Dr. Wernz is a graduate of the Kirksville College of Osteopathic Medicine with subsequent training in internal and occupational medicine. He's both ND and DO boarded in occupational medicine. After 16 years in academia, he is now working independently. Current work includes occupational and environmental medical legal consulting, reviewing coal miner x-rays for NIOSH, federal black lung evaluations, and aviation medical evaluations. I'm going to turn this over to Carl. Thank you. Thank you very much, Liz. You might have to do this just for the first one, then the clicker. Oh, okay. So this is, we're going to talk about facility walkthroughs. And this is from the perspective, we'll talk about it from a bunch of different perspectives as we kind of go through the talk. The assumption, the underlying assumption in the topic is you've been hired by a company that has some involved manufacturing process to help them with their occupational program. So these are our objectives. One thing I want you to pay attention to is, I guess it's the fourth one down, is we're sure we're looking at unique hazards of that industry, and it's the industry kind of writ large, but also in that employer, and then whatever applicable resources and regulations will apply to that particular workplace or what they're doing. So first, this is kind of his background, but I want to talk a little bit about regulatory site visits. So this is when OSHA or MSHA or, you know, the NRC or somebody like that shows up to do a walkthrough. So this is the format they follow. They have an opening conference to let the employer know what they're there for. They review documentation if that's appropriate to what they're doing. So if you think about OSHA, they may say, we'd like to see your injury log, or we'd like to, you know, see things like that. They then do the actual walkthrough out in the production area or the facility or whatever the workspace is, then the closing conference. Now, one of the rules for OSHA is that they're allowed to do a worksite visit anytime the worksite is active, and they can go anywhere the workers go. You may not have quite that much freedom, but you can still sort of do what you can. And the last thing is the closing conference, where you review what you saw and any immediate concerns or additional things that you need. So you got to think about why does OSHA do these exams? They're not there just because they heard you're the most awesome manufacturer of some product. They're there because there's some sort of a problem, or they at least are concerned about a problem. So reasons that OSHA shows up, right in an ideal world, OSHA would go around and be doing, you know, inspect every worksite every six months to look for safety issues. That hasn't ever happened in OSHA's standards. They only come out when there's a problem. Fatality or catastrophe, which is actually specifically defined, I think it's three people hospitalized or even one fatality, will bring OSHA to come visit. A complaint from a worker, program, and what that means is, let's say OSHA decides that they've had a lot of problems with people falling off of cell phone towers. They may be doing a very specific inspection of the companies that work on cell phone towers and looking at to make sure that the harnesses they're using are compliant and that the rope is inspected and stuff like that that they're supposed to be doing. Imminent danger is unusual, but it might, it can have to do with something that's going on there that people are concerned could be causing an immediate risk to workers there. And then a follow-up exam or site visit. This is when OSHA came in before and said, hey, you need to fix this thing, and they're coming back to see if you did it. So what about NIOSH? Well, NIOSH is a research agency in occupational health. They're part of the Centers for Disease Control, and they have a program called the Health Hazard Evaluation Program. And this is, the idea with this is that some, they've got a new workplace, a workplace with a new potential hazard. And they're kind of interested from a research perspective in discovering what the hazards of that kind of work might be. Recent ones, if you think about this 10 years ago, nano was all the rage, just nano was appearing in everything. And so they were doing on-site evaluations or health hazard evaluations for people who were creating nanoparticles, manipulating nanoparticles, putting them in other products and things like that, looking for problems. They have to be invited or requested. So company management can ask for help. And like in the United States, the beryllium industry is very interested in having NIOSH's input so they can kind of stay in business. Organized labor can always ask, three workers together can ask, or they can get a referral from local or state public health. They follow the same protocol. They often will do a site visit or walkthrough. They often partner with the requester to figure out the nature of the inquiry and what they're actually looking into. And just so you know this, and don't get yourself in trouble in the future in your career, they will not share their data or their results until their investigation is complete. So don't even ask, it will only piss them off. The, so we're talking a little bit about physician site visits here. So what are your goals? There's a, the first thing I want to do is I want to kind of understand what they do. Because that gives me some ideas of what the hazards and what the known hazards are going to be. What are their, what chemicals are there? What are their feed products? What do they buy? They should at least know what they purchase, right? Intermediaries that they create, their produced product. Do they, are there known, are there known aberrant products from production that's got a problem with it? At a minimum, they'll know their feed products and their, and their final product. Then in between stuff, some places they've got, they've got their own chemical engineers, it's a new product and they figure it out themselves and actually understand it. Other production places I've been in, they kind of copied somebody else's process and they really don't understand what's in between. And so that's, that's sometimes what you're looking for. Are there physical hazards, lifting or sound or heat or cold or all that kind of stuff? Anything what I call the special hazards, radioactivity, biologicals, things like that. My goal is to get some personal understanding of job duties. Not that I could do the job, but just at least I understand kind of what they're doing. I look for signage when I'm going around and does the signage kind of, would the signage inform me as a visitor or a worker of what hazards are there and what precautions are necessary to remain safe? I ask about their emergency response plans. I try to figure out what the employer knows and doesn't know about their, their own programs. And I've, I, you would think the, all the employers know about the hazards on their workplace and some are really good and some are less good. And then figure out what my role is. What do they want me to do? Are they wanting me to just, you know, take care of their workers' comp injuries? Do they, do they really want to have a program to help protect people or what's their plan? What's their goal and what do they want, what do they want me to do? Often take several visits to kind of pull all this together. First visit's just, it's basically a meet and greet. Let the employer show you their process, collect stuff. You can review the SDS sheets or at least a list of the SDS sheets you can look at, you can look up. Regulatory filings, if they have any of those, so is there an injury log if that's what they're concerned about? If it's a chemical industry and they're concerned about, you know, discharges and things like that, can they get their SARA and TASCO logs or RCRA information? Is there an emergency response plan for known hazards? And I'll directly ask about that. So if they work with cyanide or they work with carbon monoxide or some of the things that we know are always hazardous, they may very well have a plan. Like what do they, do they have cyanide kits and if they do, which one? Because there's two different ones that work quite differently. And then I always mention what I call the hazard treasure hunt, where you're looking for extra things that they hadn't even thought about as you're going around. Second visit, talk about what I found from the first visit. What did I learn in the document review? I may do the treasure hunt, the hazard treasure hunt if that hasn't been done yet. I ask about missing programs, like, you know, if I, if my first impression was the place was kind of noisy and when I look at their documentation, there's no, there's no noise program. Well, let's talk about that. Or they don't seem to have an OSHA 300 log or whatever the thing is that's missing. And that's where you get offered to assist with issues and further clarify what your role is and what they're going to handle some other way. So at the opening conference, I do want to know what they're, what hazards and programs they already have. How knowledgeable are they? And what regulations are they trying to comply with? And you may find this, this can be all over the place because sometimes they, they may be perfectly on point with the specific exposure at the workforce, but as I said, they forgot hearing conservation or they don't have anything for, you know, for injury care or first aid or something like that. Is there anything that needs to be changed, updated because of changes in the science? So if I went through their program and they're still using the 1950 or 1945 cyanide kit, well, there's a way, there are way better ways to treat cyanide at this point. And so you may want to help them upgrade that sort of thing. What's management's focus? Some industries I've been to, they are all about the OSHA log. That's like all they care about is because somehow there's some management compensation thing that's based on the OSHA log. And so that becomes really important. But or what, you know, maybe they're really interested in hazardous materials and not really don't really care so much about the OSHA log. And do they need help with compliance? And I don't know that. Who should be there? Well, obviously we start with the safety people, nursing staff, if they have one, whoever the OSHA record keeper is and at different places I've been, sometimes it's in safety, sometimes it's in HR, sometimes it's even in, it can be anywhere, but whoever that is, they should be there. The environmental compliance people. And if there is an on-site emergency response, the emergency response leadership should be there. Some plants you may find have their own fire chief and they should be involved. We want to find out from the company, things I'm trying to learn, and there's a bunch of slides of this, like what is the demographics of the employees? Is this a place with mostly young employees or is it older folks? Are there any trade secrets that I need to help protect? And if they tell me, you know, the way we make this thing is, you know, a trade secret, we won't talk about that. I mean, we'll talk about it from a safety perspective, but I'll know that I can't talk about that anywhere else. And that's fine. Do they have facilities, like is everything here? Is there another facility down the road that we have to consider also? How does all that work? And what's their corporate culture? Again, management's priorities, is there a union involved? How are union relations, how does union participation, safety and health? And what's fun to me is that sometimes the companies with unions are terrified to involve the union, but most of the unions have really good health and safety people that will come and help you if you ask them. And so sometimes we talk about that as a resource that they might engage. Regulatory standards. So what programs they have and then who's in which programs, and I've listed a bunch of them there, you know, and they might be in, they might not. It just depends on what the workplace is. Do they have commercial drivers or pilots or Coast Guard covered people? Is there a drug testing program? And do they have what I call the miscellaneous medical clearances like divers and crane operators? Is that part of what's in their workforce? If I haven't gotten them yet, I need to ask for the MSDSs, job descriptions, job physical demand matrices, if that's been done. Some employers have a return to work matrix. What this means is they have identified specific jobs that you could use for somebody that has limitations. Maybe lifting or standing or reaching overhead or whatever, where they can make those available to people to come back to. And then I asked for the plans for if they have an OSHA program on the list on the last page, I'll ask them for the details of that. So now we come to the actual walkthrough. And one of the things I do is whatever, I always take all my PPE and at least have it in the car. When I've been on site to do exams, I like to see what the process is, even if I'm just there to do a very specific exam, because it helps me kind of really take care of the company better. So whatever PPE you have, put it in your car. If you have a hard hat, take it with you, steel toes, metatarsals, safety glasses, fire resistant clothing, all that kind of stuff. I went to a Coke oven to do exams and I'd never seen a Coke oven, I wanted to see a Coke oven. And I'd read the Coke oven standard and it's got crazy words in it, like Larry car operator and lid man and stuff like that. And I had no idea what these words meant. So I wanted to actually see the workplace. I put it all in, all my safety stuff was in the car. And so I finally got to the safety guy and I said, after we're done, can you take me on a walk, just to show me the process? He said, well, you need steel toes, are metatarsal shoes okay? Well, you need to have fire resistant clothing. I said, is Nomex okay? Because I already had a Nomex coverall. And eventually we went through all the lists of stuff that you had to have and you say, I'm going to have to actually take you on this walk, aren't I? And so I got to actually see the product of the facility. If I didn't have all this stuff with me, I would never have gotten to do that. I like to follow the operation functionally, but that's not always practical. Where does it come in? How do they process it? Where does it go out? And then document it or record it if they'll let me. Again, if there's anything that's a trade secret, that's fine. I'm not worried about the photographs, the photographs are mostly to help me remember. But if I can't do that, that's okay. So when I'm out in the work facility, in the workspace, I'm looking to try and understand the things that are there. What are the physical hazards? Hot, cold, dusty, noise? Is it dark? Is it too bright? Whatever. Are there chemicals present? Now, the chemical thing, it goes on forever. I've listed some high-level ones, isocyanate, hexavalent, chrome, any lead, because lead's always bad. Are there pesticides or other things? Do they have biologic things there, some of the lab things? But also, is this an outdoor workplace where there's lots of flora and fauna problems? And is there ergonomic problems? That's what I'm really trying to look for. For each chemical that's there, once you know what the chemical is, and the question is, how can they potentially be exposed? Is this an insulation hazard only, or is it a skin hazard, or mucous membranes, or ingestion only? It's whatever. I mean, any answer could be correct, but it's whatever the answer is. How are they controlling it? Do they have local ventilation where they're working with the chemical? Are the people in PPE? Are there administrative controls? You can't obviously see that, but you can at least ask about that. I'm going to say, for the last 10 years, almost every production job that I've visited, the people rotate, and it's part of the job. This job has seven parts, and every hour you rotate, you do a different... So you only do each part for one hour each day, and that's how they do it. A little bit in contrary to what Paul was saying earlier. Non-union job. No, no. Even these are union jobs, but their jobs are lumped together, and the puts bumpers and hoods on cars is the task. And you're going to do this, and that's the thing you bid on. And then you do bumpers, right-hand bumper for an hour, left-hand bumper for an hour. And that's what they... Almost every place I've been, I'm going to say in the last 10 years, has the people rotating because it really decreases their injury rates. Oh, of course. Yeah. But you have to ask, because you're not going to sit there long enough to watch the crew all move one position every hour for a day. Is there personal protective equipment that is available, and is it being used? And it's being used correctly. The number of people I see that are walking with their ear protector things around their ears, or God help you, the people that have the ear muff things that come off their helmets, which are useless, that's all important. Is there signage? And talk to the workers. It's okay. I have no problem with... I'll ask them, when do you wear the hearing protection? When do you put the respirator on? If they've got one around their neck, because sometimes you'll need a little bit, and that's okay. Oh, only when I'm over by the number seven machine, because that's where the respiratory hazard is. Once we cross that blue line on the floor, we have to put a respirator on. That's a great answer. Actually, that's a very insightful employer, quite honestly. What about the hazard signage? So there is an infinite amount of hazard signage you might find. The one in the middle with the diamonds, that shows different levels of hazard, and that's really for outside people. That's for emergency response for the fire department and people like that. If they have a bilingual workforce, do they have signs in the correct bilingual language or multilingual signs? At one point, I was in Chile, a Spanish-speaking country, and their equipment was mostly made in Germany. They were making... It was woodworking stuff. So all the labeling on the equipment was in German and English, neither of which is Spanish. Even the big red stop button wasn't labeled in Spanish. It was labeled in German. Was it halt? It said halt. And that doesn't work in Spanish. So that was a discussion I had with the employer there. It wasn't just me. But I noticed that a lot of this... I said, why is... There's nothing here labeled in Spanish. And those labels are there for a number of reasons. One of the reasons is that they're not labeled in English. The other reason is that they're not labeled in Spanish. So that was a discussion I had with the employer there. It wasn't just me. But I noticed that a lot of this... I said, why is... There's nothing here labeled in Spanish. And those labels are there for a number of reasons. One of the reasons is that they're not labeled in English. So that was a discussion I had with the employer there. It wasn't just me. But I noticed that a lot of this... I said, why is... There's nothing here labeled in Spanish. And those labels are there for a number of reasons. One of the reasons is that they're not labeled in English. So that was a discussion I had with the employer there. It wasn't just me. But I noticed that a lot of this... I said, why is... There's nothing here labeled in Spanish. And those labels are there for a number of reasons. One of the reasons is that they're not labeled in English. So that was actually something we talked about. And that was something that was actually a service. I was working with a, it's an integrated workers comp carrier is kind of like, in Chile, the workers comp system, they had their own hospitals and their own providers and their own industrial hygienists. When you sign up for them to be, to provide your workers comp insurance, you get all this, the whole program with it. And they were actually gonna make up, they were gonna help translate some of the instructions for the workers, which I thought was really interesting because they realized that they can't read how the machine works and the warnings that they're not gonna follow them, right? So what's my treasure hunt? Well, is there a medical facility or a first aid station? And the first aid station can range from a room to, you know, one of those unitized boxes hanging on the wall, whatever they got, is there something? Are there off production assets? So, you know, this could be someplace it's a bone yard or a scrap yard. They call it different things at different, depending on what the industry is. What about rest areas? Is there, and I'm not like everything has to be, you know, look like it's the bathroom here at the hotel, but you know, is there a bathroom? Is there a bathroom with a door that closes? Is there toilet paper present? Some of that basic stuff. If there's food and water, if there's food available on property, is that like reasonably safe? I'm not sure, I'm not getting into like the, all the intimacies of food, of the food rules, but we probably should have like a door that closes between where they work with arsenic and where you work with food, okay? And maybe even separate ventilation systems. Parking traffic control, we'll talk about in a few minutes. Is the outdoor lighting and access seem reasonable? Again, if the workplace is entirely indoors, I'm not as worried about that, but if it's a workplace that's indoor or outdoor, you need to make sure they light up the outdoor part so that you're not, you don't have people walking around in the dark. And the last thing I'll ask about is their hazard communication station. If you have safety data sheets for the stuff at the workplace, that should be available to the worker. Usually they've got these books, just big books of them, but that's where, how does a worker get to that? Because that's actually a requirement from OSHA. Focus questions. Tell me a little bit more about the exposures. They all the time, are they remittent? Are there enclosed spaces with adequate ventilation? And again, I see this not infrequently where they've got a, yeah, where you've got stuff, sorry for the distraction there, I'll come back. Is there adequate ventilation? And you can open the window, you know, we're telling people that they should open the window in January is probably not quite cutting it. Having a big shop fan and all the windows closed is also probably not, all it does is share the exposure and not make it go away. Are the people wearing the respiratory or hearing protections they're supposed to wear? Does the signage and what people are doing disagree? Do I see something that suggests that maybe there's a problem? Like, is there a haze in the air? Is there a half inch of dust on all the machines in the place where nobody's using any respirator protection? And now I'm really curious what the dust is. And how are they dealing with people whose assignments are in adjacent processes? So if I'm in machine A and I'm wearing a respirator because there's some hazard, what about the guy at machine B that's four feet away? How are they being protected? Supposed visit documents. So I'll go home with the SDS sheets. If you grew up in the past, there were material safety data sheets or MSDSs. For whatever reason, it's now just a safety data sheet because it might be something that's not necessarily a material. You will find there's two or three medical sections in an SDS sheet. And so you need to read the whole thing. There's a health hazard section, there's a first aid section. Sometimes there's a section of information for physicians. Unfortunately, while the information is kind of, while the what's to be there is standardized, the formatting and the ordering varies between providers of the SDS sheets. Is there a physical job analysis? Again, not every employer has done this. This implies a pretty together employer that they have these done, but especially in jobs where they have multiple, or they have a production workforce, multiple shifts, they're kind of doing the same thing. These are often provided. And it just, what are the expectations for that specific, to be that equipment operator or whatever the job is? Separate question is what are the essential job functions? Now these have to be designated by the employer. And this is what drives ADA decisions. And if, whether the person, the person has to be able to do the essential job functions, which might not be all the things in the job. But again, this has to do with, this is something they do to help them with deciding if the person's, can be accommodated or not. Do they have a hazard communication program? Now this is usually letting the people off campus, the township, the community, the fire department, whoever it is, be aware of what the hazards are on the property and how they are to interact with those. And is there anything specific for any specific substance? So this is one from, I think, Cornell University for arsine, for a bunch of gases that they work with in a certain place. And they, it kind of walks through what's the emergency procedure for arsine? What's the emergency procedure for cyanogen? And so on and so forth. So, and these are both, these guides the library, the user, what they're supposed to do. It guides the facility and it guides the offsite people. And so, and these can be quite in depth. And quite honestly, for the one that I picked up there where they include cyanogen, it should be. Cyanogen was the thing, was one of the chemicals used by the Nazis in their gas chambers. So some of the stuff on this one is pretty nasty. And do they have signage? I mean, we're always looking for signage. Hopefully they hang it up a little better than this guy did. There's some things to look for. So you can see these are vertically stacked tanks for liquids and you can't see it as well in this picture, but you see the next picture. So when I see this kind of arrangement, my question is, if one of them starts to leak, how is it contained? Is there a system on the floor that will catch the liquid? And a side help, side question of course is, okay, so what is the hazard for each one of these things if it leaks? I mean, it might be water, which wouldn't be a big deal, but it might be something scarier. And you'll notice if you look at these pictures, each individual tank has one of the little fire diamonds on it, the fire department diamonds. So you can tell walking up to it what kind of hazard it is, whether it's biologic or fire or explosion or something special. How do they handle their chemical storage? Now, here they've got racks four high of drums of stuff, which is probably safe, but I would be more worried if those were plastic drums. Just kind of looking at how they've got it set up. This is a little bit less ideal, but again, this is much more common where, yeah, they've got a pump there to get this stuff out of the one tank. And maybe some of it leaked a little bit from the middle one, and they've got an extra ring up on their wall. And you can see that this one's been a little bit less well cared for, but still probably safe. But you want to look for what are the things in these areas? These are great big plastic carboys. The one on the left is, you can see is labeled, it's whatever code 2735 is. It looks like it's some sort of an acid thing. The one on the right though, doesn't really have, it's a big tank, it's full, you can see that. But I don't know, you can't tell from this side what it is. And sometimes it's simple stuff like orienting the tank so the labels face out all the time, which may take a little bit more attention by the employer. So this is a trans-filling operation where they're going from one kind of a tank to another kind of a tank. I'm not going to comment on the funnel, but I do like the pipe that they're running over from the big tank to the little tank, which is probably a piece of conduit, not the pipe you're supposed to use for that. However, giving them credit, they do have the tanks that they're filling in that tray on the ground. So that if they overfill or there's some spillage, it won't cause any hazard, it'll contain it. This is that Right to Know Center or MSDS book. They should be able to show you this. MSDSs, according to OSHA, need to be available where they can be found by the employees 24-7. It can be a website, it can be like this, but it has to be publicly available to the worker at three o'clock in the morning if they want to read about something they're working with. And in the closing conference, what did I find? Confirm my observations, I may have some questions, I saw this, did I understand what I saw? Because I don't want to accuse them of something that I misunderstood what was going on. Pursue unanswered questions, ask about missing documents, like I saw labels that says you have phosgene here, but I never got an MSDS for anything with phosgene in it, what am I missing? And plan a follow-up visits if that's indicated. Again, a post-visit communication, this would maybe in the form of a letter to the employer, maybe to the union, if they want to be involved or if they are involved. And then we talked about the documents reviewed and any other things that I found. So I want to look at some examples. So this is some pictures from a steel scrapyard. You'll notice, this is one of the older ones where they take, those squares, where they take those squares that you see in the middle, those that are kind of lumpy on the outside, those are probably former cars that they just took the whole car and squished it down until it was that size square and not much else in it. But you'll notice if you look around that junkyards are especially bad or scrapyards. So we've got in the foreground, there's train tracks that I have to, so I've got a trip hazard from the train tracks, which may or may not still be being used. I've got the big crane thing that's going to be moving stuff around and it's going to move and potentially hit people. I've got a pile of what probably is ground up metal. On the left-hand side, I've got the big metal things that have been squished into the cubes. So there's all sorts of different hazards there to be thought about. Purple liquid. Yeah, I'm going to give it- Drainage from that stuff that would mix with waters. Well, keep in mind if you start with steel, it does rust, right? So that could just be discoloration from the rust. It could be something more interesting too. It could be all sorts of things. I'm not going to get into scrapyard. I will not make any guesses. I've seen, scrapyards are one of the most hazardous places because they take other people's stuff and then try to process it without always being super careful. I mean, one of the things that you'll find now, if you ever tour a scrapyard, you'll notice that the first thing you'll find is radiation detectors at the gate. Like the truck can't come in without going through radiation detectors because they're afraid of getting radioactive metal brought to them because it's out there. The other thing you'll find is that they get a tank and it's still got stuff in it. And there can be quite a few hazards in this industry and the stuff's not the same size. It's an industry, but it's not a clean industry. Completely different place. This is obviously a firehouse. So these guys have a whole different set of hazards if that was the workplace you were talking about. But some of the stupid stuff they deal with, like you may notice this is the back of a fire truck. Everybody here who's old enough to remember firemen riding on the back of a fire truck, put your hand up, put your hands down now. They don't do that anymore. Firefighters do not ride on the back of the fire truck because they fall off every so often. Even with a little wrap around things, it's just, it's not worth it. And so they want the fire, firefighting has made decisions as an industry that they only want things to be, they want the hazard to be the fire or the thing they're responding to, not they're getting there. And so they've done a lot of stuff to make it way safer for them to get to the fires and other things. Does an employer have designated severe weather shelter areas? Nearly every federal building seems to have done this recently, but this is a shelter in place location. We have those all through the one building that I work at. This is an interesting, you're looking for, again, we're looking for kind of hazard-y things. Just so we've started with this, this device that he's using to lift this pallet is intended for that. This is not a forklift just holding a pallet up in the air. It's intended to hold thing, to be kind of create a work surface, you would load things onto. If you think about this, if I wanted to load a pallet of bags, 50 pound bags of dog food, if I use a device like this, it can go up and down so I can load everything kind of at waist height instead of having to start by loading on the ground and then eventually loading up above my shoulders. So that's kind of what this is originally intended for. They're stacking paper on it. That's probably a safe use of it. My big question is the pile that's on there. That's awfully big pile. Yeah, is that going to fall over on somebody? But again, the device itself is probably makes life safer. Doing the same function with a forklift would not be safe, right, because it's not designed to go to a level and stay there forever. Whereas this thing is. I'm going, so if you look into this, this is the, so on the right-hand side, there's a door. The door says I need eye protection is required that area. That's a good sign. The one thing I would be looking for in addition is, is there some, can I get eye protection as I'm going in there? The people that work there full-time are going to have eye protection. I'm not worried about that. But for visitors, somebody come in to work on a machine or whatever, is it there? That's that kind of treasure hunt thing. It's like, where do I get eye protection from if I need to go past that sign? This is another part of the scrapyard and they sort. So one of those is probably aluminum and one of them is steel and one of them is galvanized. And they sort that stuff. But, and it's manuals that they just, they're literally just throwing stuff out, different slots in the wall, into those different containers to sort it to go to its next processing place. Obviously pretty physical to get it up in. Here you can see this, we're still at the scrapyard. They're taking, they've got all sorts of piles of stuff that they need to sort. Then they pick it up, it's a regular. So there's different ways they can hold it and move it. And that's a, again, a lots of different hazards there. The big thing that, the big thing is when they pick something up, that they've done it in a way with the crane, that they're doing it in a way that there's nobody underneath it, you know? And maybe it's the only thing in that end of the plant. If the guy's down there in that end of the plant, nobody's allowed to go past a certain point. Probably needs to be marked because otherwise people will get too close and eventually you will drop something on the guys in that worksite. This is the machine that makes those cubes. As you can certainly imagine, getting something in the way of that machine, you become part, your fingers become part of the cube and that would be a bad day. This is a different worksite. And again, we're kind of looking at, this is kind of a sludge operation where they're trying to clean up the sludge and it comes out. And again, you're looking at what are the exposures there? And this would be one, I'd ask a lot of questions about, well, like, so what do we think's in the sludge and how are we protecting against that? All that sort of thing. Back in the workplace, the thing to notice here is you see that square thing in the middle? It's kind of yellow. It's a yellow square, not the big tank, but kind of coming down from the ceiling with a couple of hoses going to it. There's a red hose going to it. And there's also a, let's see if we can do this, that thing right there, that's local exhaust ventilation. And you can move that around as you're transferring these chemicals to allow you to have ventilation where you're working. And now, if I have a drum in this red thing in the middle, because that's what that is, that's a drum tipper upper thing. I'm sure it has a name, but that's where I can tip a drum up so I can, if I need to get two gallons of stuff out of the drum, I can put it in there, put open, activate the valve on the bottom, let my two gallons out, then close the valve and put the drum back down. If I want local ventilation, I move that thing over above where I'm getting that two gallons of stuff out of the drum and I have local ventilation. If it's still in its nested spot when the guy's over-transferring it, it's not buying me anything. So you got to look at what they're actually doing. Yep, sometimes really, really important. What about disaster plans? I mean, if they have known hazards, what is their plan? We'll start first for onsite activities. So how do they control spills? Do they have a way to do, whatever their chemicals are that are bad, do they have a way to do that? And I will say, just so I've said this, every once in a while, their plan is, it's okay. One of the plants where I provide onsite physician services, they had really detailed plans for about 15 chemicals that they had in bulk on the property. And two of them, as I'm going through them, the plan was, we'll just let it go. Because it was like glycerin. It's not going to hurt anything. They had a tank full of it. And in the grand scheme of things, they're like, doesn't matter. We're just going to ignore it. We'll clean up our mess, but we're not going to, they weren't setting up dikes and evacuating them three miles downwind and all that kind of stuff. They did that when it was indicated, but some things are safe if they spill. They may not be clean anymore, but they're not going to hurt anybody else. And so just be aware that that can be okay. How do they protect their own workers? Do they have a way to do decon? One of Carl's personal pet peeves is places where they have a shower and no clothes for you to put on. Because when you're- Just walk around naked, right? Yeah, well, so I've been exposed at work and I got on my clothes. Now I go to the decon shower and now I'm naked for the rest of the day. You can't put the dirty clothes back on and I have nothing else to put on. Better workforces will have like a closet full of clothes of some sort. They might be, you know, scrubs or something. Scrubs is a one way to do it. And if you're, if you don't need to worry about too much, the one place I was at, what they did was they issued clothes to people every year. And so you got, you're like, you know, you got, you know, five short-sleeved shirts and five long-sleeved shirts and a pair of pants and stuff, you know, five pairs of pants up every year. What they did was take the old stuff, you know, we, we ordered them for Bob and then Bob died. So we never issued them to Bob. And so they just kept a bunch of that stuff. They had a bunch, you know, they had, they just had like, you know, shelf for smalls and medium and large. You can buy, you know, they, they spent a little money. I mean, not a lot. They went to like, you know, Walmart and bought like underwear, underpants and, you know, stuff like that. So that they, you could actually, and they had, you know, Crocs for $4 a pair. So you actually, if you had to do it, you actually had clothes to put on. And, you know, you can go all the way to the hazmat answer of full, of floor-length trash bags. I don't recommend that, but that is a choice. And that's what, that's what they do. If we have, if we ever get a chemical weapons attack, if you ever look at what they put, give you to put on after you've been decon, it's a floor-length trash bag. It really is. It's got a head, a hole for your head and a hole for your arms. And other than that, it's just a trash bag and the wind blowing it. There ain't nothing else down there. But that's an, and so if you need a lot of stuff, that's the right answer. That's a good solution. If you just need it for two, you know, for one or two people that got exposed from the leak at the, at the tank while they were working, you can have real clothes and you really have to think that through. Okay. So do we need medical follow-up for hazards? Like, is there a specific hazard, CO, cyanide, arsenic, one of those kinds of things, arsine, where I need to have a plan? And have I engaged with my local hospital? When I was doing EMS stuff, one of our employers had cyanide and what they did was rather, they tried to engage with the hospital. The hospitals always got weird with them. And our problem was they were also surrounded by about five hospitals. So you can never exactly tell which way people would be going. So what they thought I'd do is they just bought the cyanide kits. This is back in the old cyanide kit days. And if you ever had to go get somebody with cyanide exposed, they physically gave you a cyanide kit and the instructions to take with you to the hospital. So the hospital, they knew the cyanide, the hospital had a cyanide kit and instructions. And that was, that was part of the plan. The guard check, couldn't get past the guard check without, they would give you that, that, that little tub that had all the stuff in it that you took with you to the hospital. So the person got treated. What about offsite? So this gets a little bit more complex. There are federal regulations for, called SARA, and you have, and you know, you have to notify people of what you have on site, how you're going to deal with it. Homeland, you deal with your local Homeland Security or the local emergency planning committee, which are, they're the hazmat people for your community. And every community has one. They may not be very active, but you have one. And if you ask how, when you can, you know, if you were in that industry, you probably want to have a representative on the committee so that they're always there and they get notified of anything going on in the community. The other part is interaction with local hazmat responders. And this is all over the place. One of the communities, when I was in industry, in the compressed gas industry, we went for some of our training up to one of the counties and that county had made an intentional decision as a way to bring business into the community that they created a hazmat team for the county. And they funded it. And they said, bring your chemical industries right here. We'll get you a nice place to build your plant. And we want your business. And we're not going to give you a hard time about having chemicals because you're going to work with our hazmat team. And they had some pretty nasty industries there. And they'd know they were all safe and they'd kind of been, they got lots of, you know, good paying jobs for the local guys and gals. So it was a good business decision for the county. But you have to interact with them and see what's going on. How do they deal with on-site emergencies? Now, this is, I'm not so much talking about the, this is kind of the general emergency response plan. Is there, there should be a plan if they've got anything hazardous there, or even if they don't, they should have a plan. How accurately have they identified the incidents? I mean, certainly workplace violence is something that every employer should have some sort of a plan for. Is it process related? Did something happen? Is it an employer external violence? Is it an external disaster? Did electricity go out? How does the plant function safely, or at least shut down safely when electricity goes away? Is there storm damage? Is there storm coming? All that kind of stuff. How are they going to deal with an employee injury, especially fatality? And do they have a plan for that? And I'm strongly encouraged, at minimum, they have a plan for dealing with a fatality. Because they will have, they'll have government agencies coming to visit them that they've never heard of after they have an employee fatality. So you need to have a plan to deal with that pretty much up front. There we go. So there's a medical aspect for potential hazards or likely hazards. If there's not one, should there be one? Should there be an on-site response to a specific hazard that you know is there? How is that delivered? And again, we're back to Carl's question about clothing. Everybody wants to set up an incident command post. And that's a good thing. But the question is, where's your command post if the site's not safe? You don't want to say, oh, we always have the command post in the office building seven. Over there and point to where the, you had this nice facility. And then that gets slimed in the release. You don't want people driving inside the slimed area because that's where they were told they always have to report. So you need to have an off-site places. In some of those places where there's multiple chemical industries in an area, they'll often trade off. So if you have an on-site emergency at your plant, you can have your operations center at my plant. If my plant has a problem, we're going to set up in your EOC. That's fine. Now you've got a plan, right? And that's what you need. And is there a role for you as a physician in small emergencies like fatality? The answer is there should be. Site visitors, how does that all work? Is there site visitor instruction? And this can be, it should be hazard specific. And it might be, the longest one I've ever been through was about half an hour because it involved escape respirators and stuff like that. Typically this is like three minutes or a minute. And they just say, you know, if the alarm goes off, go to the rally point, which is usually the flagpole out front. And we'll go from there, right? For a visitor. But it needs to be catered to what they're doing. If they're going to be working with your really hazardous product, you may need a little bit more instruction. The other thing to think about is psychological support for the workers if they have an on-site event. So people may have heard of this critical incident stress debriefing. So it's a couple parts of the pre-incident education, which is just fine. We just talk about the, you know, how you might react to a scenario and how you might access assistance. Diffusing. We're going to talk about it for, oh, a good 20 seconds. We say something like, this sucked. If anybody has any psychological problems, call this number. That's okay. Then there was this thing called debriefing. Now, I've been to debriefing sessions that was, everybody would sit around a group and we'd all talk about how bad it was. These are horrid. They make people psychologically worse. Never, ever allow anybody to do that in any place you're involved with. Because what you have is one person had a bad experience and now everybody does. And a few of those people will, if a person tells a story well enough that had the bad experience, which will really help them, it'll really mess up everybody else. But you do have to have access to quality counseling services and it has to be set up. You call this number. You say, I want to talk to somebody and they'll get you in a day or two. That's the way it needs to work, to work well, to have a good thing. Do not let them do a debriefing. There are still people that want to do debriefings because they were trained as psychologists 30 years ago. Don't let them. Just don't allow it to happen. It's worse. Um, what about implant traffic? So how do people get on and off the property? How do you move around inside? Um, you know, general layout, is there surface maintenance issues? You know, is it all, is it look, is it all cratered and falling apart? Or is it in reasonable repair? I mean, we're not, it doesn't need to be, you know, ready for a, you know, a lose competition, but it needs to not be completely unsafe. Um, implant we'll talk about in just a second because there's more stuff there. Um, inside the plant, if you're going to have mobile equipment and people, you need to keep them separate because when they bump into each other, it goes badly. Um, and there's lots of different ways to do this. So you'll see on the picture on the right shows designated lanes. So the big, the, the lanes with a little picture of a forklift in them, um, are for the forklift. The ones with the picture of people are for people and you're, and you know, stay in your lane as, as Dean was saying earlier, um, you can have containment systems for the people and the, the bottom right picture, the one in the middle bottom shows that the yellow is where forklifts go and the people stay inside the green area. Um, and then, uh, you can even put gates on the end that make you turn your head and look the direction the forklifts are going to come from. So think about which way, which way does traffic approach and then make sure you put the gate on. So the person, when they open the gate has to turn the correct direction to look at where the forklifts come from. Um, are there walking hazards? And again, I'm looking for, I'm not looking for there's two drops of oil on this huge wooden floor. I'm looking for, is there a problem? Is there something that you could actually fix? Um, wax floors, uh, can be slippery. Um, and sometimes the people like them because they're pretty, but they're, they can be slippery if they're not done right. Um, is there loose debris or the grates or gravel or holes they could fall into? Um, sometimes there's, uh, there's the, the bridges across, uh, assembly lines and we'll, I think there's a picture of one of those later in this talk, which is right here. So this is an official bridge to get you across the roller thing. So those brown things, they know the brown things don't move. They're flat. No, the idea is, is that if I need, if I need to go across it, I can step on the platform at my end. I can step on just the brown thing. I could go left, right, left, right. And I'm across it. It's way better than trying to walk on a thing that's trying to spin under your foot. You know, but it's better than nothing. It's this, this is, this is a, this is a significant improvement over nothing. That's all I'm saying. It's not as good as walking all the way around. Sometimes there are, sometimes there's conveyor, there's these roller conveyor belt things. They could be three or 400 feet long and it's a long walk to walk around it. Whereas I can just, I can walk across that little bridge and get across it safely. Much better than somebody trying to sneak across it on their knees, right? Or, or more likely falling when they try to walk across it on their shoes. What about lockout, lockout, tag out? Now this isn't, this applies to every industry everywhere, right? You should, if they, if they do anything, anything is powered, maybe not the Amish farmer, but everybody's, everything's powered, needs lockout, tag out at some level. And the whole idea here is if I'm going to go work on a piece of equipment that has power going to it, I need to make sure that it's not going to be energized while I'm out there. The, the best example I see is the one on the left with the, the power control box that says 480 volts on it. If you look, that's, it's got that little clampy thing that goes around the, the off, that locks that, that switch into the off position. Each guy or gal working on that problem has their own personal padlock. They have personally padlocked out that, that thing from being used. So, and everybody has to take their padlock back off, off of it again, showing they're all done working on it before it can be powered up again. That's what lockout, tag out is all about. You can do it with signs, but you have to be super careful. Locks are better because I'm not going to, I won't go unlock the power to the thing I'm working on, whereas you could take my sign off, right? So you get, and, and sometimes it's both, and sometimes you, you have to put like paper over the, the, the buttons if you can't put a lockout on it, if it doesn't have its own power supply. Training procedure-based stuff. Is there a confined space entry protocol? Now, not, if you don't have confined spaces, you don't need one of these, but if you have tanks and places, mostly it's think tank, think about having tanks on the process. That's what, that's where confined spaces are important. Do they have hot work permit process? Not everybody needs one, but if they have explosion or fire hazards, then they probably need a hot work permit process so that they don't, you know, ignite their own work, work stuff. How do they do compressed gas line repairs? Do they, how do they store PPE? Here's a question you asked that they're, it's specific to what they're doing. They may or may not have it, but if you, if they say, oh no, we don't have a hot work permit process, that's fine. Now, of course, if you're walking past all these flammable tanks, you have to, they may, they may want to encourage that they need one, but if you're not, it's fine. Visitor safety. Again, when people come onto the property, how do they, what do they need? Do they, how are they educated? Do they need PPE? They talk about emergency actions, all that. I asked about substance abuse policies. Do they have one? Do they do testing? Do they, do they need to be DOT compliant because of something that they're doing? Remember, DOT is not just truck drivers. It's also people that do pipelines and public transit and other employer types. We have an interesting question that I've been involved with a little bit in West Virginia where we're now, the fracking gas thing, they're putting a lot of pipeline stuff in and we've had these interesting discussions with employers about whether, where, at what point in that process are they covered by the DOT standards? When do they become pipeline workers and when are they just working on a piece of pipe? I don't know the answer to this completely and I don't think they do either, but once there's product in the pipe, it's definitely covered by the pipeline regulations and that would be under, and then there's, there's drug testing and other regulations from DOT that apply to them. Do they need MRO services? Always try to upsell. If they need an MRO, I'll talk to you about that. Do they have an employee assistance program? I, this becomes really important if they have, if they're doing drug testing so that they've got, you've got, what is the, and then I, if they're, if they go together say, so if somebody comes and asks for help, what is the process? And, you know, what I would like to have information for their EAP if I'm going to be seeing their patients so that if I think someone needs to be talked into the EAP, I can, I can give them the, you know, the business card for the EAP people so they can call them. There are a million resources for how to do these inspections. The OSHA field inspectors referenced me and it was actually online. There's a safety checklist program for schools that NIOSH has out there. And then all these other ones are out there as well. And are there any questions about the site walkthrough or anybody wants to share any experiences that they've had in doing one of these? And, and what I really want to know is what's the coolest bizarre thing you found? If you want to, you can unmute and ask your questions. I don't, do we have any in, in chat? Okay. They told me nothing is in chat yet. Does anybody have any questions or I said, I really want to know what the most bizarre weird thing, most bizarre cool thing is you found when I walk through? Well, years ago, when I was doing my administrative residency, I went on a facility walk site. We were trying to get industrial medicine contracts, what we called it back then. And this was a chicken processing plant. And the chickens would come hanging by their feet. And one lady's job was to grab them and sever the heads off, basically decapitate the chickens, throw the heads in a bucket. Well, about every four times she would miss the bucket. So when you'd walk by her station, you had to be very careful not to roll your ankle or fall over the severed chicken heads. That was the most bizarre thing I've ever done. So hopefully everybody heard Jack Jeffrey's chicken decapitator hazard story. I don't know if that was their official title. Chicken processor. Yes. Any, any, any, any other questions or anybody else has found something we want to share? My stories are all boring. I'm sorry, go ahead. My stories are all boring. You never, you never found a nuclear reactor or anything like that? No. One guy once decided to independently remodel some area that he had logistical, but not technically physical plant control. He just decided to do it. And there was a massive trip hazards all over the place, pipes sticking up out of the floor. He just, he was a do-it-yourselfer in a hospital. It was a bad place to be a do-it-yourselfer. And he just sort of turned his work environment into this little bit of a nightmare of trip hazards and exposed pipes and stuff. Cool. Yeah. My, that, that, that, yeah, I can, I can definitely see that happening, especially in a hospital building. My, my best story, which is not, unfortunately not mine, but it was from my previous employer was one of our, the safety guy was going around to just do an inspection of a week. We had a remote campus that was a different, it was a, I was working in an academic institution, but a remote campus halfway across the state. And the guy went walking around and he's like, what's that thing? And they said, oh, that's our nuclear reactor. And he went, wait, wait, wait, what? And back in the, the sixties, when there were, when the government was kind of in the, your friend, the, your friend, the atom phase of nuclear power, they gave about 50 schools, these, it was about the size of a washing machine. They gave these about 50 schools, these washing machine size reactors. And they had, so they, they had this thing and they had probably done stuff with it in the sixties. It had been sitting there for a long time. They had it in this display case out in the front of the school. Like, look how advanced we are. We have our own reactor. And so then 9-11 happened. They realized this could be a hazard. They put butcher paper on the inside of the glass of, still left it there, but they, and they spent years trying to get somebody to take it back. Cause DOE said, we gave that to you as a gift. We don't want it back. The DOE did eventually take it back, but they were trying to say like, should we just like take it in a forklift, just dump it in the river? Like what are we supposed to do with this thing? So that was, that was probably the best I found this on a walkthrough story was a guy that actually looked at a nuclear reactor that had been forgotten about. So I'm going to, at this point, I'll stop. I'll be back in a little bit. And so then more questions, you can put them in the chat and we'll get on that.

facility walkthroughs

occupational safety

Dr. Wernz

OSHA inspections

NIOSH evaluations

workplace hazards

safety protocols

emergency response

employee training

hazard identification