Calm down. Breathe.
The key to having confidence in your compliance program is preparation. This article is designed to help you prepare for an OSHA visit. The Occupational Safety and Health Administration (OSHA) is an agency of the U.S. Department of Labor. Tennessee OSHA is an agency of the Tennessee Department of Labor and Workforce Development. In addition to Tennessee, there are other states who have OSHA-approved State Plans. (1)
There are different types of audits:
- Complaint or referral driven inspections
- Random inspections
- Voluntary consultations at the request of the employer
OSHA evaluates complaints submitted by employees to determine if the allegation of hazards or violations must receive high priority. 2 An employee is not required to reveal his or her name when filing a complaint. OSHA may telephone the practice to discuss the concerns if the complaint is a lower-priority hazard. They will issue a fax that provides details on the alleged safety violations. The practice owner or manager would reply in writing within five (5) days indicating the hazards and the corrective action is taken. If OSHA finds the response adequate, no further action is taken.
OSHA evaluates complaints submitted by employees or others as well as referrals from another government agency to determine the appropriate priority. If the allegation of hazards or violations could result in a serious injury or illness, the complaint is given high priority 3 and an inspection is generally made.
An employee is not required to reveal his or her name when filing a complaint. OSHA may telephone the practice and perform an inquiry to discuss the concerns if the complaint is given a lower priority. OSHA will issue a letter via email or fax that provides details on the alleged safety violations. The practice owner or manager would reply in writing within five (5) days addressing the hazards and the corrective action taken. If OSHA finds the response adequate, no further action is taken.
If the hazards are assigned a high-priority, OSHA will assign a compliance officer to investigate the complaint and an unannounced inspection will be conducted. State and federal law prohibits OSHA or TOSHA from giving advance notice of the inspection. Compliance officers employed by the State are experienced in safety and have at least a bachelor’s degree in occupational health, biology, engineering, chemistry, occupational health or a related field. The OSHA official will provide you with identification on entering the premises.
Your practice may be selected for a programmed inspection. These inspections are randomly selected and advance notice is not provided. For example, the state of Tennessee instituted a Local Emphasis Program for dental offices. Dental offices are randomly selected for an on-site inspection. If you refuse entry or ask for the inspector to return at a later date, the State has the option to seek a warrant.
When the State’s compliance safety officer arrives, politely ask him or her to be seated and notify management. Management may be the owner/dentist or the practice administrator based on the structure and culture of the practice. Management should ask the officer to be seated in a private office if available.
The compliance officer starts the process with a brief opening conference. The official will explain the purpose such as response to a complaint, referral, or a programmed random inspection. The compliance officer will specifically identify the hazards addressed in the complaint or referral.
Provide the officer with your OSHA Manual. If you are using an electronic file, upload the document for their review or print the portions requested such as the Work Exposure Control Plan.
The compliance officer will audit the Work Exposure Control Plan to determine if the content is current and meets the requirements. This is a written plan to eliminate or minimize occupational exposure to bloodborne pathogens.
The Work Exposure Control Plan must contain an exposure determination that lists the job classifications of workers that have occupational exposure and include the tasks and procedures performed that may result in the exposure. The plan also addresses safer medical device evaluations, universal precautions, engineering controls, work practice controls, personal protective equipment, hepatitis B vaccinations, post-exposure management, employee medical records, labels and signage, and training records. (4)
The Work Exposure Control Plan is updated at least annually. Whether you maintain a paper version or a digital version, make certain that the plan reflects the actual date reviewed or updated in order to reflect your current needs. An outdated plan is in violation of the standard. OSHA will review the last 3-years of safer medical device evaluations. There are not a lot of choices for safer medical devices in dentistry. However, the Bloodborne Pathogens Standard requires an annual review of safer devices that includes non-managerial employees. This evaluation must be documented and filed with your OSHA Manual and notation made on the implementation log.
If you are using reusable scalpels, there must be documentation to evidence review of a safer medical device alternative, such as the disposable scalpel. If the doctor elects not to use the safer medical device, there must be adequate justification and documentation in the Work Exposure Control Plan. In addition, the practice must incorporate engineering controls such as a blade remover system.
OSHA will audit the last 3-years of your training records. The training records must list the required topics, the date, the name of the instructor and credentials, the participants’ signatures and their job titles. (5)
In addition to the Work Exposure Control Plan, OSHA will audit your Hazard Communication program and verify that your Safety Data Sheets (SDS) are in the order corresponding to the hazardous chemicals in use. (6) Your inventory or index must be in place and current. Don’t be surprised if OSHA’s official asks for a certain SDS such as your high level disinfectant or ultrasonic cleaner.
OSHA will conduct a walk-around inspection. We suggest the practice owner, practice manager or experienced safety coordinator accompany the official at all times. During the inspection, the official will point out apparent violations. Take notes during the process such as documents provided, pictures and/or videos that the official made, and any verbal feedback provided. Provide only the information requested.
Based on the nature of the violation, you may be able to correct the violations during the visit such as changing the location of a sharps container. If you are able to correct the violation during the inspection do so and be sure the compliance officer observes the correction. OSHA will conduct confidential interviews with employees. Questions the inspector may ask include:
- Do you know where the Work Exposure Control Plan is located?
- Have you ever had a sharps injury such as a needlestick? If so, how was this
- What are the hazards associated to the use of the high level disinfectant and what is the recommended personal protective equipment?
It is imperative that employees are properly trained and are comfortable being asked questions like these. We suggest quizzing employees during training sessions and team meetings to get employees into the practice of answering questions about your compliance program. The compliance officer may audit the employee medical records for employees potentially exposed to bloodborne pathogens. You must have documentation of the employee’s hepatitis B vaccination on file. Click here for detailed information about the vaccine.
Once the walk-around is completed, the compliance officer will conduct a closing conference. This is an opportunity to discuss the apparent violations with suggestions on how to correct the hazards. This is a good opportunity to ask questions and seek additional information if needed. OSHA then issues a Citation and Notice of Penalty. This document outlines the violations and rates such violations as “serious” or “other than serious.” You must display this notice in an area for the employees to view, such as the break room for three days or until all violations have been corrected.
The dental practice may request an informal conference with the area director within 15 work days (20 calendar days in Tennessee). Your attorney may be present if you desire. During this conference, you may discuss the violations, request a penalty reduction, request an extension of abatement dates. The practice may also contest the violations. Any contest must be filed during this same 15 or 20 day period.
OSHA provides a voluntary consultation service. This program helps businesses identify hazards in the workplace. The service includes a written report detailing the violations observed and offering guidance on how to abate each item. OSHA will not issue citations for the hazards noted or propose penalties for a voluntary consultation. However, OSHA consultation requires all hazards be abated within a reasonable time frame. The service is confidential and the results are not a matter of public record.
By preparing now, you will be ready for a compliance audit and have the confidence you need that your practice is following the regulations. Evaluate your practice and set timelines to accomplish the necessary tasks in order to close the gaps of your compliance program.
The Tennessee Dental Association endorses Modern Practice Solutions, LLC.
About the Author
Olivia Wann, JD served as an office manager and registered dental assistant for a general dental practice. She graduated magna cum laude from St. Joseph’s College of Maine with a Bachelor’s of Science Degree in Health Care Administration and from the Nashville School of Law with a Doctorate in Jurisprudence. Olivia is a member of the Tennessee Bar Association, OSAP, and past president of the Stewart County Chamber of Commerce. Olivia founded Modern Practice Solutions, LLC in the year 2000. One of her most popular services is a comprehensive site audit which includes a detailed, confidential work plan. Please contact Modern Practice Solutions, LLC to learn more about available programs to get your practice into compliance. Visit dentalcompliancetn.com or call (931) 232-7738.
- https://www.osha.gov/dcsp/osp/index.html, accessed on July 19, 2018
- https://www.osha.gov/OshDoc/data_General_Facts/factsheet-inspections.pdf, accessed on July 17, 2018
- https://www.osha.gov/OshDoc/data_General_Facts/factsheet-inspections.pdf, accessed on July 17, 2018
- https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf accessed on July 17, 2018