ACOEM Comments on OSHA's Voluntary Protection Programs

March 22, 2023
U.S. Department of Labor
Occupational Safety and Health Administration
200 Constitution Avenue, NW
Washington D.C. 20210
Re: Docket No. OSHA-2022-0012
To Whom It May Concern:
The American College of Occupational and Environmental Medicine (ACOEM) is pleased to respond to the request for comments on the future direction of the U.S. Occupational Safety and Health Administration’s (OSHA) Voluntary Protection Programs (VPP). Founded in 1916, ACOEM is the nation’s largest medical society dedicated to promoting employee health through preventive medicine, clinical care, research, and education. The College represents more than 4,000 physicians and other health care professionals specializing in the field of occupational and environmental medicine (OEM).
The VPP represents a valuable program and should be retained. Of course, ACOEM expects that OSHA will adequately fund compliance activities, even if it chooses to sustain, enhance, and modernize the VPP. We support OSHA’s goal to modernize VPP as a means of advancing the agency’s vision of making safety and health a core value in American workplaces. As on-the-ground specialists with an understanding of the complex web of factors affecting health in the workplace, OEM physicians understand that ensuring the health of employees increases productivity in the workplace and advances the U.S. economy.
ACOEM has experience with recognizing employers who document and improve their health and safety programs through our Excellence in Corporate Health Achievement Awards (eCHAA) and believes that a cooperative approach to planning and quality improvement pays large rewards. ACOEM’s eCHAA, was established in 1996 and recognizes organizations with exemplary health, safety, and environmental programs.
The eCHAA application process gathers detailed and useful information about the corporate governance structure and management’s commitment to health and safety and may have valuable lessons for VPP. Participating organizations submit a comprehensive application about their program and undergo a rigorous review by an expert panel to assess three key dimensions: Economic, Environmental, and Social. ACOEM’s Guide to a Healthy and Safe Workplace further details the criteria and standards considered within these three dimensions and provides examples of appropriate program components, processes, and dissemination to enable organizations to achieve these standards. Furthermore, the guide puts forth examples of outcome measures and trends that may inform the modernization of the VPP application review process.
These awards have been given to deserving organizations in manufacturing and service sectors, including city health departments, federal agencies, and healthcare systems. Of note, studies on the eCHAA have strengthened the evidence base that a healthy and safe workforce correlates with a company’s performance and its ability to provide positive returns to shareholders and surpass competitors in the market.[1] We believe these findings are relevant to OSHA as it seeks to highlight incentives to employers that may be considering the benefits of voluntarily committing to establishing and maintaining a culture approach that prioritizes the health and safety of their employees. Additional details on eCHAA are available here.
ACOEM is pleased to offer the following recommendations for OSHA’s consideration.
II. Incentives to Participate
Question 3: Does the existing exemption from programmed inspections create any concerns about workplace safety and health at these facilities?
  • VPP sites should not be exempted from programmatic OSHA inspections. Rather, those inspections should be modified to include a collection of information about best practices resulting in a documented reduction in exposure to health and safety hazards (for example, noise reduction, fall hazard reduction, reduction in silica exposure, etc.).
 III. Assessing SHMS Effectiveness
Question 1: What criteria should OSHA consider for eligibility in VPP?
  • For employers whose workplaces fall within the scope of an OSHA standard requiring medical surveillance, ACOEM recommends that medical expertise and medical participation be documented as part of the management structure and not simply as a service vendor. That is, ACOEM believes that for such employers, documentation that physicians with OEM expertise are part of the senior management.
Question 2: What concerns exist with the use of injury rates for participation in VPP?
  • While injury rates are important, too many instances of reporting suppression have demonstrated their limitations. Furthermore, VPP programs should rely more heavily on leading indicators rather than lagging indicators. VPP applications should require external, independent audits of accuracy and completeness by anonymous surveys of employees for injury/illness information and a validated safety climate scale. Applications should also require leading indicators prioritizing environmental sampling, labor-management safety committee reports, and data describing root cause investigations and responses to near-miss reporting.
VII. Tiered VPP
Question 1: Should OSHA consider a tiered approach to VPP?
  • Consideration of a tiered approach for VPP seems reasonable. ACOEM’s eCHAA recognizes organizations at gold, silver, and bronze levels. Award levels reflect an applicant’s scoring assessment weighing elements for each of the 19 standards in the three dimensions of eCHAA (Economic, Environmental, Social).
A thorough and comprehensive evaluation of each applicant’s occupational and environmental health and safety programs is undertaken. Formal feedback from the Examiners Panel regarding program strengths and suggested areas of improvement is provided to applicants. This process provides transparency and a pathway for applicants to pursue higher award levels. We strongly encourage OSHA to consider these lessons learned if it implements a tiered VPP approach.
Question 3: What benefits could OSHA provide that would encourage organizations to improve their performance and move from a lower to a higher tier?
  • In our experience with eCHAA, we have found that periodic renewal of an award status tends to sustain an employer’s gains in workplace health and safety. As our eCHAA field staff have observed, when incentives are not maintained, some employers will “fall off the wagon.”
 VIII. Effective VPP Administration
Question 1: What data should be collected during the initial application process and periodic evaluations to ensure that VPP applicants are, and remain, eligible to participate in VPP?
  • Consideration should be given to identifying industry funding sources that would allow NIOSH to collect and analyze data to evaluate individual VPP sites as well as to determine overall information about the impact of aspects of the program.

Question 3: If OSHA were to engage or authorize third-party reviewers to conduct on-site evaluations, what review process should be used to ensure the quality of the data produced during such evaluations?
  • Third-party certification procedures may be appropriate if costs are covered through the application process and if OSHA oversight is robust.
If you should have any questions or need additional information, please contact Dane Farrell (, ACOEM’s Government Affairs Representative.
Thank you for your consideration, and we look forward to collaborating with OSHA on the modernization of VPP. 
Douglas W. Martin, MD, FAADEP, FAAFP, FACOEM
American College of Occupational and Environmental Medicine (ACOEM)
[1] Fabius R, Loeppke RR, Hohn T, et al. Tracking the Market Performance of Companies That Integrate a Culture of Health and Safety: An Assessment of Corporate Health Achievement Award Applicants. J Occup Environ Med. 2016;58(1):3-8. doi:10.1097/JOM.0000000000000638