Heat Illness Prevention Program

NORTH CAROLINA GENERAL STATUTE
NCGS 95-129—Rights and Duties of Employers

Scope/Application: The General Duty Clause is used only where there is no standard that applies to the particular hazard. Employers can be cited for violation of the General Duty Clause if a recognized serious hazard exists in their workplace and the employer does not take reasonable steps to prevent or abate the hazard.

NCGS 95-129(1) - General Duty Clause
"Each employer shall furnish to each of his employee’s conditions of employment and a place of employment free from recognized hazards that are causing or are likely to cause death or serious injury or serious physical harm to his employees."
Four Elements That Are Necessary for a GDC Violation

1.	The employer failed to keep the workplace free of a hazard to which employees of that employer were exposed;
2.	The hazard was recognized in the industry;
3.	The hazard was causing or was likely to cause death or serious physical harm; and
4.	There was a feasible and useful method to correct the hazard.

Example Program: This example program was adapted from California OSHA’s Heat Illness Prevention Program for use in North Carolina. It should be modified to be site-specific to your organization.

Heat Illness Prevention Program

This program implements efficient and safe work procedures that will prevent both indoor and outdoor heat-related illnesses among employees at our workplace. It will be used for training new employees and for the annual refresher training of employees. All employees potentially exposed to hot working environments are subject to this program.

Heat-related illnesses can happen if activities in a hot workplace environment overwhelm the body’s ability to cool itself. This becomes more likely if any of the risk factors listed below are present. Examples include working in a hot environment without adequate access to water for rehydration, working in protective gear that does not allow air circulation across the skin, or working where the humidity is too high for sweat to evaporate.

Risk Factors

The following are environmental risk factors for heat illness:

•	Air temperature above 90 degrees F.
•	Relative humidity above 40 percent
•	Radiant heat from the sun and other sources
•	Conductive heat sources such as dark-colored work surfaces
•	Lack of air movement
•	Physical effort needed for the work
•	Use of nonbreathable protective clothing and other personal protective equipment

The following are personal risk factors for heat illness:

•	Lack of acclimation to warmer temperatures
•	Medical conditions, or poor general health
•	Dehydration
•	Alcohol consumption
•	Drugs and use of some prescription medications
•	Caffeine consumption
•	Previous heat-related illness

Heat-Related Illnesses

Heat rash - Signs and symptoms of heat rash include:

•	Clusters of red bumps on skin
•	Often appears on neck, upper chest, and skin folds

Heat cramps - Signs and symptoms of heat cramps include:

•	Muscle spasms or pain
•	Usually in legs, arms and trunk

Heat exhaustion - Signs and symptoms of heat exhaustion typically include:

•	Heavy sweating
•	Irritability, weakness and fatigue
•	Nausea and vomiting
•	Thirst
•	Elevated body temperature or fast heart rate
•	Light-headedness or fainting

Heat stroke - Signs and symptoms of heat stroke typically include:

•	Heavy sweating or hot, dry skin
•	Confusion
•	Slurred speech
•	Very high body temperature
•	Rapid heart rate
•	Dizziness, disorientation, or lethargy
•	Seizures or signs that mimic those of a heart attack

Program Administrator(s)

The following designated person(s) has/have the authority and responsibility for implementing the provisions of this program at this worksite. They will be responsible for updating the program as needed to meet any applicable changes at the work site.

Name/Job Title/Phone Number

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Procedures for Providing Water

Instructions: Choose and modify the items below that are applicable to your work operations and add additional    language to specify how your company intends to implement these provisions at the job site. 

•	Drinking water containers (e.g., 5 to 10 gallons each) will be brought to the site so that at least two quarts per employee are available at the start of the shift. All employees, whether working individually or in smaller crews, will have access to drinking water.

•	Paper cones or bags of disposable cups and the necessary cup dispensers will be made available to employees and will be kept clean until used.

•	The water level of all containers will be checked periodically (e.g., every hour, every 30 minutes) and more frequently when the temperature rises. Water    containers will be refilled with cool water when the water level within a container drops below 50 percent. Additional water containers (e.g., five-gallon bottles) will be delivered to replace water as needed.

•	Water will be fresh, pure, suitably cool, and provided to employees free of charge. Supervisors will visually examine the water and pour some on their skin to ensure that the water is suitably cool. During hot weather, the water must be cooler than the ambient temperature, but not so cool as to cause discomfort.

•	Water containers will be located as close as practicable to the areas where employees are working (depending on the working conditions and layout of the worksite) to encourage the frequent drinking of water. If field terrain prevents the water from being placed within a reasonable distance from the employees, bottled water or personal water containers will be made available so that employees can have drinking water readily accessible.

•	When employees are working across large areas, water will be placed in multiple locations. For example, on a multi-story construction site, water will be placed in a safely accessible location on every floor where employees are working.

•	All water containers will be kept in a sanitary condition. Water from non-approved or non-tested water sources (e.g., untested wells) is not acceptable. If hoses or connections are used, they must be approved for potable drinking water systems, as shown on the manufacturer’s label.

•	Employees will be reminded (e.g., daily) of the location of the water coolers and of the importance of drinking water frequently. When the temperature exceeds or is expected to exceed _______ (e.g., 80, 85) degrees Fahrenheit, brief “tailgate” meetings will be held with employees each morning to review the importance of drinking water, the number and schedule of water and rest breaks, and the signs and symptoms of heat illness.

•	Audible devices, such as whistles or air horns, will be used to remind employees to drink water.

•	When the temperature equals or exceeds _____ (e.g., 90, 95) degrees Fahrenheit, or during a heat wave, pre-shift meetings will be conducted before the commencement of work to both encourage employees to drink plenty of water and to remind employees of their right to take a cool-down rest when necessary. Additionally, the number of water breaks will be increased. Supervisors and/or foremen will remind employees throughout the work shift to drink water.

•	Individual water containers or bottled water provided to employees will be adequately identified to eliminate the possibility of drinking from a co-worker’s container or bottle.

In addition to the procedures above, the employer will ensure the provision of water using the following procedures:

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Procedures for Access to Shade

Instructions: Choose and modify the items below that are applicable to your work operations and add additional    language to specify how your company intends to implement these provisions at the job site. 

•	Shade structures will be opened and placed as close as practicable to the employees when the temperature equals or exceeds _____ (e.g., 80, 85) degrees Fahrenheit. When the temperature is below ______ (e.g., 80) degrees Fahrenheit, access to shade will be provided promptly, when requested by an employee. Note: The interior of a vehicle may not be used to provide shade unless the vehicle is air-conditioned, and the air conditioner is on.

•	Enough shade structures will be available at the site to accommodate all the employees who are on a break at any point in time. During meal periods, there will be enough shade for all employees who choose to remain in the general area of work or in areas designated for recovery and rest periods. Note: Employers may rotate employees in and out of meal periods, as with recovery and rest periods.

•	Employees will be informed (e.g., daily) of the location of the shade structures and will be encouraged to take a five-minute cool-down rest in the shade. An employee who takes a preventative cool-down rest break will be monitored and asked if they are experiencing symptoms of heat illness. The employee will not be ordered back to work until signs or symptoms of heat illness have abated.

•	As crews move, shade structures will be relocated to be placed as close as practicable to the employees so that access to shade is provided at all times. All employees on a recovery or rest break or a meal period will have full access to shade so they can sit in a normal posture without having to be in physical contact with each other.

•	Before trees or other vegetation are used to provide shade, the thickness and shape of the shaded area will be evaluated to ensure that sufficient shadow is cast to protect employees.

•	In situations where it is not safe or feasible to provide access to shade (e.g., during high winds), a note will be made of these unsafe or unfeasible conditions and alternative procedures will be used to provide access to shade upon request. Note: Describe the alternative procedure for access to shade below.

•	Cooling measures other than shade (e.g., use of misting machines) are provided in lieu of shade if these measures are demonstrably as effective as shade in allowing employees to cool, and of the steps that will be taken to provide alternative cooling measures but with equivalent protection as shade.

In addition to the procedures above, the employer will ensure access to shade using the following procedures:

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Procedures for Monitoring the Weather

Instructions: Choose and modify the items below that are applicable to your work operations and add additional    language to specify how your company intends to implement these provisions at the job site.

•	The supervisor will be trained and instructed to check in advance the extended weather forecast. Weather forecasts can be checked with the internet (http://www.nws.noaa.gov/), by calling the National Weather Service phone numbers (see numbers below), or by checking the Weather Channel TV Network. The work schedule will be planned in advance, taking into consideration whether high temperatures or a heat wave is expected. This type of advanced planning should take place whenever the temperature is expected to reach _____ (e.g., 70) degrees Fahrenheit or higher.

Organization/Phone Number(s)

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•	Prior to each workday, the forecasted temperature and humidity for the worksite will be reviewed and will be compared against the National Weather Service Heat Index to evaluate the risk level for heat illness. Determination will be made of whether or not employees will be exposed to a temperature and humidity characterized as either “extreme caution” or “extreme danger” for heat illnesses. It is important to note that the temperature at which these warnings occur must be lowered as much as 15 degrees if the employees are working in direct sunlight. Additional steps, such as those listed below, will be taken to address these hazards.

•	Prior to each workday, the supervisor will monitor the weather (using http://www.nws.noaa.gov/ or a simple thermometer, available at most hardware stores) at the worksite. This critical weather information will be taken into consideration to determine when it will be necessary to make modifications to the work schedule (e.g., stopping work early, rescheduling the job, working at night or during the cooler hours of the day, increasing the number of water and rest breaks).

•	A thermometer will be used at the job site to monitor for a sudden increase in temperature and to ensure that once the temperature exceeds _____ (e.g., 80, 85) degrees Fahrenheit, shade structures will be opened and made available to the employees. In addition, when the temperature equals or exceeds ____ (e.g., 95, 98) degrees Fahrenheit, additional preventive measures, such as high-heat procedures, will be implemented.

In addition to the procedures above, the employer will ensure the weather is monitored using the following procedures:

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Procedures for Handling a Heat Wave

Instructions: Choose and modify the items below that are applicable to your work operations and add additional    language to specify how your company intends to implement these provisions at the job site. 

For purposes of this section only, “heat wave” means any day in which the predicted high temperature for the day will be at least 80 degrees Fahrenheit and at least ten degrees Fahrenheit higher than the average daily high temperature in the preceding five days.

•	During a heat wave or heat spike, the workday will be cut short or rescheduled (e.g., conducted at night or during cooler hours).

•	During a heat wave or heat spike and before starting work, tailgate meetings will be held to review the Heat Illness Prevention Program procedures, the weather forecast, and emergency response procedures. Additionally, if schedule modifications are not possible, employees will be provided with an increased number of water and rest breaks and observed closely for signs and symptoms of heat illness.

•	Each employee will be assigned a “buddy” to be on the lookout for signs and symptoms of heat illness and to ensure that emergency procedures are initiated when someone displays possible signs or symptoms of heat illness.

In addition to the procedures above, the employer will ensure heat waves are addressed with the following procedures:

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High Heat Procedures

Instructions: Choose and modify the items below that are applicable to your work operations and add additional    language to specify how your company intends to implement these provisions at the job site. 

High heat procedures are additional preventive measures that this company will use when the temperature equals or exceeds _____ (e.g., 95, 98) degrees Fahrenheit.

•	Effective communication by voice, direct observation (applicable for work crews of _____ (e.g., 10, 15, 20), mandatory buddy system, or electronic means will be maintained so that employees at the worksite can contact a supervisor when necessary. If the supervisor is unable to be near the employees (to observe them or communicate with them), then an electronic device, such as a cell phone or text messaging device, may be used for this purpose if reception in the area is reliable.

•	Frequent communication will be maintained with employees working by themselves or in smaller groups (via phone or two-way radio), to be on the lookout for possible symptoms of heat illness. The employee(s) will be contacted regularly and as frequently as possible throughout the day since an employee in distress may not be able to summon help on their own.

•	Effective communication and direct observation for alertness and signs and symptoms of heat illness will be conducted frequently. When the supervisor is not available, a designated alternate responsible person must be assigned to look for signs and symptoms of heat illness. If a supervisor, designated observer, or any employee reports any signs or symptoms of heat illness in any employee, the supervisor or designated person will take immediate action commensurate with the severity of the illness.

•	Employees will be reminded constantly throughout the work shift to drink plenty of water and take preventative cool-down rest breaks when needed

•	Pre-shift meetings will be held before the commencement of work to review the high heat procedures, encourage employees to drink plenty of water, and remind employees of their right to take a cool-down rest when necessary.

In addition to the procedures above, the employer will ensure high heat is addressed with the following procedures:

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Procedures for Acclimatization

Instructions: Choose and modify the items below that are applicable to your work operations and add additional    language to specify how your company intends to implement these provisions at the job site. 

Acclimatization is the temporary adaptation of the body to work in the heat that occurs gradually when a person is exposed to it. In more common terms, the body needs time to adapt when temperatures rise suddenly, and an employee risks heat illness by not taking it easy when a heat wave or heat spike strikes, or when starting a new job that exposes the employee to heat to which the employee’s body hasn’t yet adjusted.

Inadequate acclimatization can be significantly more perilous in conditions of high heat and physical stress. Employers are responsible for the working conditions of their employees, and they must implement additional protective measures when conditions result in sudden exposure to heat their employees are not accustomed to.

•	The weather will be monitored daily. The supervisor will be on the lookout for heat waves, heat spikes, or temperatures to which employees haven’t been exposed for several weeks or longer.

•	During a heat wave or heat spike, the workday will be cut short (e.g., 12:00 p.m.), be rescheduled (e.g., conducted at night or during cooler hours), or if at all possible, cease for the day.

•	New employees and those who have been newly assigned to a high heat area will be closely observed by the supervisor or designee for the first _____ (e.g., 14 days). The intensity of the work will be lessened during a _______________ (e.g., two-week) break-in period by using procedures such as scheduling slower paced, less physically demanding work during the hot parts of the day and the heaviest work activities during the cooler parts of the day (e.g., early morning or evening). Steps taken to lessen the intensity of the workload for new employees will be documented.

•	The supervisor or the designee will be extra vigilant with new employees and stay alert to the presence of heat-related symptoms.

•	New employees will be assigned a “buddy,” or experienced coworker, so they can watch each other closely for discomfort or symptoms of heat illness.

•	During a heat wave, all employees will be observed closely (or maintain frequent communication via phone or radio) for possible symptoms of heat illness.

•	Employees and supervisors will be trained on the importance of acclimatization, how it is developed, and how these company procedures address it.

In addition to the procedures above, the employer will ensure employee acclimatization is accomplished with the following procedures:

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Procedures for Emergency Response

Instructions: Choose and modify the items below that are applicable to your work operations and add additional    language to specify how your company intends to implement these provisions at the job site. 

•	When a crew is assigned to a particular worksite, the employees and the foreman will be provided a map of the site that will allow them to give clear and precise directions to the worksite (e.g., street or road names, distinguishing features and distances to major roads) to avoid a delay of emergency medical services.

•	Prior to assigning a crew to a worksite without an infirmary, clinic, or hospital nearby, the employer will ensure that an appropriately trained and equipped person is available at the site to render first aid, if necessary.

•	Prior to the start of the shift, a determination will be made as to whether a language barrier is present at the site, and, if necessary, steps will be taken, such as assigning the responsibility to call emergency medical services to the foreman or an English-speaking employee, to ensure that emergency medical services can be immediately called in the event of an emergency.

•	All foremen and supervisors will carry cell phones or other means of communication to ensure that emergency medical services can be called. Checks will be made to ensure that these electronic devices are functional prior to each shift.

•	When an employee shows symptom(s) of possible heat illness, emergency medical services will be called, and steps will immediately be taken to keep the stricken employee cool and comfortable to prevent the progression to more serious illness. Under no circumstances will the affected employee be left unattended.

•	At remote locations, such as rural farms, lots, or undeveloped areas, the supervisor will designate an employee or employees to physically go to the nearest road or highway where emergency responders can see them. If daylight is diminished, the designated employee(s) shall be given reflective vests or flashlights to direct emergency personnel to the sick employee’s location, which may not be visible from the road or highway.

•	During a heat wave, heat spike, or hot temperatures, employees will be reminded and encouraged to immediately report to their supervisor any signs or symptoms they are experiencing.

•	Employees and supervisors will be trained on every detail of these written procedures for emergency response.

In addition to the procedures above, the employer will ensure emergency response with the following procedures:

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Procedures for Handling a Sick Employee

Instructions: Choose and modify the items below that are applicable to your work operations and add additional    language to specify how your company intends to implement these provisions at the job site. 

•	When an employee displays possible signs or symptoms of heat illness, a trained first aid employee or supervisor will evaluate the sick employee and determine whether resting in the shade and drinking cool water will suffice or if emergency service providers will need to be called. A sick employee should not be left alone in the shade as they could take a bad turn.

•	When an employee displays possible signs or symptoms of heat illness and no trained first aid employee or supervisor is available at the site, emergency service providers will be called.

•	Emergency service providers will be called immediately if an employee displays signs or symptoms of severe heat illness (e.g., decreased level of consciousness, staggering, vomiting, disorientation, irrational behavior, incoherent speech, convulsions, red and hot face), does not look fine, or does not get better after drinking cool water and resting in the shade. While the ambulance is enroute, first aid will be initiated (i.e., cool the employee by placing the employee in the shade, removing excess layers of clothing, placing ice packs in the armpits and groin area, and fan the victim). Do not let a sick employee leave the site as they can get lost or die before reaching a hospital.

•	If an employee displays signs or symptoms of severe heat illness (e.g., decreased level of consciousness, staggering, vomiting, disorientation, irrational behavior, incoherent speech, convulsions, red and hot face) and the worksite is located more than ____ (e.g., 20) minutes away from a hospital, emergency service providers will be called, the signs and symptoms of the victim will be communicated to them, and an air ambulance will be requested.

In addition to the procedures above, the employer will ensure sick employees are attended to with the following procedures:

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Procedures for Employee and Supervisor Training

Instructions: Choose and modify the items below that are applicable to your work operations and add additional    language to specify how your company intends to implement these provisions at the job site. 

To be effective, training must be understood by employees. Therefore, it must be given in a language and vocabulary the employees understand. Training records will include the date of the training, who performed the training, who attended the training, and the subject(s) covered.

•	Supervisors will be trained prior to being assigned to supervise other employees. Training will include this company’s written procedures and the steps supervisors will follow when employees exhibit symptoms consistent with heat illness.

•	Supervisors will be trained on their responsibility to provide water, shade, cool-down rests, and access to first aid, as well as the employees’ right to exercise their rights under this standard without retaliation.

•	Supervisors will be trained in appropriate first aid and/or emergency response to different types of heat illness and made aware that heat illness may progress quickly from mild signs and symptoms to a serious, life-threatening illness.

•	Supervisors will be trained on how to track the weather at the job site (e.g., by monitoring predicted temperature highs and periodically using a thermometer). Supervisors will be instructed on how weather information will be used to modify work schedules, increase the number of water and rest breaks, or cease work early if necessary.

•	All employees and supervisors will be trained prior to working outside. Training will include all aspects of implementing an effective Heat Illness Prevention Program, including providing sufficient water, providing access to shade, high-heat procedures, emergency response procedures, and acclimatization procedures contained in the company’s written program. Employees and supervisors will also be trained on the environmental and personal risk factors of heat illness and the importance of immediately reporting signs and symptoms of heat illness.

•	In addition to initial training, employees will be retrained _______ (e.g., annually, bi-annually, as needed).

•	Employees will be trained on the steps for contacting emergency medical services, including how they are to proceed when there are non-English speaking employees, how clear and precise directions to the site will be provided, and the importance of making visual contact with emergency responders at the nearest road or landmark to direct them to their worksite.

•	When the temperature is expected to exceed _____ (e.g., 80) degrees Fahrenheit, short “tailgate” meetings will be held to review the weather report, reinforce heat illness prevention with all employees, provide reminders to drink water frequently, inform them that shade will be available, and remind them to be on the lookout for signs and symptoms of heat illness.

•	New employees will be assigned a “buddy,” or experienced co-worker, to ensure that they understand the training and follow company procedures.

In addition to the procedures above, the employer will ensure proper training of employees and supervisors with the following procedures:

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