In May 2011, OSHA issued a Recordkeeping Standard Letter of Interpretation that is worth reviewing, even if the question asked is not one that pertains to your workplace. The questioner, Paul Bragenzer asked OSHA if an exercise regime would be considered medical treatment and therefore recordable. OSHA's response covers Mr. Bragenzer's question and probably the questions of many other employers about what constitutes first aid vs medical treatment.
In short, OSHA said, "Yes." If exercises are recommended to an employee that exhibits signs or symptoms of a work related injury - then it counts as medical treatment and is recordable. OSHA went on to say that "the treatments included in Section 1904.7(b)(5)(ii) [of the Recordkeeping Standard] is a comprehensive list of first aid treatments. Any treatment not included on this list is not considered first aid for OSHA recordkeeping purposes."
OSHA also makes another important distinction in the letter when it points out that "for a case to be recordable, an injury or illness must exist." In other words, exercises prescribed preinjury as a precaution, or to a person not exhibiting any signs or symptoms of an injury - would not constitute medical treatment.
You can read the entire letter below or on OSHA's Website:
May 20, 2011
Mr. Paul Bragenzer
1415 Rothbury Dr.
Grand Rapids, MI 49505
Dear Mr. Bragenzer:
Thank you for your February 2011 letter to the Occupational Safety and Health Administration (OSHA) regarding the recordkeeping regulation contained in 29 CFR Part 1904 - Recording and Reporting Occupational Injuries and Illnesses. In an effort to provide the public with prompt and accurate responses, we developed and continue to refine a set of Frequently Asked Questions (FAQ), in addition to maintaining a log of Letters of Interpretation (LOI) on the OSHA Recordkeeping web site.
Your letter asks OSHA to clarify whether an exercise regime directed by a Certified Athletic Trainer (ATC) would constitute "first aid" or "medical treatment" for OSHA injury and illness recordkeeping purposes. In general, if the ATC recommends exercise to an employee who exhibits any signs or symptoms of a work related injury, the case involves medical treatment and is a recordable case.
OSHA discussed the issue of therapeutic exercise in the preamble to the final rule revising OSHA's injury and illness recordkeeping regulation. See, 66 FR 5992, January 19, 2001. OSHA stated that it considers therapeutic exercise as a form of physical therapy and intentionally did not include it on the list of first aid treatments in Section 1904.7(b)(5)(ii). Section 1904.7(b)(5)(ii)(M) states that physical therapy or chiropractic treatment are considered medical treatment for OSHA recordkeeping purposes and are not considered first aid. Section 1904.7(b)(5)(iii) goes on to state that the treatments included in Section 1904.7(b)(5)(ii) is a comprehensive list of first aid treatments. Any treatment not included on this list is not considered first aid for OSHA recordkeeping purposes.
Please be aware that if a treatment is administered as a purely precautionary measure to an employee who does not exhibit any signs or symptoms of an injury or illness, the case is not recordable. For a case to be recordable, an injury or illness must exist. For example, if, as part of an employee wellness program, an ATC recommends exercise to employees that do not exhibit signs or symptoms of an abnormal condition, there is no case to record. Furthermore, if an employee has an injury or illness that is not work-related, (e.g., the employee is experiencing muscle pain from home improvement work) the administration of exercise does not make the case recordable either.
Your letter also requested specific guidance on several questions concerning the administration of exercise. For purposes of this response, we presume that all of the questions relate to the administration of exercise as a treatment for work-related injuries.
- Would the providing of an employee with a written home exercise program (including sets/reps and resistance) constitute first aid or medical treatment?This constitutes medical treatment.
- If the ATC utilizes stretching to relieve their symptoms, does this service constitute medical treatment or first aid?This constitutes medical treatment.
- Is the number of times seen for care significant in determining recordability?No. The number of times seen for care is not a factor when determining OSHA recordablity. The focus is on the type of treatment rather than the number of times such treatment is administered.
- Is the duration or intensity of the care significant in determining recordability?No. The duration or intensity of the care does not determine recordablity. Again, the focus is on the type of treatment.
- Are the numbers of follow-ups significant in the recordability of the care?No. The number of follow-up visits to receive care does not determine the outcome for an OSHA recordable.
- Is there a general guideline that an ATC can use to know if they are crossing the line from first aid to medical treatment?In general, first aid can be distinguished from medical treatment per Section 1904.7(b)(5)(ii) and 1904.7(b)(5)(iii). As noted above, Section 1904.7(b)(5)(ii) states that the list of first aid treatments included in Section 1904.7(b)(5)(iii) is comprehensive. Any treatments not included on the list would not be considered "first aid" for OSHA recordkeeping purposes.
Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in responses to new information. To keep appraised of such developments, you can consult OSHA's website at http://www.osha.gov.
Keith Goddard, Director
Directorate of Evaluation and Analysis