Every year, about 1,000 construction workers are killed on the job. Everyone is familiar with the Focus Four – falls, electrocutions, struck-bys and caught-in/betweens – the four hazards that kill about 90 percent of construction workers. Yet far more construction workers suffer chronic injuries or illnesses from exposures on the job.

LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni

“Health hazards in construction don’t often get the attention they deserve, in part because many of them never get counted at all,” says LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni. “It takes years for many of these chronic illnesses and injuries to first develop and then be identified. In several ways, the impact of these conditions is more widespread than the Focus Four.”

The American Industrial Hygiene Association (AIHA) Construction Committee recently published Focus Four for Health: An Initiative to Address Four Major Construction Health Hazards. This guide identifies four health hazards in construction, what can be done to prevent the injury or illness, which trades are most affected and how trade groups and safety and health professionals can help. This article examines the four health hazards identified in greater detail and gives examples of how labor and management can reduce risk for workers.

Manual Materials Handling

Injuries from manual handling of construction materials are very common. They include musculoskeletal injuries from sprains and strains to chronic back injuries. They can be serious enough to end a construction career and affect workers long into retirement. The current crisis in opioid addiction in construction has been associated with pain related to activities like manual materials handling.

Injuries caused by manual materials handling account for about 30 percent of all work-related injuries in construction and half of medical costs. It’s estimated that employers spend about $20 billion a year in workers’ compensation costs for these types of injuries, and that doesn’t even include the indirect costs of lost productivity and hiring new workers.

Construction materials are often heavy and awkward to handle. AIHA’s Focus Four for Health suggests employers focus on the weight of the load, ease of handling, awkward postures, the time/distance it must be carried and the pace or amount of handling per shift. Planning ahead for any materials handling is essential. Getting workers involved in planning the job can help minimize risk.


Hearing loss is extremely common among construction workers after 15-20 years on the job. In most states, OSHA doesn’t require employers to take action until exposures are above 90 decibels, which is extremely high. The result is that many construction workers have significant hearing loss by the end of their career, which can make retirement much more difficult and less enjoyable. Overexposure to noise can also cause many other health effects, such as high blood pressure and tinnitus and it can also contribute to cognitive decline and memory loss.

Hearing loss and other health effects can be avoided by identifying high exposure tasks and taking steps to make them quieter (e.g., buying or renting quieter equipment) or wearing hearing protection while doing the task. Some newer forms of hearing protection contain electronics that allow communication while limiting noise exposure. In addition to providing and wearing hearing protection, workers need training on noise hazards and proper use of hearing protection as well as annual hearing tests. Smartphone apps can help identify noise levels and high exposure tasks, even if they aren’t quite as accurate as the tools used by safety and health professionals.

Air Contaminants

Construction workers are exposed to many chemicals and other substances on the job that can damage their health. The dangers presented by some of them, such as asbestossilica and lead, are well-known. Some volatile chemicals, like solvents, can be dangerous even if you can’t smell them. Most contaminants get into the body when they are suspended in the air and inhaled, but others can also be absorbed through the skin. Exposures tend to be highest when materials are cut or grinded. Although the lungs are most often at risk, many air contaminants cause damage well beyond the lungs. Lead, for example, can damage the kidneys and reproductive organs. Welding fumes, which contain the heavy metal manganese, can damage the nervous system.

Employers should start by reviewing Safety Data Sheets (SDS) to determine the health risks of products used on site and what effects they can have on the body. The danger to workers will also be determined by the length of exposure and other factors, such as whether it’s being used in an enclosed space. Exposures are best controlled by using local exhaust or vacuum systems to capture the dust or fumes. Respirators are a last resort and require a full respiratory protection program that ensures the respirator fits properly and matches the hazard and exposure level. Employers should always check to see if there are less toxic alternatives available. Training is required under the OSHA Hazard Communication standard and equivalent laws in Canada (WHMIS).

High Temperatures

Most construction work is still done outdoors, but even indoor work can be hot, such as asbestos abatement in protective clothing or work in boiler rooms. Work in high temperatures can cause a range of illnesses from heat rash to heat stroke. Every year, about a dozen construction workers die from heat exposure.

It is important that workers are able to recognize the symptoms of heat illness and take quick action to prevent serious consequences. Most workers who die from heat exposure were never acclimatized to the heat. There are many more factors than temperature alone that contribute to heat illness.

AIHA’s Focus Four for Health document contains practical information for contractors and workers on how to address these health hazards and reduce the risk of chronic injuries and illnesses in construction. You can download it here. The Fund’s OSH Division can also assist LIUNA signatory contractors and other affiliates with reducing occupational exposures and protecting worker health on the job.

[Scott Schneider]