Worker on watertower


Slips, trips, and falls (STF) are a significant cause of traumatic occupational injuries and represent a substantial cost to employers, employees, and the U.S. economy. STFs occur as a result of hazardous conditions in the workplace that are not properly identified or go unabated. STFs may occur from heights or from the same level. They are often due to materials on the walking surface, abrupt changes in flooring, poor lighting, hidden hazards (such as a gap or hard to see hole in the ground), or equipment failures. Distracted walking and lack of attention or situational awareness also contributes to falls. Injuries sustained from STF can include back injuries, strains and sprains, contusions, fractures, or death. Work-related STF incidents also frequently result in serious disabling injuries that impact an employee’s ability to do their job, often resulting in lost workdays, reduced productivity, expensive worker compensation claims, and diminished ability to care for others.1 While falls-related injuries are often associated with slips or trips, slips and trips can cause an injury (e.g., pulled muscle or strain), without resulting in a fall.

According to the Bureau of Labor Statistics (BLS), there were more than 300,000 work-related STF injuries in 2015, which accounted for 27% of all occupational injuries and illnesses.2 Detrimental impacts of STF injuries are especially severe in the construction and health care industries. Specifically, falls from heights accounted for nearly 39% (364) of all deaths (937) in the construction industry. Additionally, STF injuries from the same level constituted approximately 25% (34,050) of the total STF injuries (131,280) in the Health Services and Education industry.5 Falls have ranked first among the top ten causes of work-related fatalities in the U.S. for more than a decade. Consequently, the most frequently cited regulatory standards during Occupational Safety and Health Administration (OSHA) inspections in 2015 was 29 CFR 1926.501; Fall Protection in the Construction Industry.4 An organization may incur significant direct and indirect costs in the form of medical expenses and lost productivity as a result of these injuries. The National Safety Council (NSC) estimated that the costs of STF injuries exceeded $15B in 2011 (see Figure 1).5

Figure 1: Worker’ compensation costs for the top 10 causes of disabling workplace injuries, United States, 2011

Source: NSC Injury Facts 2015

Worker’ compensation costs for the top 10 causes of disabling workplace injuries, United States, 2011

a Overexertion involving an outside source; includes injuries from excessive lifting, pushing, pulling, holding, carrying, or throwing.
b Falls on same level.
c Struck by object–such as a tool falling on a worker from above.
dFalls to lower level.
e Other exertions or bodily reactions; includes injuries from bending, crawling, reaching, twisting, climbing, stepping, kneeling, sitting, standing, or walking (and no longer includes slipping or tripping without falling).
f Roadway incidents involving motorized land vehicle.
g Repetitive motions involving micro-tasks.
h Struck against object or equipment--such as a worker walking into a door.
i Caught in or compressed by equipment or objects.

Falls to the Lower Level (FLL) continued to be the leading cause of construction-related death in 2015.1 “Fall to lower level” applies to instances in which the injury resulted from impact between the injured person and another surface at lower elevation.”5 Work-related incidents in the construction industry are frequent, and may lead to permanent disabilities and a high fatality rate. The dynamic nature and complex execution of construction projects, as well as the transitory nature of their manpower and worksites makes it difficult to establish routine and fixed standards, and work practices. Falls to lower level ranks second behind highway crashes in number of workplace fatalities, and is the sixth leading event resulting in cases involving days away from work.5

Falls on the Same Level (FSL) were the leading type of worker injury in 2015 (197,260 total cases) and has been the leading injury type since 2011, according to the BLS (see Figure 2).1 “Fall on same level” applies to instances in which the injury was produced by impact between the injured person and another surface without elevation.5 FSL are of particular concern to health care facilities because STFs are the second most common cause of lost-workday injuries in hospitals.” 3 STFs thus cause lost workdays, reduced productivity, expensive worker compensation claims, and diminished ability to care for patients.3 BLS reports that in 2015, the incidence rate of lost-workday injuries from STFs on the same level in hospitals was 27.8 cases per 10,000 full-time employees, 2 which was substantially greater than the average rate for all other private industries combined (generally 20.1 per 10,000 employees). After overexertion, FSL ranks second in the number of nonfatal injuries involving days away from work, but generally is not one of the top ten events resulting in fatalities.5

Exhibit 2: Incidence rates for occupational injuries and illnesses with days away from work by selected detailed events or exposures, all ownerships, 2011‐15

Source: NSC Injury Facts 2015

Incidence rates for occupational injuries and illnesses with days away from work by selected detailed events or exposures, all ownerships, 2011‐15

Fall Protection Requirements

Prudent practices demand, and federal standards require employers to develop and implement fall protection plans, institute passive and active fall protection systems, provide proper equipment, and train employees to do their work safely. Job-specific fall protection plans must be developed for all work performed on heights. Passive fall prevention systems (e.g., guardrails, safety nets, hole covers), should be installed at all walking-working surfaces and leading edges, above six feet, where feasible.7 The correct type of equipment (i.e., lifts, ladders, scaffolds, personal fall arrest systems [PFAS]) must be provided, maintained in good condition, and used properly.7 All workers should receive hazard awareness, equipment-specific, and PFAS-specific training before they begin work on heights above six feet8 (standards are four feet in general industry and five feet in maritime industry). Periodic hazard awareness training in the form of toolbox talks (TBT), new equipment training, and when changes in projects occur are critical to saving lives.7 OSHA and the National Institute of Occupational Safety and Health (NIOSH) are valuable information sources, as the two agencies collaborate and organize outreach campaigns to raise awareness among workers and employers regarding common fall hazards in construction.9

Industry Best Management Practices (BMP)

To help minimize STF related incidents, Altarum Institute recommends the following best practices:

  • Keep walking-working surfaces clear from contaminants and obstructions
  • Keep working areas free from clutter, and clean spills
  • Minimize walking surface irregularities indoors and outdoors
  • Manage weather related conditions (e.g., ice, snow, rain water) immediately
  • Ensure work areas, hallways, stairwells, and outside areas are well-lit
  • Install passive fall-protection mechanisms (e.g., rails, barriers, nets), as appropriate
  • Footwear should be appropriate for the working conditions
  • Use proper tools/equipment (e.g., stepstools, ladders, PFAS) for all jobs
  • Provide awareness and job-specific training to employees
  • Investigate all STF-related incidents and correct hazardous conditions immediately


  1. Centers for Disease Control (CDC), STF Guide, 2011-123
  2. BLS News Release, USDL-16-2130, Thursday, November 10, 2016
  3. Slip, Trip, and Fall Prevention for Healthcare Workers, DHHS (NIOSH) Publication No. 2011-123 (December 2010),
  4. Top 10 Standards cited by OSHA,
  5. National Safety Council (NSC), Injury Facts, 2015
  6. BLS News Release, USDL-16-2304, (pg-3)
  7. OSHA Fall Prevention Campaign,
  8. 29 CFR 1926.501(b)(1)
  9. National Occupational Research Agenda (NORA),

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