Workers' compensation loss prevention representative contact and risk of lost-time injury in construction policyholders

IntroductionInsurance loss prevention (LP) representatives have access and contact with businesses and employees to provide targeted safety and health resources. Construction firms, especially those smaller in size, are a high-risk population. This research evaluated the association between LP rep contact and risk for lost-time injuries in construction policyholders.MethodsWorkers' compensation data were utilized to track LP rep contact with policyholders and incidence of lost-time injury over time. Survival analysis with repeated events modeling calculated hazard ratios (HR) and 95% confidence intervals (CI).ResultsCompared no LP contact, one contact was associated with a 27% reduction of risk (HR = 0.73, CI = 0.65–0.82), two with a 41% (HR = 0.59, CI = 0.51–0.68), and three or more contacts with a 28% reduction of risk (HR = 0.72, CI = 0.65–0.81).ConclusionsLP reps appear to be a valuable partner in efforts to reduce injury burden. Their presence or contact with policyholders is consistent with reduction in overall incidence of lost-time injuries.Practical applicationsReduction in lost-time injuries, resulting in reduced workers' compensation costs for policyholders and insurance companies, builds a business-case for safety and injury prevention. LP reps are often a low or no-cost benefit for insurance policyholders and may be an important injury prevention resource for small firms and/or those with lack of safety resources and staff.     

Adult opinions about the age at which children can be left home alone, bathe alone, or bike alone: Second Injury Control and Risk Survey (ICARIS-2)

ProblemThis study describes adult opinions about child supervision during various activities.MethodsData come from a survey of U.S. adults. Respondents were asked the minimum age a child could safely: stay home alone; bathe alone; or ride a bike alone. Respondents with children were asked if their child had ever been allowed to: play outside alone; play in a room at home for more than 10 minutes alone; bathe with another child; or bathe alone.ResultsThe mean age that adults believed a child could be home alone was 13.0 years (95% CI = 12.9-13.1), bathe alone was 7.5 years (95% CI = 7.4-7.6), or bike alone was 10.1 years (95% CI = 10.0-10.3). There were significant differences by income, education, and race.DiscussionAssessing adult's understanding of the appropriate age for independent action helps set a context for providing guidance on parental supervision. Guidelines for parents should acknowledge social norms and child development stages.Impact on IndustryKnowledge of social norms can help guide injury prevention messages for parents.     

Hospitalizations for immersion-related injuries in Alaska 1991–2000

ObjectiveThis study analyzed factors associated with injuries to hospitalized victims of nonfatal immersion-related events in Alaska from 1991 through 2000.DataAlaska Trauma Registry (ATR) records of victims of nonfatal immersion events requiring hospitalization were examined to identify factors associated with injury outcomes. Subjects were divided into two groups: the “immersion only” (IO) group had no additional injuries associated with their immersion-related events, while subjects in the “associated injury” (AI) group incurred additional trauma during injury events.ResultsThere were 176 ATR records of nonfatal immersion events. In 87 (49.5%) cases, hospitalizations were due to the effects of immersion only (IO group). In 89 (50.5%) cases, hospitalizations were due not only to the effects of immersion, but also due to additional injuries occurring immediately before or while immersion took place (AI group). The final logistic regression model revealed statistically significant relationships between age greater than 12 years, female gender, white ethnicity, and operation of water transport vehicles, and increased risk for associated injury outcomes (p < 0.05).DiscussionThis study is the first of its kind to analyze factors associated with the most severe nonfatal immersion-related injuries in Alaska, and identifies target populations for future safety campaigns.     

Prevention of occupational injuries: Evidence for effective good practices in foundries

IntroductionOccupational injuries are a relevant research and practical issue. However, intervention studies evaluating the effectiveness of workplace injury prevention programs are seldom performed. Method: The effectiveness of a multifaceted intervention aimed at reducing occupational injury rates (incidence/employment-based = IR, frequency/hours-based = FR, severity = SR) was evaluated between 2008 and 2013 in 29 Italian foundries (22 ferrous; 7 non-ferrous; 3,460 male blue collar workers/year) of varying sizes. Each foundry established an internal multidisciplinary prevention team for risk assessment, monitoring and prevention of occupational injuries, involving employers, occupational physicians, safety personnel, workers' representatives, supervisors. Targets of intervention were workers, equipment, organization, workplace, job tasks. An interrupted time series (ITS) design was applied. Results: 4,604 occupational injuries and 83,156 lost workdays were registered between 2003 and 2013. Statistical analysis showed, after intervention, a reduction of all injury rates (− 26% IR, − 15% FR, −18% SR) in ferrous foundries and of SR (− 4%) in non-ferrous foundries. A significant (p = 0.021) ‘step-effect’ was shown for IR in ferrous foundries, independent of secular trends (p < 0.001). Sector-specific benchmarks for all injury rates were developed separately for ferrous and non-ferrous foundries. Conclusions: Strengths of the study were: ITS design, according to standardized quality criteria (i.e., at least three data points before and three data points after intervention; clearly defined intervention point); pragmatic approach, with good external validity; promotion of effective good practices. Main limitations were the non-randomized nature and a medium length post-intervention period. In conclusion, a multifaceted, pragmatic and accountable intervention is effective in reducing the burden of occupational injuries in small-, medium- and large-sized foundries. Practical Applications: The study poses the basis for feasible good practice guidelines to be implemented to prevent occupational injuries, by means of sector-specific numerical benchmarks, with potentially relevant impacts on workers, companies, occupational health professionals and society at large.     

Fatigue and on-duty injury among police officers: The BCOPS study

IntroductionPolicing involves inherent physical and psychological dangers as well as occupational stressors that could lead to chronic fatigue. Although accounts of adverse events associated with police fatigue are not scarce, literature on the association between chronic fatigue and on-duty injury are limited. Methods: Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. A 10-item questionnaire was administered to assess how tired or energetic the officers generally felt irrespective of sleep hours or workload. The questionnaire consisted of five positively worded and five negatively phrased items that measured feelings of vigor/energy and tiredness, respectively. Total as well as separate scores for positive and negative items were computed by summing scores of individual items. Payroll records documenting each officer's work history were used to assess occurrence of injury. Poisson regression was used to estimate prevalence ratios (PR) of injury. Results: Nearly 40% of officers reported feeling drained. Overall prevalence of on-duty injury during the past year was 23.9%. Injury prevalence showed a significant increasing trend across tertiles of total fatigue score: 19.6, 21.7, and 30.8% for lowest, middle and highest tertiles, respectively (trend p-value = 0.037). After controlling for potential confounders, a 5-unit increase in total fatigue score was associated with a 12% increase in prevalence of injury which was marginally significant (p = 0.075). A 5-unit increase in fatigue score of the positively worded items was associated with a 33% increase in prevalence of injury (PR = 1.33, 95% CI: 1.04–1.70, p = 0.022). Conclusion: Officers who do not feel active, full of vigor, alert, or lively had a significantly higher prevalence of non-fatal work place injury compared to their counter parts. Practical applications: With additional prospective evidence, workplace interventions designed to enhance level of energy may reduce feelings of tiredness and hence may prevent workplace injury.     

Validation of the principles of injury risk zones for motorcycle protective clothing

IntroductionThe distributions of motorcycle crash impacts and injuries were compared to the four impact risk zones and protective performance specified in the European Standard for motorcycle clothing (EN 13595).MethodsCrashed motorcyclists' (n = 117) injuries and clothing damage were categorized by body area into the four risk zones. Three levels of protection were defined: protective clothing with impact protection, protective clothing only and non-protective clothing.ResultsThe distribution of impact/injury sites corresponded to the predictions of EN 13595, with the proportion of all injuries decreasing from 43.9% in Zone 1, to 18.0%, 16.7%, and 11.5% in Zones 2 to 4, respectively. Protective clothing modified the distribution of injuries with substantially more injuries (OR = 2.69, 95% CL: 20.1–3.59) at unprotected impact sites.Practical applicationThese findings support an appropriate framework for determining performance specifications for the manufacture of motorcycle clothing that will effectively reduce the risk of injury in crashes.     

Work-safety tension, perceived risk, and worker injuries: a meso-mediational model

IntroductionWork-safety tension arises when workers perceive that working safely is at odds with effectively doing their jobs. We proposed that workers’ perceptions of work-safety tension would be associated with higher levels of perceived risk, which would, in turn, relate to worker injuries on the job.MethodGrocery store workers (n = 600) completed an online survey and organizational worker injury reports were obtained for a two-year period following the survey. Survey results were linked to subsequent worker injuries using hierarchical generalized linear modeling.ResultsWe found support for the proposed meso-mediation model: department work-safety tension predicted subsequent worker injuries, partially through an association with workers’ risk perceptions.ConclusionsSafety researchers and consultants and organizational leaders should look beyond typically-examined safety climate constructs, such as management commitment to safety, and pay particular attention to workers’ perceptions of work-safety tension.     

Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004–2012

Introduction: Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers. Methods: Self-reported weight, height, and injuries within the previous three months were collected annually for U.S. workers in the National Health Interview Survey (NHIS) from 2004–2012. Participants were categorized as normal weight (BMI: 18.5–24.9 kg/m²), overweight (BMI: 25.0–29.9), obese I (BMI: 30.0–34.9), and obese II (BMI: 35 +). The prevalence of injury and prevalence ratios from fitted logistic regression models was used to assess relationships between obesity and injury after adjusting for covariates. Sampling weights were incorporated using SUDAAN software. Results: During the 9-year study period from 2004 to 2012, 1120 workers (78 workers per 10,000) experienced a work-related injury during the previous three months. The anatomical sites with the highest prevalence of injury were the back (14.3/10,000 ± 1.2), fingers (11.5 ± 1.3), and knees (7.1 ± 0.8). The most common types of injuries were sprains/strains/twists (41.5% of all injuries), cuts (20.0%), and fractures (11.8%). Compared to normal weight workers, overweight and obese workers were more likely to experience work-site injuries [overweight: PR = 1.25 (95% CI = 1.04–1.52); obese I: 1.41 (1.14–1.74); obese II: 1.68 (1.32–2.14)]. These injuries were more likely to affect the lower extremities [overweight: PR = 1.48, (95% CI = 1.03–2.13); obese I: 1.70 (1.13–2.55); obese II: 2.91 (1.91–4.41)] and were more likely to be due to sprains/strains/twists [overweight: PR = 1.73 (95% CI = 1.29–2.31); obese I: PR = 2.24 (1.64–3.06); obese II: PR = 2.95 (2.04–4.26)]. Conclusions: Among NHIS participants, overweight and obese workers were 25% to 68% more likely to experience injuries than normal weight workers. Practical applications: Weight reduction policies and management programs may be effectively targeted towards overweight and obese groups to prevent or reduce work-site injuries.     

Better effect of the use of a needle safety device in combination with an interactive workshop to prevent needle stick injuries

ObjectivesThis study compares the effectiveness of two types of interventions with no intervention on the prevention of needle stick injuries (NSIs).MethodsHealth care workers, who were at risk for NSIs, were eligible for this three-armed cluster randomized controlled trial. In total, 23 hospital wards were randomly assigned to 1 of 2 intervention groups, which were given either a needle safety device and a workshop (NW; 7 wards, n = 267) or a workshop only (W; 8 wards, n = 263), or to a control group (C; 8 wards, n = 266). The primary outcome was the half-year incidence of NSIs, which was measured through questionnaires and official notification at the occupational health service at baseline (T0), 6 months (T1) and 12 months (T2) after baseline. Analysis were done by intention to treat. This study is registered as a prospective randomized trial, number NTR1207.ResultsA statistically significant difference was found between the groups for the half-year incidence of NSIs (p = 0.046) on the basis of questionnaire data with ORs for reported NSIs for the NW group compared with the control group of 0.34 (95% CI: 0.13–0.91) and 0.45 (95% CI: 0.19–1.06) for the W group compared with the control group. The officially registered NSIs during the study period showed no statistical differences between the groups.ConclusionsThe combined intervention of the introduction of needle safety devices and an interactive workshop led to the highest reduction in the number of self-reported NSIs compared to a workshop alone or no intervention.     

Assessing the impact of risk-taking behavior on road crash involvement among University students residing in two Mediterranean countries

Surveillance systems are indispensable for injury prevention; yet, detailed electronic records are rarely available. The “Student’s Health Card” is a self-reporting electronic tool addressing health issues of University students, while aiming to actively involve them in preventive practices and health promotion. Utilizing data from the injury prevention related section, this study sought to investigate the impact of risk-taking behavior on road crash involvement among University students residing in two Mediterranean countries. A total of 978 University students, 451 Greek and 527 Italian, provided information on prior road crash involvement, as well as on eight behavioral variables, comprising a risky behavior score. Multiple logistic regression analysis was performed. The already known tendency for clustering of risky behaviors was evident. One degree increment in the risky behavior score was found to increase the risk of road crash involvement by 35%. Driving after drinking (OR = 2.55, CI = 1.53–4.26), riding with a drunk driver (OR = 2.19, CI = 1.08–4.45) and tobacco smoking (OR = 1.95, CI = 1.18–3.22) significantly multiplied the risk. Despite their better compliance with safety measures, Italian students, compared with Greek, reported worse alcohol-related driving habits and engaged more frequently in mobile phone use while driving. Clustering of risky behaviors was found to be an important predictor of road crash involvement. Screening and awareness of risk-taking propensity of University students could guide early intervention. The “Student’s Health Card” could provide, at minimal cost, reliable risk-taking and road crash involvement information, which is needed for both personal risk assessment and surveillance purposes.     

Traffic environment and demographic factors affecting impaired driving and crashes

IntroductionData availability has forced researchers to examine separately the role of alcohol among drivers who crashed and drivers who did not crash. Such a separation fails to account fully for the transition from impaired driving to an alcohol-related crash.MethodIn this study, we analyzed recent data to investigate how traffic-related environments, conditions, and drivers’ demographics shape the likelihood of a driver being either involved in a crash (alcohol impaired or not) or not involved in a crash (alcohol impaired or not). Our data, from a recent case–control study, included a comprehensive sampling of the drivers in nonfatal crashes and a matched set of comparison drivers in two U.S. locations. Multinomial logistic regression was applied to investigate the likelihood that a driver would crash or would not crash, either with a blood alcohol concentration (BAC) = .00 or with a BAC ≥ .05.ConclusionsTo our knowledge, this study is the first to examine how different driver characteristics and environmental factors simultaneously contribute to alcohol use by crash-involved and non-crash-involved drivers. This effort calls attention to the need for research on the simultaneous roles played by all the factors that may contribute to motor vehicle crashes.     

Healthcare utilization and costs among older adult female drivers and former drivers

PurposeThis study compared the healthcare utilization and costs for specific types of medical services among older adult women who currently drive and those who no longer drive.MethodsThis study included 347 women aged 65 or older who were either former (had stopped driving) or current drivers, randomly sampled from a large U.S. health plan to participate in a telephone survey, and who had automated health records with healthcare utilization and cost data. Bivariate analyses and generalized linear modeling were used to examine associations between driving status and healthcare utilization and costs.ResultsAdjusting for age, income, and marital status, former drivers were more likely than current drivers to use mental health care services (RR = 3.37; 95% CI: 1.03, 10.98). Former drivers also tended to use more inpatient (RR = 1.85; 95% CI: 0.88, 3.87) and emergency services (RR = 1.89; 95% CI: 0.96, 3.70), but results did not reach statistical significance. Total annual healthcare costs in 2005 were almost twice as high for former drivers compared with current drivers ($13,046 vs. $7,054; mean difference = $5,992; 95% CI: -$360, $12,344), although this relationship was not statistically significant (CR = 1.61; 95% CI: 0.88, 2.96).Impact on IndustryFormer drivers were more than three times as likely as current drivers to use mental health services, and tended to use more emergency and inpatient services. Further research on factors that potentially mediate the relationship between driving status and health service use is warranted.     

Young drivers' perceptions of culpability of sleep-deprived versus drinking drivers

Introduction: Sleep-deprived driving can be as dangerous as alcohol-impaired driving, however, little is known about attitudes toward sleep-deprived drivers. This study examined the extent to which young drivers regard sleep-deprived compared to drinking drivers as culpable for a crash, and how their perceptions of driving while in these conditions differ. Method: University student participants (N = 295; M = 20.4 years, SD = 1.3; 81% women) were randomly assigned to read one of five fatal motor-vehicle crash scenarios, which differed by aspects of the driver's condition. Culpability ratings for the drinking driver were higher than those for the sleep-deprived driver. Results: Qualitative findings revealed that driving while sleep-deprived was viewed as understandable, and driving after drinking was viewed as definitely wrong. The dangers of sleep-deprived driving remain under-recognized.     

Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older,United States, 2006–2011

IntroductionWith the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern.MethodsWe analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups.ResultsFrom 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥ 65 years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥ 100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥ 65 years was $40 billion.ConclusionIncreasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥ 65 years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare.Practical applicationsWith the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.     

Fatal and serious injuries related to vulnerable road users in Canada

IntroductionThe goals of this study were to analyze possible trends of fatal and serious injuries related to vulnerable road users in Canada (pedestrians, cyclists and motorcyclists) from 1990 to 2012 and the role of alcohol and drugs in these cases. Drugs have rarely been documented with respect to vulnerable road users.MethodThe Traffic Injury Research Foundation's National Fatality and Serious Injury Databases and the Public Health Agency of Canada's Canadian Hospitals Injury Reporting and Prevention Program databases were used. Numbers and rates of fatalities and serious injuries among vulnerable road users were analyzed and regression models were used to assess changes over time.ResultsThe analyses show that while the absolute number of fatalities and the rate per 100,000 population among vulnerable road users may be decreasing, no such trends are apparent when looking at the proportions of these road user fatalities out of all motor-vehicle fatalities. The trend for the proportion of motorcyclist fatalities is significantly increasing (coef. = 0.16, p < 0.001). The elderly (76 years or older) are overrepresented among pedestrian fatalities, and serious injuries (they represent 18.5% of all pedestrian fatalities but only 5.8% of the population), while those 15 years or younger are overrepresented among cyclists (they represent 23.3% of cyclist fatalities but 19.5% of the population), and those 16 to 25 years old are overrepresented among motorcyclists (27.2% of motorcyclists fatalities and 13.6% of population). Alcohol and drug use among fatally injured vulnerable road users were significant problems, especially among pedestrians. Among fatally injured pedestrians tested for alcohol and drugs, 39.7% and 43.4% tested positive, respectively.ConclusionsWith the promotion of walking and cycling as forms of exercise and the popularity of motorcycling, the safety of vulnerable road users is an important issue. The results corroborate previous research and extend our understanding about the influence of alcohol and drugs in vulnerable road user injuries.Practical applicationsThese findings can help better inform prevention and mitigation initiatives for vulnerable road users.     

Agricultural injuries in Etawah district of Uttar Pradesh in India

Increased use of farm machinery along with other agricultural inputs has enhanced the production and productivity of Indian farms. Simultaneously, it has also increased occupational health hazards on the farms. Major occupational health hazards are farm related injuries. Very little information is available about the type and nature of agricultural injuries on Indian farms. In the present study, agriculture injuries data were collected for the period 1996–2000 for the Etawah district of Uttar Pradesh in India. It has a total population of 1.4 million while 0.75 million were associated with agricultural activities. The agricultural injuries incidence rate was 0.8 per thousand workers per year in the study area. Out of all agricultural injuries, 9% injuries were fatal. The highest number of injury victims were in the age group of 30–44 years. The highest percentages of injured victims were literate but non-matric. The monetary loss due to agricultural injuries in the study area was estimated to be about US $730,000 per year. To minimize agricultural injuries, development of interventions and trainings needs to be organized at block levels for proper and safe operation of agricultural equipment.     

The role of risk perception and other risk-related judgements in transportation mode use

AimsThe core aim of the present study was to examine the role of risk perception in use of private and public modes of transportation. An additional aim was to examine the relative importance of perception of transport risks with risk perception of non-transport factors and also to investigate differences in worry, perceived control of transportation modes, as well as trust in authorities’ risk handling, safety motivation, and attitudes towards transport safety.SampleThe results are based on a mailed self-completion questionnaire survey carried out among a representative sample of the Norwegian public aged from 18 to 65 years (n = 1864). Data collection was carried out during October–December 2008.ResultsPerceived control related to private modes of transportation, knowledge about safety and trust in authorities were found to be significantly different among respondents who often used private modes of transportation compared to those who most often used public modes. It was no significant difference in severity of consequences due to which transport modes that the respondents used most frequently.ConclusionIt may be that conclusions of previous research about the role of consequence judgement for precautionary action and demand for risk reduction are misleading when generalised to decisions about transport mode use.     

Bicycle helmet use among persons 5 years and older in the United States, 2012

IntroductionIn 2013, injuries to bicyclists accounted for 925 fatalities and 493,884 nonfatal, emergency department-treated injuries in the United States. Bicyclist deaths increased by 19% from 2010 to 2013. The greatest risk of death and disability to bicyclists is head injuries. The objective of this study was to provide estimates of prevalence and associated factors of bicycle riding and helmet use among children and adults in the United States.MethodCDC analyzed self-reported data from the 2012 Summer ConsumerStyles survey. Adult respondents (18 + years) were asked about bicycle riding and helmet use in the last 30 days for themselves and their children (5 to 17 years). For bicycle riders, CDC estimated the prevalence of helmet use and conducted multivariable regression analyses to identify factors associated with helmet use.ResultsAmong adults, 21% rode bicycles within the past 30 days and 29% always wore helmets. Respondents reported that, of the 61% of children who rode bicycles within the past 30 days, 42% always wore helmets. Children were more likely to always wear helmets (90%) when their adult respondents always wore helmets than when their adult respondents did not always wear helmets (38%). Children who lived in states with a child bicycle helmet law were more likely to always wear helmets (47%) than those in states without a law (39%).ConclusionsDespite the fact that bicycle helmets are highly effective at reducing the risk for head injuries, including severe brain injuries and death, less than half of children and adults always wore bicycle helmets while riding.Practical applicationStates and communities should consider interventions that improve the safety of riding such as policies to promote helmet use, modeling of helmet wearing by adults, and focusing on high risk groups, including Hispanic cyclists, occasional riders, adults, and children ages 10 to 14.     

Does employee safety influence customer satisfaction? Evidence from the electric utility industry

ProblemResearch on workplace safety has not examined implications for business performance outcomes such as customer satisfaction.MethodIn a U.S. electric utility company, we surveyed 821 employees in 20 work groups, and also had access to archival safety data and the results of a customer satisfaction survey (n = 341).ResultsIn geographically-based work units where there were more employee injuries (based on archival records), customers were less satisfied with the service they received. Safety climate, mediated by safety citizenship behaviors (SCBs), added to the predictive power of the group-level model, but these two constructs exerted their influence independently from actual injuries. In combination, two safety-related predictor paths (injuries and climate/SCB) explained 53% of the variance in customer satisfaction.DiscussionResults offer preliminary evidence that workplace safety influences customer satisfaction, suggesting that there are likely spillover effects between the safety environment and the service environment. Additional research will be needed to assess the specific mechanisms that convert employee injuries into palpable results for customers.Impact on IndustryBetter safety climate and reductions in employee injuries have the potential to offer payoffs in terms of what customers experience.