The Occupational Safety and Healthcare Administration (OSHA) released the National Emphasis Program (NEP) on March 12, 2021. The intent of the NEP is to provide guidance and authority to OSHA to conduct on-site and/or virtual inspections that will ensure business owners are protecting their employees, specifically, in the high-risk targeted industries.
The Agency for Health Care Administration (AHCA) and National Association for the Support of Long Term Care (NASL) recently collaborated and hosted a presentation focused on the NEP program and what to expect if your facility comes under an audit. Essentially, the NEP allows OSHA to have access to inspect your facility based solely on the NEP and may not necessarily be triggered by a complaint. Thus, providers should not construe the NEP as a structured timing survey program such as seen with the Department of Health (DOH).
It is important to know the NEP provides guidance to those states governed by OSHA Federally. States that operate as “state-planned states” are not required to follow the NEP, unless the state adopts the NEP as recommended by the Federal NEP. The presenter recommended a risk assessment be conducted for these providers. To find out if your state is a “state-planned state” review the States Plans on the OSHA website. The states that are shown in the darkest blue and have the double asterisks have state-planned programs.
Who Are the Targets?
It is important to know whether your entity is a targeted Industry. Tier I industries are deemed to be the highest risk to employees. OSHA will pull information from injury and illness logs to generate a list of facilities within a region for those Tier I industries. The schedule of NEP visits will be compiled based on the information in the injury and illness logs. The list of targeted industries was generated from information contained in Healthcare by the 2017 National Association of Insurance Commissioners’ (NAIC) codes and includes:
- Offices of Physicians
- Offices of Dentists
- Home Health Care Services
- Ambulance Services
- General Medical and Surgical Hospitals
- Psychiatric and Substance Abuse Hospitals
- Skilled Nursing Facilities
- Continuing Care Retirement Communities
- Assisted Living Facilities
- Residential Intellectual and Developmental Disability Facilities
The OSHA area office will generate a list of targeted facilities. The Regional offices possess the authority to delete from their target list any facility that has undergone a comprehensive or partial health inspection to address COVID-19 hazards with an opening conference date occurring within the 12 previous months and resulted in one of the following outcomes:
- Serious citations related to COVID-19 hazards which are under contest or for which the statement period has not yet expired.
- No serious citations were issued for hazards related to exposure to SARS-CoV-2.
- Serious citation(s) were issued for hazards related to exposure to SARS-CoV-2, but a follow up inspection documented appropriate and effective efforts by the employer to abate the serious hazards cited.
Keep in mind, these do not eliminate your possible selection of being surveyed, but your facility may appear to pose less risk to your employees. OSHA Compliance Specialists can certainly be reminded of your successes in the past 12 months and could remove you from the targeted list.
What Should I Expect in This Audit?
The surveyors will always start with a review of documents. OSHA Compliance Specialists may come onsite or may do the review virtually. The document request list may include 40-50 items needed to respond to the audit. The most critical document is your COVID-19 Protocol and Plan., This should reflect how you implemented and updated COVID-19 and OSHA policies and procedures which supported your OSHA plan to protect employees.
Highlights of the plan’s contents should include contingency planning for emergencies (like the current pandemic); protocols for Personal Protective Equipment (PPE) procurement; donning and doffing training, and appropriate use; record keeping practices; and the facility’s Respiratory Protection program. The respiratory program must demonstrate written protocols and FIT testing procedures; Medical Evaluations; PPE sourcing; employee training and retraining; and COVID-19 testing records. The employer’s injury and illness records should identify any workers with recorded illnesses or symptoms associated with exposure(s) to persons with suspected or confirmed COVID-19. If a case is work-related, specific follow up information is required. OSHA recognizes the employer’s challenges in confirming the COIVD-19 exposure, but the burden of proof lies with the employer to conclude the positive COVID-19 diagnosis is not work-related.
What Should I Do?
In summary, the best defense for a NEP survey is preparation and planning. If you expect to be surveyed, you’ll have everything you need ready to go. Now is the time to pull out your COVID-19 preparedness plan and review it. Be prepared to talk about your plan. Identify what worked, what didn’t work, how you might have changed it, any new guidance, or if there is a process that needs updating and any retraining that is needed.. Your COVID-19 and OSHA plan must articulate why you made a choice not to pursue and implement any recommendation. Ensure you have a written respiratory protection program that includes your process for sourcing PPE, medical evaluations and fit test kits, and respiratory protection. Demonstrate re-training on respiratory protection with your staff on an as needed basis upon new guidance. Lastly, review your documentation of injuries and illnesses. Keep in mind OSHA Record Retention requires five years.
How Can LW Consulting, Inc. Help?
- LW Consulting, Inc. (LWCI) can review your plan and offer comments.
- LWCI can facilitate a debrief of your pandemic response as it relates to your plan.
- LWCI has staff who are Infection Preventionist Certified.
- LWCI’s experts possess knowledge in Housekeeping Services.
- LWCI also offers a customizable OSHA Plan for providers, on our LWCI Store, which includes a chapter dedicated to COVID-19.
Do you have additional questions? Set up a 15-minute discussion with one of our experts,
Deborah Alexander, Director, CHC, CHPC, PMP, DPT, MED, STC, CSCS.