How To Check If Your Job Is Safe

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1 Occup. Med. Vol. 48,. 1, pp , 1998 Copyright 1998 Rapid Science Publishers for SOM Printed in Great Britain. All rights reserved /98 Employers' awareness and compliance with occupational health and safety regulations in Taiwan S. C. Hu,* C. C. Lee, f J. S. C. Shiao* and Y. L. Guo 1 ^Department of Public Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan; "tdepartment of Environment and Occupational Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan; ^Department of Nursing, China Junior College of Medical Technology, Tainan, Taiwan An investigation of employers' awareness and compliance with occupational health and safety (OHS) regulations was conducted in a representative group of employers randomly selected from the manufacturing industry in Taiwan. A total of 1,003 employers were interviewed by trained public health personnel. Ten questions related to perceptions of general OHS and five practices on OHS regulations were measured. The results of this study show that the employers were better aware of their responsibility for posting safety warnings, personal protection and providing safety and health equipment. They were less aware of their responsibility in minimizing injuries and accidents in the workplace and in not hiring someone who was found unfit for a certain job from pre-employment physical examination. Less than half of employers knew about regulations of environmental monitoring and even fewer had heard of Material Safety Data Sheets. Level of education and size of the plant were highly associated with employers' awareness of OHS and the awareness was the most significant predictor in the five practices of OHS regulations in this study. Promotion of employers' awareness of OHS in small sized industries in particular, is warranted to enhance better compliance, and a focus for these efforts is identified by this investigation. Key words: Attitudes and practice; health education; knowledge; occupational health and safety. Occup. Med. Vol. 48, 17-22, 1998 Received 24 February 1997; accepted in final form 21 July INTRODUCTION Rapid industrialization in the past two decades has brought fast economical development in Taiwan. However, the risks of work-related diseases, injuries and accidents have increased with the economic growth. A total of 25,851 occupational injuries including 740 deaths were reported in 1993, which resulted in a direct compensation payment and indirect costs of one billion US dollars. 1 This loss was approximately equal to the total budget of 15 average universities in a fiscal year in Taiwan. If psychological loss of the victims' Correspondence and reprint requests to: Y. L. Guo, Department of Environment and Occupational Health, College of Medicine, National Cheng-kung University, Tainan, Taiwan family and other unreported injuries were accounted for, the estimated loss will be greater. According to research, small sized plants were found to have the highest incidence of work-related injuries in Taiwan. 2 These work-related injuries and accidents were significantly associated with insufficient knowledge and unsafe behaviours for both employers and employees. 3 ' 4 Those who did not take occupational health education programmes were fivefold more likely to encounter occupational injuries than those who took programmes. 4 Due to financial and technical disadvantages, most of the small to medium sized industries in Taiwan were less capable of providing health and safety equipment and programmes to the workers. Workers thereby did not have enough training for managing their risks in the worksite. 5 They learned

2 18 Occup. Med. Vol. 48, 1998 knowledge and skills regarding occupational health and safety (OHS) informally from co-workers and employers. 6 Therefore, employers' comprehension of occupational health was not only an important source of employees' knowledge and behaviour related to workplace health and safety but also a significant determinant of the level of good safety and health of the workplace. 5 ' 6 While several articles had discussed the employees' knowledge and perception related to occupational health, 5 " 10 investigations on employers have been lacking. 11 This study aimed to investigate employers' awareness and compliance with OHS regulations in Taiwan and to identify factors associated with such awareness and compliance. METHOD RESULTS A total of 1,003 employers completed the interview. Table 1 shows that most of the employers were male (81%), married (96%), at least high school graduates (65%), with an average age of 42 years and employment duration of 14 years. Ninety-five per cent of the employers were from small to medium sized plants from diverse industries. The major types of the industries included metal (20.8%), electronic (10.7%) mechanic (10.4%), clothing and leather (9.5%), paper and printing (8.3%) and plastic (8.3%) industries, etc. Table 2 summarizes the employers' responses to the 10 questions related to the general awareness of occupational health and safety. Most employers thought that they were responsible for posting safety warnings (78.8%) and providing personal protection Employers of the manufacturing industry were the target of our study because this industry accounted for most of the compensation payment in Taiwan. Employers were defined as the owner, the highest level of manager or his/her deputy in the plant. A list of 22 different kinds of manufacturing factories in 1991 which included more than 100,000 plants was obtained from the Ministry of Economy in Taiwan. Plants with fewer than five employees were excluded from this investigation due to feasibility constrains. All eligible plants (85,634) were sorted by the number of employees and a total of 1,000 plants were selected for inclusion in the study by using systematic random sampling method. In the case of refusal or closed business, another plant from the same district in the same size category was selected randomly as a replacement. One employer in each selected plant was interviewed by trained public health personnel in the district of the plant. The interview questions included (1) 10 perceptions of general concepts of occupational health and safety; (2) five required practices of OHS regulations in Taiwan, such as pre-employment physical examination, periodical health examination, occupational health and safety personnel, hazard notification and OHS education programmes and (3) sociodemographics of the employer, such as age, gender, marital status, levels of education, years of service and number of employees of the plant. For each perception item, a score point of one was given if the employer's response was compatible with answers of good safety and health. The total score of the awareness of OHS was calculated by summing up these score points, with a minimum of 0 and a maximum of 10 points. The compliance with OHS was examined by analyzing the five required practices of OHS regulations independently. After being checked by logical statement, data were entered into personal computers and were analyzed by SAS/PC software. The statistical methods included descriptive statistics, multiple regression and logistic regression. Table 1. Sociodemographic data of employers Variables Male Female (yrs) < >50 Mean (SD) Married Single Level of education < High school High school College and graduate school Years of service < >20 Mean (SD). of employees >99 Mean (SD) Major types of factories Food manufacturing Clothing and leather manufacturing Wood and furniture manufacturing Paper and printing manufacturing Chemical manufacturing Plastic manufacturing Metal manufacturing Mechanics manufacturing Electronic manufacturing Transportation manufacturing n % (9.24) (8.16) (110.14)

3 S. C. Hu etal.: Occupational health and safety compliance in Taiwan 19 Table 2. Employers' awareness of occupational health and safety Items 1. Do you think employers are responsible for purchasing and maintaining safety and health equipment in the worksite? * 2. Do you think the employers are responsible for posting safety warnings at the necessary sites? * 3. Who do you think are responsible for providing personal protection for workers? Employees Employers* Both 4. Who do you think are responsible for injuries or accidents occurring in the workplace? Employees Employers* Employers are partially responsible 5. What do you think if a worker was found unfit for a certain job from the result of pre-employment physical examination? The employer may decide whether or not to hire the worker The employer may hire the worker after reporting to government The employer is not allowed to hire the worker* 6. What will you do if one of your employees sustains occupational diseases or injuries? Lay-off the employee with payment Unpaid vacation Pay fully during rehabilitation and remove the employee from dangerous worksite* 7. What will you do if one of your employees is exposed to toxic gas and becomes unconscious in the worksite? Rescue the employee right away Make sure about your own safety before rescuing* Ask for professional rescuers' help* 8. For any chemical used in the workplace, do you think you should know its name and potential toxicity? * Only if it is known to be hazardous to humans 9. Do you know what 'Material Safety Data Sheets' are? * 10. Do you think environmental monitoring is required by the government if a worksite is categorized as to be hazardous? * Total score: Mean (SD) 6.10 (1.91) * Indicates the most compatible answers to good safety and health. for workers (89.2%). However, fewer employers (66.0%) thought that they were responsible for purchasing and maintaining safety and health equipment. Even fewer employers (48.7%) believed that they were fully responsible for injuries and accidents in the workplace. For employees who sustained occupational injury or disease, one fourth of the employers would either lay-off the employees or give unpaid vacation. Only 73.1% of the employers would remove the employee from the hazardous place and continue full pay during rehabilitation. More than half of the employers (62%) did not know they were not allowed to hire someone for a certain job if he or she was found inappropriate from pre-employment physical examination. One third of the employers would go directly to rescue an unconscious worker due to exposure to toxic gas, without considering their own safety. More than a quarter of the employers did not think they should know the names and toxicity of chemicals used unless the chemical was known to be hazardous. Only one third of the employers knew about Material Safety Data Sheet (MSDS) and less than half of the employers knew that environmental monitoring for hazardous worksites was required by the law. After scoring the answers with right (1) and wrong (0) 3 we found that the average score was relatively low at 6.1, in a range

4 20 Occup. Med. Vol. 48, 1998 Table 3. Employers' compliance and awareness of occupational health and safety regulations by the size of the workplace Items Number of employees 5-9 (n = 384) (n = 428) (n = 146) >99 (n = 45) Total (n= 1,003) Compliance (%) 1. Providing pre-employment physical examination 2. Providing periodical health examination Setting up occupational health and safety personnel 4. tifying hazards in the worksite 5. Assigning employees to participate in OHS education programmes Awareness score Mean SD from Among the five selected practices related to OHS regulations (Table 3), hazard notification had been done best (87%), followed by periodical health examination for workers (41%). Less than 30% of the employers reported providing a pre-employment physical examination, maintaining occupational health and safety personnel and arranging for employees to participate in OHS programmes in the past year. After break down by the number of employees, we found that the five practices as well as the awareness of OHS were all significantly associated with the size of the plant. The larger the plants the employers were at, the more awareness and better compliance with OHS regulations they had. The results of multiple regression for the awareness of OHS on sociodemographic factors were summarized in Table 4., level of education and size of the plant were three significant predictors for employers' awareness of OHS, whereas gender, age and duration of service were not associated with the awareness of OHS. Employers who were married, had more years of education and managed larger plants had higher scores of awareness of OHS than those who were single, less educated and operated small plants. The results of logistic regression on factors associated with the five OHS practices were summarized in Table 5. Older employers and better awareness scores were associated with greater likelihood of providing pre-employment physical examination. Older employers, higher level of education, shorter duration of service and higher scores of awareness were associated with greater likelihood of providing periodic health examinations. Older employers, higher level of education, larger size of the plant and higher scores of awareness were associated with maintaining OHS personnel. Male employers, larger size of the plant and higher scores of awareness were associated with Table 4. Multiple regression analysis of factors associated with the score of awareness of occupational health and safety Variables. of employees Standardized coefficients t p value * ** " : 0 = female, 1 = male; age: actual years of age; marital status: 0 = married, 1 = single; years of education: actual years of formal education; years of service: actual years of employment in the plant; no. of employees: reported no. of employees *p < 0.05 **p< 0.01 *"p< frequencies of hazard notification. More years of education and service, larger size of the plant and higher scores of awareness of the employer were associated with a greater likelihood of assigning employees to participate in OHS educational programmes. DISCUSSION This is the first study in Taiwan to investigate the awareness and compliance with OHS regulations in a representative group of employers in the manufacturing industry. Despite rapid economic development, this study showed that the general awareness of occupational safety and health in employers was relatively lacking. As indicated in previous studies, 3 " 5 one of the major causes of not being able to control occupational injuries is the limited knowledge and perception of the importance of occupational safety and health in em-

5 S. C. Hu etal.: Occupational health and safety compliance in Taiwan 21 Table 5. Logistic regressions for factors associated with employers' compliance with occupational health and safety regulations Variables Standardized coefficients x 2 Providing pre-employment physical examination. of employees Providing periodic health examination. of employees Maintaining occupational health and safety personnel. of employees tifying hazards in the. of employees Assigning employees to. of employees worksite participate OHS programmes p value " "* * *** * *" ** *" " **" ** * "' ** * " " : 0 = female, 1 = male; age: actual years of age; marital status: 0 = married, 1 = single; years of education: actual years of formal education; years of service: actual years of employment in the plant; no. of employees: reported no. of employees *p < 0.05 "p < 0.01 ***p < ployers and employees. The lack of OHS knowledge and perception in employers is probably a more important factor than in employees. 6 An average awareness score of 6.1 in response to the questions highly associated with the OHS regulations indicated a significant deficiency in the employers' knowledge. This score could also serve as an indicator for OHS awareness for the year of 1993, and could be re-examined in the future to determine the progress of OHS awareness in Taiwan. In this investigation, the employers were more aware of their responsibilities in the regulation of posting safety warnings, personal protection and providing safety and health equipment. However, they were less aware of their responsibilities in fully preventing worksite injuries and accidents. Even a quarter of the employers would not provide full-paid vacation for employees who were injured at work. This might have caused them to be less motivated to provide a safe working environment. Also, the employers in this study were relatively unaware of knowing the toxic hazards in the workplace. For example, 30% of the employers did not consider it necessary to know the names of chemicals used at work, and less than half of the employers knew that environmental monitoring for hazardous worksites was mandatory. The low percentage (one third) of the employers who knew about MSDS might be due to the fact that MSDS was just introduced in Taiwan in 1992, and was not ubiquitously enforced in all industries. In comparison with other countries, it seems unusual that the law in this nation does not allow employers to hire a person who was found inappropriate for a specific job from the result of pre-employment physical examination. In fact, this situation is still compatible with the international standards. The law in Taiwan not allowing employers to hire an unfit worker is not job discrimination but a consideration of protecting the worker from exposure to a hazardous environment. Generally, most pre-employment physical exam provide only a regular exam. A specific exam would not be provided unless the job-applicant is to work in a hazardous environment. Since most workplaces in Taiwan are categorized as general workplaces, it is understandable that more than half of the employers did not know about this regulation. In this country, mortality has often resulted from rescue attempts by an inexperienced co-worker or employer who witnessed an unconscious employee due to asphyxia or exposure to toxic gas. It was disappointing, but not surprising to find that one third of the employers would go directly to rescue an unconscious worker, without considering their own safety. Education concerning this matter is warranted to prevent further adverse outcomes associated with such attempts. Concerning the compliance with OHS regulations, hazard notification and periodical health examination for workers has been done better than pre-employment physical examination, the maintenance of OHS personnel and the arrangement of OHS programmes. The fact that only 30% of the employers reported maintaining OHS personnel was because this requirement was mandated only on plants of 30 employees or more. The low percentage of employers providing preemployment physical examination and arranging for

6 22 Occup. Med. Vol. 48, 1998 employee participation in OHS education programmes was found mostly in smaller plants, specifically in those with fewer than 30 employees. This seems to support the findings of a previous study 12 that smaller industries were less willing or capable of investing in equipment, training, and education for good safety and health. In the regression analysis of factors associated with OHS awareness, it was shown that married employers, in a larger plant with higher levels of education were more aware of OHS. The awareness score was not increased with employers' age or year of service. In finding factors associated with OHS compliance, older employers were more concerned with employees' health problems; and more years of education was associated with an increased likelihood of providing periodical health examinations, of maintaining OHS personnel, and of arranging OHS education programmes. Number of employees was first related to all five areas of OHS compliance in the chi-square test. However, after controlling for other possible factors, it was found that size of the plant was a significant predictor only on three OHS practices in the logistic regression analysis. These three OHS practices included the maintenance of OHS personnel, the arrangement of OHS education programme and hazard notification. In other words, the larger the plant was, the more likely it was to provide a safe and healthy work environment. The most consistent predictor of all five OHS practices was the score of awareness of OHS. Employers who were more concerned with OHS were more likely to comply with OHS regulations. was not associated with any practice related to OHS. Employers with shorter years of service were found to be more likely to provide periodical health examination and employees' OHS education. This could be explained as new employers wanting to show their concerns with employees' health and safety, by providing the above two OHS services. Another interesting finding was the gender difference in hazard notification. In this culture, women were often protected from working in dangerous jobs. Consequently, female employers were less likely to notify workers about hazards in the worksite owing to their relative lack of experience in working with hazardous materials and in charging of hazardous workplaces. It is well-known that the economic growth in Taiwan has been achieved mainly by the small to medium sized enterprises. In the manufacturing industry, more than 80% of the factories are small-sized with less than 30 employees. As shown in a previous study, 3 " 4 this large proportion of smaller sized plants accounted for the high incidence of occupational injuries in Taiwan. Employers of smaller plants were less aware of OHS and complied with fewer of the related regulations. It seems to be a major obstacle to the improvement of occupational safety and health in Taiwan. With a shortage of OHS inspector manpower, the inspection rate for industries in Taiwan has been less than 10% each year. Therefore, despite the rather complete and strict OHS regulations, enforcement of these regulations has been limited, especially in smaller workplaces. In conclusion, a large proportion of the manufacturing industry in this rapidly industrializing country are small-sized. This is associated with employers who are less knowledgeable in OHS and who comply with fewer OHS practices. Awareness of OHS is one of the most important factors for sound compliance with OHS regulations. Measures towards improving the awareness of OHS for smaller workplaces are warranted in order to promote the workers' safety and health in Taiwan. ACKNOWLEDGEMENTS This study was supported by a grant from Department of Health, Executive Yuan, Taiwan, Republic of China. REFERENCES 1. 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