wisconsin (WI) Department of Health Services has collected, analyzed, and disseminated data on WI’s work-related illnesses, injuries, and deaths. The Occupational Health and Safety Surveillance Program enhances surveillance of occupational injuries and illnesses to yield important information about trends, disease clusters, and emerging issues that will support annual priorities and effective, science-based interventions for targeted worker populations. The fundamental component of this Expanded Program has three specific aims which includes continuing and expanding WI’s occupational illness, injury, and death surveillance activities. For Aim 1, the program collects, analyzes, and interprets occupational health surveillance data for 25 occupational health indicators and uses that information to determine program priorities, guide outreach and intervention activities, and report summarized results annually to NIOSH. WI also creates the state demographic employment profile and conducts in-depth investigation and case follow-up activities for adult lead poisoning surveillance and prevention in WI. The program also explores development of regional data indicators, including a multi-state agricultural injury indicator. The second program aim is disseminating occupational health information to WI stakeholders and national partners. For Aim 2, the program focuses on timely, targeted dissemination of information to stakeholders in a useful format to promote appropriate action and collaborate with other Division of Public Health programs to disseminate OH information. The last aim includes identifying, developing, and promoting public health interventions to improve occupational health and safety. The program plans to incorporate new data provided through partnerships with key stakeholders and expand surveillance capacity by developing new occupational health resources and guidance for effective workplace interventions. The program’s inter-agency Occupational Surveillance Advisory Group continues to promote communication and collaboration across state and federal agencies, academic institutions, and private organizations. WI also has targeted five new innovative population based and individual level components for inclusion and implementation over the next five years which include: (1) proposal of a Council of State and Territorial Epidemiologists agricultural injury indicator developed by the Tri-State Occupational Health Collaborative (occupational epidemiologists from Minnesota, Iowa, and Wisconsin); (2) consulting with the National Farm Medicine Center – a NIOSH-funded Center for Agricultural Safety and Health (Ag Center) – to study agricultural injuries in young workers via a formal data use agreement between the WI Division of Public Health and the center for access to trauma and ambulance data; (3) conducting take-home lead surveillance in WI and evaluating their initial performance, and sharing methods with other states who have separate child and adult databases; (4) implementing and evaluating free text Industry and Occupation and NIOSH’s Industry and Occupation Computerized Coding System autocoding for adult lead records; and (5) automating the identification of occupational exposures using WI Poison Center and National Poisoning Data System data.

The three expanded projects in this program are: 1) Enhancement of Occupational Surveillance through Electronic Case Reporting and Data Capture, 2) Surveillance, Epidemiology, and Prevention of Occupational Infectious Diseases, and 3) Occupational Respiratory Disease Surveillance.

*Enhancement of Occupational Surveillance through Electronic Case Reporting and Data Capture*This expanded project implements a comprehensive health informatics initiative to significantly enhance occupational surveillance of reportable exposures, illnesses, and injuries. The COVID-19 pandemic highlighted the importance of capturing industry and occupation data to detect workplace outbreaks and characterize workplace exposure risks. Strong collaborations between the Occupational Health and Safety Surveillance Program and key stakeholders have already been established, and the WI surveillance program will continue to cultivate new partnerships to improve surveillance data quality and improve data collection. This project has four aims: (1) enhance surveillance of occupational diseases through electronic case reporting (eCR); (2) develop comprehensive and standardized collection of industry and occupation for reportable conditions associated with workplace exposures and hazards; (3) contribute to the development of national occupational disease reporting standards; and (4) supplement and enhance reportable disease surveillance with workers’ compensation data and Behavioral Risk Factor Surveillance System  data.

*Surveillance, Epidemiology, and Prevention of Occupational Infectious Diseases*This second expanded project has three aims: (1) identify occupational infectious diseases through robust surveillance and respond to occupational outbreaks; (2) characterize burden and risk factors for occupational infectious diseases to inform public health action, policy development, and research priorities; and (3) prevent occupational infectious diseases through outreach and education. WI will focus on two areas that are most relevant to WI, including COVID-19 and infectious diseases associated with agriculture and forestry such as enteric (intestinal disease caused by micro-organisms such as viruses, bacteria and parasites), tickborne, and mycotic diseases (disease caused by a fungus).

*Occupational Respiratory Disease Surveillance*The third expanded project allows this WI state surveillance program to identify and characterize occupational respiratory diseases in the state, identify occupations and job tasks that place workers at risk, and implement measures to prevent respiratory disease in the workforce. The project has three aims: (1) implement a robust surveillance system to characterize the burden of reportable occupational respiratory diseases in WI, including silicosis, asbestosis, chemical pneumonitis, and lung diseases caused by biodusts and bioaerosols; (2) provide analysis, interpretation and dissemination of findings from reportable occupational respiratory disease surveillance; and (3) prevent occupational respiratory disease through comprehensive outreach and education efforts to clinicians, employers, and workers. The project plans for innovation via two ways: (1) case reporting and screening/detection education for WI clinicians; and (2) new uses of existing data sources to increase case capture including the use of hospitalization data to identify cases, use of workers’ compensation data to identify cases, and use of electronic case reporting and the Centers for Disease Control and Prevention’s Reportable Conditions Knowledge Management System to increase reporting.

### NIOSH State Surveillance Program Focus on Timely COVID-19 Related Projects

During fiscal year (FY) 2021, NIOSH provided extramural funding for projects that address challenges related to the coronavirus disease 2019 (COVID-19). This included one year of funding provided through the Centers for Disease Control and Prevention’s (CDC) COVID-19 response efforts for NIOSH’s state surveillance program. Fifteen of the 22 NIOSH-funded states requested and received funding for 26 projects focused on either one or both of two areas: (1) worker safety and health support, safe return to work policies, and mitigation or prevention of COVID-19 outbreaks in various industrial sectors, or (2) strengthening vaccine confidence in workers. These projects are described below.

**Support for Worker Safety and Health, Safe Return to Work Policies, and Mitigation or Prevention of COVID-19 Outbreaks in Various Industrial Sectors**

The California Occupational Health and Safety Surveillance Program aims to do the following:
                    - Implement and enhance a workplace COVID-19 outbreak surveillance system by: (1) collecting and analyzing COVID-19 outbreaks reported by employers as required by law; and (2) using workers’ compensation claims data to identify workplace outbreaks.
                    - Use its longstanding access to California workers’ compensation claims data to identify (retrospectively since March 1, 2020 and prospectively on a quarterly basis) all employers with at least three claims of exposure to or infection of SARS-CoV-2— the virus that causes COVID-19. This analysis builds on its collaboration with the NIOSH Center for Workers’ Compensation Studies and other states to describe SARS-CoV-2 exposure and infection among workers for all 2020 claims and provide insights on long-term COVID-19 with detailed summaries for 2020 and 2021 claims, including diagnoses, treatments, impairment, and disability and mortality by employer factors and worker factors.
                    - Develop and maintain the California Department of Public Health website reporting of COVID-19 outbreaks by industry.
                    - Establish a communication and translation plan to do the following: (1) notify target audiences of surveillance and investigation findings; (2) publicize the consequences of unrecognized or uncontrolled workplace exposures; and (3) promote effective measures to prevent exposures, injury, and illness to others who can implement change.
                    - Use COVID-19 outbreak data and findings from other data sources to engage key OSH partners to address informational and prevention needs for occupations and industries at high risk for COVID-19 outbreaks, specifically around safe return to work, methods to reduce or prevent COVID-19 exposures, and management of COVID-19 outbreaks.

The Occupational Health Fundamental-Plus Surveillance Program in Connecticut aims to do the following:
                    - Provide resources to small employers in Connecticut (CT) in Wholesale and Retail Trade and Services sectors to help with job hazard and workplace risk assessments and strategies for the prevention of COVID-19 transmission and outbreaks among workers.
                    - Launch a targeted information and assistance campaign to prevent COVID-19 transmission and outbreaks within the Wholesale and Retail and Service sectors in CT.
                    - Create a consolidated toolkit for risk assessment, policy development, and mitigation strategy implementation procedures specific to both the Wholesale and Retail Trade and Services sector workplaces.
                    - Distribute the above-mentioned toolkit to assist small business employers with designing policies and procedures for the use of layered mitigation strategies in their workplaces.
                    - Measure employer satisfaction with the toolkit materials provided, including a high level of implementation of recommended mitigation strategies in the Wholesale and Retail Trade and Services sectors in CT, as well as employee and customer support and satisfaction for the policies and procedures in use.
                    - Work with the CT Department of Economic and Community Development to review, revise, and summarize prior guidance for workplaces in the Wholesale and Retail Trade and Services sectors that were developed and required to be in place during business reopening periods in CT.
                    - Work with chambers of commerce and local health departments and districts in Eastern CT and other areas with lagging COVID-19 vaccine coverage to provide outreach and disseminate the detailed above-mentioned employer toolkit and other outreach materials to assist employers with implementing mitigation strategies.
                    - Provide targeted messaging focused on the conditions in the Wholesale and Retail Trade and Services sectors that impact COVID-19 risk to employers, employees, and customers and highlight the benefits of the proposed mitigation strategies.
                    - Develop a centralized email and telephone point-of-contact dedicated to our target business operators in the Wholesale and Retail Trade and Services sectors, where employers can direct questions and solicit general and specific assistance with the development of their policies and procedures.
                    - Assist employers to create clear standards for the following: (1) use of masks by employees inside workplaces; (2) implementation of engineering controls around ventilation; and (3) implementation of symptom assessment guidelines before the start of work shifts.
                    - Conduct regular education programs to employers and workers with instruction on ventilation, cleaning, and overall hygiene, as well as assist with helping employers create clear policies and a demonstrable program for testing, contact tracing, isolation, and quarantine of affected workers.

The Georgia Occupational Safety and Health Surveillance Program (GA-OHS) aims to do the following:
                    - Increase employer and worker awareness of best practices for preventing exposure to SARS-CoV-2 — the virus that causes COVID-19 — and outbreaks in non-healthcare industries that are at high-risk for these challenges through the following: (1) providing high-risk industry employers with a toolkit of resources containing specific guidance and strategies to prevent the spread of COVID-19 including how to develop a workplace COVID-19 exposure control plan; and (2) increasing access to worksite mobile vaccination units.
                    - Focus on Georgia’s industries that are at high risk for COVID-19 exposure and outbreaks which are the following: Georgia Schools, Poultry, Meat, Manufacturers, and Fruit and Vegetable Growers.
                    - Provide easily accessible COVID-19 vaccination to workers in industries at high risk for exposures and outbreaks.
                    - Initiate contact with industries at high risk for SARS-CoV-2 exposure and outbreaks through their respective professional associations (e.g., Georgia School Superintendents Association, Georgia Poultry Federation, Georgia Cattlemen’s Association, Georgia Association of Manufacturers, and Georgia Fruit and Vegetable Growers Association, etc.) and state agencies such as the Georgia Department of Public Health (DPH) School Health Nursing Program, Georgia Farm Bureau, and Georgia Department of Commerce to conduct outreach to specific industries and share the toolkit of COVID-19 resources and information about requesting an onsite mobile vaccination unit.
                    - Provide employers wanting a mobile vaccination unit onsite the chance to request a unit through the GA-OHS program.
                    - Provide employers with a toolkit of COVID-19 resources and information on post-vaccination considerations such as how to appropriately evaluate and manage employees who have signs and symptoms of COVID-19 after receiving a vaccine.
                    - Provide small- or medium-sized employers the opportunity to request off-site vaccinations located near the worksite (closed or open to the public).
                    - Leverage the Georgia DPH’s existing partnership with the Georgia Community Organized Relief Efforts (CORE), which currently works with DPH to provide free COVID-19 vaccines across the state with mobile units from November 2021 to June 2022.
                    - Collaborate with CORE and employers requesting mobile units to determine where mobile vaccination teams should provide vaccination services and how to best provide vaccines in a way that is comfortable and accessible.
                    - Evaluate the usefulness and impact of their prevention and intervention activities.

The Illinois Occupational Surveillance Program aims to do the following:
                    - Building on a previous collaboration with other state surveillance programs to develop a case definition for work-related COVID-19 cases and provide a narrow summary analysis of cases meeting the definition, expand the analysis by examining additional datasets and conducting more detailed analyses which will include all variables in each dataset beyond the six types of data in the original project (occupation, age, sex, industry, firm size, and geographic region).
                    - Utilize three datasets to identify work-related COVID cases which are the Illinois first reports of injury, supplemental reports of injury, case management data on contested indemnity claims filed with the Illinois Workers’ Compensation Commission, and emergency department and admission data (compData).
                    - Use workers’ compensation data to describe occupations and industries at high risk for exposure to SARS-CoV2 — the virus that causes COVID-19 — and outbreaks, as well as identify characteristics of worksites with recognized COVID-19 outbreaks as defined by the CDC.
                    - Analyze time-based trends from January 2020 to the most current data time point and stratify these data by employee characteristics, severity of illness, occupation, and industry.
                    - Analyze spatial patterns and clusters of work-related COVID-19 cases by worksite, zip code, and county to identify geographic areas of concern controlling for important covariates such as population density, county vaccination rates, and mandated local control measures (e.g., limits on public gatherings, required masks, etc.).
                    - Evaluate the impact of corporate defined infection control policies on rates of COVID-19 cases captured in workers’ compensation data among 10 of the largest private sector employers in Illinois that required on-site work.
                    - Assess the number of workers experiencing severe occupational outcomes as measured by lost wages, days of lost work, and permanent disability, and identify risk factors for these severe outcomes by occupation and industry.
                    - Use hospital data to compare differences in clinical outcomes among COVID-19 patients with a workers’ compensation payer compared to all other COVID-19 patients, controlling for critical factors such as age and comorbidities.
                    - Evaluate the impact of state and local public health mandates on workplace COVID-19 outbreaks and cumulative infection rates beginning in January 2020 based on Illinois first reports of injury and supplemental reports of injury.
                    - Analyze rates of reported COVID-19 cases among three groups of precarious workers in Illinois including low wage workers, temporary employment agency workers, and nursing home staff, and provide a detailed analysis of all key variables in workers’ compensation datasets to identify important risk factors associated with illness among these precarious workers.
                    - Identify subgroups of workers and occupations/industries at risk for COVID-19 exposure and outbreaks, evaluate the effectiveness of public health actions on COVID-19 transmission in the workplace, and inform ongoing prevention strategies for infectious diseases.
                    - Define the scope of COVID-19 exposure and outbreaks, define strategies to mitigate the problem, and communicate findings and recommendations for reducing transmission of COVID-19 in the workplace to its partners and other groups with an interest or concern related to this topic.

The Kentucky Occupational Safety and Health Surveillance (KOSHS) Program aims to do the following:
                    - Evaluate existing KOSHS data sets to identify COVID-19 cases in workplace specific settings by exploring multiple morbidity and mortality data sets and identifying workplace exposure associated COVID-19 cases including: (1) syndromic surveillance morbidity and mortality data; (2) workers’ claims first reports of fatal and nonfatal injuries; (3) Occupational Safety and Health Administration (OSHA) 36 fatality and catastrophe reports; and (4) death certificates.
                    - Identify hotspot areas throughout the Commonwealth of Kentucky through analysis of multiple existing data sets.
                    - Identify key industries within each county hotspot potentially impacted by COVID-19 and conduct semi-structured interviews with 15-20 of the identified industries to understand industry specific actions during the COVID-19 pandemic and the policies and practices in place to allow for a safe return to work and prevent or reduce exposures to COVID-19.
                    - Perform COVID-19 analyses, develop a statewide hotspot map, identify industries in the top three counties in hotspot analysis, and produce and disseminate industry sector specific reports with the above-mentioned interview results with examples of COVID-19 exposure best practices.

The Occupational Health & Injury Surveillance program in Louisiana aims to do the following:
                    - Measure the burden of COVID-19 outbreaks and associated cases in occupational settings and use these data to inform and develop guidance for employers and employees, especially in the most impacted occupational sectors.
                    - Provide additional support to the Louisiana Office of Public Health (LOPH), Section of Environmental Epidemiology and Toxicology (SEET) to assist them in responding to requests for guidance associated with the COVID-19 pandemic.
                    - Support the Infectious Disease Epidemiology (ID Epi) Program of LOPH in conducting contact tracing of COVID-19 cases maintaining a comprehensive database of contact tracing call data, including the occupation of positive COVID-19 cases and demographic data (age, race, sex, address, etc.).
                    - Support a collaboration between SEET and the ID Epi Program focused on analyzing the above-mentioned contact tracing call data, which will include looking at past occupational outbreaks and identifying ongoing or emerging COVID-19 outbreaks and using these analyses to form the basis for measuring the burden of COVID-19 within Louisiana occupational settings.
                    - Develop guidance for employers and employees using the above-mentioned analysis.

The Expanded Occupational Health Surveillance Program in Massachusetts aims to do the following:
                    - Use their existing state-based surveillance program to support worker safety and health, guide recommendations for safe return to work policies, and mitigate or prevent COVID-19 outbreaks in various industrial sectors in Massachusetts, while applying a lens of health equity.
                    - Understand patterns in COVID-19 risk and the burden of disease to better inform efforts to prevent, reduce, and mitigate exposures and outbreaks of COVID-19 and address inequities.
                    - Build off work done in the past year and use multiple data sources to examine work-related risk factors by occupation and/or industry in conjunction with racial and ethnic minority groups and other key demographics.
                    - Generate information that can be used to guide actions for safe return to work, the reduction and prevention of COVID-19 exposures and outbreaks.

Michigan’s Expanded Program in Occupational Injury and Illness Surveillance aims to do the following:
                    - Develop best practices for interventions that prevent, reduce, and mitigate exposures to SARS-CoV2 — the virus that causes COVID-19 — and outbreaks and identify the status of interventions and activity that are not being implemented by industry for targeting educational outreach.
                    - Compile data related to Michigan OSHA COVID-19 inspections to review and describe the characteristics of industries that were inspected for both fatal and non-fatal COVID-19 cases and violations of COVID-19 regulations.
                    - Analyze Michigan death certificates of COVID-19 fatalities by industry and occupation to provide background information and highlight the importance of industry specific recommendations.
                    - Develop and disseminate industry/occupation specific educational material to employers, trade organizations and unions that summarizes the results of the COVID-19 inspections and death certificate analysis.

The Minnesota Occupational Health and Safety Surveillance Program aims to do the following:
                    - Improve industry and occupation (I/O) data collection in Minnesota’s syndromic surveillance of COVID-19, collect and analyze industry, occupation, and employment-related information on long COVID patients (or individuals with post-COVID conditions), assess the impact of COVID-19 in Minnesota workplaces; and perform return to work safety and vaccine outreach to at-risk workers and workplaces in greater Minnesota (non-Twin Cities metro area).
                    - Increase hospitals’ reporting of COVID-19 cases through the syndromic surveillance system in Minnesota by working with hospitals and the existing syndromic surveillance data feed to identify employment information in hospital records for COVID-19 cases with the goal of getting the data into the routine data feed.
                    - Improve syndromic surveillance as a source for occupational health and safety surveillance and inform I/O collection for other conditions in the syndromic surveillance system in future years.
                    - Collect and analyze I/O and employment-related information on long COVID patients by collaborating with the Minnesota Department of Health’s Environmental Public Health Tracking Program’s Long-Term Chronic Disease and Injury Surveillance Annex.
                    - Through the Long-Term Chronic Disease and Injury Surveillance Annex, conduct a planned survey of long COVID cases, which will ask about industry, occupation, employment status, and other impacts of COVID-19 on employment.
                    - Assess the impact of COVID-19 in occupational settings through an analysis of clusters of COVID-19 cases in essential Minnesota businesses over time by industry sector, linking these clusters with standardized I/O information on cases to determine infection risks in different business sectors.
                    - Partner with businesses the Minnesota Department of Health has previously worked with on COVID-19 safety protocols or contact tracing to conduct a survey of businesses that had COVID-19 case clusters to determine which policies impacted their response to this issue and gain information on what they did, what they learned, and how they will they apply this knowledge in the future.
                    - Collaborate with the Statewide Health Improvement Partnership (SHIP) — a legislatively funded initiative — to help at-risk employers provide a safe return to work for employees and education opportunities regarding vaccine hesitancy through the following:                       - identifying four local public health SHIP agencies working in areas where vaccine hesitancy coincides with concern about healthcare workers or small employers in need, and where vaccine rates are lower.
                      - developing an assessment tool to assist local public health staff when they are speaking with employers.
                      - training local public health staff on speaking with employers about workplace safety regarding COVID as well as promoting vaccine and education about vaccine hesitancy.
                      - developing an evaluation framework for the work being done by local public health SHIP agencies.
                      - monitoring, supporting, and evaluating progress of the local agencies.
                      - focusing on small employers (under 1,000) as well as employees in the healthcare industry. 

The Expansion of the New Hampshire Occupational Health Surveillance Program aims to do the following:
                    - Promote worker safety and health by providing timely statistics that support the creation of safe return-to-work policies that mitigate or prevent COVID-19 outbreaks in essential workers.
                    - Focus on employer policies regarding employee testing and vaccination and disseminate industry- and state-level statistics related to COVID-19 testing and vaccination requirements for small business employees.
                    - Focus on barriers to stopping workplace spread of COVID-19 and disseminate industry- and state-level statistics with respect to COVID-19 related barriers to operating capacity (e.g., ability to maintain social distancing in the workplace, etc.).
                    - Focus on vaccination patterns and vaccine hesitancy among essential workers (i.e., persons working in essential work locations such as hospital workers, first responders, and workers in food manufacturing facility) and will disseminate location-, demographic, and state-level statistics.
                    - Use data from the Census Bureau’s Small Business Pulse Survey (SBPS) and Household Pulse Survey (HPS) to estimate and disseminate statistics that address key issues in the effort to prevent workplace spread of COVID-19.
                    - Inform OSH officials, employers, and workers on factors that remediate workplace spread, using the data collected in the Census Bureau’s SPBS and HPS.
                    - Produce a monthly press release, infographic, and webcast describing key findings at the national level using the latest releases of the SBPS and HPS.
                    - Post industry- and state-level statistics (and corresponding standard errors) on the UNH-hosted NH Occupational Health Surveillance Program’s  webpage  and develop press-releases and infographics to provide examples of how to use the statistics, along with providing technical assistance to persons and organizations interested in using these files and generating state- and/or industry-specific analyses and infographics.

The Texas Occupational Safety and Health Surveillance Program aims to do the following:
                    - Use Texas Poison Center Network and Texas Syndromic Surveillance (TxS2) databases to detect and track work-related exposures, including use or misuse of hazardous substances and chemicals, such as cleaning and disinfectant products, in relation to the COVID-19 pandemic.
                    - Conduct detailed analyses of poison center and syndromic surveillance data to identify and monitor statistical trends, emerging issues, and patterns in occupational exposures and health conditions in relation to the COVID-19 pandemic.
                    - Conduct additional follow-ups for potential occupational clusters of high-priority involving exposures to hazardous substances in relation to the COVID-19 pandemic.
                    - Use the information above to help guide its program in planning targeted education and outreach activities to prevent hazardous exposures, such as cleaning and disinfection products or other substances, in at-risk worker populations.
                    - Improve identification of work-related injury and illness clusters in relation to COVID-19, and better utilize data and resources.
                    - Influence workplaces, communities, and policy making to reduce and prevent COVID-19, with the goal of reducing and preventing COVID-19 exposure and outbreaks and occupational health issues in worker populations.

The Washington Occupational Injury and Illness Surveillance Program aims to do the following:
                    - Establish a system to monitor the SARS-CoV-2 infection rate in K-12 school teachers and staff.
                    - Establish COVID-19 case rates in Washington State K-12 public school teachers and staff from March 2020 forward, with rates among elementary school teachers being calculated separately from rates among secondary school teachers.
                    - Identify school districts with high rates of COVID-19 cases among teachers and staff.
                    - Contribute to the detection of COVID-19 outbreaks in K-12 schools by working with the Washington State Department of Health school cluster investigation team and local health jurisdictions.
                    - Link one database containing COVID-19 cases — the Washington Department of Health’s Disease Reporting System (WDRS) — to two retirement system databases, the Washington’s Department of Retirement System’s Teachers Retirement System, and the School Employees Retirement Systems data to estimate the COVID-19 case rates for teachers in Washington.
                    - Following the above-mentioned data linkage, aim to determine rates (COVID cases/100 teachers) and develop COVID trends over time.
                    - Publish data on COVID-19’s impact on Washington State K-12 teachers and staff.

The Occupational Health and Safety Surveillance Program aims to do the following:
                    - Collaborate with the University of Wisconsin School for Workers (SFW) via a contract to assist in the development of best practices for interventions that prevent, reduce, and mitigate exposures and outbreaks of COVID-19, its variants, and future mutations.
                    - Collaborate with the SFW to create educational programming and opportunities to further the interest of worker safety and health.
                    - Collaborate with the SFW to create a curriculum and provide adult education on COVID-19 workplace and community safety to workers, their families, and communities across the state.
                    - Collect and analyze data on worker COVID-19 experiences that will help guide recommendations for actions that lead to safer workplaces and communities.
                    - Develop curriculum to present and distribute to workers throughout Wisconsin regarding safe practices to prevent the spread of COVID-19 and its variants.
                    - Conduct education of workers in at least fifteen workplaces or worker communities that focus on best practices to prevent infection of SARS-CoV-2 — the virus that causes COVID-19 — and its variants at the worksite.
                    - Create and provide financial support for worker councils in which workers can provide input to the Wisconsin Department of Health Services regarding best practices and practices to support health and safety.
                    - Interview workers and regional experts to develop best practices for businesses, employers, workers, OSH professionals, and public health professionals in preventing spread of COVID-19 in workplaces that include underserved populations.
                    - Provide reports on best practices developed and educational programming provided.

**Support for Vaccine Confidence in Workers**

The California Occupational Health and Safety Surveillance aims to do the following:
                    - Track and evaluate the vaccination coverage among the food and agricultural workforce in Merced County, CA, by building upon a collaboration established with the University of California, Merced (UC Merced) Community and Labor Center.
                    - Establish a communication and translation plan to notify target audiences of surveillance and investigation findings, publicize the consequences of unrecognized or uncontrolled workplace exposures, and promote effective measures to prevent exposures, injuries, and illness to others who can implement change.
                    - In collaboration with partners at the UC Merced, engage with key occupational health stakeholders (i.e., groups representing employers and workers, health professional organizations, government agencies including Merced County Health Department, and others) to promote coordination and communication across diverse areas of expertise, knowledge levels, and worker populations in Merced County and assist employers, health care providers, and worker organizations in their efforts to increase worker vaccination coverage in the food and agricultural sector.
                    - Convene a multi-stakeholder working group to evaluate current vaccination coverage, share best approaches for worker education and address barriers to vaccination such as paid time off and sick leave, improve access to vaccination including vaccination sites at the workplace, and overcome gaps in vaccine coverage.
                    - Provide consultation and assistance to Merced County employers and worker organizations about Cal/OSHA requirements, California Department of Public Health or local health orders and advisories, and best occupational health practices to mitigate risk of exposure to SARS-CoV-2— the virus that causes COVID-19, track vaccination coverage, and respond to outbreaks.

The Occupational Health Fundamental-Plus Surveillance Program in Connecticut aims to do the following:
                    - Work closely with the Connecticut State Department of Education (CSDE) to provide guidance related to COVID-19 mitigation strategies, policies, and procedures, along with stakeholder feedback.
                    - Determine the percentages of teachers, paraprofessionals, volunteers, and other PreK-12 school staff who have initiated and reached full vaccination status by school and district and increase that number.
                    - Increase the percentage of teachers, paid staff, and volunteers who have contact with PreK-12 schools in Connecticut and initiate and complete vaccination for COVID-19.
                    - Launch a targeted outreach campaign to reduce vaccine hesitancy and increase vaccine coverage in Connecticut’s educational workforce by developing and delivering messages that promote the wide benefits of COVID-19 vaccination to workers in education, their families, and their school communities, while also addressing currently identified contributors to vaccine hesitancy, including but not limited to misinformation, lack of access, and systemic mistrust.
                    - Work with the CSDE Communications Offices, school administrators, local health departments, and teachers’ unions to determine an appropriate format and forum for educational materials directed at workers in education.
                    - Collaborate with CSDE partners and statewide advocacy groups to develop and provide webinars and question/answer sessions regarding COVID-19 vaccinations, including addressing hesitancy and misinformation.
                    - Provide vaccination clinics for students, staff, and families in all Connecticut school districts via either the Connecticut State Department of Public Health Mobile Vaccination Unit, local health departments, or other partner providers, with the goal of exceeding 90% coverage of COVID-19 vaccination among Connecticut’s educational workforce.
                    - Develop a centralized email and telephone point-of-contact dedicated to PreK-12 school employees, where they can direct questions and solicit general and specific assistance with finding a vaccine provider.
                    - Collect and analyze aggregate data from school districts (to the extent they become available) regarding vaccination status of teachers, paraprofessionals, and other educational staff to estimate the level of vaccine coverage among these groups.
                    - Continue existing partnerships with educational stakeholders throughout Connecticut including school superintendents, nurses, school medical directors, teachers’ unions, professional organizations, and others to share and report aggregate COVID-19 data from schools throughout the prior school year.
                    - Continue existing partnerships with The American Federation of Teachers and Connecticut Educators Association to influence legislation for making educational workers a priority for vaccine availability.

The Georgia Occupational Health Surveillance Program (GA-OHS) aims to do the following:
                    - Provide education and awareness about vaccine risks, benefits, and safety through various media campaigns, targeting workers in specific industries with high risk of exposure to SARS-CoV-2 due to frequent close contact with the public or coworkers, which includes workers in Education (elementary and secondary schools), Manufacturing (Animal Slaughtering and Processing and Carpet and Rug Mills), and Agricultural industries.
                    - Focus campaigns in 5 Public Health Districts in GA, also considered rural areas of the state where there is high vaccine hesitancy and where the majority of workers in the targeted industries live and work. For schools, the campaign will not only include teachers and aides, but also other school staff such as custodial workers, food and nutrition staff, librarians, secretaries, counselors and other administrators, and bus drivers.
                    - Use results from the state’s available COVID-19 case surveillance data and survey results from the Georgia Behavioral Risk Factor Surveillance System COVID-19 Call-back Survey to help inform campaign messaging.
                    - Evaluate the impact of the media campaigns.

The Illinois Occupational Surveillance Program aims to do the following:
                    - Increase vaccine uptake among low-wage, essential workers through building on an existing partnership with the Chicago Workers Collaborative (CWC) — a workers’ center in Chicagoland that addresses the health and safety of low-wage workers with a particular focus on those hired through temporary staffing companies.
                    - Focus on temporary workers, who are primarily Hispanic or Latino in Chicago and are among the essential workforce, that have continually gone to work during the pandemic: manufacturing, warehousing, and food processing industries.
                    - Support CWC to register 800 of the hardest-to-reach workers and their families in suburban communities north of Chicago, where mainly Hispanic or Latino persons work, and build on a vaccine campaign that is underway in connection with local health departments.
                    - Scale up the Mobile Vaccine Point of Dispensing (POD) Program, bringing COVID-19 educational workshops via social media and community forums and mobile vaccine pods to the places where essential workers are located, including their worksites, neighborhoods, and faith communities.
                    - Evaluate the POD program.

The Kentucky Occupational Safety and Health Surveillance (KOSHS) Program aims to do the following:
                    - Identify reasons for vaccine hesitancy among employees who care for residents of long-term care settings, which are the most vulnerable population for COVID-19.
                    - Work with the Kentucky Department of Public Health and Kentucky Center for Assisted Living to disseminate surveys to current long-term care employees.
                    - Use CDC’s Vaccine Confidence Survey Question bank to develop a survey exploring vaccination status, perspective on vaccinations, perspective on information received, and how long-term care employees are receiving COVID-19 vaccine information.
                    - Analyze the above-mentioned survey results and produce a long-term care specific profile on COVID-19 vaccination hesitancy which will be used in collaboration with NIOSH to develop communications, education, and trainings to assist employers to reduce vaccine hesitancy in long-term care settings.
                    - Disseminate industry sector specific profiles on COVID-19 vaccination hesitancy.

The Massachusetts Occupational Health Surveillance Program aims to do the following:
                    - Increase COVID-19 vaccination rates among Massachusetts (MA) workers and build capacity to better understand patterns of vaccination in workers.
                    - Build upon its existing state-based surveillance program to strengthen vaccine confidence in workers in MA by: (1) using existing data sources to identify groups of workers that may need tailored messaging or other enhanced engagement around COVID-19 vaccination; (2) conducting outreach to employers, workers, and community-based organizations in MA to enhance vaccination efforts in the Commonwealth; and (3) building capacity in MA to collect work-related information in their immunization registry.
                    - Develop strategies to enhance COVID-19 prevention and address concerns around vaccination by understanding risks for COVID-19 and patterns regarding hesitancy and collecting industry and occupation data from people who are vaccinated.
                    - Increase vaccination rates with a corresponding decrease in disparities in vaccination rates in the Commonwealth and improve surveillance infrastructure to support vaccination efforts in the future.

Michigan’s Expanded Program in Occupational Injury and Illness Surveillance aims to do the following:
                    - Use the Michigan Behavioral Risk Factor Surveillance System (MiBRFSS) to survey the Michigan general population to determine COVID-19 vaccination rates by industry and occupation controlling for age, gender, race, and morbidity.
                    - Use the MiBRFSS to survey rates and reasons for hesitancy to the COVID-19 vaccination among the Michigan general population by industry and occupation controlling for age, gender, race, and morbidity.
                    - Develop and disseminate industry/occupation specific educational material to employers, trade organizations and unions to address reasons for COVID-19 hesitancy within specific industries/occupations.
                    - Use the COVID-19 vaccination and reasons for hesitancy data to guide interventions to move employers, health care providers, unions and other agencies, and workers to take action to increase COVID-19 vaccination rates.

The Minnesota Occupational Health and Safety Surveillance Program aims to do the following:
                    - Determine the rates of SARS-CoV-2 infection and COVID-19 vaccinations among firefighters in Minnesota (MN) and examine factors related to COVID-19 vaccine status and intentions to get vaccinated among these firefighters.
                    - Collaborate with the MN Department of Health (MDH) Long-Term Surveillance (LTS) Annex, located within the MDH Environmental Public Health Tracking Program’s Long Term Chronic Disease and Injury Surveillance Annex, to investigate and track long-term COVID-19 follow-up in individuals with post-COVID conditions.
                    - Through membership in the LTS Annex, MN will collaborate on a survey of long-term COVID-19 cases and the impact of vaccination on long-term COVID patients and vaccination rates among this population by industry and occupation sector.
                    - Assess workplace vaccination policies and impacts by surveying businesses with COVID-19 case clusters to ask about their workplace vaccination efforts, vaccine policies, and the impact of vaccines on their workforce.
                    - Prevent COVID-19 outbreaks in Minnesota firefighters through improved vaccine uptake, which is expected to occur via a partnership between MN and the HealthPartners Institute, HealthPartners Occupational Medicine Department, Minnesota Firefighter Initiative, and Minnesota State Fire Chiefs Association to evaluate vaccination rates and disseminate education for Minnesota firefighters.
                    - Provide insights into which targets may be important to address to encourage future vaccination in firefighters and design a future intervention that incorporates behavioral approaches to address the identified targets to improve favorable attitudes towards vaccination.

The Expansion of the New Hampshire Occupational Health Surveillance Program aims to do the following:
                    - Collaborate with the New Hampshire (NH) Public Health Association’s (NHPHA) VaxWell NH Immunization Alliance to increase NH’s capacity to collect industry and occupation data and information on COVID-19 vaccination in workers, understand the barriers of essential frontline workers in accessing and accepting the COVID-19 vaccine, and conduct outreach to employers and worker groups to increase vaccine confidence among essential worker populations in the state.
                    - Conduct activities to reach business leaders and discuss how to support employees and understand the barriers of essential frontline workers in accepting the COVID-19 vaccine and develop outreach strategies targeted to employers to help them navigate the appropriate return-to-work policies that will support their employees’ acceptance of the COVID-19 vaccination.
                    - Support the NHPHA in forming a workgroup as part of the Immunization Alliance, comprised of key public health stakeholders, labor representatives, business leaders from all sectors, the Chambers of Commerce, and other economic leaders throughout the state, to create and promote a best practice toolkit for promoting vaccine uptake among NH workers.
                    - Along with NHPHA, engage with a consultant to develop a communications, marketing, and outreach plan to assist employers in New Hampshire with informing the workforce about vaccines (risks, benefits, safety, development, testing, approvals) to reduce hesitancy and increase confidence in receiving a vaccination.
                    - Leverage NHPHA’s relationship with New Hampshire’s 13 Regional Public Health Networks to build relationships with the regional business community and disseminate best practices and messaging designed to increase vaccine confidence.

The New Mexico Occupational Health Surveillance Program aims to do the following:
                    - Continue using a staged priority plan to distribute vaccine based on both health-related risk factors (e.g., age and comorbidities, etc.) and occupation to ensure that essential workers are protected as soon as it is feasible.
                    - Support efforts to assess the success of NM’s vaccination strategy in the working population and implement data-driven efforts to increase vaccination in industries that appear to have high rates of hesitant workers by (1) obtaining access to the vaccine registration data; and (2) reaching out to professional and community organizations to offer and provide trainings on vaccine hesitancy.
                    - Develop messaging to overcome vaccine hesitancy that is specifically aimed at vaccine-hesitant individuals and educate employers and other authority figures who are in support of vaccination on effective ways to address hesitancy in their employees and/or community members.
                    - Continue identifying and focusing on counties in New Mexico with the lowest vaccination rate to maximize the effectiveness of the vaccination strategy intervention.
                    - Use information on locations with the lowest vaccination rate to drive industry-based interventions and tailor materials to populations in counties with low vaccination rates indicated by data review.
                    - Develop and distribute print materials and post them online to assist employers and employees in making informed decisions about vaccination and implement face-to-face communications in the counties with low vaccination rates.
                    - Use data and feedback from educational outreach efforts to design and implement a public service ad campaign to encourage workers to get vaccinated with a focus on industries of the highest concern.

The Occupational Safety and Health Surveillance in New York State aims to do the following:
                    - Continue its digital media campaigns to engage the public about work-related issues which includes a social media campaign to deliver messaging to increase vaccine confidence, reduce vaccine hesitancy, and increase worker vaccinations with an emphasis on high-risk essential workers especially healthcare workers.
                    - Reduce vaccine hesitancy and increase worker vaccinations especially among essential workers by partnering with the Center for Environmental Health’s on outreach and education to develop materials and distribute them through a digital media campaign and deliver messaging about the COVID-19 vaccine to essential workers in New York State (NYS).
                    - Hold a communication campaign and focus on messages related to vaccine safety and effectiveness.
                    - Use the most current data available on the NYS COVID-19 Vaccine Tracker webpage to target the appropriate workers in lower vaccine prevalent counties and workers from racial and ethnic minority groups which are more likely to be more vulnerable to COVID-19 risk factors.

Washington’s Expanded Program in Occupational Injury and Illness Surveillance aims to do the following:
                    - Add questions to the Washington Behavioral Risk Factor Surveillance System (BRFSS) to assess if a person received a COVID vaccine, whether there is vaccine hesitancy (measured by the ‘probability’ of getting COVID vaccination), and other additional information about timing of vaccination doses.
                    - Use the BRFSS to estimate vaccination rates by industry and occupation at the sector and major occupation group level, estimate vaccine hesitancy by industry and occupation based on those describing a low probability of receiving the vaccine, and explore the relationship between employer’s expectations of personal protective equipment (PPE) use and vaccine hesitancy, as well as vaccine hesitancy in relationship to other health behaviors captured in the BRFSS.
                    - Estimate Washington State industries with high and low proportions of vaccinated workers and perform outreach to industry sectors with low vaccination rates.
                    - Use injured worker data in the Washington workers compensation data system, that will provide the Washington Department of Health personal identifiers to identify worker vaccination status.
                    - Provide vaccination status for injured workers, using the North American Industrial Classification System and the Standard Occupational Classification system, and assign known industry and occupation codes to cases with and without vaccination.
                    - Estimate vaccination rates by industry using employment estimates from the American Community Survey and the Current Population Survey and publish a descriptive summary of these results.
                    - Coordinate with the Washington State Department of Labor and Industries Communications Office, other groups of interest including labor unions and business associations, industry specific listservs and other industry specific media distribution systems to provide data and educational information to industries with low vaccination rates.
                    - Combine the above-mentioned data regarding vaccination hesitancy with questions regarding mask use in the workplace and whether work had been disrupted by the COVID pandemic.

The Occupational Health and Safety Surveillance Program aims to do the following:
                    - Partner with Family Health La Clinica (FHLC) to address vaccine hesitancy in Wisconsin’s group of workers who are at higher risk for COVID-19 illness, which includes agricultural workers in the FHLC service area of central Wisconsin — a population consisting of mostly Hispanic or Latino persons— as well as migrant and seasonal agricultural workers (MSAW) across the state.
                    - Collaborate with FHLC to enhance agricultural employer-related data and support enhanced communications and messaging to address vaccine hesitancy and low vaccination rates through developing messaging, media campaigns, key communication tools, and educational materials for FHLC service area residents, MSAW and their employers, and delivering COVID‐19 vaccination information electronically and via onsite presentations.
                    - Develop COVID-19 vaccine information and educational materials that will be distributed via the FHLC English/Spanish website for the 2022 season which will include education and information campaigns disseminated via electronic media and social media.
                    - Engage in public speaking engagements with groups of employers and community leaders to address vaccine hesitancy and promote COVID-19 vaccinations.

### Program Performance One-Pagers

                        - Surveillance Program
                        - Center for Workers’ Compensation Studies

                        - Surveillance Program
                        - Center for Workers’ Compensation Studies

                        - Surveillance Program
                        - Center for Workers’ Compensation Studies

                        - Surveillance Program
                        - Center for Workers’ Compensation Studies

                        - Surveillance Program

### Fiscal Year (FY) Extramural Research Program Highlights

Program achievements featured in the Extramural Research and Training Program Annual Reports
          - FY 2017
          - FY 2018
          - FY 2019

### Funding Opportunity Announcements

All cooperative agreement funding opportunity announcements can be found at:https://www.cdc.gov/niosh/oep/cooperative.html

### Additional Resources

          - NIOSH Division of Safety Research including Fatality Assessment and Control Evaluation/FACE and Center for Motor Vehicle Safety
          - NIOSH Center for Workers’ Compensation Studies (CWCS)
          - NIOSH Pesticide Surveillance Program
          - NIOSH Respiratory Health Division (RHD) including Respiratory Surveillance Program
          - NIOSH State-based Occupational Health Surveillance Clearinghouse

January 27, 2021
National Institute for Occupational Safety and Health