Looking at job tasks overall to reduce injuries is a crucial step in any safety program strategy. Every organization should take the proactive approach to create interventions on specific operations to reduce the musculoskeletal injuries and maintain a safe work environment.
By Edmund S. Starowicz Jr., Christian Summers and Julie Florek

Changes are potentially needed to protect employees and improve worker compensation claims for employers. Sanitation workers are exposed to repetitive manual lifting resulting in high frequency and severity of workers compensation claims. To properly assess the ergonomic concerns within specific job tasks while collecting refuse, Public Employer Risk Management Association (PERMA) used ergonomic wearable technology to determine the most “at risk” job tasks based on data collected. The data, in combination with a structured workshop, was used to review how tasks are performed, re-engineer tasks if possible or create an engineering control to reduce the risks.

The Problem
Injuries involving lifting and high-risk postures average $4.28 million per year of total indemnity claims costs at PERMA. In the area of public works and sanitation, lifting represents 60 percent of the overall totals, costing $2.5 million annually on average, roughly $35,500 per lost time claim. Overexertion and cumulative trauma are the most significant factors in these injuries. The intent of this article is to share the study movements analysis and related information as it relates to normal job tasks within sanitation. Using the technology currently available to measure these types of injuries, work processes can be re-engineered to avoid reoccurrence of common injuries.

PERMA’s organizational review of claims for sanitation workers and their resulting injuries found that musculoskeletal injuries from lifting were the most prevalent. Also identified were possible contributing factors, including specific job tasks, how the tasks were performed and equipment used. All were evaluated to determine a potential intervention to mitigate the claims.

Figure 1: How sensors work. Figures courtesy of PERMA.

Sanitation workers across the country are in one of the most dangerous jobs for municipal employees. The manual lifting of waste containers is a key task for sanitation and recycle workers in the industry. Varying sizes of containers, environmental conditions, weights of materials in the containers and surrounding public interaction all contribute to the risks associated with the daily operations of sanitation workers. Key tasks for sanitation workers include:
• Collecting receptacles
• Lifting and dumping receptacles
• Climbing onto the sidestep
• Returning receptacles
• Jumping off the sidestep
• Riding on the sidestep

Performing these tasks result in three primary ergonomic risk factors:
1. High task repetition
2. Forceful exertions
3. Repetitive or sustained awkward postures

Many municipalities and sanitation districts could purchase automated equipment, which reduces the impact of the ergonomic risk factors on sanitation and recycle workers. This study examines an organization,
representing other districts in PERMA’s membership, where using automated systems cannot be used due to congested municipal street locations resulting in the requirement of manual lifting.

PERMA partnered with DorsaVi, a wearable technology company, alongside a current member, having a large exposure in sanitation, to perform the tasks of the job while wearing sensors, as well as, being videotaped for later analysis.
The activity under review was manual handling tasks that required proper body movement and lifting techniques through wearable technology supplied by DorsaVi. Monitoring the activity while collecting data on where the problem areas were, allowed for potentially re-engineering the high-risk job tasks to reduce and/or prevent the injury.

During the testing, sensors were placed in locations noted in Figure 1. A “risk position” is defined, in this study, as any movement outside of the “neutral zone”, in which a person is standing straight up with their hands hanging down. Bending forward, way back or moving their hands over their head are examples of someone moving out of the “neutral zone” and into a “risk position”. Chances of injury increase exponentially the further someone moves away from the “neutral zone”.
Using the sensors in prominent areas, such as the back and shoulders as depicted, provides readings when movements enter at risk positions.

Additionally, the support of video footage highlights the tasks to be reviewed for possible reengineering or process changes. During the workshop phase of this process, these readings are critical to combine data and facts while maintaining the integrity of the original task being evaluated.

The tasks of sanitation and recycling were divided into seven key areas to analyze and score:
1. Collecting receptacles
2. Lifting/Dumping
3. Returning Receptacles
4. Climbing and Riding
5. Climbing Sidestep
6. Riding Sidestep
7. Jumping off Sidestep

Figure 2: Intervention reduction costs.

The employees varied in experience, age, previous injuries and many other factors. They were studied to determine what tasks were at a greater risk for potential injury. Both the data and footage were analyzed to develop a list of key findings and results to help formulate areas that could be reengineered for safer results. Samples of the findings include:
• ‘Collecting receptacles’ and ‘lifting and dumping’ were the highest risk subtasks for employees.
• Good manual handling awareness and technique significantly reduced workers’ lower movement risk score.
• Both sanitation and recycle workers had very high repetitive movements, especially in the shoulders.

Since completing this project, claims with the participating member have been monitored. The business benefits were significant. Figure 2 depicts an overall decrease in frequency and severity of claims related to the manual disposal of garbage and recycling. This will result in savings to not only the member, but also to the PERMA association as a whole organization. With an estimated cost of approximately $35,500 per lost time claim, avoiding one claim could allow a
municipality to pay for training or other safety equipment needs. Even a small reduction of just 10 percent of the annual cost, could result in an overall savings of $250,000.

Associated with any workplace injury, there are the indirect costs to a municipality ranging anywhere from four to 10 times the cost of the claim itself. Some examples include overtime and replacement costs to cover shifts, potential property damages, and the overall strain and decreased moral to the workforce.

Providing a safe work environment for all staff promotes a healthier, more productive workforce leading to immeasurable benefits such as improved moral and overall staff loyalty. By providing the right resources, in the right place, at the right time, organizations can help keep their employees safe and healthy at the end of each day.

Using an extrapolation to the industry, the saving and productivity would be significant for any sanitation industry employer. Attention to these musculoskeletal injures is needed by every employer and changes as noted will be needed.

The Solution
Re-engineering of job tasks was reviewed and discussed offering the following possible solutions. Following are general suggestions to be evaluated and considered on an individual basis as solutions vary for all sanitation operations and have varying degrees of resources required to implement. Industry discussion on three key areas is necessary:
1. Manual handling and introduction of related programs
2. Changes to receptacles
3. Truck changes

Manual Handling
There are seven suggestions for industry employers to consider:
1. Update manual handling training with best practice training
2. Re-evaluate work processes and implement job rotation
3. Implement short “reset” breaks after completing tasks with biomechanical demand
4. Automated side loader if applicable to reduce risk of personnel injury
5. Introduce a physical maintenance and injury prevention program
6. Introduce a ‘pre-start’ warm up routine
7. Train staff in pre-determining container load weights

Changes to Receptacles
Receptacles have three changes that could benefit the employer with their injury reduction program:
1. Use potential design changes to recycling tubs
• Ergonomically sensitive recycle containers to reduce bending to handle boxes
2. Use other assistance equipment to reduce injury, such as lifting devices
3. Consider uniform garbage container use throughout all routes

Truck Changes
The most difficult of the three solutions noted would be the truck modifications of step riding and hand hold changes that would provide the best return on investment and reduction of injuries:
• Truck design modifications to rails and steps
1. Modifying steps
a. Consider adjustable steps to allow any worker to make the easiest transition to the step based on their individual body requirements

2. Modifying rails
a. Hand holds provided at multiple levels or adjustable heights to reduce the amount of above the center of body weight for holding rails by sanitation workers

3. Design changes to hopper heights
a. Low profile hopper height to allow easier dumping of receptacles to prevent musculoskeletal injuries
b. This will allow less strain on the back and upper shoulders
• Lowering clearance in the rear loading area

Many sanitation employers are reluctant to modify trucks due to warranty issues. For the industry to begin getting approval from manufacturers on these ergonomic alternations to the vehicles would only provide benefits to employers and the safety of their employees. Collaborations with potential buyers could begin major refuse vehicle manufacturers as potential starters for future modification in their equipment.

PERMA Resources
In conjunction with our testing and sharing of information, PERMA has three other suggestions in addition to the modification to equipment and training:
1. Consider using vendor ergonomic wearable technology for ongoing movement risk assessments and employee training to reduce risk on a case-by-case basis. The new technology will be an eye opener for your organization and could be a great tool in your toolbox.

2. Use Sanitation Best Practices Training Video for Sanitation workers created by PERMA. Use it to train your staff: www.dropbox.com/s/oukwl5m7antgbel/PERMA%20Best%20Practices-%20Waste%20Collection.mp4?dl=0

3. Understanding the areas of this collection process that are considered a high risk for employee injury will not only benefit the participating organization, but can also assist any entity who performs similar job tasks. Each employer should consider their own tasks since each operation is unique.

The Call to Action
Looking at job tasks overall to reduce injuries is a crucial step in any safety program strategy. Many times, job tasks are performed routinely and without supervision to ergonomic concerns, leading to poor technique and potential risk of injury.

Manual handling jobs especially should be evaluated and modified, if possible, when employees are put in awkward body positions needed to perform their work. Using sensors and wearable technology as a tool, combined with the data, and workshopping the findings with members—as PERMA has developed a process to adequately capture and evaluate high risk movements and work with its membership to implement change. Evaluations and re-testing are all important. Every organization should take the proactive approach to create interventions on specific operations to reduce the musculoskeletal injuries and maintain a safe work environment. | WA

Edmund S. Starowicz Jr. is PERMA’s DPW Risk Management Specialist. He has been with PERMA for five years focusing on safety within the areas of Department of Public Works and Highway sectors of the PERMA membership. Edmund formerly was the Deputy Commissioner of Public Works at the Town of Pittsford. His professional accreditations include, Six Sigma-certified Green Belt Quality Improvement Facilitator, formerly NYS licensed IV-A wastewater treatment plant operator, landfill licensed operator, Hazwoper Certification required per OSHA 1910.120 – Hazardous Waste Operations and Emergency Response (HAZWOPER) expired, 30 hour OSHA General Industry Safety and Health training, and he is OSHA/RIT certified as both General Industry Safety and Health Specialist, and a General Industry Safety Professional. He can be reached at (888) 737-6269, ext. 113.

Christian Summers is PERMA’s Director of Risk Management. With PERMA for four years, Christian oversees the Risk Management Department, evaluating training programs and risk solutions to PERMA’s municipal members in New York State. He is a certified OSHA General Industry Safety Professional and is a licensed New York State Property and Casualty Broker. He can be reached at (888) 737-6269, ext. 111.

Julie Florek is PERMA Communications Specialist. With PERMA for three years in the Member Services Department, Julie facilitates consistent messaging and strategy for all internal and external communications related to the PERMA program. She can be reached at (888) 737-6269, ext. 102.

PERMA, Public Employer Risk Management Association, Inc. (Latham, NY) is a member-owned, not-for-profit association of public entities providing risk management services and workers’ compensation coverage through a group self-insurance program. PERMA provides local units of government with a cost-effective alternative to traditional workers’ compensation programs and to improve the quality of services provided to injured employees. Approximately 65 professionals provide claims management services, as well as nurse case management, risk management, coverage underwriting and member services. PERMA now has more than 550 member municipalities with more than $56 million in contributions and more than $300 million in assets. It has been recognized 17 consecutive years with a Certificate of Excellence in Financial Reporting from the Government Finance Officers Association (GFOA). For more information, call (518) 220-1111 or Toll Free (888) 737-6269.