Worker Health Hazards at Large Construction Worksites

Large commercial building projects, such as data centers, warehouses, distribution centers, and office parks, can be among the most complex and hazardous worksites. The leading safety hazards in construction are well known. The industry’s “fatal four” safety hazards are caught-in or -between hazards, electrocution, falls, and struck-by hazards. (The Occupational Safety and Health Administration [OSHA] refers to these as the “Focus Four” hazards.) 

Occupational health hazards in construction can include heat or thermal stress, musculoskeletal disorders (MSDs), silica and other airborne contaminants, and noise-induced hearing loss.

In 2023, the American Industrial Hygiene Association’s (AIHA) Construction Committee developed a guidance document with a “focus four” approach to occupational health hazards in the construction industry, including manual materials handling, noise, respiratory hazards, and high temperatures. The guidance includes a section for each health hazard describing why each is important and providing practical steps employers and other stakeholders can take to recognize, reduce, and control exposures.

While the AIHA guidance is written for small and midsize firms in the construction industry, many of the same issues also plague larger employers on more complex projects. Health hazards on a worksite may be less observable than safety hazards. For example, odor and visibility are unreliable indicators of how much of a potentially hazardous chemical might be in the air.

Large commercial construction projects can also involve hundreds or even thousands of workers on a single site simultaneously.

Heat Illnesses

Heat illnesses can lead to worker hospitalizations or even death. While there’s no current federal standard for workplace heat exposure or heat illness prevention (OSHA proposed one in 2024), there are state standards in California, Colorado, Maryland, Oregon, and Washington. Minnesota has a standard for workplace exposure to both hot and cold temperatures.

The state heat illness prevention standards have similar requirements for water, rest, and shade, as well as for worker acclimatization and training.

Manual Materials Handling, Ergonomics, and MSDs

Construction can involve hard, physically demanding work, such as lifting and lowering heavy loads or pushing and pulling difficult-to-move objects. Some tasks involve awkward postures, such as stooping over, bending, pivoting, twisting, or working in cramped spaces. The biomechanical forces created by such work can cause injuries to the soft tissues, muscles, and tendons. As such physically demanding work is repeated day after day, it can lead construction workers to notice pain or stiffness, or the repeated trauma may finally catch up with them as an MSD.

Remember the “W-H-A-T PACE” acronym for addressing the risk factors in manual materials handling:

• Weight: The heavier the object, the higher the risk of overexertion.
• Handling ease: Loads with contents likely to move, loads that can’t be carried close to the body, or loads without handles all increase the risks of MSDs.
• Awkward postures, such as bending, kneeling, reaching, stooping, and twisting, increase risk.
• Time/distance: Loads that must be carried a greater distance or for a longer time are higher risk.
• PACE: The number of loads that must be moved per shift.

Noise

High noise levels at a construction worksite can damage the sensory cells in the ear, resulting in hearing loss. You and your subcontractors need hearing conservation programs to protect employees from workplace noise exposure and prevent noise-induced hearing loss.

An OSHA-compliant hearing conservation program includes exposure monitoring, preemployment and regular hearing tests (audiometric tests) for employees exposed to noise levels over 85 decibels (dBA), hearing protection, training, and recordkeeping. You must reduce your workers’ exposure to noise through engineering controls (such as substituting less noisy tools in a “buy quiet” or “rent quiet” program), administrative controls (such as placing louder equipment farther from workers in restricted areas), and hearing protection.

Ear-protective devices inserted in the ear (earplugs) must be fitted individually by a competent person. Manufacturers of hearing protection may provide information and training materials on proper use and fit.

Air Contaminants, Silica, and Respiratory Protection

In a national survey, more than half of construction workers reported being regularly exposed to vapors, gases, dust, or fumes at work twice a week or more—double the rate for all industries combined. In another poll of working adults, construction and workers in outdoor occupations were almost twice as likely as other workers (43% versus 22%) to say there’s something about their workplace they think may be harmful to their health.

Industrial hygienists have developed a variety of air concentration limits to guide exposure-control efforts. Air contaminants that can cause damage during brief but high-level exposures include those that are:

• Immediately dangerous to life or health (IDLH), when exposure at a certain level is likely to cause death or permanent health effects or prevent escape;
• Short-term exposure limits (listed as STELs)—concentrations that shouldn’t be exceeded for any 15-minute period; and
• Ceiling limits (listed as C or STEL-C), for which exposures must not exceed a certain level at any time.

For some substances, OSHA has enforceable standards with permissible exposure limits (PELs), the National Institute for Occupational Safety and Health (NIOSH) has nonregulatory recommended exposure levels (RELs), and the American Conference of Governmental Industrial Hygienists (ACGIH) has recommended threshold limit values (TLVs).

Respirable crystalline silica (RCS) is generated in large quantities during the cutting, grinding, drilling, and abrasive blasting of concrete, masonry, and stone materials—common activities on large commercial construction projects. RCS is one of the most serious occupational health hazards in construction. Chronic inhalation of RCS causes silicosis, an irreversible and potentially fatal fibrotic lung disease, as well as lung cancer, kidney disease, and autoimmune conditions.

OSHA amended its RCS standards in 2016 to include a lower PEL and revised its National Emphasis Program (NEP) for RCS in 2020. The NEP targets many types of construction, including commercial and institutional building construction, industrial building construction, and several types of specialty contracting.

The revised NEP includes new inspection procedures for compliance safety and health officers (CSHOs) and a requirement that state plans participate in the NEP due to nationwide exposures to silica.

CSHOs must bring calibrated instruments, pre-weighed filters, and other equipment to perform air sampling. They also look for other health hazards, such as elevated noise levels from cutting, drilling, or blasting operations; exposure to beryllium dust during abrasive blasting; and heat stress. They also inform workers of their right to file a whistleblower complaint if they experience retaliation for complaining about silica exposure or other workplace hazards to management.

Whenever workers face respiratory hazards, employers must have a written respiratory protection program. Required program elements include the following:

• Employee medical evaluations—can your employees safely wear respirators?
• Procedures for selecting respiratory protection.
• Initial and annual fit testing.
• Procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, discarding, and maintaining respirators.
• Procedures for ensuring adequate air quality, quantity, and flow of breathing air in atmosphere-supplying respirators.
• Employee training on potential respiratory hazards during routine and emergency situations.
• Employee training in the proper use of respirators, including putting on and removing them, and any limitations in their use and respirator maintenance.
• Procedures for evaluating the effectiveness of your program.

You and your subcontractors will also need hazard communication programs for other chemical hazards. A compliant hazard communication program includes the use of chemical labels and safety data sheets (SDSs), as well as employee information and training.

OSHA inspectors will review the written program during a workplace walkaround and confirm that the program includes a complete inventory of all hazardous substances; methods for informing employees of hazards encountered in both routine and nonroutine tasks; and methods for informing other employers’ employees at multiemployer worksites, such as whether all workers at a site know how to access information about the program.

Mental Health

There are also mental health hazards in construction. Workplace suicides peaked in 2019 at 307, according to the Labor Department’s Bureau of Labor Statistics (BLS). In 2024, there were 263 workplace suicides—down from 281 in 2023.

Suicides can be especially high in construction work. You may want to have your supervisors include a suicide prevention toolbox talk to try to destigmatize seeking help. Your employee assistance programs (EAPs) may be able to provide a list of mental health resources and posters you can display in offices and at worksites describing the warning signs of suicide risks.

This year’s Construction Suicide Prevention Week is September 14 to 18. Outlines for toolbox talks in English and Spanish are available online, and OSHA maintains links to resources on its own website.

Your construction workforce may largely be composed of young, male, temporary workers steeped in a culture of risk-taking and drug and alcohol abuse. Marijuana remains the most detected controlled substance in workplace drug tests.

Resources

Helpful resources include the following:

• OSHA’s Heat Illness Prevention campaign;
• OSHA’s construction industry crystalline silica topic page;
• NIOSH’s construction hazards topic page;
• NIOSH’s RELs for hundreds of chemicals;
• NIOSH’s noise meter app and hearing loss prevention resources page;
• Revised NIOSH Lifting Equation (RNLE) Applications Manual;
• NIOSH 2016 Criteria for a Recommended Standard: Occupational Exposure to Heat;
• Associated General Contractors of America (AGC) Safety Management Training Course (SMTC); and
• Center for Construction Research and Training (CPWR), affiliated with North America’s Building Trades Unions (NABTU).

Steps You Can Take

Steps you can take toward effective safety management on a large, complex construction project might include the following:

• Requiring all major subcontractors to submit and implement a written safety plan as a contract condition, with specified minimum requirements for training, inspection, incident reporting, and competent persons;
• Establishing safety goals that include both lagging incident rate targets and leading indicator targets and communicating those goals to all project teams;
• Requiring that preconstruction hazard identification and risk assessment be performed by qualified safety professionals as a deliverable of the project planning process;
• Performing regular site safety walkarounds with project leadership and documenting observations and corrective actions;
• Conducting weekly safety coordination meetings with all subcontractors and using them to identify upcoming high-hazard activities requiring elevated oversight;
• Ensuring all subcontractors designate competent persons for each required program element and verifying their qualifications before work begins;
• Because PPE is the last line of defense and not the first, enforcing the use of specified engineering controls, such as local exhaust ventilation and wet methods for silica, before allowing work to proceed; and
• Knowing the signs and symptoms of occupational health hazards present on your site—heat illness, silica overexposure, hearing damage, chemical exposure—and being prepared to act if workers exhibit symptoms.