Health and Safety

Performance Indicator Definitions

Health and Safety Performance Indicator Definitions

Health and Safety

Performance
Indicator Definitions

Health and Safety Performance Indicator Definitions

Health and Safety Performance Indicator Definitions

Contents
5
Purpose

General Definitions

Safety Indicators

Injury Numbers

Calculated Indicators

12

Health Indicators

14

Definitions of Health Indicators Used in Data Entry and Reporting

14

Health Metric Definitions

16

Appendix: Further Information

18

Definitions

18

Health indicator criteria

20

Health Risk Assessment

28

Ergonomics Assessment

31

Health and Safety Performance Indicator Definitions

Purpose
6
This document contains the definitions used by ICMM for lagging (outcome) safety
and health metrics. These metrics are captured in the ICMM Benchmarking
database (http://www.shecbenchmarking.com). Indicators are separated into those
collected (and reported) and those not collected, but calculated.
The document also contains, as appendices, additional information on metrics,
which may be used as a basis for improvements to benchmarking in the future. In
particular, the appendices include information on possible leading (system/process
implementation/leadership) indicators, and improved health metric indicators which
provides information to member companies for determining future direction for
health management and health research.
The document has been prepared based on input from ICMM member companies
and from the International Aluminium Institute (IAI).
The intent is:
To define a core group of metrics to be used by all ICMM member companies;
To ensure that the metrics are simple to apply and are relatively general in scope;
To provide clear definition of key terms;
To provide additional metrics which may be used on a voluntary basis by
individual companies.

1 If you wish to register to use the ICMM Benchmarking Database, please contact the ICMM secretariat (info@icmm.com)

Health and Safety Performance Indicator Definitions

General Definitions
7
Employee
Individual employed directly by the company. The preference in the database is to
count directly supervised contractors as contractors, however where companies do
not separate this information from employee information, it is acceptable to count
them and their associated injuries under employee data.
Contractor
Any individual, company or other legal entity that carries out work, work-related
activities, or performs services pursuant to a contract for service. This includes
sub-contractors, and personnel working both full time and part time.
Occupational Illness
An occupational illness is any abnormal condition or disorder, other than one
resulting from an occupational injury, caused by exposures to factors associated
with employment. It includes acute or chronic illnesses or diseases, which may be
caused by inhalation, absorption, ingestion or direct contact.
Illnesses are distinguished from injuries in that the latter occur at an instant in
time. For injury, the gap between exposure and the onset of signs or symptoms is
short (minutes to hours, but less than one shift) whereas the gap for illness is
longer (days, weeks or years). If there is a known latency period for the
development of illness following an acute exposure, then the condition is to be
considered an illness. This will also apply to injuries that eventually result in
occupational diseases e.g. asthma resulting from acute high level exposure to an
irritant gas.
Work-related Activities
Work-related activities are those where the employer can set safety, health and
environmental standards, and can supervise and enforce their application.
If an event or exposure in the work environment either caused or significantly
contributed to an injury, or significantly aggravated a pre-existing condition, then
the case is considered work-related. Work-relatedness is presumed for injuries
resulting from events or exposures occurring at the employers work
establishment unless an exception specifically applies.
Injuries and illnesses occurring away from the work establishment are considered
work-related only if the worker is engaged in a work activity or is present as a
condition of his or her employment or contract.
Work performed as a part of haulage of product between operated sites, whether
by directly employed or contract operators, would normally be included as workrelated. Work performed at a contractors home base is not included as workrelated unless it is clearly under the supervision and standards of the company.

Health and Safety Performance Indicator Definitions

8
Injuries and illnesses that occur while the employee is travelling are work-related
if at the time of the injury or illness the employee/contractor was engaged in
work-related activities in the interests of the employer. Examples of these
activities include:
Driving or being driven in a vehicle for work-related purposes, irrespective of
the cause of any incident involving the vehicle.
Flying to visit another site or customer/supplier contact.
Being transported to and from customer contacts after lodging has been
established and as part of work-related activity.
Entertaining, or being entertained to transact, discuss or promote business,
provided the entertainment is at the direction of the employer.
However when travelling employees check into a hotel, motel or other lodging,
they establish a home away from home. Thereafter, their activities are evaluated
in the same manner as for non-travelling employees. For example, injuries
sustained when commuting from a hotel to a temporary work site are not workrelated, just as injuries sustained during an employees normal commute from a
permanent residence to an office are not considered work-related.
Work Environment
The work environment is defined as the establishment and other locations where
one or more employees are working or are present as a condition of their
employment.
Pre-existing Conditions
Pre-existing conditions are those which an individual brings with them to the
current employer, either caused by exposure at another workplace or by nonoccupational factors.
Significant Aggravation
A significant aggravation is defined as occurring when an incident occurring at
work results in tangible consequences that go beyond those the worker would
have experienced as a result of the pre-existing illness/disease alone, absent the
aggravating effects of the workplace.
Routine Functions
Routine Functions are work activities/assigned duties that the employee regularly
performs at least once per week or as part of the roster cycle.

Health and Safety Performance Indicator Definitions

Safety Indicators
9
Injury Numbers
Fatalities
Work-related injury resulting in death of employee or contractor. Fatalities are
categorised according to the following types:
Electrical
Explosions and Fires
Falls from Heights
Geotechnical
Hazardous Substances
Machinery, Equipment and Hand Tools
Mobile Equipment
Slips, Trips and Falls
Other
Lost Time Injuries
A Lost Time Injury (LTI) is a work-related injury resulting in the
employee/contractor being unable to attend work on the next calendar day after
the day of the injury. If a suitably qualified medical professional advises that the
injured person is unable to attend work on the next calendar day after the injury,
regardless of the injured persons next rostered shift, a lost time injury is deemed
to have occurred.
Restricted Work Injuries
A Restricted Work Injury (RWI) is a work-related injury which results in the
employee/contractor being unable to perform one or more of their routine
functions for a full working day, from the day after the injury occurred. An RWI
should be certified by advice from a suitably qualified health care provider.
Lost Time + Restricted Work Injuries
Some companies do not differentiate between Lost Time and Restricted Work
Injuries. For such companies, counts of LTIs reported to the ICMM database
include RWIs, and are marked as such in the database. As a result, the main
benchmarking injury statistic that should be used is the Lost Time + Restricted
Work Injury count (and associated frequency rate). However, the preference is that
the ICMM database LTI count excludes RWIs and that RWIs are counted separately.
Medical Treatment Injuries
A Medical Treatment Injury (MTI) is a work-related injury resulting in the
management and care of a patient to combat disease or disorder, including any
loss of consciousness, which does not result in lost time or restricted work.
MTIs include (for example) suturing of any wound, treatment of fractures,
treatment of bruises by drainage of blood, treatment of second and third degree
burns.

Health and Safety Performance Indicator Definitions

10
MTIs do not include:
Visits to physicians or other licensed health care professional solely for
observation or counselling.
The conduct of diagnostic procedures, such as X-rays and blood tests, including
the administration of prescription medications used solely for diagnostic
purposes (e.g. eye drops to dilate pupils etc.).
Visits to physicians or other licensed health care professionals solely for
therapy as a preventative measure (e.g. physiotherapy or massage as
preventative therapy, tetanus or flu shots).
First Aid Injuries (FAIs) as listed in the Appendix.
First Aid + Medical Treatment Injuries
Some companies do not differentiate between Medical Treatment and First Aid
Injuries. For such companies, counts of MTIs reported to the ICMM database
include FAIs, and are marked as such in the database. The preference is that the
ICMM database MTI count excludes FAIs.
Days Lost Reporting
Days lost are counted as the number of calendar days2 after the day of the
incident, during which the employee or contractor is unable to perform all of their
routine functions or is temporarily assigned to a different job. This includes full
days lost, as for a Lost Time Injury. Days lost counting ceases if the person ceases
employment with the company, or the person is permanently reassigned to a new
job.3
Days lost are counted during the month in which the days lost occurred. Some
companies credit days lost in the month in which the injury or illness occurred
rather than the month in which the days lost are incurred. While this is not
preferred for the ICMM database, it is an option as it makes very little difference to
injury rates over time.
Time spent travelling, or waiting for diagnosis following an incident is not included
in days lost, unless the injury becomes classified as a Lost Time Injury or a
Restricted Work Injury.
No lost days are recorded for fatalities.
Days lost to Lost Time Injuries
The number of calendar days during which an employee or contractor is unable to
attend work during the month in which the lost days occurred.

2 Some companies count scheduled work days instead of calendar days. Where this is done it is clearly marked as such
in the database. Companies using this practice should also indicate whether lost time/ restricted work injuries are
counted as such if the injured party is unable to attend work on the next calendar day rather than the next scheduled
work day.
3 Some companies cease counting lost days after 180 lost calendar days have elapsed. The preference for the ICMM
database is that the full number of lost days is supplied, in other words that a 180 day limit is not applied.

Health and Safety Performance Indicator Definitions

11
Days lost to Restricted Work Injuries
The number of calendar days during which an employee or contractor is able to
attend work but is unable to perform one or more of his / her routine functions,
during the month in which the lost days occurred.
Days lost to Lost Time & Restricted Work Injuries
Total of calendar days lost (both restricted work and lost days) during the month in
which the days lost occurred.
Days lost to Work-related Diseases
The number of calendar days during which an employee or contractor is either
able to attend work but is unable to perform all his / her routine functions, or is
unable to attend work, due to occupational illness which is work-related.
Days lost to Non Work-related Illnesses and Injuries
The number of calendar days during which an employee or contractor was unable
to attend work due to non work-related illness or injury.4
Exposure Hours
The exposure hours used in injury performance calculations are the total
number of hours worked by employees or contractors carrying out work-related
activities. This includes hours worked onsite, offsite and travelling on behalf of
work, but excludes hours spent travelling as part of normal commuting to and
from a person's place of residence.
Exposure hours reported should reflect actual hours worked, not planned hours.

4 Not all companies will be able to supply this statistic at this stage, and companies will not be monitored against the
supply of this statistic yet.

Health and Safety Performance Indicator Definitions

12
Calculated indicators
Total Recordable Injuries (TRIs)
TRI = Number of (Fatalities + Lost Time Injuries
+ Restricted Work Injuries + Medical Treatment Injuries)

Frequency Rate (FR)

Injury frequency rates are normally expressed as the number of injuries per
million hours worked.
FR = Number of injuries * 1,000,000 / hours worked
In some jurisdictions, such rates are expressed per 200,000 hours worked. The
ICMM database defaults to calculating frequency rates based on million hours
worked, but can also be set to calculate rates per 200,000 hours. Where rates are
described in text, the denominator used should be mentioned to avoid confusion.

Fatality Frequency Rate (FFR)

FFR = Fatalities * 1,000,000 / hours worked

Lost Time Injury Frequency Rate (LTIFR)

LTIFR = LTIs * 1,000,000 / hours worked

Total Recordable Injury Frequency Rate (TRIFR)

TRIFR = (Fatalities + LTIs + RWIs + MTIs) * 1,000,000 / hours worked

Health and Safety Performance Indicator Definitions

13
Severity Rate (SR)
SR = (Days lost to LTIs and RWIs) * 1,000,000 / hours worked

Duration Rate (DR)

DR = (Days lost to LTIs and RWIs) / Number of (Fatalities + LTIs + RWIs)

Absentee Rate (AR)

AR = Total days lost * 1,000,000 / hours worked
Total days lost = days lost to LTIs and RWIs plus days lost to work-related diseases
plus days lost to non work-related illnesses and injuries.

Number of Personnel

Total personnel = hours worked per year / 20005

5 2000 hours per year = 50 weeks x 40 hours and is an approximation of an average number of hours per year per person
exposed

Health and Safety Performance Indicator Definitions

Health Indicators
14
Definitions of Health Indicators Used in Data Entry and Reporting
New Cases (per disease):
Only new cases are counted for lagging indicators.
New cases are counted when all of the following criteria are met:
There is a known association between the exposure(s) and the occupational
illness or disease.
There is evidence of current or previous exposure to the agent of concern
during employment with the current member company.
A dose sufficient (with respect to concentration and duration of exposure) to
cause the illness/disease has been documented through an appropriate
professional assessment (e.g. industrial hygiene reports) or a professional
opinion that the exposure is consistent with the condition.
There is evidence of the illness/disease as diagnosed by a medical practitioner.
The necessary (minimum) latency period exists to establish the probability of
association.
There has been no previous recorded illness of same type involving the same
body part, or the individual has had a previous recorded illness of same type
affecting the same body part but had recovered completely (all signs and
symptoms had disappeared) from the previous illness and an event or exposure
in the work environment caused the signs or symptoms to reappear (NOTE: for
illnesses where the signs or symptoms may recur or continue in the absence of
an exposure in the workplace, the case must only be recorded once. Examples
include occupational cancer and pneumoconioses).
Significant aggravation of a pre-existing condition shall also be counted as a new
case when all of the above criteria are met.
New cases are counted separately for employees and contractors.
New cases are counted as of the date the illness/disease is diagnosed and are
reported on a calendar year basis.
To ensure usability of benchmarking data, definitions of cases are provided. These
case definitions are not necessarily consistent across all national regulatory
frameworks, but do conform to international conventions (e.g., WHO, ISO, ILO,
CDC, ATS/ERS, etc.) where possible.

Health and Safety Performance Indicator Definitions

15
Fatalities (per disease):
Number of deaths resulting from an occupational disease within the reporting
year, counted according to the date of death.

Disease Rates:
Disease rates are expressed per 1000 persons at work. The number of personnel
at work is calculated as noted on the previous page based on hours worked.
Note: the calculation of meaningful statistics for diseases involving a long lag
period prior to the development of the disease poses a definitional challenge. No
method is ideal. However, for comparative purposes, and to provide a standard
baseline, a disease rate is applied, even for diseases with a long lag period prior to
their manifestation. It is recognized that this rate is not a true reflection of risk to
the current working population.

Health and Safety Performance Indicator Definitions

16
Health Metric Definitions
Health metric definitions with their associated World Health Organization
International Classification of Diseases (ICD-10) identifier.

Work Related Asthma

Asthma is work related when there is an association over time between
symptoms and work. A criteria for inclusion of work-related asthma can be found
in the appendix.

Work Related Chronic Obstructive Pulmonary Disease (COPD)6

Cases of COPD should be reported if they meet the following criteria:

[ICD-10: J45, J45.1,

J45.9]

[ICD-10: J42, J43,

J44]

Recognized by a Workers Compensation Authority or equivalent

Recognized as an occupational disease by the physician responsible for the site
For a more detailed criteria, see appendix.

Pneumoconioses
A medical diagnosis of parenchymal lung disease with compatible radiological
findings related to exposures to a range of substances (see appendix).

Work Related Cancers

A medical diagnosis of cancer related to exposures to a range of agents (see
appendix for list). Specific guidelines (based on the scientific literature) on work
relatedness for bladder and lung cancer in the primary aluminium industry are
provided as appendices.

Infectious Diseases
Vector-borne diseases (e.g. malaria) in persons not originally from, or living
permanently in, relevant disease endemic areas.

Deep Vein Thrombosis (DVT)

[ICD-10: J61, J62,

J63, J63.0, J63.1,
J63.2, J63.8 ]

[ICD-10: C67 (C67.0C67.9), C34 (C34.0C34.9), C45 (C45.0C45.9)]

[ICD-10: B50-54,
A90-99, and potentially
others in the A and
B categories]

[ICD-10: I80]

A medical diagnosis of DVT that has occurred as a result of work-related travel.

6 Sources used to develop these criteria: Quebec compensation guidelines; review of aluminium industry epidemiology
studies (e.g., Moira Chan-Yeung, Norwegian studies and Richard Martin's unpublished study)

Health and Safety Performance Indicator Definitions

17

Silicotuberculosis

[ICD-10: J65]

An X-Ray consistent with silicosis (see Pneumoconioses above) as well as positive

sputa microscopy or culture for Mycobacterium tuberculosis.

Beryllium Related
Beryllium sensitization and chronic beryllium disease (CBD). See appendix for
further details.

Hearing Loss7

[ICD-10: J63.2,
T56.7]

[ICD-10: H83.3]

OSHA Recordable Hearing Shift (Incidence): An age-corrected average hearing

shift in either ear of greater than or equal to 10 dB at 2000, 3000 and 4000 Hz
when compared to baseline, coupled with a greater than or equal to 25 dB average
hearing level in the same ear at 2000, 3000 and 4000 Hz. See:
www.osha.gov/recordkeeping/hearinglossflowchart.pdf

Hand-Arm Vibration Syndrome

Vibration White Finger (VWF) equal to or greater than the Stockholm grading of 2.

Musculo-Skeletal Syndrome
A medical diagnosis of disorders and diseases of the musculoskeletal system
having a proven causal relationship with work and associated with repetitive
motion and/or stress. Disorders arising out of single events are specifically
excluded and are regarded as injuries.

Occupational Dermatitis
Non-infectious inflammation of the skin provoked by contact with an external
chemical or substance, accompanied by itching, cracking, blistering & ulcerations

Platinosis (Platinum Salt Sensitivity)

[ICD-10: J45, J45.1,

J45.9]

[ICD-10: M62.6,
G56.0, G57.5, M65,
M65.4, M70, M71,
W43, etc.]

[ICD-10: L23 and

L23.X, L24 and L24.X,
L25 and L25.X]

[ICD-10: T56.9]

Allergy to complex halogenated salts of platinum is an acquired hyper-sensitivity

to the complex salts of platinum which becomes manifest after a variable period of
symptomless exposure. The clinical characteristics include one or more symptoms
and signs of dermal, ocular and nasal allergy and/or asthma.

7 Other definitions of hearing loss (Prevalence and Standard Threshold Shift) are in the Appendix and should be used
where applicable.

Health and Safety Performance Indicator Definitions

Appendix: Further Information

18
This appendix contains additional definitions and examples to provide further
understanding of the definitions above. These definitions are not currently directly
used in ICMM benchmarking.

A Definitions
A1

First Aid Injury

A First Aid Injury is recorded when first aid treatment is required as a result of a
work-related injury. OSHA determines First Aid to mean the following treatments:
Visit(s) to a health care provider for the sole purpose of observation
Diagnostic procedures, including the use of prescription medications solely for
diagnostic purposes
Use of non prescription medications including antiseptics
Simple administration of oxygen
Administration of tetanus/diphtheria shot(s) or booster(s)
Cleaning, flushing or soaking wounds on skin surface
Use of wound coverings such as bandages, gauze pads etc.
Use of hot and cold therapy e.g. compresses, soaking, whirlpools, non
prescription creams/lotions for local relief except for musculoskeletal
disorders.
Use of any totally non-rigid, non-immobilizing means of support e.g. elastic
bandages
Drilling of a nail to relieve pressure for subungal haematoma
Use of eye patches
Removal of foreign bodies embedded in the eye if only irrigation or removal
with cotton swab is required
Removal of splinters or foreign material from areas other than the eyes by
irrigation, tweezers, cotton swabs or other simple means.
All of the above are regarded as First Aid Injuries, regardless of the health care
provider, who may be a physician, nurse or other health care provider.
A2

Sickness

The role negotiated with society. Sickness is the external and public mode of being
unhealthy. Sickness is the social role, a status, a negotiated position in the
world, a bargain struck between the person, henceforward called "sick", and a
society which is prepared to recognise and sustain the person.
A3

Lagging and Leading Indicators

Lagging indicators, also sometimes called trailing, downstream or after-the-fact

indicators, provide historical information about health and safety performance.
With lagging indicators, nothing can be changed to alter the measure of health and
safety performance, as it is history. Any changes made may influence future
performance but cannot alter the past performance. Classic injury statistics (i.e.,

Health and Safety Performance Indicator Definitions

19
injury frequency rate, lost workday rate, etc.) are examples of lagging indicators.
Leading indicators, also sometimes called upstream indicators, are used as
predictors of health and safety performance. The advantage of using leading
indicators of performance is that actions can be taken to alter the course of health
and safety performance. If an indicator predicts poor performance, it is not
necessary to wait to see if the prediction is correct. Changes can be implemented
to increase the probability of improved performance. Thus, leading indicators can
provide guidance whereby there is greater assurance of achieving good health and
safety performance.
A4

Leading Indicators for Occupational Health

Measurement of leading indicators is considered to add value to the understanding

of organizational efforts to improve the management of Occupational Health in the
workplace.
Reporting of leading indicators also encourages organizations to adopt recognized
occupational and environmental health management practices and is important to
the sustainability of the organization and its employees.
The following indicators are considered relevant to the above objectives:

Management
System
Certification

Description

Measure

Number of plants with recognized health

and safety management systems (e.g.
OHSAS 18001 or equivalent).

Number of
plants certified
compared with
total number of
plants asked.

IAI Objective: Implementation of

Management Systems for Health and Safety
in 95% of Member Company plants by 2010.
Employee Exposure Health risk management is essential for
the well-being of employees. This process
Assessment
involves HIRARC (Hazard Identification,
Risk Assessment, Risk Control).

IAI Objective: Implementation of an

Employee Exposure Assessment 95% of
Member Company plants by 2010.
Ergonomics
Process

Is there a formal process in place to

identify AND control specific ergonomic
risks?

Percentage of
plants with a
formal process
in place that
fulfil the defined
criteria as
specified in the
attached criteria
document.
Percentage of
sites with
process in place

Health and Safety Performance Indicator Definitions

20
B Health indicator criteria
B1

Asthma
All Asthma

Non-Work-Related Asthma
No association between
symptoms and work.

Work-related Asthma
Asthma is work-related when
there is an association over time
between symptoms and work.

Work-aggravated
Work-aggravated asthma is preexisting or coincidental new onset
asthma which is made worse by
exposures in the workplace.

Allergic/Immunolgic*
Allergic OA is characterized by a
latency period between first
exposure to a respiratory sensitizer
at work and the development of
symptoms; the sensitizer may be
an agent of high (lgE-mediated) or
low molecular weight; latency can
range from weeks to years. For
some agents causing this type of
OA, evidence for an immunologic
mechanism is still lacking (or may
not exist).

Work-caused (true OA)

Occupational asthma (OA) is
asthma caused by workplace
exposure and not by factors outside
of the workplace. OA can occur in
workers with or without prior
asthma.

Irritant/Non-Immunologic*
Irritant-induced OA may occur
within a few hours of a high
concentration exposure to an
irritant, gas, fume or vapour at
work (e.g. classic acute RADS), or
in response to chronic low-level
irritant exposures which may
manifest after an extended period
of time (days to years). Most
Asthma in the Primary Aluminium
Industry is generally viewed to
belong in this latter category.

Health and Safety Performance Indicator Definitions

21
CRITERIA FOR WORK-RELATED ASTHMA
COMMENTS
Compatible exposure history
AND Compatible
symptoms (subjective
evidence of airflow
limitation)

a) One or more of the following: Cough (with exertion

or at rest), sputum, wheeze, chest tightness,
difficulty in breathing, breathlessness
b) Symptoms are typically episodic, and often worse
when sleeping following a work shift.
c) May occur immediately or delayed (after several
hours or during sleep) following exposure

AND Objective evidence

of airflow limitation

a) Spirometry showing reduced FEV1 or FEV1/FVC

values relative to personal baseline or appropriate
population predicted values, which is at least
partially reversible either spontaneously or in
response to treatment
Bronchodilator response must demonstrate an
increase in FEV1 of >12% and >200 ml from the
baseline value during a single testing session; or
b) non-specific bronchial hyper-responsiveness as
demonstrated by histamine or methacholine
inhalation challenge (i.e., PC20 < 8mg/ml or
equivalent)

AND Temporal
relationship to the work
environment/exposure

a) Symptoms improve on days away from work, such as

days off, weekends, holidays; or
b) Symptoms worsen during or after the work day (less
sensitive than a); or
c) Serial pulmonary function measurements:
PEFR: at least 4 readings per day for a sufficient
period of time to quantify readings during several
continuous days at work as well as several
continuous days away from work, and showing a
circadian variation of at least 20% on days at
work and showing a pattern of improvement on
days away from work
Spirometry
Histamine or methacholine challenge testing; or
d) Cross-shift spirometry showing a fall in FEV1 of at
least 10%

Supporting Information

Daily diary: symptoms, medication use, etc.

Diffusing capacity; detailed respiratory function tests
Exclusion of alternative diagnoses

Health and Safety Performance Indicator Definitions

22
B2

Work Related Chronic Obstructive Pulmonary Disease (COPD)

8

Definition of COPD (ATS/ERS)

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable

disease state characterised by airflow limitation that is not fully reversible. The
airflow limitation is usually progressive and is associated with an abnormal
inflammatory response of the lungs to noxious particles or gases, primarily caused
by cigarette smoking. Although COPD affects the lungs, it also produces significant
systemic consequences.
8

Diagnosis of COPD (ATS/ERS)

The diagnosis of COPD should be considered in any patient who has the following:
symptoms of cough; sputum production; or dyspnoea; or history of exposure to
risk factors for the disease.
The diagnosis requires spirometry; a post-bronchodilator forced expiratory volume
in one second (FEV1)/forced vital capacity (FVC) <70% confirms the presence of
airflow limitation that is not fully reversible.
Spirometry should be obtained in all persons with the following history: exposure
to cigarettes; and/or environmental or occupational pollutants; and/or presence of
cough, sputum production or dyspnoea.
Spirometric classification has proved useful in predicting health status, utilisation
of healthcare resources, development of exacerbations and mortality in COPD.
COPD: Diagnosis and classification of severity World Health Organization
A simple classification of disease severity into four stages is presented below. The
management of COPD is largely symptom-driven, and there is only an imperfect
relationship between the degree of airflow limitation and the presence of
symptoms. The staging, therefore, is a pragmatic approach aimed at practical
implementation and should only be regarded as an educational tool, and a very
general indication of the approach to management. FEV1 refers to forced
expiratory volume in one second and values refer to measures of FEV1 taken after
use of a bronchodilator. FVC refers to forced vital capacity.
Poorly reversible airflow limitation associated with other diseases such as
bronchiectasis, cystic fibrosis, tuberculosis, or asthma is not included except
insofar as these conditions overlap with COPD. In many developing countries both
pulmonary tuberculosis and COPD are common. Therefore, in all subjects with
symptoms of COPD, a possible diagnosis of tuberculosis should be considered,
especially in areas where this disease is known to be prevalent. In countries in
which the prevalence of tuberculosis is greatly diminished, the possible diagnosis
of this disease is sometimes overlooked.

8 *Excerpted from: Eur Respir Jrn 2004: 23; 932-946. ATS/ERS TASK FORCE. Standards for the Diagnosis and Treatment

of Patients with COPD: a summary of the ATS/ERS position paper.

Health and Safety Performance Indicator Definitions

23
Stage

Severity

Criteria

Stage 0

AT RISK

Characterized by chronic cough and sputum

production. Lung function, as measured by
spirometry, is still normal.

Stage I

MILD COPD

Characterized by mild airflow limitation (FEV1/FVC

< 70% but FEV1 > 80% predicted values) and usually,
but not always, by chronic cough and sputum
production. At this stage, the individual may not even
be aware that his or her lung function is abnormal.
Stage II

MODERATE
COPD

Characterized by worsening airflow limitation

(FEV1/FVC < 70%; 50% < FEV1 < 80% predicted) and
usually the progression of symptoms, with shortness
of breath typically developing on exertion. This is the
stage at which patients typically seek medical
attention because of dyspnea or an exacerbation of
their disease. The presence of repeated exacerbations
has an impact on the quality of life of patients and
requires appropriate management.

Stage III

SEVERE
COPD

Characterized by severe airflow limitation (FEV1/FVC

< 70%; 30% < FEV1 < 50% predicted) or the presence
of respiratory failure or clinical signs of right heart
failure. Patients may have severe (Stage III) COPD
even if the FEV1 is > 30% predicted, whenever these
complications are present. At this stage, quality of life
is appreciably impaired and exacerbations may be
life-threatening.

Guidelines for recognition as an occupational disease (Aluminium Industry):

The epidemiological literature pertaining to COPD in the primary aluminium
industry suggests that COPD is associated with pot-room work exposure. There is
insufficient evidence to link COPD with exposures in other areas like casting,
carbon-plant operations and alumina refining.
If occupational COPD is defined as COPD that would not have arisen without work
exposure, some threshold of exposure needs to be agreed upon. The literature
does not yield a consistent threshold. It is proposed that for the sake of simplicity
in reporting, the following arbitrary criteria be used for physician-designation of
occupational COPD:
Non-smokers: 10 years or more of pot-room work
Ex-smokers and smokers: 20 years or more of pot-room work
All COPD cases with a prior diagnosis of pot-room asthma
These criteria should not be used to second-guess Workers Compensation
Authority recognized cases, all of which should be reported.

Health and Safety Performance Indicator Definitions

24
B3

Beryllium

Beryllium sensitization* is an allergic condition to beryllium that can develop

after a person breathes beryllium dust or fumes. Some researchers think it might
also occur if beryllium penetrates the skin through an open cut or from a
beryllium splinter.
Diagnostic Criteria:
Sensitization requires at least 2 positive BeLPTs, performed as separate tests
(2 tests on blood, or one blood and one BAL)
No evidence of abnormal physiological, anatomical or pathological changes
consistent with CBD
No symptoms
Chronic beryllium disease9 (CBD) is a lung condition that can develop after a
person breathes beryllium dust or fumes. The immune system sees beryllium as a
foreign invader, and builds an army of cells in the bloodstream that are
prepared to react to beryllium wherever they see it in the body. In CBD, the
reaction of the immune system against inhaled beryllium particles has resulted in
scarring (called granulomas) in the lungs.
Diagnostic Criteria:
Confirmed sensitization
Plus compatible pathologic, physiologic, functional or radiographic
abnormalities
Symptoms may or may not be present
B4

Pneumoconioses list of substances

Asbestos
Cobalt
Refractor Ceramic Fibres
Silica
Cristobalite
Coal Workers Pneumoconiosis
Other substances known to cause pneumoconiosis.

9 Source: National Jewish Medical Centre, Denver, Co.

Health and Safety Performance Indicator Definitions

25
B5

Cancers

B5.1 Cancer agents list:

Asbestos
Benzidine and salts
Bichloromethyl ether (BCME)
Chromium and chromium compounds
Coal tars and coal tar pitches, soot
Beta-naphthylamine
Vinyl chloride
Benzene or its toxic homologues
Toxic nitro- and amino-derivatives of benzene or its homologues
Ionizing radiation
Pitch, bitumen, mineral oil, anthracene, or the compounds, products or
residues of these substances
Coke oven emissions
Compounds of nickel
Dust from wood
Cancer caused by any other agents not mentioned in the preceding items where
a direct link between the exposure of a worker to this agent and the cancer
suffered is established.

B5.2 Bladder Cancer

The following criteria should be used to determine if a case of bladder cancer in
an individual working in the primary production of aluminium is work-related:

Pathology confirmed diagnosis of bladder cancer

Individual is currently or has previously worked in a coal tar pitch (CTP) job
CTP exposure at the industrial level is documented
Latency from first exposure to CTP until onset of symptoms or date of diagnosis
of at least 10 years
Calculated attributable risk (i.e., probability of causation) >50%, independent of
smoking.
AR% = [(RR exposed RR unexposed)/RR exposed] X 100
AR of 50% corresponds to a relative risk (RR) of 2.0, and also to
a cumulative exposure to BaP = 19g/m3 years *
RR = Relative Risk
AR = Attributable Risk

*Armstrong B, et al. Compensating Bladder Cancer Victims Employed in

Aluminium Reduction Plants. Journal of Occupational Medicine 1988: 30; 10. 771775

Health and Safety Performance Indicator Definitions

26
B5.3 Lung Cancer
The following criteria should be used to determine if a case of lung cancer in an
individual working in the primary production of aluminium is work-related:

Pathology confirmed diagnosis of lung cancer

Individual is currently or has previously worked in a coal tar pitch (CTP) job
CTP exposure at the individual level is documented
Latency from the first exposure to CTP until onset of symptoms or date of
diagnosis of at least 10 years
Calculated P (i.e., probability of causation) >50%, taking into account the
smoking history of the individual.*
(0.0476)(B[a]P) x 100%
P = 1 + (0.33)(p - y) + (0.0476)(B[a]P)
P = Probability that the cancer is of occupational origin (upper 95% confidence
limit)
B[a]P = ug/m3-year B[a]P total career dose
P y = Cumulative tobacco exposure in pack-years
* Armstrong B, Theriault G. Compensating Lung Cancer Patients Occupationally
Exposed to Coal Tar Pitch Volatiles. Occupational and Environmental
Medicine.1996: 53: 160-167.

B6.

Additional Hearing Loss Metrics

ICMM and IAI member companies are moving towards using the following hearing
loss definitions. Once a reasonable number of companies have data in these
formats, the Benchmarking database will be modified to include capture of cases
according to these definitions.
Hearing Impairment (Prevalence): As per ISO criteria and at:
www.who.int/pbd/deafness/hearing_impairment_grades/en/index.html (see
opposite page)
It is recognized that organizations will require time to implement this metric. The
IAI/ICMM committee felt that if the 1000, 2000 and either 3000 or 4000 Hz data
were available, then this metric should be reported by the organization.
OSHA Standard Threshold Shift (Incidence Early Loss Indicator): Individual sites
and organizations are encouraged to collect data on this metric. A standard
threshold shift (STS) is an age-corrected change in hearing threshold relative to
the baseline audiogram of an average of 10 dB or more at 2000, 3000, and 4000 Hz
in either ear. (as per OSHA Regulations: UU1910.95(g)(10)(i)UU).

Health and Safety Performance Indicator Definitions

27
Grade of
Impairment

Corresponding
audiometric
ISO value

Performance

Recommendations

No or very slight
hearing
problems. Able to
hear whispers

0 No
impairment

25 dB or better
(better ear)

1 Slight
impairment

26-40 dB
(better ear)

2 Moderate
impairment

41-60 dB
(better ear)

3 Severe
impairment

61-80 dB
(better ear)

Able to hear
some words
when shouted
into better ear.

Hearing aids needed. If no

hearing aids available, lipreading and signing should
be taught.

81 dB or greater
(better ear)

Unable to hear
and understand
even a shouted
voice.

Hearing aids may help

understanding words.
Additional rehabilitation
needed. Lip-reading and
sometimes signing essential.

4 Profound
impairment
including
deafness

Able to hear and

repeat words
spoken in normal
voice at 1 metre
Able to hear and
repeat words
spoken in araised
voice at 1 metre

Counseling. Hearing aids

may be needed.

Hearing aids usually

recommended.

Grades 2, 3 & 4 are classified as disabling hearing impairment

The audiometric ISO values are averages of values at 500, 1000, 2000, 4000 Hz

B7 Musculoskeletal
These may include but are not limited to:
Carpal tunnel syndrome
Rotator cuff syndrome
De Quervain's disorder
Trigger finger
Tarsal tunnel syndrome
Sciatica
Epicondylitis
Tendonitis
Raynaud's phenomenon
Whole body vibration syndrome
Herniated spinal disc
Whole Body Vibration Syndrome.

Health and Safety Performance Indicator Definitions

28
C Health Risk Assessment
Name

3.5 Health Risk Management

a. Hazard Identification, Risk Assessment,
Risk Control (HIRARC)
b. Employee Health Assessment

Definition

Health risk management is essential for the well-being

of employees. This process involves HIRARC and
Employee Health Assessment.

Unit of measurement

Percent of plants with a formal process in place that

fulfil the defined criteria as specified under Target
Condition.

Measurement methods

Record the number of plants with a formal HIRARC

program that meets the defined criteria as specified
under Target Condition.

Purpose

To indicate to what degree the industry has a formal

health risk management process in place that meets the
criteria for HIRARC and Employee Health Assessment
processes.

Aggregation method

Add up company data

Target Condition

Each site should have implemented and update at least

annually:
A) HIRARC process that includes ALL of the following
elements:
Identification/classification of all health hazards
(e.g. acceptable significant or insignificant,
uncertain health hazards
Quantitative assessment of risk for all uncertain
health hazards
Control of unacceptable health risks via appropriate
counter measures (e.g. personal protective
equipment, engineering controls, product
substitution etc.)
Annual reviews of effectiveness of the process.
1. Occupational Hygiene (OH) Qualitative Exposure
Assessments
This refers to assessing all chemical and physical
agents by Similar Exposure Group (SEG) at a location
and deciding whether the SEG should be classified as
insignificant, significant, unacceptable, or uncertain.
Significant risks are those which exceed 50% of the
Occupational Exposure Limit (OEL). By definition,
insignificant risk would be less than 50% of the OEL.
Unacceptable SEGs would be those exceeding an

Health and Safety Performance Indicator Definitions

29
Target Condition

OEL. Uncertain SEGs would be those for which a

decision as to exposure level is unknown. Agents
assessed also include process intermediates and
byproducts produced in the manufacturing process.
In order to state that an OH qualitative exposure
assessment is in place, at least 95% of identified
agents need to be assessed and categorized.
2. OH Quantitative Assessments
Uncertain SEGs, identified in (1) above, need to be
categorized as either insignificant, significant, or
unacceptable through quantitative analysis. The
number/percentage of uncertain SEGs should be
tracked. The ultimate goal is 100% assessments
completed (e.g. no uncertain SEGs)
In order to state that an OH quantitative exposure
assessment process is in place, 95% and above of the
uncertain SEGs must be quantitatively assessed via
OH sampling techniques.
3. Number of Unacceptable SEGs identified by agent
and number of impacted employees
Unacceptable SEGs are those which exceed an OEL.
Agent includes a description of chemical (e.g. CTP,
asbestos, silica, etc.) or physical (e.g. noise, heat,
radiation, etc.) agents.
4. Percentage compliance with personal protective
equipment requirements (PPE)
How many of the affected employees in unacceptable
SEGs defined above are wearing required PPE (e.g.
respirators, hearing protection, protective clothing,
etc.)?
5. Percentage of unacceptable EGSs that have been
reduced to acceptable status via engineering,
administrative, and/or substitution controls.
Acceptable means the exposure is less than the OEL
B) Employee Health Assessment based on ALL of the
following elements:
Pre-placement physical exams covering critical
elements:
Relevant periodic health assessments for ALL
identified health risks include fitness for duty
issues as well as exposure to chemicals,
physical, or biological agents.
Fitness for duty evaluations include mobile
equipment operators, respirator users and heatexposed individuals.

Health and Safety Performance Indicator Definitions

30
Target Condition

For chemical exposures, surveillance should be

initiated for employees exposed to >50% of the
OEL.
For noise, surveillance should be initiated for
noise exposures at 80 dbA and above (8-hour
TWA)
The above exams should be carried out on a
frequency that meets accepted health surveillance
practices
The percentage of required exams completed
should be tracked. The ultimate goal should be
100% completion rate for required surveillance
exams
A system to communicate results to employees
An annual site summary of results (without
individual attribution) and appropriate follow-up
process

Examples of health assessments for relevant

exposures:
Hearing tests for noise exposure
Spirometry for exposures to respiratory irritants
Appropriate surveillance measures for exposure to
carcinogens
General health and medication review for exposure
to heat
General health and medication review and vision
tests for vehicle operators.
Data available?

NO. Needs to be included in an annual survey on SD

indicators.

Health and Safety Performance Indicator Definitions

31
D Ergonomics Assessment
Name

Ergonomic Process

Definition

Plants with a formal ergonomic process in place to

identify AND control specific ergonomic risks which
fulfils the defined criteria as specific under Target
Condition.

Unit of measurement

Percentage of plants with processes in place.

Measurement methods

Record the number of plants with a formal ergonomic

process that meets the defined criteria as specified
under Target Condition.

Purpose

To measure the implementation of company-specific

ergonomic processes to favourably impact on
ergonomic-related injury and illness.

Aggregation method

At the company level, add up the data, determine the

percentage of plants that meet the criteria.
At the IAI level, determine the overall industry
number/percentage from reported company data.

Target condition

Each site should have implemented all of the following

items:
Written ergonomics policies and procedure
Employee training
An effective medical management program
And at least one of the following:
Ergonomic risk factor determination (qualitative) on
relevant job tasks has been completed
Ergonomic hazard analyses (quantitative) are
performed for tasks where ergonomic risk factors
have been identified
Significant ergonomic risks have been prioritized
for control
When a plant has not satisfied the above target
conditions, the plant is considered not to have met the
requirements and would not be included in the final tally.

Health and Safety Performance Indicator Definitions

32
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Health and Safety Performance Indicator Definitions

Health and Safety Performance Indicator Definitions

ICMM International Council on Mining and Metals

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