OSHA administers the Occupational Safety and Health Act of 1970 (OSH Act), which was enacted to assure so far as possible safe and healthful working conditions for the nation’s workers. OSHA helps ensure the safety and health of 106 million private sector workers at approximately 8.7 million worksites in the United States by operating over 80 area offices that report to 1 of 10 regional offices. OSHA sets occupational safety and health standards and is responsible for enforcing them. The agency directly enforces these standards in about half the states; the remaining states have been granted authority by OSHA to set and enforce their own workplace safety and health standards under a state plan approved by OSHA. The OSH Act and OSHA’s regulations generally require employers to prepare and maintain records of work-related injuries and illnesses sustained by their workers and make them available to OSHA upon request. These requirements are referred to as OSHA’s recordkeeping requirements. OSHA has established definitions and guidelines to assist employers in determining which injuries and illnesses must be recorded. Employers are required to maintain a log of recordable injuries and illnesses incurred at each worksite. OSHA requires employers to post summaries of these injury and illness logs annually at each worksite and provide them to OSHA if requested. In addition, under a section of the OSH Act referred to as the whistleblower protection provision, employers are prohibited from retaliating against employees for taking certain protected actions, including reporting work-related injuries or illnesses, and OSHA is responsible for investigating workers’ complaints of retaliation. To help ensure compliance with federal occupational safety and health standards and OSHA’s recordkeeping requirements, OSHA conducts enforcement activities such as on-site inspections of worksites. OSHA conducts these inspections in response to fatalities, serious injuries, complaints from workers, and referrals. In addition, OSHA targets industries and employers with a high number of workplace injuries and illnesses for inspection. When inspecting worksites, OSHA inspectors identify hazards that could lead to workers’ injuries or illnesses, review worksites’ injury and illness records, evaluate employers’ safety and health management systems, and meet with employers and worker representatives to discuss their findings and possible courses of action to correct hazards and improve their systems. Employers that fail to comply with the safety and health standards may face sanctions, such as paying penalties for violations. In its field operations manual, OSHA provides guidance to inspectors, employers, and workers on compliance with safety and health standards, inspections, and penalty assessments. To help employers comply with safety and health standards and recordkeeping requirements, OSHA supplements its enforcement efforts with voluntary cooperative programs, outreach, and training in which OSHA invites employers to collaborate with the agency and uses a variety of methods to encourage employers to adopt practices designed to foster safer and healthier working conditions. For example, OSHA’s Voluntary Protection Programs (VPP) recognize employers with exemplary safety and health systems and relatively low injury and illness rates, and exempts them from routine inspections. Small employers that request on-site consultation services may be recognized through OSHA’s Safety & Health Achievement Recognition Program (SHARP), which exempts those with exemplary safety and health management systems from routine inspections for up to 3 years. OSHA also trains employers and workers on how to comply with its standards and other regulations by, for example, providing online materials and reaching out directly to employer and worker groups. For example, each OSHA area office typically has one outreach specialist who serves as a resource to a variety of groups including businesses, trade associations, unions, and community groups.on OSHA’s cooperative programs, training resources, and tools available on the agency’s website. In addition, during inspections, OSHA’s inspectors provide information to employers on the strengths and weaknesses of their safety and health management systems. OSHA encourages employers to take a multifaceted approach to preventing and controlling hazards and creating an effective safety and health management system or a positive safety culture.OSHA, the four elements of an effective safety and health management system are as follows: (1) Management commitment and employee involvement Employers should develop a safety and health policy, communicate it to all employees, and demonstrate commitment to it by, for example, instilling accountability for safety and health and ensuring an open exchange of information about safety issues. Employees should be involved in safety- and health-related activities such as accident investigations. (2) Worksite analysis Employers should have a thorough understanding of all hazardous situations to which employees may be exposed, as well as the ability to recognize and correct these hazards. Accurate injury and illness records can be used to identify and prevent work-related injuries and illnesses. (3) Hazard prevention and control Employers should have clear procedures for preventing and controlling hazards identified through worksite analysis, such as a hazard tracking system and a written system for monitoring and maintaining workplace equipment. (4) Safety and health training Training is necessary to reinforce and complement management’s commitment to safety and health and to ensure that all employees understand how to avoid exposure to hazards. As part of their safety and health management systems, many employers use safety incentive programs to encourage safety in the workplace. These programs provide workers with rewards for achieving certain safety goals. Examples of these rewards include cash, meals, tangible goods, and public recognition. Employers can provide such rewards on the basis of individual or group performance depending on the program’s design. There are two types of safety incentive programs: rate-based programs, which reward workers for achieving low rates of reported injuries or illnesses, and behavior-based programs, which reward workers for certain behaviors such as recommending safety improvements (see fig. 1). Rate- based programs provide workers or groups of workers with rewards such as bonuses and prizes for having no or a low number of work-related injuries and illnesses during a specified period. For example, an employer’s rate-based program may reward workers with $100 bonuses for having no reported work-related injuries or illnesses in a given year. Behavior-based programs provide workers or groups of workers with rewards for demonstrating safe behaviors but are not tied to low injury and illness rates. For example, an employer’s behavior-based program may reward workers with gift cards for identifying hazardous conditions and suggesting safety improvements. Some experts we interviewed used the term behavior- based safety programs to describe an approach to workplace safety that focuses on worker behavior as the cause of work-related injuries and illnesses. However, in this report, we use the term behavior-based program to define a type of safety incentive program that is a component of an employer's safety and health management system. These systems may include other workplace safety policies such as demerit systems that discipline workers for failing to follow safety procedures. Employers’ safety and health management systems often include other workplace safety policies. For example, some employers require the participation of frontline workers and management in safety committees to help foster communication and address safety-related issues and encourage workers to promptly report injuries or illnesses and address safety hazards. Other workplace safety policies are designed to prevent injuries and illnesses by holding workers accountable for using safe work practices. Demerit systems discipline workers for unsafe work practices such as failing to follow safety procedures. For example, some employers have policies that discipline workers for not wearing protective gear or for other unsafe practices linked to reported injuries. In addition, some employers have drug and alcohol testing policies, which provide for the testing of workers (1) prior to employment, (2) at random intervals for some or all workers, (3) at scheduled times for all workers, (4) when there is evidence that suggests a worker may have used drugs or alcohol, or (5) after a workplace incident, such as an injury, occurs. Little conclusive academic research exists on whether safety incentive programs and other workplace safety policies affect workers’ injury and illness reporting, but several experts stated that rate-based programs may discourage injury and illness reporting. Of the 26 studies of workplace safety we reviewed, we identified 6 that evaluated the effect of safety incentive programs on workplace safety, but only 2 of these studies specifically evaluated the programs’ effect on reporting of injuries. Each of the six studies, however, had methodological limitations that prevent generalizing the effects of these programs on injury and illness reporting for all workers. The six studies that evaluated safety incentive programs reached different conclusions about their effect on workplace safety. Three studies— including the two that specifically evaluated the programs’ effect on reporting of injuries—focused on one type of safety incentive program and found that their effect on workplace safety was inconclusive or that the programs had no effect. For example, one study in which nurses were surveyed to determine how often injuries and illnesses were reported in their workplaces found that rate-based safety incentive programs had no effect on injury reporting. reporting which may differ from actual reporting due to, for example, faulty memories, and thus its results are not definitive. The three studies that did not focus on only one type of safety incentive program found that the programs reduced injuries; however, these studies did not quantify the programs’ effect on injury and illness reporting. The authors of these studies acknowledged that, when the programs provide incentives for not reporting an injury—such as providing a monetary reward for having a low injury and illness rate—workers may underreport injuries. For example, the authors of one study noted that workers may “intentionally fail to report injuries in an effort to preserve potential bonuses for their work groups.” Information on the six studies is summarized in table 1. Jean Geiger Brown, Alison Trinkoff, Kenneth Rempher, Kathleen McPhaul, Barbara Brady, Jane Lipscomb, and Charles Muntaner, “Nurses Inclination to Report Work-Related Injuries: Organizational, Work-Group, and Individual Factors Associated with Reporting,” AAOHN Journal, vol. 53, no. 5 (2005): 213-217. The study analyzed workers’ perceptions of reporting behavior which may differ from actual reporting behavior; therefore, the results are not definitive. In addition to reviewing existing studies, we interviewed over 50 experts and industry officials from academia, employer associations, a law firm, a consulting firm, unions, and state and federal safety and health agencies to obtain their opinions about the effect of safety incentive programs and other workplace safety policies on injury and illness reporting. Several of them told us that an unintended consequence of rate-based programs may be discouraging workers from reporting injuries and illnesses. For example, when workers’ injuries are relatively minor or easy to hide, and if the rewards provided under the program are relatively large, workers may not report their injuries to preserve their rewards. Potential underreporting of injuries and illnesses is even greater when an incentive creates peer pressure on workers to not report injuries. For example, when all workers on a team get a reward only if no one on the team has an injury, there may be pressure on all members of the team to not report injuries. According to some experts we interviewed, it is difficult to quantify the effect safety incentive programs may have on injury and illness reporting partly because researchers do not have access to workers’ medical records. Without such access, workers who do not report their injuries cannot be identified and this information cannot be used to explore whether workers’ decisions to not report their injuries were linked to their employers’ safety incentive programs. Several experts and industry officials we interviewed also mentioned that, along with safety incentive programs, some workplace safety policies may discourage workers from reporting injuries and illnesses. For example, policies that punish workers for unsafe practices that are linked to injuries may—depending on the nature of the injury and the policy—inhibit them from reporting injuries. Such policies include demerit systems that have consequences for workers who report injuries or illnesses, such as giving workers warnings, demotions, or terminating them for recurrences. However, some employers use demerit systems to discipline workers who engage in unsafe practices such as not wearing protective gear, and such demerit systems may have no effect on workers’ reporting of injuries and illnesses. According to officials from a union, workplace safety policies that single out workers who report injuries or illnesses by, for example, requiring them to wear identifying clothes such as an orange vest, may also discourage them from reporting. In addition, according to several experts, policies that require drug and alcohol testing after an injury is reported—compared to those that are applied on a routine basis to all workers—may deter workers from reporting injuries. We found only one study that evaluated the effect of these other workplace safety policies mentioned by experts and industry officials as having a potentially adverse effect on injury and illness reporting. This study evaluated the effect of post-incident drug testing on injury and illness reporting and found evidence that such testing may discourage reporting of relatively minor injuries that are easy to hide. While some safety incentive programs and other workplace safety policies may discourage injury and illness reporting, research we reviewed indicated that how employers manage safety has a greater influence on workers’ actions, including whether they are likely to report injuries and illnesses, than any one program or policy. Among the 26 studies we reviewed, most found that employers that promote a positive safety culture may encourage workers to use safe behaviors, report injuries and illnesses, or reduce the incidence of injuries and illnesses. We identified 21 studies that evaluated the effect of an employer’s safety culture on workplace safety. Of these studies, 16 indicated that having a good safety culture has a positive effect on workers’ use of safe behaviors, injury and illness rates, or reporting of injuries and illnesses, and 5 indicated that a good safety culture had a mixed or inconclusive effect. According to the studies we reviewed, workplaces with a positive safety culture placed a strong emphasis on safety by, for example, encouraging open communication about safety issues, placing a high priority on safety training, and having procedures that prevented breakdowns in workplace safety. Some researchers concluded that in such environments, workers felt that they could report injuries and illnesses without fear of reprisal or blame from management or fellow workers. Of the four studies we reviewed that evaluated the effect of a positive safety culture on reporting of work-related injuries or accidents, safety culture increased the likelihood of injury and illness reporting. three found that having a positive Policies that help employers create a positive safety culture and keep workers safe and healthy were generally perceived as being proactive versus reactive. For example, employers with proactive policies that require workers to report near-miss incidents to help identify hazards and other safety concerns before an injury takes place were more likely to have a positive effect on injury and illness reporting. Each of the studies had a methodological issue that may limit the generalizability of the findings. For example, three of the four studies included nonrandom samples and the results may be affected by selection bias. In contrast, according to the studies we reviewed, workplaces with a negative safety culture do not place a strong emphasis on safety. These employers do not encourage open communication about safety issues or prioritize safety training. According to two experts we interviewed, some employer safety programs focus on workers' behaviors as the cause of work-related injuries and illnesses, and have policies that discipline workers for failing to follow safety procedures. As a result, workers in these environments may be less likely to report injuries or illnesses because, if they lack safety training, communication is poor, or they are not encouraged to report injuries and illness, they may not know how to report them, or may fear being disciplined. According to our survey, in 2010, an estimated 116,000 of about 153,000 manufacturers in the United States (75 percent) had safety incentive programs or had other workplace safety policies that, according to several experts, may affect workers’ reporting of injuries and illnesses. However, we estimated that safety incentive programs were less prevalent than other workplace safety policies, such as demerit systems, that discipline workers for unsafe work practices.a quarter of manufacturers had some type of safety incentive program and most had a demerit system or post-incident drug and alcohol testing We also estimated that policy. Demerit systems were the most common policy reported, followed by post-incident drug and alcohol testing policies (see fig. 2). Very few manufacturers had only one type of safety incentive program, and few had only one type of other workplace safety policy. Most manufacturers had more than one safety incentive program or other workplace safety policy, and more than 20 percent had several, according to our estimates. For example, one manufacturer who participated in our survey had a program that rewarded workers with a luncheon for having no injuries that resulted in lost time on the job, and provided a separate reward to the worker who submitted the best safety suggestion during the month. Manufacturers with multiple types of programs or policies were more than twice as likely to have a demerit system or conduct post-incident drug and alcohol testing than they were to have a rate-based or behavior-based program (see fig. 3). Large manufacturers were more likely to have safety incentive programs and demerit systems than smaller manufacturers. We estimated that large manufacturers were more than three times as likely to have safety incentive programs compared with small manufacturers. Although safety incentive programs and other workplace safety policies were less common among small manufacturers, most small manufacturers had demerit systems and many had post-incident drug and alcohol testing policies (see fig. 4). Companies sometimes request information on manufacturers’ injury and illness rates before signing a contract with them to manufacture goods. According to some workplace safety experts, such contractors may feel pressure to lower injury and illness rates to avoid the risk of losing bids for contracted work. Manufacturers whose injury and illness rates were requested by potential contracting companies were more than twice as likely to have rate-based safety incentive programs than manufacturers whose rates were not requested. We estimated that 31 percent of U.S. manufacturers performed contractual work in 2010. Contracting companies requested injury and illness rate data from nearly a third of these manufacturers prior to signing a contract with them. Thirty-eight percent of these manufacturers that had their injury and illness rates requested reported having rate-based programs in 2010. In contrast, 13 percent of the manufacturers that had did not have their injury and illness data requested by potential contracting companies prior to signing a contract reported having rate-based programs in 2010. U.S. manufacturers provided incentives to workers for a variety of safety goals and behaviors. Nearly three-quarters of manufacturers with rate- based programs, according to our estimates, rewarded workers for having no reported injuries and illnesses. Forty percent rewarded workers for having a low number or rate of injuries and illnesses during a specific time period, and 23 percent of them rewarded workers for reducing the number or rate of reported injuries and illnesses. Nearly 70 percent of manufacturers with behavior-based programs rewarded workers for recommending workplace safety improvements and 37 percent rewarded them for wearing protective gear. The criteria for providing rewards differed between rate-based and behavior- based programs, but the types of rewards manufacturers provided and the types of workers targeted by both of these safety incentive programs were similar. For both types of programs, monetary awards, meals, and other non- monetary awards, such as gift cards, were more commonly offered than time off work or a token of recognition, such as a plaque. Manufacturers used safety incentive programs to target various levels of workers and worker groups, including entire workplaces, work teams such as department or shifts, supervisors, and frontline workers. However, the percentage of manufacturers that rewarded individual frontline workers through either rate- based or behavior-based safety incentive programs was twice as high as those that rewarded supervisors. OSHA can use its enforcement authority to address certain aspects of safety incentive programs and other workplace safety policies, but the effectiveness of these activities is limited. Although the OSH Act does not mandate that OSHA regulate safety incentive programs, OSHA officials told us the agency could potentially issue a regulation to address safety incentive programs and other workplace safety policies. However, OSHA has not done so because, according to OSHA officials, it has focused its regulatory resources on other priorities such as projects that address exposure to serious safety and health hazards. Some of OSHA’s enforcement tools can be used to address certain aspects of safety incentive programs and other workplace safety policies, but these tools are not designed to systematically address these programs. For example, a worker may file a whistleblower protection complaint if the worker reports an injury and, under the rules of the employer’s safety incentive program, is subsequently excluded from receiving a reward, such as a bonus. However, such claims may only address the adverse action experienced by an individual worker and not address the potential overall negative impact a safety incentive program may have on the workplace. Under its recordkeeping regulations, OSHA can address recordkeeping violations that occur as a result of safety incentive programs and other workplace safety policies, but it cannot address potential disincentives to injury and illness reporting associated with the policies. For example, OSHA can cite employers for failing to properly record injuries or illnesses under its recordkeeping regulations, but the relationship between a safety incentive program and potential underreporting of injuries and illnesses is not directly addressed in these requirements. To find evidence of underreporting, inspectors must interview workers, review their medical records, and compare these records to employers’ injury and illness logs to determine whether an injury or illness occurred but was not reflected on the log. 29 U.S.C. §§ 657(c), 658(a). For OSHA’s recordkeeping regulations, see generally 29 C.F.R. part 1904. the accuracy of employers’ injury and illness logs and identify and correct any mistakes or omissions. OSHA began this program in September 2009, and in February 2010 established a goal of auditing injury and illness records at approximately 350 worksites nationwide over a 2-year period. Inspectors compared employers’ injury and illness logs to workers’ medical records, and interviewed workers, managers, recordkeepers, and first-aid providers. As part of these audits, OSHA directed inspectors to consider the effect of safety incentive programs or other workplace safety policies on injury and illness reporting, and when recordkeeping violations were found, in assessing the severity of the violation. For example, according to OSHA officials, if inspectors found underreporting of injuries and illnesses and concluded that a safety incentive program was a contributing factor, the inspector could classify the violation as willful, which carries an increased penalty. However, the guidance provided to inspectors did not specify how this assessment should be done and, in our interviews with OSHA area office officials we found that OSHA inspectors inconsistently considered safety incentive programs when reviewing employers’ injury and illness records. For example, one area office official said that the penalty assessment for a recordkeeping violation would be the same regardless of the existence of a safety incentive program. In addition, because OSHA did not select a nationally representative sample of worksites for these inspections, OSHA cannot use the results to determine the effect of safety incentive programs and other workplace safety policies on injury and illness reporting nationwide. OSHA has developed policy guidance on safety incentive programs for the VPP, but the guidance for its other cooperative programs and for its enforcement efforts does not address safety incentive programs or other workplace safety policies. For example, OSHA’s guidance on its SHARP program, a voluntary cooperative program that focuses on smaller employers, does not address safety incentive programs. Similarly, OSHA’s field operations manual does not provide guidance to its inspectors for addressing safety incentive programs during inspections. In June 2011, OSHA issued a policy memorandum for the VPP program that contains specific criteria for safety incentive programs, including the types of programs that are encouraged for VPP sites and those that are prohibited. Programs that promote accurate injury and illness reporting are encouraged, while participants in the VPP are now prohibited from having safety incentive programs that focus on the number of injuries and illnesses, such as rate-based programs that reward workers for achieving low injury and illness rates. This policy memorandum does not address other workplace safety policies that might impact injury and illness reporting. OSHA officials are required to ensure current VPP participants are in compliance with this policy when participants are reevaluated to determine whether they will be allowed to continue to participate in the program, but the new policy is not included in the VPP manual. Officials from one regional office estimated that almost 20 percent of its VPP participants have safety incentive programs that are not in compliance with this new policy. In addition to providing guidance on its voluntary cooperative programs, OSHA often provides safety information to employers during its on-site inspections. In its guidance on conducting inspections, OSHA’s field operations manual outlines the educational duties that inspectors have as part of the inspection process. For example, inspectors are expected to discuss the strengths and weaknesses of the employers’ safety and health management system and advise the employer of the benefits of effective systems during the closing conference of the inspection. However, the field operations manual does not make any references to safety incentive programs or other workplace safety policies. Other OSHA resources lack guidance about safety incentive programs and other workplace safety policies. Outreach specialists and materials available on OSHA’s website are additional sources of information that can educate employers and workers about how safety incentive programs and other workplace safety policies may affect a workplace’s safety and health management system. Although outreach specialists each develop materials and approaches for addressing the needs of employers in their particular geographic area, each has an opportunity to discuss the potential risks and benefits of safety incentive programs and the potential impact of workplace safety policies on injury and illness reporting during discussions about recordkeeping, safety and health management systems, and OSHA’s cooperative programs, among other topics. In addition, many resources are available to employers through OSHA’s website, including fact sheets about recordkeeping and best practices, such as the Effective Workplace Safety and Health Management Systems fact sheet. This fact sheet and several others do not discuss safety incentive programs or other workplace safety policies, although some do address aspects of a positive safety culture. Safety incentive programs exist in the context of a workplace’s safety culture. Some types of programs, particularly those that are tied to low injury and illness rates, may discourage injury or illness reporting. However, the same programs in workplaces with positive safety cultures may have no effect with regard to reporting. Similarly, some workplace safety policies, such as those that punish workers in some way for reporting injuries or illnesses, may discourage workers from reporting injuries and illnesses, especially when implemented in a workplace with a negative safety culture. Because OSHA relies heavily on accurate injury and illness reporting in tailoring its programs and allocating its finite enforcement resources, it is important for the agency to assess the impact of safety incentive programs and certain workplace safety policies on injury and illness reporting, particularly given their prevalence. Without accurate data, employers engaged in hazardous activities can avoid inspections and may be allowed to participate in voluntary programs that reward employers with exemplary safety and health management systems by exempting them from routine inspections. OSHA can encourage employers to create positive safety cultures and avoid safety incentive programs and workplace safety policies that may have a negative effect on injury and illness reporting. However, because safety incentive programs and certain workplace safety policies are not addressed in OSHA guidance, including its field operations manual, OSHA inspectors may not consider these programs and policies during worksite inspections, even as they observe key aspects of the workplace’s safety culture. As a result, inspectors may miss opportunities to educate employers about the benefits of promoting a positive safety culture and avoiding prevalent programs and policies that can discourage accurate reporting of injuries and illnesses. In addition, in the absence of consistent guidance on the potential benefits and risks of some safety incentive programs and workplace safety policies, OSHA may recognize some employers as having exemplary safety and health management systems without considering the potentially negative effects of some of their programs and policies. To increase consistency across OSHA’s cooperative programs, the Secretary of Labor should direct the Assistant Secretary of OSHA to implement criteria on safety incentive programs and other workplace safety policies across all of its cooperative programs such as VPP and SHARP. The criteria should be consistent with the most recent VPP guidance memorandum that prohibits employers with safety incentive programs that focus on injury and illness rates from participating in the program. To help OSHA inspectors consistently educate employers about the importance of safety culture, the Secretary of Labor should direct the Assistant Secretary of OSHA to add language about key elements of a positive safety culture—and the potential effect of different types of safety incentive programs and other workplace safety policies—to its field operations manual. We provided a draft of this report to Labor for review and comment. Labor’s Assistant Secretary for OSHA provided written comments, which are reproduced in appendix IV. OSHA agreed with our recommendations and emphasized the agency’s concern about workplace programs that appear to encourage safe work practices but actually discourage workers from reporting injuries. OSHA also provided technical comments, which we incorporated as appropriate. In response to our recommendation that OSHA implement criteria on safety incentive programs and other workplace safety policies across all of its cooperative programs such as VPP and SHARP, OSHA stated that it will provide policy guidance about safety incentive programs across the agency’s cooperative programs. According to OSHA, this guidance will be similar to the VPP policy prohibiting participants from using safety incentive programs that have the potential to discourage workers from reporting injuries. Establishing such criteria across all of its cooperative programs will help OSHA accurately recognize employers with exemplary safety and health management systems. In response to our recommendation that OSHA add language about key elements of a positive safety culture—and the potential effect of different types of safety incentive programs and other workplace safety policies— to its field operations manual, OSHA stated that it has issued guidance for its inspectors about safety incentive programs that underscores the agency’s position that programs that discourage workers from reporting injuries may violate whistleblower protection statutes and OSHA’s recordkeeping regulations. OSHA issued this guidance to regional and whistleblower program officials in March 2012 and published it on the agency’s website, but it has not yet been incorporated into the agency’s field operations manual. As agreed with your offices, unless you publically announce the contents of this report earlier, we plan no further distribution until 30 days from the report date. At that time, we will send copies of this report to the Secretary of Labor, relevant congressional committees, and other interested parties. In addition, the report will also be available at no charge on GAO’s website at http://www.gao.gov. If you or your staff have questions about this report, please contact me at (202) 512-7215 or moranr@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. Key contributors to this report are listed in appendix V. To determine what is known about the effect of workplace safety incentive programs and other workplace safety policies on injury and illness reporting, we conducted a literature search for relevant studies. We sought studies that analyzed the effect of workplace safety incentive programs; other workplace safety policies, such as post-incident drug testing; or safety culture on workers’ use of safe practices; injury and illness rates; or reporting of injuries and illnesses. To identify the studies, we searched bibliographic databases covering scientific, safety, medical, and economic literature, including ArticleFirst, CINAHL, EconLit, Electronic Collections Online, EMBASE, MEDLINE, ProQuest, PsycINFO, SciSearch, and Social SciSearch for relevant search terms and citations of studies. We limited the searches to materials published in 2001 or after. We performed these searches from August 2011 to October 2011, and identified over 600 abstracts of studies. Among these studies, we excluded those that did not satisfy our criteria that each study (1) be published in a peer-reviewed journal and (2) contain relevant, primary research conducted in the United States. We also excluded studies that seemed duplicative or did not meet GAO’s methodological standards. To assess the methodological quality of the studies, two GAO research methodologists independently reviewed each study that satisfied our criteria and excluded those that did not contain original research or lacked rigor. Using this approach, we identified 26 methodologically sound studies (see app. II for a list of the 26 studies). To supplement our understanding of what is known about the effect of safety incentive programs and other workplace safety policies on injury and illness reporting, we interviewed experts and industry officials from academia, employer associations, a law firm, a consulting firm, unions, and state and federal occupational safety and health agencies. We spoke with individuals from the University of Connecticut, Boston University, Institute for Work and Health, United Steel Workers, United Mine Workers of America, American Federation of Labor and Congress of Industrial Organizations, National Association of Manufacturers, Mercer, Voluntary Protection Programs Participants’ Association, Gibson, Dunn & Crutcher, Occupational Safety and Health Administration (OSHA), Bureau of Labor Statistics (BLS), National Institute for Occupational Safety and Health, Chemical Safety Board, and state occupational safety and health agencies in California, North Carolina, South Carolina, and Vermont. To identify these experts and industry officials, we reviewed relevant trade press and congressional transcripts and sought referrals from interviewees. To ensure balance, we spoke with an array of experts and industry officials with varying backgrounds and perspectives. To study the prevalence of workplace safety incentive programs as well as other workplace safety policies that may affect injury and illness reporting, we surveyed a nationally representative sample of manufacturing worksites. We selected a systematic random sample of 1,000 manufacturers from a total of 26,552 included in our sample frame of data. Our sample frame consisted of the set of manufacturers with 11 or more employees contained in a nationally representative BLS establishment survey fielded in 2010. This list was a relatively complete, current source of business names and addresses that had undergone a strict refinement process to remove establishments that were out of business, duplicates, or miscoded. We sorted the manufacturers by the sample weight for the BLS survey prior to the systematic random selection in order to ensure that a range of manufacturers was obtained. We designed and implemented a dual mode survey (mail and web-based) to obtain information from manufacturers on the types and characteristics of safety incentive programs and policies used at their workplaces, and the extent to which they performed contractual work for other companies. To develop our survey questions, we drew on information we gathered from interviews with occupational safety and health stakeholders and from scholarly studies on occupational safety and health. We pretested the survey with nine manufacturers that represented the three size populations of manufacturers studied (small, medium, and large) and submitted the questionnaire for an additional independent review by two survey specialists within GAO and experts in OSHA and BLS. We then made revisions based on their feedback prior to finalizing the survey. We conducted the survey using a self-administered questionnaire, and offered prospective respondents the option of completing and mailing a hard copy questionnaire or completing the questionnaire online (see app. III for a copy of the survey). To encourage participation, we mailed a reminder postcard, a second questionnaire, and made follow-up phone calls to all those who had not yet responded in regular intervals prior to closing the survey. A total of 663 manufacturers responded, resulting in a final weighted response rate of 62.4 percent. Because we surveyed a sample of manufacturers, the survey results are weighted estimates for a population of manufacturers and thus are subject to sampling errors associated with samples of this size and type. Our sample is only one of a large number of samples we might have drawn. As each sample could have provided different estimates, we expressed our confidence in the precision of our particular sample’s results as a 95 percent confidence interval (e.g., plus or minus 10 percentage points). We excluded 29 of the sampled manufacturers because we were able to determine that they were out of business at the time of our survey or they indicated that they did not engage in manufacturing. Therefore, all 29 of the manufacturers we excluded were considered out of scope. All estimates produced from the sample and presented in this report are representative of the in-scope population. The practical difficulties of conducting any survey may introduce errors resulting from the data collection procedures, commonly referred to as nonsampling errors, which can introduce unwanted variability into the survey results. There are four primary sources of nonsampling error: 1. Measurement—error in responses recorded on the survey instruments resulting from poorly worded, biased, or sensitive questions; ambiguous instructions; or lack of information available to respondents. 2. Nonresponse—bias from failing to get responses from establishments whose answers would have differed significantly from those that did participate. 3. Coverage—bias from failing to include all eligible establishments or from including ineligible establishments in the list from which we sampled. 4. Data processing—error arising from faulty handling or processing of the data. We took extensive steps in developing the questionnaire, collecting the data and analyzing the results to address the potential sources of nonsampling error. To minimize measurement error, GAO staff with subject-matter expertise collaborated with a survey design specialist to develop the questionnaire. We pretested the instrument using cognitive interviewing techniques and interviewed the pretest respondents to ensure that (1) the questions and instructions were clear, unambiguous, and in the correct order; (2) the terms we used were precise; (3) the survey did not place an undue burden on the respondents completing it; and (4) the survey was unbiased. To assess the risk of nonresponse bias, we obtained answers over the phone to three survey questions from 19 nonrespondents. We statistically compared the answers from the nonrespondents with those of our respondents on these three questions and found no statistically significant differences. Our sample frame minimized the risk of coverage error by drawing on a nationally representative list of manufacturers that was thoroughly reviewed and cleaned to remove ineligible establishments. Finally, we took several steps to reduce processing errors: (1) Quality control measures were implemented during preparation and mailout of survey packages to ensure that the respondents would receive the package with the proper login identification number and that the packages contained the correct contents. (2) We contracted with an outside company to enter the data from the paper questionnaires into a database, and we checked a 10 percent sample of the database as a quality control measure. (3) Respondents who completed questionnaires online entered their answers directly which eliminated the errors associated with a manual data entry process. (4) After we analyzed the data, a second independent data analyst checked all of the computer programs for accuracy. To examine OSHA’s efforts to address safety incentive programs, we reviewed relevant federal laws and regulations, OSHA’s policies and procedures, and interviewed OSHA officials regarding the agency’s activities. We interviewed selected OSHA officials from the agency’s national office as well as several regional and area offices to learn about (1) their efforts to address the potential impact of safety incentive programs and workplace policies on injury and illness reporting, (2) the recordkeeping enforcement initiative, and (3) their views on safety incentive programs and the potential relationship between these programs and injury and illness reporting. We interviewed officials from three regional offices and five area offices representing 5 of the 10 different OSHA regions. In all of these interviews we attempted to meet with regional and area office officials with experience in the recordkeeping enforcement initiative and those that oversee cooperative programs and other outreach and training efforts. We visited five OSHA offices and spoke with officials from four state occupational safety and health agencies. We selected these offices based on their geographic dispersal and representation of OSHA regions. To assess the results of OSHA’s recordkeeping enforcement initiative, we analyzed data from the OSHA Recordkeeping Inspection Assistant database, which contains records of the inspections OSHA conducted in 2009, 2010, and 2011. Prior to our analysis, we assessed the reliability of the OSHA Recordkeeping Inspection Assistant database by reviewing information obtained from OSHA about the database, and interviewing a knowledgeable agency official. Where there were discrepancies in the data, we worked with this official to clarify and, in some cases, correct the data. For example, we found two records that were missing key identifying information about the OSHA region in which the inspections occurred. On the basis of our assessment, we concluded that the updated data were sufficiently reliable for our reporting purposes. We conducted this performance audit from September 2010 to April 2012 in accordance with generally accepted government auditing standards. These standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives. Alavosius, Mark, Jim Getting, Joseph Dagen, William Newsome, and Bill Hopkins. “Use of a Cooperative to Interlock Contingencies and Balance the Commonwealth.” Journal of Organizational Behavior Management, vol. 29, no. 2 (2009): 193-211. 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Zohar, Dov, and Gil Luria. “The Use of Supervisory Practices as Leverage to Improve Safety Behavior: A Cross-Level Intervention Model.” Journal of Safety Research, vol. 34, no. 5 (2003): 567-577. In addition to the contact named above, Gretta L. Goodwin, Assistant Director, and Joel Green, Analyst-in-Charge, managed all aspects of this assignment; James E. Lloyd III and Michelle Loutoo Wilson made significant contributions to all phases of the work; Grace Cho made substantial contributions to data analysis and message and report development; Carl Barden and Pamela Davidson provided assistance in designing the study, conducting data analysis, and developing the report; Lorraine Ettaro, Stuart Kaufman, and Carl Ramirez helped with survey administration; Delores Hemsley assisted in data collection; Catherine Hurley assisted in data analysis; Ashley McCall provided literature search assistance; Barbara Chapman, Cynthia Saunders, and Elizabeth Wood assisted in the methodological review of studies; Susannah Compton assisted in message and report development; James Bennett created the report’s graphics; Sarah Cornetto provided legal advice; and Amber Yancey-Carroll and Anna Bonelli reviewed the report to check the facts presented.

Summary: OSHA relies on employer injury and illness records to target its enforcement efforts. Questions have been raised as to whether some safety incentive programs and other workplace safety policies may discourage workers' reporting of injuries and illnesses. GAO examined (1) what is known about the effect of workplace safety incentive programs and other workplace safety policies on injury and illness reporting, (2) the prevalence of safety incentive programs as well as other policies that may affect reporting, and (3) actions OSHA has taken to address how safety incentive programs and other policies may affect injury and illness reporting. GAO reviewed academic literature, federal laws, regulations, and OSHA guidance; surveyed a nationally representative sample of manufacturing worksites; and interviewed federal and state occupational safety and health officials, union and employer representatives, and researchers. Little research exists on the effect of workplace safety incentive programs and other workplace safety policies on workers' reporting of injuries and illnesses, but several experts identified a link between certain types of programs and policies and reporting. Researchers distinguish between rate-based safety incentive programs, which reward workers for achieving low rates of reported injuries or illnesses, and behavior-based programs, which reward workers for certain behaviors, such as recommending safety improvements. Of the six studies GAO identified that assessed the effect of safety incentive programs, two analyzed the potential effect on workers reporting of injuries or illnesses, but they concluded that there was no relationship between the programs and injury and illness reporting. Experts and industry officials, however, suggest that rate-based programs may discourage reporting of injuries and illnesses. Experts and industry officials also reported that certain workplace polices, such as post-incident drug and alcohol testing, may discourage workers from reporting injuries and illnesses. Researchers and workplace safety experts also noted that how safety is managed in the workplace, including employer practices such as fostering open communication about safety issues, may encourage reporting of injuries and illnesses. In 2010, from its survey, GAO estimated that 25 percent of U.S. manufacturers had safety incentive programs, and most had other workplace safety policies that, according to experts and industry officials, may affect injury and illness reporting. GAO estimated that 22 percent of manufacturers had rate-based safety incentive programs, and 14 percent had behavior-based programs. Almost 70 percent of manufacturers also had demerit systems, which discipline workers for unsafe behaviors, and 56 percent had post-incident drug and alcohol testing policies according to GAOs estimates. Most manufacturers had more than one safety incentive program or other workplace safety policy and more than 20 percent had several. Such programs and policies were more common among larger manufacturers. Although the Occupational Safety and Health Administration (OSHA) is not required to regulate safety incentive programs, it has taken limited action to address the potential effect of such programs and other workplace safety policies on injury and illness reporting. These programs and policies, however, are not addressed in key guidance such as OSHA's field operations manual for inspectors. OSHA has cooperative programs that exempt employers with exemplary safety and health management systems from routine inspections. One such program prohibits participants from having rate-based safety incentive programs, but guidance on OSHAs other cooperative programs does not address safety incentive programs. Similarly, OSHA inspectors and outreach specialists provide information to employers about the potential benefits and risks of safety incentive programs, but the guidance provided to inspectors in its field operations manual does not address these programs. GAO recommends that OSHA provide guidance about safety incentive programs and other workplace safety policies consistently across the agency's cooperative programs, and add language about safety incentive programs and other workplace safety policies to the guidance provided to inspectors in its field operations manual. OSHA agreed with the recommendations, and noted its plans to address them.