RISK PROFILE

SUPERMARKET SECTOR

1. SECTOR : SUPERMARKETS

2. ISTAT CODES (ATECO 91): 52.11.2

3. ISPESL CODE:

SURVEY ZONE

4. NATIONAL:

5. REGIONAL:

6. PROVINCIAL: CITY OF MILAN

7. USL: ASL CITY OF MILAN

8. YEAR OF SURVEY: 1993

9. NUMBER OF EMPLOYEES: 600

9A. CLERKS:

9B. WORKERS: 600

10. NUMBER OF COMPANIES: 34

11. SURVEY BODY: ASL CITY of MILAN-SPSAL

12. REFERENCE PERSON: DR. SUSANNA CANTONI

ADDRESS: VIA RICORDI, 1

POSTAL CODE: 20131

CITY : MILAN

PROVINCE: MILAN

PHONE: 02/29505431

FAX: 02/29505430

E-MAIL:

13. ACCIDENTS: FROM 1986 TO 1991

TOTAL : 644 OF WHICH FATAL: NONE

14. OCCUPATIONAL DISEASES: NONE

NOTE: THE ACCIDENTS ARE DESCRIBED IN THE ANNEXE “ANALYSIS OF THE ACCIDENT PHENOMENON”

FLOW-CHART

HEALTH SURVEY

Results of the survey

Introduction

In the period July ‘92 - March ‘93 health check-ups were conducted on 260 employees of a chain of supermarkets.

The aim of the survey was to investigate the health conditions of a representative sample of the population of workers employed in supermarkets.

The workers were subjected to the following medical protocol:

- Specialised occupational health examination, with the giving of health-related questionnaires targeted for skin pathology and eye symptoms;

- Clinical and functional assessment of the locomotion apparatus.

Specialised checks by physiologists and X-rays were requested for some persons who required further investigation.

The procedure for appointments with the workers (off working hours and on a voluntary basis) sometimes prevented the completion of the specialised checking due to the absence of the persons involved. In these cases, where possible, diagnoses were made for suspected pathology with the proper indications for the person’s physician.

Description of the sample

The persons examined were employed in 10 different locations where all the persons having the requisites of selection were examined.

The criterion of selection: job seniority of at least 4 years and full time employment.

Tab. 1 shows the subdivision by gender.

For the purposes of the analysis of the rate of osteoarticular pathologies, a subdivision by 10-year age classes was made as shown in Tab. 2, since the rate of these pathologies increases as the age rises.

The average age of the male and female sample was similar (Tab. 3).

The various jobs done inside a supermarket involve different risks for health; therefore, in the analysis of the distribution of some pathologies, the persons were subdivided by job tasks.

The tasks were aggregated by analogies of risk.

There is a distinction between those who said they worked exclusively at the cash register or at the shelves and those who said they had a 50% alternation between the two tasks. The tasks of packaging fruit, meat and delicatessen and of butcher and delicatessen worker were aggregated.

Clerical jobs were collected under the item "others".

As we see in Tab. 4 the distribution of males and females is not uniform, with the males mainly working at the shelves, meat/delicatessen and in the warehouse and the females at the cash registers and at the refund desk.

Clinical-functional pathologies of the rachis

The protocol of assessment of the rachis called for a targeted anamnesis and a functional clinical assessment. A diagnosis was made based on standard criteria of spondylarthropathy (SAP) expressed in three levels of increasing seriousness, according to the three levels of the spinal column.

This distinction is necessary since the cervical, dorsal and lumbrosacral are functional entities with different responses to the risk factors due to a fixed posture or mechanical overloading.

The following tables show the percentage of persons showing spondylarthropathy in the various levels of the rachis, subdivided by gender and age class, and compared with the data of control groups not exposed to risks for the rachis.

With regard to, males no differences are observed with respect to the control groups for cervical pathologies, while the females have a greater rate with respect to the controls in all the age classes (Fig. 1 and 2).

The distribution of cervical SAP in females was assessed with the X2 test 2, giving a statistically significant value (p 0.01).

Fig. 3 shows the distribution of cervical SAP by type of work and age class.

The greatest rate of cervical SAP was shown in employees at the refund desk, cash registers and cash registers/shelves. The rate is due to the postural characteristics of the job task of the employees at the cash registers and cash registers/shelves, which involve bent positions of the cervical area of the rachis and repetitive movements of upper limbs.

For the persons at the refund desk, this pathology is probably due to both the job itself and their previous seniority as cashiers.

Figures 4 and 5 show the percentages of diagnosis of dorsal SAP.

With regard to males, the situation does not have a single interpretation. In the younger age classes (which however have few members) there is a greater rate with respect to the control group, not confirmed in the older classes. For the age class 16-25, control data are not available.

This condition seems to suggest that the younger workers are assigned above all the heaviest tasks.

For the females there is clearly a higher rate of dorsal SAP with respect to the control group, also in this case with a higher percentage in the age class 26/35. In any case, the X2 test gives statistically significant values both for the males and the females (p 0.01).

Examining the distribution of the pathologies by job tasks (Fig. 6), we see that the greatest rate of dorsal SAP is among the employees at the cash registers, cash registers/shelves and at the refund desk, similar to the cervical area, and among the employees in packaging.

Also in this case the ways of performing the work seem to be responsible for the highest percentage of pathologies.

The analysis of the pathologies of the lumbar tract shows a clearly higher rate than the control group both among the males and the females. This situation is related to the fact that the lumbar area is sensitive to work involving fixed postures and/or the transfer of weights (Fig. 7 and 8).

Also in this case the X2 test shows statistical significance (males p = 0.05, females p 0.01).

In distribution by task (Fig. 9), the highest percentages occur in the tasks with a more fixed posture (cash register and packaging), handling of weights (shelves) and the combination of the two conditions (cash registers/shelves).

Tab. 5 shows the functional and organic pathologies of the rachis.

The organic pathologies were diagnosed both by examining the medical documentation provided by the patients and by directly conducting instrument examinations.

The first major aspect is that only 40.3% of males and 26.2% of females have no pathology of the rachis.

This indication is obviously very general, since one must consider the different seriousness of the pathologies detected, but it is in any case an indicator of the general status of the health of the population.

Among the pathologies encountered, there were 21 cases (8.1%) of quite serious cervical degenerative pathologies (discopathy, posterior and frontal, arthrosis, uncoarthrosis) and 20 cases (7.7%) of degenerative lumbar pathologies (discopathy, serious osteophytosis, posterior arthrosis).

There were 7 cases of herniated disc, developing or as the consequence of surgery. In males the rate recorded was 3.4%, compared to the expected 1.5-2% of cases in the general population (Tab. 6).

Furthermore, the number of persons with acute lumbago was high.

The data for total lumbago (number of episodes in the entire lifetime) and lumbago for the past 12 months is high. The data in international literature show a rate of 1.5-2% for lumbago in the past 12 months, while in the population examined there are rates 8-10 times higher.

This result is indicative of job activities involving an excessive transfer of weights.

The comparison with a control group shows highly significant values for the X2 test (p 0).

Pathologies of the upper limbs

With regard to the pathologies of the upper limbs, the most characteristic symptoms were surveyed.

The rate of cervical-brachial symptoms (pain in neck and shoulders) (Tab. 7), paresthesia (anomalous sensations) (Tab. 8), weakness (loss of strength) (Tab. 9) and pain in the hand (Tab. 10) was always greater in females with respect to the males.

Assessing the distribution by job task, higher percentages of cervical-brachial pain are reported by employees in tasks executed with arms lifted and unsupported (cash register, packaging, refund desk) (Tab. 11).

Paresthesia is present in a large number of women, and the jobs where there is a greater rate are at the cash register, packaging and refund desk (Tab. 12).

The weakness symptom was found mainly in employees at the cash registers and in the meat/delicatessen section sections (Tab. 13).

Pain symptoms of the hand are mainly reported by employees in packaging (Tab. 14).

Tab. 15 shows the rate of joint pathologies diagnosed.

There is a low rate of these pathologies. This is due to the low frequency of these pathologies in the general population, and the need for instrument examinations for a correct diagnosis of these pathologies. As already shown previously, it was not always possible to conduct the checking necessary to clarify some diagnostic doubts, so that it is reasonable to assume that the rate of joint pathologies in this sample may be underestimated.

Despite the possible underestimation, joint pathologies are a relevant problem for this population.

The pathologies of the upper limbs recorded were grouped in a diagnosis of Cumulative Trauma Disorders (CTD).

The main pathologies considered were: irradiated cervical pathology, thoracic compression, scapula-humerus periarthritis, epicondilitis, epitrochleitis, carpal tunnel.

CTDs derive from work involving the repeated and continuous use of a segment of the upper limbs, thus increasing as the action is repeated in an identical manner and are aggravated by frequency of performance.

The group examined showed a CTD rate of 11.8% in males and 24.1% in females (Tab. 16).

International literature shows rates of 1-2% in the general population, both in males and females.

The figure is thus highly indicative of a causal role of work activity in producing CTD.

This consideration is confirmed by the analysis of the distribution of pathologies by job task (Tab. 17).

The persons most affected are, in fact, employees in packaging, at the cash registers and in the meat/delicatessen section, i.e. those whose job involves highly repetitive movements of the upper limbs.

GENERAL CLINICAL PATHOLOGIES

The general diagnoses were made, in most cases, on the basis of clinical data alone, since it was not possible to conduct chemical, biological or instrument checking.

When possible, the health documentation exhibited by the workers was taken into account.

No evidence of pathologies of the various organs and apparatus was found (Tab. 18).

Detailed analysis was made of cases of eczema dermatitis of the hands directly observed by us, and thus in persons who came for the check-up with the pathology occurring (Tab. 19).

Most of the persons affected by eczema dermatitis were among those working at the shelves, in relation to contact with packaging the surface of which may have irritating or allergy-producing, e.g. detergents.

OCULAR PATHOLOGIES

Also for the diagnosis of ocular pathology, in practice, only the medical documentation presented was taken into account, and only sporadic cases of serious eye disease were recorded (Tab. 20).

A targeted questionnaire was given to survey ocular symptoms, forming as a whole the asthenopia syndrome (Tab. 21).

Control data are not available for groups of persons who do not work in sectors requiring significant strain on sight, such as at video terminals, but the rate of these symptoms is lower in the ordinary population.

However, analysing the distribution of the main symptoms by type of work, we can gain further information.

The work showing a greater risk of asthenopia syndrome is that at the cash registers due to the continuous passing of moving objects and to the lighting conditions, since the cash registers are located near the outside windows.

Therefore, the rates of the various symptoms among cashiers, cashiers/shelf workers and other workers are shown (Tab. 22, 23, 24).

As demonstrated by the data shown, for the cash register and cash registers/ shelf workers, there is a constantly higher rate of pathologies, confirming the presence of working conditions which, though directly pathogenic, cause of greater eye fatigue.

SUITABILITY FOR TASKS

Some of pathologies for which the persons examined were affected were serious enough for advising against the continuation of this work or of some particular tasks.

In almost all the cases these are pathologies of the rachis and the main joints, which can be attributed at least a role as joint cause in the type of work activity performed.

The counter-indications, expressed according to the criteria published in the review "La Medicina del lavoro" (N. 5 vol. 84, 1993), should be interpreted as a greater risk, in the long term, of worsening health conditions due to the undertaking of the tasks identified as risk tasks.

Tables 25 and 26 show the number and percentage of persons to be understood as not suitable for the job task undertaken, temporarily or permanently.

CONCLUSIONS

The data collected as a whole show how the make workers examined have a higher rate of lumbrosacral spondylarthropathy with respect to a control group, while female workers show a rate of both cervical and lumbrosacral spondylarthropathy higher than the control group.

The data on the dorsal area, on the other hand, can be variously interpreted.

The work tasks showing the highest risk for the cervical area of the rachis were those at the refund desk, cash registers and the cash registers/shelves.

For the dorsal rachis the tasks with the highest risk were those at the cash registers, cash registers/shelves, refund desk and packaging.

With regard to the lumbrosacral rachis the tasks with the highest risk were those at cash registers/shelves, cash register, shelves and packaging.

The risk due to the handling of weights is likewise confirmed by the high occurrence of acute lumbago.

A high rate of "Cumulative Trauma Disorders", related to the performance of repetitive movements of the upper limbs, was observed.

The workers in packaging, cash registers and in the meat and delicatessen sections proved to have significantly higher rates of this pathology.

Other pathologies of concern are eczema dermatitis in the hands, involving mainly the employees at the shelves.

As already stated, in this case, the contact with some materials, for example detergents, with irritating or allergy-producing characteristics, seems to be responsible.

Problems from sight fatigue especially affect employees at the cash registers, presumably in relation to the lighting characteristics of the workplaces and the need to observe objects in continuous movement.

Furthermore, there were a significant number of pathologies suggesting that some work tasks should not be undertaken.

It is therefore necessary to find a suitable placement for these persons in the supermarket activities.

From the clinical considerations made it seems advisable that the workers in the supermarkets be subjected to periodical health checkups, with particular focus on the assessment of the pathologies of the rachis and the upper limbs (Tab. 27).

The purpose of these checkups is to identify the persons affected by pathologies in the initial stage, in order to allow an adequate preventive action, and the persons affected by pathologies in course, in order to assign them, where necessary, to work tasks without risks of aggravation.

The checkups could take place every three years or less according to the worker’s state of health (Tab. 28).

Likewise necessary is primary prevention oriented towards the ergonomic restructuring of workplaces and change of the way in which work tasks are undertaken.

This restructuring should involve the adoption of cash registers with adequate spaces and adjustable seats.

Furthermore, there should be an adequate system of alternating the work tasks in order to allow pauses for postural change enabling physiological recovery.

This system of pauses is the only preventive tool immediately available for the prevention of "Cumulative Trauma Disorders" and should thus adopted for the work at the cash registers, in packaging, and in the meat and delicatessen sections.

With regard to the handling of weights, the adoption and constant use of mechanical aids for loading and unloading goods, warehouse operations and working at the shelves.

Suitable technical measurements should be used to deal with the problem of the lighting at the cash registers.

It would be useful to provide light gloves in fabric allowing transpiration for the employees working at the shelves.

Finally, educational campaigns for the workers can be a useful tool of prevention.

These campaigns could consist of courses for acquisition by the employees of the basic principles of ergonomics and education and training for the handling of loads and postures placing less strain on the rachis and the upper limbs.

TAB. 11.1 - Persons examined.

	N.	%
MALES	119	45.8
FEMALES	141	54.2
TOTAL	260	100

TAB. 11.2 - Distribution by age class and gender.

		ALL		MALES		FEMALES
AGE CLASSES	N.		%	N.	%		N.	%
15-25	13		5	10	8,4		3	2.1
26-35	66		25.4	33	27.7		33	23.4
36-45	130		50	50	42		80	56.7
46-55	41		15.8	21	17.6		20	14.2
> 55	10		3.8	5	4.2		5	3.5

TAB. 11.3 - Average age.

GENDER	AVERAGE	DS
MALES	39.6	8.34
FEMALES	40.2	7.2

TAB. 11.4 - Distribution by task and gender.

		ALL		MALES			FEMALES
WORK	N.		%		N.	%		N.	%
CASH REGISTER	69		26.5		0	0		69	49.9
SHELVES	65		25		51	42.9		14	9.9
CASH REGISTER AND SHELVES	20		7.7		1	0.8		19	13.5
PACKAGING (fruit, meat, delicatessen)	46		17.7		24	20.2		22	15.6
MEAT/DELICATESSEN	32		12.3		30	25.2		2	1.4
WAREHOUSE (workers and warehouse workers)	7		2.71		7	5.9		0	0
REFUND DESK	13		5		0	0		13	9.2
OTHER (clerical, sales personnel, sales contracts)	8		3.1		6	5		2	1.4
TOTAL	260				119	100		141	100

TAB. 11.5 – Cervical spondylarthropathy in males, by age classes

TAB. 11.6 – Cercival spondylarthropathy in females, by age classes

esposti= exposed controlli = checks

TAB. 11.7 - Distribution of cervical SAP by iob and age class

cassa = cash reg.; scaffal. = shelves; cass./scaf. = cash reg./shelves; confez. = packaging; rimborsi = refunds; alter = other

TAB. 11.8 – Dorsal spondylarthropathy in males, by age class

esposti= esposed controoli = checks

dato non disponibile = data not available

TAB. 11.9 – Dorsal pondylarthropathy in females, by age classes

TAB. 11.10 - Distribution dorsal SAP by job and age class

TAB. 11.11 – Lumbar spondylarthropathy in males, by age classes

TAB. 11.12 – Lumbar spondylarthropathy in females, by age classes

TAB. 11.13 - Distribution of lumbar SAP by job and age classes

TAB. 11.14 - Distribution and rate of pathologies of the rachis by gender.

	MALES			FEMALES
CERVICAL	N.	%	N.		%
SAP I AFFECTING THE UPPER LIMBS	3	2.5	3		2.1
SAP I WITHOUT RADIATING EFFECT	8	6.7	19		13.4
SAP II WITH RADIATING EFFECT			11		7.8
SAP II WITHOUT RADIATING EFFECT	7	5.8	18		12.7
SAP III WITH RADIATING EFFECT			3		2.1
SAP III WITHOUT RADIATING EFFECT	3	2.5	7		4.9
LIGHT CERVICAL-BRACHIAL PAIN	7	5.8	15		10.6
TRANSVERSAL PROCESS OF C7			5		3.5
CERVICAL RIB			2		1.4
KLIPPEL FEIL SYN. (VERTEBRAL AND/OR DORSAL SYNOSTOSIS)	1	0.8	1		0.7
SINGLE REGRESSIVE DISCOPATHY	2	1.7	5		3.5
MULTIPLE REGRESSIVE DISCOPATHY	1	0.8	3		2.1
POSTERIOR AND/OR FRONTAL ARTHROSIS	1	0.8	2		1.4
UNCOARTHROSIS	3	2.5	4		2.8
REDUCTION OF JOINT FORAMEN			2		1.4
LIGHT THORACIC COMPRESSION (SUSPECTED)			1		0.7
RETROLISTESIS			1		0.7
DORSAL
SAP I WITH RADIATING EFFECT TO CHEST	1	0.8
SAP I WITHOUT RADIATING EFFECT	11	9.2	27		19.1
SAP II WITHOUT RADIATING EFFECT	3	2.5	11		7.8
SAP III WITHOUT RADIATING EFFECT			1		0.7
BACK PAIN	1	0.8	4		2.8
STRUCTURED CURVED BACK	7	5.8	2		1.4
KYPHOSCOLIOSIS	3	2.5	1		0.7
RESULTS OF LIGHT JUVENILE OSTEOCHONDRITIS			1		0.7
VERTEBRAL MALFORMATION	1	0.8
DIFFUSE OSTEOPHYTOSIS	3	2.5	3		2.1
LUMBROSACRAL
SAP I WITH RADIATING EFFECT	1	0.8
SAP I WITHOUT RADIATING EFFECT	17	14.2	16		11.3
SAP II WITH RADIATING EFFECT	3	2.5	7		4.9
SAP II WITHOUT RADIATING EFFECT	13	10.9	28		19.8
SAP III WITHOUT RADIATING EFFECT	2	1.7	4		2.8
SAP III WITH RADIATING EFFECT WITH NEGATIVE LASEGUE	2	1.7	3		2.1
SAP III WITH POSITIVE LASEGUE AND/OR WASSERMAN	1	0.8	2		1.4
LIGHT LUMBAGO	6	5.0	10		7.0
REDUCED MUSCLE-TENDON DISTENSION	8	6.7	4		2.8
STRUCTURED HYPERLORDOSIS	1	0.8	3		2.1
L5 EMBEDDED IN ILIAC WINGS	5	4	6		4.2
TRANSVERSAL PSEUDO-ARTICULAR PROCESS	2	1.7	1		0.7
RETROLISTESIS	3	2.5	2		1.4
SINGLE REGRESSIVE DISCOPATHY	1	0.8	5		3.5
MULTIPLE REGRESSIVE DISCOPATHY			1		0.7
BRIDGE OSTEOPHYTOSIS			1		0.7
DIFFUSE OSTEOPHYTOSIS	6	5	3		2.1
POST. ARTHROSIS OF THE LUMBROSACR. JOINT	1	0.8	2		1.4
DISK PROTRUSION	2	1.7
PROTRUDED HERNIATED DISC			1		0.7
RESULTS OF SURGICAL REDUCTION OF HERNIATED DISC WITH LAMINECTOMY	1	0.8
RESULTS OF SURGICAL REDUCTION OF HERNIATED DISC	1	0.8	2		1.4
LIGHT SCOLIOSIS	11	9.2	18		12.7
ACUTE RECURRING LUMBAGO	3	2.5	7		4.8
NO PATHOLOGY OF RACHIS	48	40.3	37		26.2

TAB. 11.15 - Distribution of herniated disc and acute lumbago by gender.

	MALES				FEMALES
		N.	%	MIN-MAX	N.	%	MIN-MAX
HERNIATED DISC		4	3.4		3	2.1
ACUTE LUMBAGO TOTAL		39	32.8	1 - 10	34	24.5	1 - 20
ACUTE LUMBAGO LAST YEAR		12	10.1	1 - 2	16	12.8	1 - 3

TAB. 11.16 - Distribution of cervical-brachial pain.

GENDER	NEG.	POS.
	N. %	N. %
MALES	117 98.3	2 1.7
FEMALES	114 80.9	27 19.1

TAB. 11.17 - Distribution of the paresthesia symptoms in upper limbs

GENDER	NEG.	POS.
	N. %	N. %
MALES	106 89.6	13 10.9
FEMALES	103 73	38 27

TAB. 11.18 - Distribution of weakness symptoms

GENDER	NEG.	POS.
	N. %	N. %
MALES	114 95.8	5 4.2
FEMALES	121 85.8	20 14.2

TAB. 11.19 - Distribution of the hand pain symptoms

GENDER	NEG.	POS.
	N. %	N. %
MALES	114 95.8	5 4.2
FEMALES	128 90.8	13 9.2

TAB. 11.20 - Distribution of cervical-brachial pain by job activity

	NEG.		POS.
JOBS		N. %	N. %
CASH REGISTER		57 82.6	12 17.4
SHELVES		60 92.3	5 7.7
CASH REGISTERS/ SHELVES		18 90	2 10
PACKAGING		38 82.6	8 17.4
MEAT/ DELICATESSEN		32 100
WAREHOUSE		7 100
REFUND DESK		11 84.6	2 15.4
OTHER		8 100

TAB. 11.21 - Distribution of paresthesia symptoms by job activity

	NEG.	POS
JOBS	NEG. %	NEG. %
CASH REGISTER	45 65.2	24 34.8
SHELVES	56 86.2	9 13.8
CASH REGISTERS/ SHELVES	20 100
PACKAGING	36 78.3	10 21.7
MEAT/ DELICATESSEN	27 84.4	5 15.6
WAREHOUSE	7 100
REFUND DESK	10 76.9	3 23.1
OTHER	8 100

TAB. 11.22 - Distribution of the weakness syndrome by job activity

	NEG.	POS.
JOBS	N. %	N. %
CASH REGISTER	57 82.6	12 17.4
SHELVES	62 95.4	3 4.6
CASH REGISTERS/ SHELVES	19 95	1 5
PACKAGING	42 91.3	4 8.7
MEAT/ DELICATESSEN	27 84.4	5 15.6
WAREHOUSE	7 100
REFUND DESK	13 100
OTHER	8 100

TAB. 11.23 - Distribution of symptoms of hand pain by job activity

	NEG.	POS.
JOBS	N. %	N. %
CASH REGISTER	65 94.2	4 5.8
SHELVES	62 95.4	3 4.6
CASH REGISTERS/ SHELVES	19 95	1 5
PACKAGING	37 80.4	9 19.6
MEAT/ DELICATESSEN	31 96.9	1 3.1
WAREHOUSE	7 100
REFUND DESK	13 100
OTHER	8 100

TAB. 11.24 - Distribution and rate of joint pathologies (diagnosis).

	MALES		FEMALES
RIGHT SHOULDER	N.	%		N.	%
SUSPECTED SCAPULAL-HUMERUS PERIARTHRITIS (LIGHT FUNCTIONAL ALTERATION)	2	1.6		1	0.7
SCAPULAL-HUMERUS OR TENDON PERIARTHRITIS OF CAP TISSUE (MAJOR FUNCTIONAL ALTERATION)	1	0.8
CALCIFIED SCAPULAL-HUMERUS PERIARTHRITIS (DUPLAY)				3	2.1
RIGHT ELBOW
EPICONDILITIS	1	0.8		2	1.4
EPITROCHLEITIS	1	0.8		1	0.7
OLECRAN BURSITIS				3	2.1
PERIARTICULAR PERIARTHRITIS	1	0.8		1	1.4
EPICONDYLE PAIN WITHOUT EVIDENT CLINICAL SIGNS	1	0.8		3	2.1
LEFT ELBOW
EPICONDILITIS	1	0.8
EPICONDYLE PAIN WITHOUT EVIDENT CLINICAL SIGNS				2	1.4
OTHER SYNDROMES	1	0.8
RIGHT HAND WRIST
CARPAL TUNNEL SYNDROME (CLINICAL TESTS POSITIVES)				1	0.7
SERIOUS CARPAL TUNNEL SYNDROME GRAVE (WITH EMG AND/OR RX ALTERATIONS)				2	1.4
METACARPAL PHALANGEAL RIZOARTHROSIS				1	0.7
LEFT HAND WRIST
RESULTS OF SURGERY FOR CARPAL TUNNEL SYNDROME	1	0.8		1	0.7
METACARPAL PHALANGEAL RIZOARTHROSIS				1	0.7
INTERPHALANGEAL METACARPAL ARTHROSIS	1	0.8
RIGHT HIP-FEMUR
COXOARTHROSIS	1	0.8		2	1.4
DYSPLASIA AND/OR DISLOCATION OF THE HIP				1	0.7
LIGHT COXALGIA (WITHOUT FUNCTIONAL DISORDER)	1	0.8
LEFT HIP-FEMUR
COXOARTHROSIS	1	0.8		2	1.4
DYSPLASIA AND/OR DISLOCATION OF THE HIP				1	0.7
RESULTS OF SURGERY FOR DISLOCATION OF THE HIP				1	0.7
RIGHT KNEE
GONARTHROSIS				1	0.7
FEMUR-PATELLA ARTHROSIS				1	0.7
LEFT KNEE
GONARTHROSIS				1	0.7
LIGHT GONALGIA (WITHOUT FUNCTIONAL DISORDER)	1	0.8
NO JOINT PATHOLOGY	107	89.9		121	85.8

TAB. 11.25 - Distribution of "Cumulative Trauma Disorders" (CTD) by gender

	Neg.	Pos.
GENDER	N. %	N. %
MALES	105 88.2	14 11.8
FEMALES	107 75.9	34 24.1

TAB. 11.26 - Distribution of "Cumulative Trauma Disorders" (CTD) by job activity

	Neg.	Pos.
JOBS	N. %	N. %
CASH REGISTER	51 73.9	18 26.1
SHELVES	60 92.3	5 7.7
CASHIERS SHELVES	19 95.0	1 5.0
PACKAGING	31 67.4	15 32.6
MEAT DELICATESSEN	25 78.1	7 21.9
WAREHOUSE	6 85.7	1 14.3
REFUND DESK	12 92.3	1 7.7
OTHER	8 100.0

TAB. 11.27 - Distribution of clinical diagnoses

	N.	%
NO PATHOLOGIES	152	61.5
ENDOCRINE PATH.	8	3.2
NEUROLOGICAL PATH.	4	1.6
EAR PATH.	6	2.4
CARDIOVASCULAR PATH. VARICOSE VEINS IN LEG HIGH BLOOD PRESSURE	22 8 9	8.9 3.2 3.6
RESPIRATORY PATH.	5	2
DIGESTIVE SYSTEM PATH.	17	6.9
UROGENITAL PATH.	4	1.6
SKIN PATH ECZ. DERM.	26 15	10.5 6.1

TAB. 11.28 - Distribution of eczema dermatitis by job activity

	NO	PRES.
JOBS	N. %	N. %
CASH REGISTER	58 93.5	4 6.5
SHELVES	54 87.1	8 12.9
CASHIERS SHELVES	17 100
PACKAGING	43 95.6	2 4.4
MEAT DELICATESSEN	28 96.6	1 3.4
WAREHOUSE	7 100
REFUND DESK	12 100
OTHER	8 100

TAB. 11.29 – Eye symptoms

SYMPTOMS	N.	%
SENSATION OF DRYNESS IN THE EYES	4	1.6
BURNING EYES	39	15.3
WATERING EYES	22	8.6
PHOTOPHOBIA	18	7.1
EYE FATIGUE	68	26.7
SEEING DOUBLE	2	0.8
HEADACHE	21	8.23

TAB. 11.30 - Distribution of burning eyes by job activity

	ASS.	PRES.
JOBS	N. %	N. %
OTHER	147 88.6	19 11.4
CASHIERS	55 79.7	14 20.3
CASH REG./SHELVES	12 66.7	6 33.3

TAB. 11.31 - Distribution of watering eyes by job activity

	ASS.	PRES.
JOBS	N. %	N. %
OTHER	157 94.6	9 5.4
CASHIERS	59 85.5	10 14.5
CASH REG./SHELVES	15 83.3	3 16.7

TAB. 11.32 - Distribution eye fatigue by job activity

	ASS.	PRES.
JOBS	N. %	N. %
OTHER	136 81.9	30 18.1
CASHIERS	38 55.1	31 44.9
CASH REG./SHELVES	11 61.1	7 38.9

TAB. 11.33 - Distribution of headache by job activity

	ASS.	PRES.
JOBS	N. %	N. %
OTHER	158 95.2	8 4.8
CASHIERS	58 84.1	11 15.9
CASH REG./SHELVES	16 88.9	2 11.1

Tab. 11.34 - Persons with pathologies of the rachis involving limitations of job activity

	ALL			MALES		FEMALES
		N.	%	N.	%		N.	%
NO COUNTERINDICATIONS		231	88.8	108	90.8		123	87.2
PERMANENT COUNTERINDICATIONS - LIGHT WEIGHTS CAN BE LIFTED OCCASIONALLY		8	3.1	3	2.5		5	3.5
PERMANENT COUNTERINDICATIONS - LIGHT WEIGHTS CAN BE LIFTED AT SLOW RATE		9	3.5	3	2.5		6	4.3
TEMPORARY COUNTERINDICATIONS		12	4.6	5	4.2		7	5.0
TOTAL		260		119			141

Tab. 11.35 - Persons with pathologies in the upper limbs involving limitations of job activity

	ALL				MALES		FEMALES
		N.	%	N.		%		N.	%
NO COUNTERINDICATIONS		249	95.8	117		98.3		132	93.6
PERMANENT COUNTERINDICATIONS		7	2.7	2		1.7		6	4.3
TEMPORARY COUNTERINDICATIONS		4	1.5	1		0.8		3	2.1

Tab. 11.36 - Programme of health monitoring for SUPERMARKET workers

WORK UNDERTAKEN	CHECKUP ON ENGAGEMENT	PERIODICAL 3-YEARLY CHECKUPS
CASHIER	* GENERAL MEDICAL CHECKUP * CLINICAL AND FUNCTIONAL EVALUATION OF UPPER LIMBS	* GENERAL MEDICAL CHECKUP WITH FOCUS ON: - EYES - SKIN * CLINICAL AND FUNCTIONAL EVALUATION OF THE: - RACHIS - UPPER LIMBS
EMPLOYEES AT SHELVES	* GENERAL MEDICAL CHECKUP * CLINICAL AND FUNCTIONAL EVALUATION OF THE: - RACHIS - UPPER LIMBS	* GENERAL MEDICAL CHECKUP WITH FOCUS ON: - EYES - SKIN * CLINICAL AND FUNCTIONAL EVALUATION OF THE: - RACHIS - UPPER LIMBS
MEAT DEPT.	* GENERAL MEDICAL CHECKUP * CLINICAL AND FUNCTIONAL EVALUATION OF THE: - RACHIS - UPPER LIMBS * E.C.G. * EXAM FOR TREATMENT OF FOOD INFECTIONS	* GENERAL MEDICAL CHECKUP WITH FOCUS ON: CARDIOVASCULAR SYSTEM * CLINICAL AND FUNCTIONAL EVALUATION OF THE: - RACHIS - UPPER LIMBS
- EMPLOYEES IN THE DELICATESSEN - EMPLOYEES IN PACKAGING	* GENERAL MEDICAL CHECKUP * CLINICAL AND FUNCTIONAL EVALUATION OF THE UPPER LIMBS * TESTS FOR TREATMENT OF ALIMENTARY INFECTIONS	* GENERAL MEDICAL CHECKUP * CLINICAL AND FUNCTIONAL EVALUATION OF THE: - RACHIS - UPPER LIMBS
EMPLOYEES IN LOADING AND UNLOADING, SORTING OF MERCHANDISE AND WAREHOUSE	* GENERAL MEDICAL CHECKUP * CLINICAL AND FUNCTIONAL EVALUATION OF THE: - RACHIS - UPPER LIMBS * E.C.G	* GENERAL MEDICAL CHECKUP WITH FOCUS ON: CARDIOVASCULAR SYSTEM * CLINICAL AND FUNCTIONAL EVALUATION OF THE: - RACHIS - UPPER LIMBS

Tab. 11.37 – Specific symptoms and pathologies requiring specialised examination by occupational physician outside the 3-year period.

UPPER LIMBS	CONTINUOUS JOINT PAINS AND/OR MUSCLE PAINS; FREQUENT NIGHTTIME PARESTHESIS IN FINGERS PERSISTING CERVICAL-BRACHIAL PAIN
RACHIS LUMBROSACRAL	PERSISTING LUMBO-SCIATIC NEURALGIA ACUTE LUMBAGO
SKIN	APPEARANCE OF SYMPTOMS ON UNCOVERED AREAS
CARDIO-CIRCULATORY SYSTEM (ONLY WORKERS IN MEAT DEPT. AND EMPLOYEES IN LOADING AND UNLOADING)	CARDIO-CIRCULATORY SYMPTOMS
OTHER SYMPTOMS CONNECTED TO JOB ACTIVITY	FOR EXAMPLE: - VIOLENT SNEEZING (NON-SEASONAL) OR ASTHMA ATTACKS ETC. DURING WORK SHIFT - PATHOLOGIES THAT CAN BE AGGRAVATED BY THE TASKS UNDERTAKEN OR BE INCOMPATIBLE WITH THEM

ACCIDENTS

The data shown in this chapter are the result of a study conducted by some Health Protection Units at workplaces in Milan through the systematic interpretation of company accident registers which, pursuant to Article 403 of Pres. Decree 547 of 1955, as amended by Art. 4 of Leg. Decree 626/94, are required to keep updated at their plant.

This study was conducted in order to verify the occurrence and the seriousness of accidents in a sector thus far little studies, identifying the most important types of accident in order to formulate adequate prevention plans, and to assess the applicability of a methodology for the systematic interpretation of the accident registers already used by other authors in sectors other than supermarkets (Di Credico et al., Arduini et al.).

This method has proved easy to apply and also usable in situations with few resources available, as in most local services for prevention at workplaces.

The study is based on the analysis of the information contained in the accident registers of 34 food supermarkets located in the Municipality of Milan, employing a total of approximately 1,300 employees/year, for a total of 644 accidents occurring over a 5-year period ('86-'90 for 25 supermarkets; '87-'91 for the other 9). The few accidents recorded with consequence of a duration less than 3 days were not considered; their registration was not systematic, since it was not required by the law in force at the time.

For the calculation of rates of frequency and seriousness, the following statistical indexes are applied:

a) Index of frequency (IF): this is the ratio between the number of accidents and hours worked in un year

number accidents

IF = ----------------------- x 1.000.0000

number hours worked

b) Index of seriousness (IG): this is the ratio between the number of days of absence due to the accident and hours worked in a year

number days absence

IG = ------------------------- x 1000

number hours worked

c) Average duration (Min. Decree): this is the arithmetical average of working days lost for each accident

number days absence

Min. Decree = -----------------------

number accidents

Furthermore, the work for each accident occurred is identified and the type of event, in order to classify it according to the pair "type of work – type of event".

Table 1 shows the values of the indexes calculated on the basis of all the accidents allowed in the study in the period of observation.

No statistically significant ratios were observed between the various indexes in the various years taken into consideration.

Figure 2 shows a graph with all the indexes of frequency of some sectors for 1989 (Ortolani) compared with the index of frequency of the same year shown in the sample of this study.

This comparison highlights a frequency of accidents in the 34 supermarkets slightly less than that of the food sector, which is one of the sectors with the highest frequency rate, after sectors known to involve serious accidents, such as construction and wood processing.

Every accident was thus identified according to the pair "type of work - type of event".

There are 221 potential pairs (17 types of work x 13 types of event); in the situations examined all the accidents are described by 58 pairs.

The pairs describing only one accident and those characterised by insufficient information, were excluded by the subsequent analysis focusing on 34 pairs, describing 587 accidents (91% of the total). The pairs similar for type of work and type of event (for example cutting bread, cutting cheese/ contact with knife blade) were further grouped, so that the 34 pairs were classified in 18 types (see table 3).

On the basis of these types, 95% of the 587 accidents taken into consideration were divided into two major classes: the accidents connected with the cutting operations the merchandise and accidents connected with handling; the remaining 5% of the accidents occurred during the cleaning of premises or during the closing of various doors (safes, lockers, refrigerators) (Figure 4).

The types of accident connected with cutting of the merchandise account for 46% of the total of accidents occurring in the 5-year period considered.

Most of the accidents occurred in the operations of manual cutting, with a knife, of the meat and of other foods (types A, B, C). These types account for 157 accidents, i.e. 27% of the total; in general these are not very serious accidents, with injuries from minor cutting mainly of the hands.

The use of slicers in the delicatessen section and of machines for the bone cutting and the preparation of food in the meat department (types D, E, F) involved 47 accidents, i.e. 8% of the total, some of which are particularly serious.

Various accidents (35, i.e. 6% of the total) refer to injuries from cutting during the cleaning of slicers and of knives (type G).

Finally 30 accidents, i.e. 5% of the total are represented by cutting of hands during the opening of cardboard boxes of merchandise with the cardboard cutter.

In the operations of handling, storage, loading and unloading of merchandise and related activities there were 290 accidents, i.e. 50% of the total.

The accidents classified in this group show a higher average duration with respect to those connected with the cutting of the merchandise; the longer absence is due to the different type of injuries recorded, above contusion and in some cases bone fractures.

During the handling of merchandise, the types of event are: merchandise falling onto the workers (type M: 56 accidents, i.e. 10%), unusual effort or movement (type P: 24 accidents, i.e. 7%), contact with cutting material, hitting against furniture and fittings, crushing, slipping (types I, N, Q, OR).

One particular case of accidents belonging to this group is the unhooking of sides of beef, with traumatic injuries to the worker. This occurs due to the lack of securing systems on transport trolleys.

A total of 12% of accidents took place due to hitting, slipping and falling on flat areas during normal transit in the sections and going up and down stairs between different areas of supermarkets (types S,T).

In some cases there were risks of burning due to the presence of machines for packaging products with high temperature plates without thermostats.

This study shows a significant risk of accidents by frequency.

The pairing of the type of work and event for every accident involved the grouping of all the accidents occurring in a 5-year period for a few types.

Analysing the types in which there is the use of simple manual tools, we can hypothesise that many accidents are due to the inadequate use of personal protection devices:

- During the cutting of the meat in the meat section they do not always wear a glove made of cutting-proof material on the hand holding the piece of meat;

- During the boning operations, workers should wear not only gloves but also cut-proof aprons;

- Suitable gloves should also be work during other cutting operations products, for example in the cleaning of vegetables or the opening of cardboard containers with the cardboard cutter.

With regard to accidents occurring during the use of machines, more serious with respect to the previous ones, we can observe that the worse offenders are slicers and machines for bone cutting.

Another aspect emerging in the accident registers is the high number of events due to hitting against various furniture and fittings. This indicates an inadequate arrangement of equipment and fittings and/or a lack of space, a factor common to many supermarkets of the city of Milan due to the difficulties in obtaining large and suitable areas in previously existing structures and the high costs of these areas.

The numerous accidents from falling probably indicate slippery floors and transit routes not properly marked.

The following contribute to the occurrence of accidents:

a) Problems related to traffic and the flow of merchandise (location of different premises and work zones, the volume of the merchandise handled, the means used to handle the merchandise, width of passages, irregular and slippery ground, holes)

b) Poor lighting (except for the area used for sales, the lighting is often insufficient; sometimes the lights are not properly shielded, leading to dazzling)

Some types of accidents, for example injuries from effort during the lifting of merchandise, there is probably the lack adequate lifting equipment for the workers.

The chapters on the various work phases provide suggestions on the safety requirements of some machines and equipment that most often cause accidents, and personal protection devices.

Also with regard to the structural requirements and the means for the handling of loads, see the chapters concerned.

References

L. Arduini, F. Brunetti, E. Pavanello, G. Pianosi, P. Porta, V. Valioni: "Analisi del fenomeno infortunistico in fonderie di ghisa e acciaio di seconda fusione"; in atti Convegno su aspetti emergenti dei rischi e della pathologia nel settore of the metalmeccanica leggera e delle fonderie di seconda fusione, Poggibonsi 15-17 October 1986.

L. Della Torre, F. Limonta, F. Valsecchi: "Analisi del fenomeno infortunistico in un salumificio"; La Medicina del lavoro 1988, 79: 4: 303-311.

N. Di Credico, F. Merluzzi, A. Grieco: " Proposta per un metodo di raccolta, di elaborazione e controllo dei dati relativi al fenomeno infortunistico in fabbrica. "; Assessorato alla Sanità della Regione Lombardia-Clinica del lavoro " L. Devoto ", University of Milan, 1980.

G. Ortolani: "Incidenti sul lavoro nelle costruzioni"; in atti del 2^ Convegno Nazionale sicurezza in edilizia - SNOP, Vicenza 24 October 1991.

M. Rocher, J.M. Vacheret, B. Vandevyver: "Enquete preliminaire sur les risques d'accidents dans les Hypermarches et supermarches"; Cahiers des notes documentaires 125, 4, 1986.

USL 16 Modena - Usl 19 Vignola Servizi di Medicina Preventiva e Igiene occupazionale "Gli incidenti nella lavorazione carni" Quaderno N. 35 - 1990 Regione Emilia-Romagna.

	Period '86-'90	1986	1987	1988	1989	1990	1991
Frequency index (IF)	52.0	46.4	52.3	59.1	47.9	50.9	54.7
Seriousness index (IG)	0.8	0.6	0.8	0.8	0.8	0.7	0.8
Average duration days	15	13	14	13	18	14	15
Number supermarkets		22	31	31	34	34	34
Hours worked	12,378,447	1,440,913	2,523,027	2,383,106	2,543,331	2,630,147	857,923
Total days of temporary invalidity	9,425	881	1,899	1,840	2,135	1,935	722
Number accidents	644	67	132	141	122	134	47

Table 1 Statistical indexes of accidents occurring in the period '86-'91 in 34 food supermarkets

table 3- types of accident in 34 food supermarkets

i - types related to the cutting of merchandise: meat, salami, other food and auxiliary processing: cleaning of equipment
work/procedure		number of accidents		average duration
a - Manual cutting of meat/contact with knife blade		72		11
b – Boning of ham and meat/contact with knife blade		35		13
c - Cutting of salami, fish, cheese, vegetables, bread/contact with knife blade		50		13
d - Use of slicer for salami and meat/contact with cutting blade		36		9
e – Use of machine for bone cutting /contact with blade		8		13
f - Preparation of food/contact with machines		3		38
g – Cleaning sharp work tools/contact with blades		35		12
h – Opening boxes of merchandise/contact with cardboard cutter blade		30		9
total type i		269		14
ii - types connected with the handling of merchandise for storage, shifting, unloading and loading, placing on shelves and related activities
i - Handling merchandise/contact with cutting material	27		15
l - Handling merchandise/hit by various equipment	29		10
m - Handling merchandise/hit by merchandise	56		13
n - Handling merchandise/hitting against furniture and fittings	18		14
o - Handling merchandise/slipping	27		26
p - Handling merchandise/unusual effort or movement	44		15
q - Handling merchandise/crushing	12		29
r - Moving/contact with merchandise	8		11
s - Moving/hitting against furniture and fittings	12		23
t - Moving/slipping	57		20
u – Opening boxes merchandise/contact with cutting material	4		8
total type ii	290		16
iii - other types
v - Cleaning furniture and fittings/contact with cutting material	3		5
z – Closing doors/hitting against furniture and fittings	13		11
w - Preparation of food/hit by equipment	4		8
y – Cleaning/hitting against furniture and fittings/	4		10
total type iii	28		8
total general	587		14

campione = sample alimentari = food metalmeccanico = mechanical trasporti = transport services = services edilizia = construction legno = wood

Fig. 2 Comparison between the indexes of frequency in some production sectors and in the sample examined (1989)

taglio merce = cutting of products movimentazione merce = handling of goods altro = other

Fig. 4 Main types of accident in supermarkets

A particular case of accident belonging to this group is the unhooking of sides of beef, with traumatic injuries to workers. This occurs due to the lack of securing systems on the trolleys.

In some cases there were risks of burning due to the presence of machines for packaging products with high temperature plates without thermostats.

The following contribute to the occurrence of accidents:

a) Problems related to traffic and the flow of merchandise (location of different premises and work zones, the volume of the merchandise handled, the means used to handle the merchandise, width of passages, irregular and slippery ground, holes)

b) Poor lighting (except for the area used for sales, the lighting is often insufficient; sometimes the lights are not properly shielded, leading to dazzling).

5. FIRE PREVENTION

The “premises used for display and/or sale, wholesale or retail, with a gross area exceeding 400 sq. mt. including services and storage” are subject to the control of the Provincial Fire Department Headquarters (item 87 of D.M. 16/2/82).

This control consists in three phases in this order:

· Examination and approval of project

· Issue of the Fire Prevention Certificate

· Periodical visits for fire prevention

Without an approved project and the Fire Prevention Certificate, the business cannot be opened.

In recent years some regulations have been issued allowing provisional undertaking of business if there are declarations by the owner of the business, with attached certificates of compliance issued by authorised professionals, to confirm the application of the prevention measures required by the Provincial Fire Department Headquarters. These opportunities were provided by Law 818/84, allowing for the issue of a “Provisional Certificate of non-opposition”, and were repeated in Pres. Decree 37/98 allowing for the issue of a “Provisional authorisation to do business”.

For undertaking sales on premises with a gross area less than 400 sq. mt., though not included among the businesses subject to the direct control of the Provincial Fire Department Headquarters, the necessary measures of fire prevention must be adopted pursuant to Pres. Decree 547/55, Leg. Decree 626/94 and Min. Decree 10/3/98.

The main legislative references for fire prevention are:

· Pres. Decree 547/55 - Regulations for the prevention of accidents at the workplace.

· Pres. Decree 689/59 - Determination of enterprises and processes subject, for the purposes of the fire prevention, to advance examination and testing by the Fire Department Headquarters .

· Law 966/65 - Regulation of tariffs, payment procedures and payment of personnel of the National Fire Department for the services subject to payment.

· Circular N. 75 of 1967 - Criteria of fire prevention for department stores, emporia etc.

· Letter-Circular n.5210/4118/4 of 1975 - Clarifications regarding the application of the point 97 of the list attached to Interministry Decree N. 1973 of 27/9/65 – Partial amendments to Circular N. 75 of 3/7/67. (Note: the point 97 of Decree 1973/65 was replaced by point 87 of Ministry Decree 16/2/82).

· Pres. Decree 577/82 - Approval of the regulation concerning the undertaking of services of fire prevention and security.

· Min. Decree 16/2/82 - Amendments of Ministry Decree 27/9/65, concerning the determination of the activities subject to fire prevention visits. (Note: last list, still in force, of activities subject to checking by Fire Department Headquarters)

· Law 818/84 - Provisional Certificate of non-opposition for the activities subject to fire prevention checks.

· Leg. Decree 626/94 - Implementation of EEC Directive regarding the improvement of the safety and health of workers at the workplace.

· Pres. Decree 37/98 - Regulation with regulations on procedures for fire prevention.

· Min. Decree 10/3/98 - General criteria of fire safety and for emergency management at workplaces.

5.1. Assessment of the fire risk and classification of the risk level

Min. Decree 10/3/98, issued for implementation pursuant to Art. 13 of Leg. Decree 626/94, defines the procedures to follow for the assessment of the fire risk.

In particular, this involves classifying the level of fire risk (high, medium, low); it thus indicates all the preventive, protective and precautionary measures applied in order to reduce the risk of the outbreak of fire and to guarantee the protection of persons in case of fire.

Following the indications provided by the Annexe I of Ministry Decree 10/3/98 supermarkets can be classified as follows:

gross area < 400 sq.mt. - low fire risk

gross area > 400 sq.mt. - medium fire risk

gross area open to the public > 10,000 sq.mt. - high fire risk

The prevention and protection measures to be adopted are therefore different according to the classification shown above.

5.2. Preventive, protective and precautionary measures

1) Large stores cannot be located in buildings with height at eaves exceeding 31 metres and also containing hotels, clinics, school or premises for public entertainment. If there are other activities, the premises of the supermarket must have independent entrances, stairs and lifts and must be separated from premises with other use with structures resistant to fire.

2) There must be safety exits with an adequate number and size with respect to the maximum possible crowding, calculated on the gross area of the floor.

The calculation of maximum possible crowding must be made in relation to the characteristics of the supermarket:

	Basement floors & ground floor	Upper floors	offices/services
department stores and food supermarkets	0.4 pers./sq.mt.	0.2 pers./sq.mt.	0.1 pers./sq.mt.
hypermarkets and shopping centres		0.2 pers./sq.mt.	0.05 pers./sq.mt.
supermarkets and specialised firms	0.1 pers./sq.mt.	0.05 pers./sq.mt.	0.05 pers./sq.mt.
supermarkets for furniture and fittings	0.05 pers./sq.mt.	0.04 pers./sq.mt.	0.05 pers./sq.mt.

On the basis of maximum crowding, it is thus possible calculate the number and sizes of the exits with an outflow capacity of every module and the maximum length of exit routes.

For places with medium or low fire risk the overall width of safety exits must not be less than:

number maximum of persons present

width (metres) = -------------------------------------------------- x 0.60

50

rounded to the next highest whole number.

The minimum width must not be less than m. 0.80 for the places with low fire risk, and non less than m. 1.20 for the places with medium fire risk.

In the case of places classified with high fire risk, the outflow capacity (maximum number of persons who can go out through an exit of one module) varies according to the location of the floor concerned (ground floor, basement floors, upper floors).

3) The safety exits must open onto “safe places”.

4) The safety exits must be located in such a way as to be reachable with paths not exceeding:

15 - 30 metres, for areas a fire risk high

30 - 45 metres, for areas a fire risk medium

45 - 60 metres, for areas a fire risk low

5) The safety exits and exit routes must be clearly marked and equipped with emergency lighting.

6) The width of stairs must not be less than the width of the emergency exits, when the stairs serve only one floor. In the case of stairs servicing several floors their width must be proportional to maximum crowding provided for the two most crowded contiguous floors.

7) The storerooms and warehouses for merchandise must be separated from sales premises with structures resistant to fire.

8) There must be a system for fire detection and alarm.

9) Fire extinguishing equipment and plant must be installed in relation to the classes of fire, the risk level and sizes of the complex. In large places, and, in general, in areas with high fire risk there must be also be fixed type extinguishing systems with automatic triggering.

10) The results of checking and maintenance of fire fighting plant and equipment must be shown in specific registers.

11) The owner of the business must draw up an emergency plan containing the organisational and management measures to implement in case of fire.

12) The owner of the business must appoint the workers in charged of the implementation of the measures for fire prevention, fire fighting and emergency management. The workers appointed must attend a specific training course.

1. SECTOR: SUPERMARKETS

2. WORK PHASE: ARRIVAL AND UNLOADING OF GOODS

3. INAIL CODE: 130

4. RISK FACTOR:

SAFETY RISKS DUE TO STRUCTURES, EQUIPMENT, TOOLS AND MACHINES;

HEALTH AND ENVIRONMENTAL RISKS DUE TO PHYSICAL AND CHEMICAL AGENTS

INDIRECT OR ORGANISATIONAL RISKS DUE TO THE ORGANISATION OF WORK AND ERGONOMIC FACTORS

5. RISK CODE

6. N. EMPLOYEES: 600

Chapter 1 – “The work phase”

The merchandise arrives on trucks and is unloaded by supermarket employees who also work in other phases of the work cycle.

According to the structure and the sizes of the supermarkets the unloading operation can take place using a metallic lift platform (in some cases moved manually), on which the loading trolleys are placed, or if the platform is unavailable, using transpallets and forklifts.

The unloading and transport of meat, except for the few stores where it is put directly into refrigerators, takes place together with other goods and refrigerator reached going through the warehouse; the meat is hung on hooks attached to metallic guides secured to the ceiling and run manually.

Chapter 2 – “Equipment and machines”

· Forklifts

· Electric transpallets

· Manual transpallets

· Mobile platform

· Hoist and track

· Roll trainers

All the equipment in use, except for the platforms, manual transpallets and roll trainers, is subject to Pres. Decree 459/94 (Machines Directive). Therefore equipment purchased after 21/9/96 must be in compliance with the essential safety requirements set forth in Annexe I of the above-mentioned rule.

This compliance must be shown by the CE mark and declaration of compliance.

Equipment in use and in particular manual equipment generally shows maintenance drawbacks.

Chapter 3 – “The risk factor”

Safety risks due to the characteristics of the work areas, the organisation of the work and the characteristics of the equipment, tools and machines used:

· Risks of merchandise falling onto the workers (one particular case of accidents belonging to this group is the unhooking of sides of beef, with traumatic injuries to the worker)

· Risks of improper movements or excessive physical effort

· Risks of contact with cutting material

· Risks of hitting against furniture and fittings

· Risks of falling due to slipping

· Risks of falling from above (from the platform or vehicles)

· Fire risk

Health-environmental risks due to physical and chemical agents:

· Risks from physical agents due to exposure to poor microclimatic and climatic conditions

· Risks from inhaling of exhaust gas of trucks

Indirect or organisational risks due to the characteristics of the work activity and of the organisation of the work:

· Risks related to the manual handling of loads

· Risks related to the insufficiency of space with inadequate routes and difficulty in handling of the merchandise

· Risks from biomechanical overloading of upper limbs

For the estimate of safety risks see the general chapter on accident trends. The specific analysis of safety risks was not made in this phase since workers employed in the unloading of goods also intervene directly in other phases of the work cycle (storage in the warehouse, preparation of meat, preparation of fruit and vegetables, sales personnel, preparation of shelves).

The analysis of accidents was made using the accident registers of 34 supermarkets, from 1986 to 1990.

For the description of the fire risk see the attached report on “Fire prevention”.

The risks linked to poor microclimatic conditions are essentially due to the fact that the unloading of the merchandise takes place near platforms or in premises not protected from climatic factors, exposing the workers in winter to lower temperatures and in summer to higher temperatures than the limits allowed for thermal wellbeing.

The extent of these risks is hard to quantify, being in relation to weather changes, geographical areas and the structural characteristics of the areas (unloading in the open, premises with or without air conditioning).

The chemical risks are related to the emission of exhaust gas of trucks generally equipped with diesel engines.

The exhaust gas typical of a diesel engine contains carbon monoxide (CO) with concentrations of about 0.1% and hydrocarbons (HC) (about 700 ppm) deriving from uncombusted fuel or products of partial oxidation.

There may be sulphur dioxide due to the combustion of organic compounds of sulphur present in diesel fuel. The exhaust gas of a diesel engine can contain up to 0.5 gr/cu.mt. of particulate that becomes very visible as black smoke.

The temperature of combustion in engines is sufficiently high to cause the formation of nitrogen oxides (Nox); up to 4000 ppm of nitrogen oxides may be present in exhaust gas.

The characteristic and unpleasant odour of diesel engines is due to the presence of oxygenated compounds (aldehydes, acrolene etc.) products of partial oxidation of some fractions of fuel.

Estimate of the risks from handling loads

The structural features and the location of urban supermarkets, generally lacking large areas for private use and large premises for initial storage of the merchandise, and situated near roads with heavy traffic, are elements increasing the need for manual handling. There is often no platform for unloading and the incoming pallets of merchandise are brought into the store using manual transpallets with the help of special ground adaptation platforms that are positioned and removed at every arrival of merchandise in order to avoid permanently blocking traffic.

The operations with risks include the actions of manual lifting and the pulling of loads.

For the assessment of the risks from lifting of loads the NIOSH formula was used.

With regard to pulling, reference was made to the limits proposed by “The Ergonomics Group – Health and Environment Laboratories – Eastman Kodak Company”: 22.5 Kg at the start of the pulling, 18 Kg during the course, 36 Kg at stopping; the comparison with the tables of SNOOK and CIRIELLO (1991) also appears useful.

The main operations involving risks, identified in the work phase being examined, are as follows:

- Positioning ramp or platform

- Pulling of pallets with manual transpallets

- Shifting of roll-trainers, with wheels, by pushing

In this work phase the actions of pulling and pushing often involve changing levels and/or irregularity of various types of floors: ramps and/or access platforms in the store, passing in lifts to go to the basement floor etc. The important general elements in the assessment of the risk in actions of pulling and pushing, in all the work phases, consist of: conditions of maintenance of the roll-trainer wheels, often proving very poor, types of routes to follow, depending not only on the length but also how windy they are, often involving much manoeuvring because of narrow spaces.

Risks from lifting: assessment according to the NIOSH

Positioning of the ramp: metallic structure weighting about 120 Kg. lifted by two workers (60 Kg./each).

Applying the formula we obtain the recommended maximum weight (PR)= 6.6Kg (I.R. of 18!)

Positioning of the platform: metallic structure weighting about 70 Kg. Carried by two persons (35 Kg./each).

Applying the formula we obtain the recommended maximum weight (PR) =7.33 Kg. (I.R.= 9)

Risks from pulling: from the assessments made and comparison with the reference values the following emerged:

- Pulling of roll-trainers designed to be pushed: transit of the trolley with about 100 Kg. on the ramp with an angle of 8°.

The force measured with the dynamometer was about 20-25 Kg. (starting).

I.R. > 1

Estimate of risks due to the insufficiency of space

Often the zones for unloading merchandise lack a net separation between the areas used for temporary storage and those used for the passages of vehicles and workers; this results in narrow spaces with difficulties in the handling of merchandise.

Estimate of the risks from mechanical overloading of upper limbs

The presence of loads with inadequate or missing handles causes difficulty in grasping by the workers employed in the unloading of merchandise, with consequent overloading of the structures of the hand.

Chapter 4 – “Expected harm”

· Contusions, sprains, fractures, injuries from cutting, piercing and lacero-contusion, crushing.

· Hypothetical harm from physical and chemical agents.

· Pathologies of the muscle-skeletal system, with particular reference to the rachis and the upper limbs, from the manual handling of loads and from biomechanical overloading.

Report on harm ascertained

Accident trends are described in the chapter already quoted with reference to the entire work sector.

Although there are no specific data in literature we can hypothesise the possible occurrence of pathologies of the upper and lower respiratory tract and the osteo-arthro-muscular system due to exposure to poor microclimatic and climatic conditions and/or exhaust gas of trucks.

With regard to harm deriving from the manual handling of loads and the mechanical overloading of upper limbs see the chapter “Health monitoring”.

The data shown there refer to the entire group of workers in supermarkets and include all the phases of the work cycle; these cannot be broken down since the same workers can rotate in the various phases on a variable basis. The workers assigned permanently to one phase, in the sample taken into consideration in our surveys, formed an overly small number to allow statistical and epidemiological analysis.

Psychological drawbacks deriving from the organisation of work and in particular from monotonous and repetitive activities was not assessed during our surveys.

Chapter 5 – “Intervention”

The prevention of safety risks of workers must have various operational phases affecting the overall organisation of “storage in the warehouse” and in particular:

· Storage in the warehouse of merchandise according to its weight and shape

· Formation of pallets of adequate height

· Adequate aids for the handling of merchandise

· Adequately indicated routes with differentiation for persons and means

· Sufficient space for the handling of the merchandise

· Suitable PPD (gloves, footwear) and information and training of personnel on their use

In the case of the unloading of merchandise, it is indispensable to have adequate loading bays and levelling platforms where the trucks can easily park; in these cases blocking devices should be installed.

It should be recalled that packages do not have adequate means for holding will easily slip from the hands and, above all the heaviest ones, can be a cause of serious accidents to the lower limbs (crushing of fingers etc.). The use of safety shoes for this type of activity is hard to make the workers accept, since they prefer to wear comfortable and light shoes. In any case, should the remaining risk not be completely eliminable, suitable protective shoes shall be provided, as well as control over the real use of these PPD. The best solution would be to modify the packaging systems of merchandise currently adopted to facilitate the holding of the load.

Very often pallets are stored in the warehouse in piles; this is inadequate and dangerous.

The warehouse must be equipped with suitable shelves so that every pallet can be placed adequately on specific shelves.

It is advisable to use the lowest shelves to place pallets with the merchandise requiring manual piking, with upper levels for the pallets to be taken whole.

For the handling of pallets on high levels, the use of the electric forklift with a cabin that can be lifted, together with the forks, to the level of the pallet, is safe and easy. The visibility of the operator will always be excellent in every work phase.

Meat, once unloaded from the trucks, is stored in refrigerators. In the most modern ones, the hook system used to hang the sides of beef is controlled electrically. The tracks must be equipped with systems preventing the detaching of the hooks.

Improvement of microclimatic conditions

Sometimes the unloading bay for trucks is located along a perimeter wall of the warehouse. In these cases in order to prevent a high volume of indoor air from escaping during unloading operations, with worsening of the microclimate, canvas sheets are used to close the sides of the opening.

In the case of unloading outdoors, in winter, the workers must be provided with suitable PPD (jackets) to defend them from poor weather conditions.

Reduction of risks from vehicle emissions

Some behavioural regulations contribute to reducing the emission of trucks in arrival; keep the engine on for the time minimum indispensable, without useless acceleration.

Then there are structural and technical measures required to further reduce the concentrations of pollutants.

The environment characteristics of incoming vehicles are also important with sufficient space to favour adequate ventilation and easier manoeuvres. In some cases it may be necessary to use aspiration tubes to convey unloading area fumes outside the roof of the building.

Recently, a certain improvement of exhaust gas emissions has occurred thanks to catalytic devices on trucks.

Reduction of the risks from the manual pulling of loads

In order to reduce the physical effort in operations of manual pulling the following is required:

* The surface of the floor must be smooth and without irregularities;

* The use of wheels with adequate diameter: generally, the greater the diameter, the less the force required;

* Periodical maintenance of wheels (both bearings and outer coating). The preparation of periodical planning of maintenance is advisable;

* If manual trolleys are used, the weight pulled should not exceed 230 Kg. The maximum distance of the route is 16 m. for the three-wheel trolleys, and 33 m four-wheel trolleys;

* If manual transpallets are used, the weight pulled should not exceed 680 Kg. The maximum recommended distance is of 33 m.

* No exceeding of the upper limits of the horizontal force necessary to start up (22.5 Kg), maintain (18 Kg), and stop (36 Kg) a manual trolley.

It is necessary to plan the procedures for storage in warehouses for the prevention of harm to the locomotion capacity of workers, and for safety problems.

With regard to the first point, the full pallets just unloaded from trucks should be placed not on the ground but preferably on specific shelves at a height of 60-65 cm from ground level (above knee height).

It is advisable to request suppliers not to stack merchandise on pallets at a height exceeding 70-80 cm; this will allow the worker, once the pallet has been placed at above knee height, to remove the highest packages at a height less than that of the shoulders (135-140 cm). If the worker is allowed to lift of the load within these two heights (min. 65, max 135), useless and harmful bending the trunk can be avoided, allowing for the lifting of loads with weight exceeding 5-6 Kg. allowed by the NIOSH if the load is lifted in an improper position.

The delivery pallets on which the packages are loaded must have height regulation. This will allow the workers not only to take the package, but also to put it down keeping their backs substantially straight.

When the packages are lifted from the storage area to place them on the pallet, avoid turning the trunk only (twisting), but making the movement using the lower limbs.

In order to avoid shifting the load by turning 180°, the transpallet can be placed in such a way that the worker turns 90° only.

With regard to the unit weights of packages, these should not exceed 20-25 Kg.

The packages having a size or shape not allowing for easy handling (e.g. sacks) must always be lifted (especially for weight exceeding 20 Kg.) by two workers.

In general the maximum measures recommended for a container are 51 cm long, 36 cm deep and 15 cm high.

Increasing the sizes, the weight they contain must be reduced.

In general the lifting and transfer of loads with a weight less than 10 Kg. require only some simple design and organisational measures: frequent handling of weights of 20-25 Kg. can be allowed only when there is suitable ergonomic design of the workplace (absence of bending-twisting of the trunk, weight very near to the body, very low speed). It is therefore advisable to ask supplies for merchandise in packages with unit weights possibly equal to or less than 10 Kg.

Reduction of risks due to the insufficiency of space

The areas equipped for the unloading of merchandise, where temporary storage also takes place, must have their own space well distinguished from traffic and pedestrian routes, so that there is sufficient space for the easy handling of loads.

Reduction of risks from mechanical overloading of upper limbs

The continuous grasping of objects and/or the transport of loads with handles having unsuitable sizes can be harmful for the structure of the hand. It could be useful, although not a complete solution, to implement the following suggestions:

* Avoid carrying for distances over a few metres, weights (equipped with handles) over 10 Kg. with one hand only, and for longer distances use trolleys;

* Transport of weights equipped with very narrow handles can be harmful for the structure of the hand. Handles of cans should be equipped adequately at the time of manufacturing;

* It could be useful to provide the workers with gloves having a protective layer in the palm, to be used when lifting objects with handles with an overly small diameter; however, it must first be ascertained that this solution does not reduce the effectiveness of the hold;

* For the transport of cases (e.g. fruit crates), these should also be provided with suitable handles;

* Grasping with the palm facing downwards (e.g. cans without handles) is dangerous if used often. It is a strain on the structures of the hand because the strain is almost exclusively on the small inner muscles of the fingers. Using this type of lifting, in order not to fatigue the structures of the hand, there should be no repeated varying of objects weighing over 1/2 Kg. (from Ergonomic Design for people at work -Chap. 20 - Vol. 2- Eastman Kodak Company).

It is therefore preferable to:

- Pull the object as close as possible to the packaging place, without lifting it;

- If it has handles, use them to lift it;

- If it does not have handles, lift it as far as is possible with both hands.

Chapter 6 – “Contracting to outside firms”

In the sample of enterprises examined by us, all the work of this phase is conducted by dependent employees of the supermarket, with various types of contract (part-time, limited term etc.), without the use of external contracting.

Chapter 7 – “Legislative references”

· Pres. Decree 547/55 – Regulations for the prevention of accidents at the workplace

· Pres. Decree 303/56 – General regulations for occupational health

· Leg. Decree. 277/91 – Implementation of Directives N. 80/1107/EEC, N. 82/605/EEC, N. 83/477/EEC, N. 86/188/EEC and N. 88/642/EEC, regarding protection of the workers against risks deriving from exposure to chemical, physical and biological agents during work, pursuant to Art 7 of Law 30 July 1990 N. 212

· Leg. Decree. 626/94 and subsequent amendments, to implement Directives N. 89/391/EEC, N. 89/654/EEC, N. 89/655/EEC, N. 89/656/EEC, N. 90/269/EEC, N. 90/270/EEC, N. 90/394/EEC and N. 90/679/EEC regarding the improvement of the safety and health of workers at the workplace

· Leg. Decree. 475/92 – Implementation of the Directive N. 89/686/EEC of the Council of 21/12/1989, regarding the harmonisation of legislation of Member States regarding personal protection devices

· Pres. Decree 459/96 – Regulation for the implementation of Directives N.89/392/EEC, N. 91/368/EEC, N. 93/44/EEC and 93//68/EEC concerning the harmonisation of legislation of Member States regarding machines

· Leg. Decree 155/97 – Implementation of Directives 93/43/EEC and 96/3/EEC concerning hygiene in food products

· Leg. Decree. 156/97 – Implementation of Directive 93/99/EEC concerning supplementary measures for the official control of food products

· Municipal regulations on health and building

Regulations of good practice and guidelines

· Guidelines of application of Leg. Decree 626/94 by the Co-ordination of Regions and Autonomous Provinces- October 1996

· NIOSH “Work practices guide for manual lifting”, NIOSH technical report, N. 81-122 U.S., 1981

1. SECTOR: SUPERMARKETS

2. WORK PHASE: STORAGE IN THE WAREHOUSE

3. INAIL CODE: 130

4. RISK FACTOR:

SAFETY RISKS DUE TO STRUCTURES, EQUIPMENT, TOOLS AND MACHINES;

HEALTH AND ENVIRONMENTAL RISKS DUE TO PHYSICAL AGENTS

INDIRECT OR ORGANISATIONAL RISKS DUE TO THE ORGANISATION OF WORK AND ERGONOMIC FACTORS

5. RISK CODE

6. N. EMPLOYEES: 600

Chapter 1 – “The work phase”

The merchandise unloaded is sorted, carried and stored in the departments or areas of the supermarket:

- Areas for the preparation for sale (meat display, delicatessen preparation, final toasting of bakery products, pre-packaging of fruit and vegetable products)

- Refrigerators (perishable merchandise)

- Warehouse (non-perishable merchandise)

The merchandise for immediate resale is left in the area for incoming goods, in order to rapidly replace products finished at the point of sale.

Packaged products (canned goods, bottles, milk etc.) are partly place in the warehouse and partly put directly on sale.

Frozen products and fish in vacuum packs, if the supermarket does not have a suitable freezer, are immediately placed in the freezers for frozen goods in the sales area.

Other perishable goods go directly to the refrigerators (meat, fruit and vegetables).

Chapter 2 – “Equipment and machines”

· Forklifts

· Electric transpallets

· Manual transpallets

· Hoist and track

· Roll trainer

· Manual cutters for removing packaging

· Cardboard press

All the equipment in use, except for platforms, manual transpallets and roll trainers, is subject to Pres. Decree 459/94 (Machines Directive). Therefore the equipment purchased after 21/9/96 must be in compliance with the essential safety requirements stated in Annexe I of the above-mentioned law.

This compliance must be shown by the CE mark and declaration of compliance.

Equipment in use and in particular manual equipment generally show poor maintenance.

Chapter 3 – “The risk factor”

Safety risks due to the characteristics of the work areas, the organisation of the work and the characteristics of the equipment, tools and machines used:

· Risks of merchandise falling onto the workers (One particular case of accidents belonging to this group is the unhooking of sides of beef, with traumatic injuries to the worker. This occurs due to the lack of securing systems on transport trolleys)

· Risks of improper movements or excessive physical effort

· Risks of contact with cutting material

· Risks of hitting against furniture and fittings

· Risks of falling due to slipping

· Risks of cutting of hands due to the use of cutters

· Risks of falling from above in the phases of storage in the warehouse in the higher levels of shelves

· Risks from crushing and cutting due to contact with moving parts of machines and equipment

· Electric risks due to contact with electrically powered equipment

· Fire risk

Health and environmental risks due to physical agents:

· Risks from physical agents due to exposure to poor microclimatic and climatic conditions.

Indirect or organisational risks due to the characteristics of the work activity and of the organisation of the work:

· Risks related to the manual handling of loads

· Risks related to the insufficiency of space with inadequate routes and difficulty in handling of the merchandise

· Risks from biomechanical overloading of upper limbs

For the estimate of safety risks see the general chapter on accident trends. The specific analysis of safety risks was not made in this phase since workers in the warehouse also intervene directly in other phases of the work cycle (unloading of goods, preparation of meat, preparation of fruit and vegetables, sales personnel, preparation of shelves).

The analysis of accidents was made using the accident registers of 34 supermarkets, from 1986 to 1990.

For the description of the fire risk see the attached report on “Fire prevention”.

The risks related to poor microclimatic conditions derive from the fact that all supermarkets have air conditioning plant which is indispensable not just to guarantee comfortable microclimatic conditions for the clients, but also due to the characteristics of the buildings used by supermarkets (very large premises without normal ventilation and lighting). The risks for health of workers are related to the malfunctioning of plant due to inadequate design and/or maintenance. The situations most often occurring are as follows:

- Underdimensioning of the plant with respect to the number of persons present, with an insufficient change of air;

- Outside air inlets too far from the aspiration device with significant loss of volume;

- Wrong positioning of the outside air intake grille (near sources of pollution) with contamination of the air in the work environment

- Imbalances in the distribution of the air through le the inlets or the anemostats, created by zones with low temperature due to the display of frozen or fresh food and the aspiration from specific departments such as roast food department and the distribution of fresh fish.

- Poor maintenance and cleaning of plant with possible inlet of chemical and/or biological pollutants. It should be recalled that poor cleaning of plant can favour the proliferation of micro-organisms in the humidifiers.

Estimate of the risks from handling of loads

The temporary storage of the non-perishable merchandise (drinks, various canned goods etc. ) and their subsequent transfer to the sale area may involve the need to completely remove the merchandise form the incoming pallets and roll-trainers, make new trolleys available and then unload more pallets to supply the sales areas. The reasons for this procedure are the limitations on the space available and the fact that the central merchandise warehouses do not send pallets arranged by contents, but rather on a casual basis taking into account weight and volume, with the need to unpack the pallets to choose the goods required immediately.

The usual operations during this work phase are as follows:

- Pulling of incoming pallets with manual transpallets

- Removal of canned goods from pallets

- Removal of cardboard boxes from pallets

- Removal of packages with water bottles from pallets

- Pulling on the masonry ramp of pallets with manual transpallets.

- Pulling on the masonry ramp of roll-trainers with mineral water

- Pulling on the metallic ramp of pallets with manual transpallets

- Positioning of perishable goods in refrigerators

- Attachment of sides of beef to the hooks on their chains.

It should be pointed out that the operations of pulling up masonry ramps are necessary due to limited space often not corresponding to need, also on the structural level. General elements important in the assessment of the risks from pulling and pushing trolleys in all the work phases are as follows: conditions of maintenance of the wheels of roll-trainers, often found to be very poor, the types of routes to follow, not only in relation to lengths, but also on how winding the routes are, which often requires much manoeuvring due to lack of space.

Risks from lifting: assessment according to the NIOSH

- Removal of canned goods from pallets: this takes place from an initial position ranging from a minimum of 15 cm up to 195 cm from floor level with repositioning on mechanical trolleys or manual trolleys with the bottom being 20 - 50 cm from floor level and with an angular dislocation of 90°.

The weight of the canned goods ranges between 7 - 20 Kg. with box due to the general lack of holding points or handles.

Applying the formula we obtain recommended maximum weights (PR) of about 1 Kg. (IR>3)

- Removal of cardboard boxes from pallets: this takes place from the initial position ranging from a minimum of 30 cm up to 150 cm from floor level with repositioning on mechanical trolleys or manual trolleys with the bottom being 20 - 50 cm from floor level, with angular dislocation of 180° and with frequencies exceeding 15 lifts per minute.

The weight of the cardboard ranging from a few kilos up to 20 Kg. with boxes that are not the best and without holding points or handles.

Applying the formula current work is shown to be unsuitable due to the high frequency of actions/min. since the rate of lifting exceeds 12-15 times per minute.

- Removal from pallets of packages water bottles: this takes place from an initial position ranging from a minimum of 47 cm up to 110 cm from floor level, with repositioning on the trolley with shelves between 20 cm and 155 cm, angular dislocation of 90° and rates higher than 15 lifts per minute.

The weight of containers ranges from 9 to 12 Kg. with good packaging and without holding points or handles.

Applying the formula the work is shown to be unsuitable due to the high rate of acts/min.

- Hooking quarters of beef: the carcass weighing 70-100 Kg is hung on the hook of the pulling chain, with attachment at a height of about 150 cm above floor level.

In all the operations of lifting analysed here, the recommended NIOSH limits are far exceeded. This is due mainly to the position of lifting with bent back, the twisting of the trunk and fast rates. Therefore the lumbar column and the scapula-humerus system is especially at risk.

Risks from pulling

In the operations of pulling incoming pallets on manual transpallets, the greatest effort by the workers consists in "holding back" the load along a ramp and in preventing the various packages, excessively loaded on the pallet, from falling. From the assessments made and the comparison with the reference limits, the following emerged:

- Pulling on masonry ramp with manual transpallet: the force measured with the dynamometer for the shifting of a pallet by manual transpallet of the weight of about 700 Kg. was 38 Kg. (arm 86 cm, slope at pulling 42°).

The horizontal component is = 38.2 Kg. (recommended limit 22.5 Kg). IR>1

The vertical component is = 25 Kg.

- Pulling on masonry ramp of mineral water trolley designed for pushing, about 500 Kg, in transit on the 3° ramp: the force measured with the dynamometer was 25-30 Kg (starting) with peaks of 40 Kg for the realignment of the wheels. Recommended limit: 22.5 Kg (IR>1)

- Pulling on the metallic ramp of manual transpallet: the force measured with the dynamometer due to shifting on a manual transpallet of a pallet weighing about 500 Kg was 40 Kg. (arm 78 cm, slope at pulling 35°).

The horizontal component is = 32.7 Kg. (recommended limit 22.5 Kg.) IR >1

The vertical component is = 22.9 Kg.

- Positioning the perishable goods in refrigerators: This involves the positioning in refrigerators of fruit and vegetables, by the pulling and pushing of manual transpallets and the positioning of meat and fish, in cases of various weight, and sometimes also put on pallets with the related operations of pulling or pushing, and eventually the partial removal from pallets in the refrigerator, or through the hooking of the sides of beef to the chain.

All the values of force of pulling measured are higher than the recommended limits; this involves high risk due to the locomotion system of the workers (back, upper limbs).

Estimate of risks due to the insufficiency of space

Often in storage areas in the warehouse there is no distinct separation between the areas dedicated to storage and those for the passage of vehicles and employees; this leads to limited space with difficulties in the handling of merchandise.

Estimate of the risks from mechanical overloading of upper limbs

The presence of loads with inadequate handles or without handles leads to difficulty in grasping by the workers employed in the unloading of merchandise with consequent overloading of the structures of the hand.

Chapter 4 – “Expected harm”

· Contusions, sprains, fractures, injuries from cutting, piercing and lacero-contusion, crushing, shock and burns from electricity.

· Hypothetical harm due to poor microclimatic conditions.

· Pathologies of the muscle-skeletal system, with particular reference to the rachis the upper limbs, from the manual handling of loads and from biomechanical overloading.

Report on harm ascertained

Accident trends are described in the chapter already quoted with reference to the entire work sector.

Although there are no specific data in literature we can hypothesise the possible occurrence of pathologies of the upper and lower respiratory tract and the osteo-arthro-muscular system due to exposure to poor microclimatic conditions.

With regard to harm deriving from the manual handling of loads and mechanical overloading of upper limbs see the chapter “Health monitoring”.

The data shown there refer to the entire group of workers in supermarkets and include all the phases of the work cycle; these cannot be broken down since the same workers can rotate in the various phases on a variable basis. The workers assigned permanently to one phase, in the sample taken into consideration in our surveys, formed an overly small number to allow statistical and epidemiological analysis.

Psychological drawbacks deriving from the organisation of work and in particular from monotonous and repetitive activities were not assessed during our surveys.

Chapter 5 – “Intervention”

The prevention of safety risks of the workers involves various operational phases affecting the overall organisation of “storage in the warehouse” and in particular:

· Storage in the warehouse of merchandise according to thief weight and shape

· Preparation of pallets of adequate height

· Adequate aids for the handling of merchandise

· Routes adequately marked and distinguished for persons and vehicles

· Sufficient space for the handling of the merchandise

· Suitable PPD (gloves, footwear) and information and training of personnel on their use

It should be recalled that packaging materials do not have adequate means of grasping, easily slipping from the hands and, above all the heavier ones that can cause serious accidents to the lower limbs (crushing of fingers, etc.). The use of safety shoes for this type of activity is hard to make the workers accept, since they prefer to wear comfortable and light shoes. In any case, should the remaining risk not be completely eliminable, suitable protective shoes shall be provided, as well as control over the real use of these PPD. The best solution would be to modify the packaging systems of merchandise currently adopted to facilitate the holding of the load.

It has been observed that pallets are more or less regularly stacked up in the warehouse; this is inadequate and dangerous.

The warehouse must be equipped with suitable shelves so that every pallet can be adequately placed on suitable shelves.

It is advisable to use the lowest shelves for the pallets with the merchandise requiring manual piking, and higher levels for the pallets to be taken whole.

For the handling of pallets on high levels, the use of the electric forklift with a cabin that can be lifted, together with the forks, to the level of the pallet, is safe and easy. The visibility of the operator will always be excellent in every work phase.

Cardboard pressing machines are used in this department and are generally equipped with all safety devices necessary for preventing injury to the hands or other parts of the body by moving parts.

Improvement of microclimatic conditions

The adequate design and maintenance of air conditioning plant is essential to guarantee a proper temperature for the workers. Some of the measures deemed necessary are described below.

Primary air and air inlets:

*The inlet of primary air must at least guarantee a volume of 30 cu.mt./hour per person, considering the maximum estimated crowding. This rate must be verified under normal operating conditions of the plant.

*The number of air changes (volumes of rooms/hour) can be low, although in any case there should be at least 1-2 air changes/hour.

*The air inlets must be positioned in areas far from sources of pollutants, at a height of at least mt. 6 from road levels where there is vehicle traffic.

*The filters installed must guarantee high efficiency in order to prevent the accumulation of small particles in the conduits. It is likewise advisable to verify that the areas where the filters are located are airtight in order to avoid the direct passage of the air into the distribution zone.

*During checking of the plant, sight inspection inside the conduits may involve, in different cases, the need to request extraordinary internal cleaning.

*In case of plant failure, normal activity on the premises must be prohibited.

-Temperature and velocity of the air:

*The temperature in the work zones must comply with the limits recommended for thermal comfort (PMV and PPD indexes) in relation to energy outlays and the thermal resistance of clothing. The relative humidity must be between 40 and 60%

*There must not be temperature differences of the air in the various areas, either horizontally or vertically (it should be recalled that the ISO standard 7730 indicates the value of 3°C as the maximum range of air temperature variation in the vertical direction).

*The radiating temperature must also be homogeneous in the various directions (the aforesaid ISO standard states that the variation of the radiating temperature caused by the presence of windows or of other cold vertical services must be less than 10°C).

*The velocity of the air in the workplaces must be less than the value of 0.15 m/sec.

*The laminar flows on the access zones must prevent the formation of air currents with considerable temperature differences with respect to environment air and the presence of significant positive or negative radiation.

-Pollutants:

*Checking must be conducted to verify the presence of fibrous insulation materials in the conduits. In case of presence of this material the inside of the conduits must be cleaned and overhauled.

*The humidification basins must be periodically emptied and cleaned. It does not seem sufficient just to adopt particular products added to the water, which have the function of preventing the proliferation of bacteria and/or fungi.

*The plant must be subjected to periodical cleaning and maintenance. Furthermore, the replacement of filters and the cleaning of outside air inlet grilles must take place regularly.

Reduction of the risks from the manual pulling of loads

In order to reduce the physical effort in operations of manual pulling the following is required:

* The surface of the floor must be smooth and without irregularities;

* The use of wheels with adequate diameter: generally, the greater the diameter, the less the force required;

* Periodical maintenance of wheels (both bearings and outer coating). The preparation of periodical planning of maintenance is advisable;

* If manual trolleys are used, the weight pulled should not exceed 230 Kg. The maximum distance of the route is 16 m. for the three-wheel trolleys, and 33 m four-wheel trolleys;

* If manual transpallets are used, the weight pulled should not exceed 680 Kg. The maximum recommended distance is of 33 m.

* No exceeding of the upper limits of the horizontal force necessary to start up (22.5 Kg), maintain (18 Kg), and stop (36 Kg) a manual trolley.

It is necessary to plan the procedures for storage in warehouses for the prevention of harm to the locomotion capacity of workers, and for safety problems.

With regard to the first point, the full pallets just unloaded from trucks should be placed not on the ground but preferably on specific shelves at a height of 60-65 cm from ground level (above knee height).

It is advisable to request suppliers not to stack merchandise on pallets at a height exceeding 70-80 cm; this will allow the worker, once the pallet has been placed at above knee height, to remove the highest packages at a height less than that of the shoulders (135-140 cm). If the worker is allowed to lift of the load within these two heights (min. 65, max 135), useless and harmful bending the trunk can be avoided, allowing for the lifting of loads with weight exceeding 5-6 Kg. allowed by the NIOSH if the load is lifted in an improper position.

The delivery pallets on which the packages are loaded must have height regulation. This will allow the workers not only to take the package, but also to put it down keeping their backs substantially straight.

When the packages are lifted from the storage area to place them on the pallet, avoid turning the trunk only (twisting), but making the movement using the lower limbs.

In order to avoid shifting the load by turning 180°, the transpallet can be placed in such a way that the worker turns 90° only.

With regard to the unit weights of packages, these should not exceed 20-25 Kg.

The packages having a size or shape not allowing for easy handling (e.g. sacks) must always be lifted (especially for weight exceeding 20 Kg.) by two workers.

In general the maximum measures recommended for a container are 51 cm long, 36 cm deep and 15 cm high.

Increasing the sizes, the weight they contain must be reduced.

In general the lifting and transfer of loads with a weight less than 10 Kg. require only some simple design and organisational measures: frequent handling of weights of 20-25 Kg. can be allowed only when there is suitable ergonomic design of the workplace (absence of bending-twisting of the trunk, weight very near to the body, very low speed). It is therefore advisable to ask supplies for merchandise in packages with unit weights possibly equal to or less than 10 Kg.

Reduction of risks due to the insufficiency of space

The areas equipped for the unloading of merchandise, where temporary storage also takes place, must have their own space well distinguished from traffic and pedestrian routes, so that there is sufficient space for the easy handling of loads.

Reduction of risks from mechanical overloading of upper limbs

The continuous grasping of objects and/or the transport of loads with handles having unsuitable sizes can be harmful for the structure of the hand. It could be useful, although not a complete solution, to implement the following suggestions:

* Avoid carrying for distances over a few metres, weights (equipped with handles) over 10 Kg. with one hand only, and for longer distances use trolleys;

* Transport of weights equipped with very narrow handles can be harmful for the structure of the hand. Handles of cans should be equipped adequately at the time of manufacturing;

* it could be useful to provide the workers with gloves having a protective layer in the palm, to be used when lifting objects with handles with an overly small diameter; however, it must first be ascertained that this solution does not reduce the effectiveness of the hold;

* For the transport of cases (e.g. fruit crates), these should also be provided with suitable handles;

* Grasping with the palm facing downwards (e.g. cans without handles) is dangerous if used often. It is a strain on the structures of the hand because the strain is almost exclusively on the small inner muscles of the fingers. Using this type of lifting, in order not to fatigue the structures of the hand, there should be no repeated varying of objects weighing over 1/2 Kg. (from Ergonomic Design for people at work -Chap. 20 - Vol. 2- Eastman Kodak Company).

It is therefore preferable to:

- Pull the object as close as possible to the packaging place, without lifting it;

- If it has handles, use them to lift it;

- If it does not have handles, lift it as far as is possible with both hands.

Chapter 6 – “Contracting to outside firms”

In the sample of enterprises examined by us, all the work of this phase is conducted by dependent employees of the supermarket, with various types of contract (part-time, limited term etc.), without the use of external contracting.

Chapter 7 – “Legislative references”

· Pres. Decree 547/55 – Regulations for the prevention of accidents at the workplace

· Pres. Decree 303/56 – General regulations for occupational health

· Leg. Decree. 277/91 – Implementation of Directives N. 80/1107/EEC, N. 82/605/EEC, N. 83/477/EEC, N. 86/188/EEC and N. 88/642/EEC, regarding protection of the workers against risks deriving from exposure to chemical, physical and biological agents during work, pursuant to Art 7 of Law 30 July 1990 N. 212

· Leg. Decree. 626/94 and subsequent amendments, to implement Directives N. 89/391/EEC, N. 89/654/EEC, N. 89/655/EEC, N. 89/656/EEC, N. 90/269/EEC, N. 90/270/EEC, N. 90/394/EEC and N. 90/679/EEC regarding the improvement of the safety and health of workers at the workplace

· Leg. Decree. 475/92 – Implementation of the Directive N. 89/686/EEC of the Council of 21/12/1989, regarding the harmonisation of legislation of Member States regarding personal protection devices

· Pres. Decree 459/96 – Regulation due to the implementation of Directives N.89/392/EEC, N. 91/368/EEC, N. 93/44/EEC and 93//68/EEC concerning the harmonisation of legislation of Member States regarding machines

· Leg. Decree 155/97 – Implementation of Directives 93/43/EEC and 96/3/EEC concerning hygiene in food products

· Leg. Decree. 156/97 – Implementation of Directive 93/99/EEC concerning supplementary measures for the official control of food products

· Municipal regulations on health and building

Regulations of good practice and guidelines

· Guidelines of application of Leg. Decree 626/94 by the Co-ordination of Regions and Autonomous Provinces- October 1996

· NIOSH “Work practices guide for manual lifting”, NIOSH technical report, N. 81-122 U.S., 1981

1. SECTOR: SUPERMARKETS

2. WORK PHASE: PREPARATION OF SHELVES

3. INAIL CODE: 130

4. RISK FACTOR:

SAFETY RISKS DUE TO STRUCTURES, EQUIPMENT, TOOLS AND MACHINES;

HEALTH AND ENVIRONMENTAL RISKS DUE TO PHYSICAL AGENTS

INDIRECT OR ORGANISATIONAL RISKS DUE TO THE ORGANISATION OF WORK AND ERGONOMIC FACTORS

5. RISK CODE

6. N. EMPLOYEES: 600

Chapter 1 – “The work phase”

The merchandise from the various departments (meat, fruit and vegetables, bakery, fish), is brought from the warehouse and the unloading area to the sales area using transpallets and roll trainers. The merchandise is arranged on the pallets according to the criteria of weight and type. Sometimes there is preliminary removal from pallets and at others the pallets already arranged are used.

Chapter 2 – “Equipment and machines”

· Electric transpallets

· Manual transpallets

· Roll trainers

· Manual cutters for removing packaging

· Ladders

All the equipment in use, except for platforms, manual transpallets and roll trainers, is subject to Pres. Decree 459/94 (Machines Directive). Therefore the equipment purchased after 21/9/96 must be in compliance with the essential safety requirements stated in Annexe I of the above-mentioned law.

This compliance must be shown by the CE mark and declaration of compliance.

Equipment in use and in particular manual equipment generally show poor maintenance

Chapter 3 – “The risk factor”

Safety risks due to the characteristics of the work areas, the organisation of the work and the characteristics of the equipment, tools and machines used:

· Risks of merchandise falling onto the workers

· Risks of improper movements or excessive physical effort

· Risks of contact with cutting material

· Risks of hitting against furniture and fittings

· Risks of falling due to slipping

· Risks of cutting of hands due to the use of cutters

· Risks of falling from ladders during the positioning of the merchandise on upper shelves

· Fire risk

Health and environmental risks due to physical agents:

- Risks from physical agents due to exposure to poor microclimatic conditions

- Risks related to the inadequacy of the lighting system;

Indirect or organisational risks due to the characteristics of the work activity and of the organisation of the work:

· Risks related to the manual handling of loads

· Risks related to ergonomic factors due to repetitive movements of upper limbs

For the estimate of safety risks see the general chapter on accident trends. The specific analysis of safety risks was not made in this phase since workers in the preparation of shelves also intervene directly in other phases of the work cycle (unloading of goods, storage in the warehouse, preparation of meat, preparation of fruit and vegetables, sales personnel).

The analysis of accidents was made using the accident registers of 34 supermarkets, from 1986 to 1990.

For the description of the fire risk see the attached report on “Fire prevention”.

The risks related to poor microclimatic conditions derive from the fact that all supermarkets have air conditioning plant which is indispensable not just to guarantee comfortable microclimatic conditions for the clients, but also due to the characteristics of the buildings used by supermarkets (very large premises without normal ventilation and lighting). The risks for health of workers are related to the malfunctioning of plant due to inadequate design and/or maintenance. The situations most often occurring are as follows:

- Underdimensioning of the plant with respect to the number of persons present, with an insufficient change of air

- External air inlets too far from the aspiration device with significant loss of volume

- Wrong positioning of the outside air intake grille (near sources of pollution) with contamination of the air in the work environment

- Imbalances in the distribution of the air through the inlets or anemostats, created by zones with low temperature due to the display of frozen or fresh food and the aspiration from specific departments such as roast food department and the distribution of fresh fish.

- Poor maintenance and cleaning of plant with possible inlet of chemical and/or biological pollutants. It should be recalled that poor cleaning of plant can favour the proliferation of micro-organisms in the humidifiers.

The risks related to the inadequacy of the lighting system are due to a poor lighting design, with consequent presence of over-lighted and under-lighted areas. In general, this situation is due to the fact that the lighting is designed in order to attract attention to the products on sale, without taking into account the needs of the workers.

Estimate of the risks from handling of loads

During this work phase the individual weight of the packages handled is in general lower compared to the other phases (arrival and unloading, storage in the warehouse, preparation of meat, preparation of fruit and vegetables), since the cardboard boxes containing more than one package of product are often opened on the incoming trolley, and the single packages are placed on the shelf.

A significant element of postural risk of this phase is reaching far, above all to higher shelves, requiring workers to perform continuous movements of extreme bending and hyperextension of the trunk.

The risks from repetitive movements of upper limbs are related to the repetition of the same movements, always involving the same groups of muscles, in particular during the packaging operations.

The constant grasping of objects and/or the transport of loads with unsuitable handles can be harmful for the joints and muscle-tendon structures of the upper limbs.

The inadequacy of the handles, requiring concentration of effort on the smallest muscle groups, undoubtedly contributes to increasing the risk to the joints and muscle-tendon structures.

The extent of the risk relevant in this work phase depends on the frequency of the movements, the effort applied and the overall duration of the operations involving repetitive movements.

Chapter 4 – “Expected harm”

· Contusions, sprains, fractures, injuries from cutting, piercing and lacero-contusion, crushing.

· Hypothetical harm due to poor microclimatic conditions and inadequate lighting.

· Pathologies of the muscle-skeletal system, with particular reference to the rachis, from the manual handling of loads.

· Tendonitis, tenosynovitis, scapula-humerus periarthritis (Duplay syndrome), carpal tunnel syndrome from repetitive movements.

Report on harm ascertained

Accident trends are described in the chapter already quoted with reference to the entire work sector.

Although there are no specific data in literature we can hypothesise the possible occurrence of pathologies of the upper and lower respiratory tract and the osteo-arthro-muscular system due to exposure to poor microclimatic conditions.

Poor lighting can cause asthenopia syndrome in employees.

With regard to harm deriving from the manual handling of loads and repetitive movements of upper limbs see the chapter “Health monitoring”.

The data shown there refer to the entire group of workers in supermarkets and include all the phases of the work cycle; these cannot be broken down since the same workers can rotate in the various phases on a variable basis. The workers assigned permanently to one phase, in the sample taken into consideration in our surveys, formed an overly small number to allow statistical and epidemiological analysis.

Psychological drawbacks deriving from the organisation of work and in particular from monotonous and repetitive activities were not assessed during our surveys.

Chapter 5 – “Intervention”

The prevention of safety risks of the workers involves various intervention regarding equipment, the environment and the organisation of the work.

The workers must be equipped with adequate aids for the handling of merchandise, routes must be adequately marked and distinguished for persons and vehicles, space must be sufficient for the handling of the merchandise.

Suitable PPD (gloves, footwear) must be available, and the personnel must be informed and trained on their use.

It should be recalled that packaging does not have adequate means of grasping, easily slipping from the hands and, above all the heavier ones that can cause serious accidents to the lower limbs (crushing of fingers etc.). The use of safety shoes for this type of activity is hard to make the workers accept, since they prefer to wear comfortable and light shoes. In any case, should the remaining risk not be completely eliminable, suitable protective shoes shall be provided, as well as control over the real use of these PPD. The best solution would be to modify the packaging systems of merchandise currently adopted to facilitate the holding of the load, and thus reduce the risk of harm to the osteoarticular system.

Improvement of microclimatic conditions

The adequate design and maintenance of air conditioning plant is essential to guarantee a proper temperature for the workers. Some measures considered necessary are described below.

Primary air and air inlets:

*The inlet of primary air must at least guarantee a volume of 30 cu.mt./hour per person, considering the maximum estimated crowding. This rate must be verified under normal operating conditions of the plant.

*The number of air changes (volumes of rooms/hour) can be low, although in any case there should be at least 1-2 air changes/hour.

*The air inlets must be positioned in areas far from sources of pollutants, at a height of at least mt. 6 from road levels where there is vehicle traffic.

*The filters installed must guarantee high efficiency in order to prevent the accumulation of small particles in the conduits. It is likewise advisable to verify that the areas where the filters are located are airtight in order to avoid the direct passage of the air into the distribution zone.

*During checking of the plant, sight inspection inside the conduits may involve, in different cases, the need to request extraordinary internal cleaning.

*In case of plant failure, normal activity on the premises must be prohibited.

-Temperature and velocity of the air:

*The temperature in the work zones must comply with the limits recommended for thermal comfort (PMV and PPD indexes) in relation to energy outlays and the thermal resistance of clothing. The relative humidity must be between 40 and 60 %

*There must not be temperature differences of the air in the various areas, either horizontally or vertically (it should be recalled that the ISO standard 7730 indicates the value of 3°C as the maximum range of air temperature variation in the vertical direction).

*The radiating temperature must also be homogeneous in the various directions (the aforesaid ISO standard states that the variation of the radiating temperature caused by the presence of windows or of other cold vertical services must be less than 10°C).

*The velocity of the air in the workplaces must be less than the value of 0.15 m/sec.

*The laminar flows on the access zones must prevent the formation of air currents with considerable temperature differences with respect to environment air and the presence of significant positive or negative radiation.

-Pollutants:

*Checking must be conducted to verify the presence of fibrous insulation materials in the conduits. In case of presence of this material the inside of the conduits must be cleaned and overhauled.

*The humidification basins must be periodically emptied and cleaned. It does not seem sufficient just to adopt particular products added to the water, which have the function of preventing the proliferation of bacteria and/or fungi.

*The plant must be subjected to periodical cleaning and maintenance. Furthermore, the replacement of filters and the cleaning of outside air inlet grilles must take place regularly.

Reduction of the risks from the manual pulling of loads

In order to reduce the physical effort in operations of manual pulling the following is required:

* The surface of the floor must be smooth and without irregularities;

* The composition of the outside coating must be rigid since the greater is the hardness, the less force is required;

* Wheels of adequate diameter must be used; generally, the greater the diameter, the less force is required;

* Periodical maintenance of the wheels ( both the bearings and the outer coating). The preparation of periodical planning of maintenance is advisable;

* If manual trolleys are used, the weight pulled should not exceed 230 Kg. The maximum distance of the route is 16 m. for the three-wheel trolleys, and 33 m four-wheel trolleys;

* If manual transpallets are used, the weight pulled should not exceed 680 Kg. The maximum recommended distance is of 33 m.

* No exceeding of the upper limits of the horizontal force necessary to start up (22.5 Kg), maintain (18 Kg), and stop (36 Kg) a manual trolley.

It is necessary to plan the procedures for storage in warehouses for the prevention of harm to the locomotion capacity of workers, and for safety problems.

With regard to the first point, the full pallets just unloaded from trucks should be placed not on the ground but preferably on specific shelves at a height of 60-65 cm from ground level (above knee height).

It is advisable to request suppliers not to stack merchandise on pallets at a height exceeding 70-80 cm; this will allow the worker, once the pallet has been placed at above knee height, to remove the highest packages at a height less than that of the shoulders (135-140 cm). If the worker is allowed to lift of the load within these two heights (min. 65, max 135), useless and harmful bending the trunk can be avoided, allowing for the lifting of loads with weight exceeding 5-6 Kg. allowed by the NIOSH if the load is lifted in an improper position.

The delivery pallets on which the packages are loaded must have height regulation. This will allow the workers not only to take the package, but also to put it down keeping their backs substantially straight.

When the packages are lifted from the storage area to place them on the pallet, avoid turning the trunk only (twisting), but making the movement using the lower limbs.

In order to avoid shifting the load by turning 180°, the transpallet can be placed in such a way that the worker turns 90° only.

With regard to the unit weights of packages, these should not exceed 20-25 Kg.

The packages having a size or shape not allowing for easy handling (e.g. sacks) must always be lifted (especially for weight exceeding 20 Kg.) by two workers.

In general the maximum measures recommended for a container are 51 cm long, 36 cm deep and 15 cm high.

Increasing the sizes, the weight they contain must be reduced.

In general the lifting and transfer of loads with a weight less than 10 Kg. require only some simple design and organisational measures: frequent handling of weights of 20-25 Kg. can be allowed only when there is suitable ergonomic design of the workplace (absence of bending-twisting of the trunk, weight very near to the body, very low speed). It is therefore advisable to ask supplies for merchandise in packages with unit weights possibly equal to or less than 10 Kg.

Reduction of risks from repetitive movements of upper limbs

The continuous grasping of objects and/or the transport of loads with handles having unsuitable sizes can be harmful for the structure of the hand. It could be useful, although not a complete solution, to implement the following suggestions:

* Avoid carrying for distances over a few metres, weights (equipped with handles) over 10 Kg. with one hand only, and for longer distances use trolleys;

* Transport of weights equipped with very narrow handles can be harmful for the structure of the hand. Handles of cans should be equipped adequately at the time of manufacturing;

* it could be useful to provide the workers with gloves having a protective layer in the palm, to be used when lifting objects with handles with an overly small diameter; however, it must first be ascertained that this solution does not reduce the effectiveness of the hold;

* For the transport of cases (e.g. fruit crates), these should also be provided with suitable handles;

* Grasping with the palm facing downwards (e.g. cans without handles) is dangerous if used often. It is a strain on the structures of the hand because the strain is almost exclusively on the small inner muscles of the fingers. Using this type of lifting, in order not to fatigue the structures of the hand, there should be no repeated varying of objects weighing over 1/2 Kg. (from Ergonomic Design for people at work -Chap. 20 - Vol. 2- Eastman Kodak Company).

It is therefore preferable to:

- Pull the object as close as possible to the packaging place, without lifting it;

- If it has handles, use them to lift it;

- If it does not have handles, lift it as far as is possible with both hands.

Chapter 6 – “Contracting to outside firms”

In the sample of enterprises examined by us, all the work of this phase is conducted by dependent employees of the supermarket, with various types of contract (part-time, limited term etc.), without the use of external contracting.

Chapter 7 – “Legislative references”

· Pres. Decree 547/55 – Regulations for the prevention of accidents at the workplace

· Pres. Decree 303/56 – General regulations for occupational health

· Leg. Decree. 277/91 – Implementation of Directives N. 80/1107/EEC, N. 82/605/EEC, N. 83/477/EEC, N. 86/188/EEC and N. 88/642/EEC, regarding protection of the workers against risks deriving from exposure to chemical, physical and biological agents during work, pursuant to Art 7 of Law 30 July 1990 N. 212

· Leg. Decree. 626/94 and subsequent amendments, to implement Directives N. 89/391/EEC, N. 89/654/EEC, N. 89/655/EEC, N. 89/656/EEC, N. 90/269/EEC, N. 90/270/EEC, N. 90/394/EEC and N. 90/679/EEC regarding the improvement of the safety and health of workers at the workplace

· Leg. Decree. 475/92 – Implementation of the Directive N. 89/686/EEC of the Council of 21/12/1989, regarding the harmonisation of legislation of Member States regarding personal protection devices

· Pres. Decree 459/96 – Regulation due to the implementation of Directives N.89/392/EEC, N. 91/368/EEC, N. 93/44/EEC and 93//68/EEC concerning the harmonisation of legislation of Member States regarding machines

· Leg. Decree 155/97 – Implementation of Directives 93/43/EEC and 96/3/EEC concerning hygiene in food products

· Leg. Decree. 156/97 – Implementation of Directive 93/99/EEC concerning supplementary measures for the official control of food products

· Municipal regulations on health and building

Regulations of good practice and guidelines

· Guidelines of application of Leg. Decree 626/94 by the Co-ordination of Regions and Autonomous Provinces- October 1996

· NIOSH “Work practices guide for manual lifting”, NIOSH technical report, N. 81-122 U.S., 1981

1. SECTOR: SUPERMARKETS

2. WORK PHASE: PREPARATION OF MEAT

3. INAIL CODE: 130

4. RISK FACTOR:

SAFETY RISKS DUE TO STRUCTURES, EQUIPMENT, TOOLS AND MACHINES;

HEALTH AND ENVIRONMENTAL RISKS DUE TO PHYSICAL AND CHEMICAL AGENTS

INDIRECT OR ORGANISATIONAL RISKS DUE TO THE ORGANISATION OF WORK AND ERGONOMIC FACTORS

5. RISK CODE

6. N. EMPLOYEES: 200

Chapter 1 – “The work phase”

The meat department is usually directly connected with the refrigerator and the sales area to allow easy loading of the sales counter. The employees remove sides of beef or other large pieces of meat from the refrigerators and place them on the processing counter. The meat is cut, processed, prepared in portions and pre-packaged, and then brought to the sales counters.

Chapter 2 – “Equipment and machines”

· Slicer

· Meat packager

· Fixed water cleaner

· Dishwasher

· Bone saw

· Knife steriliser

· Sharpener

· Steak cutter

· Cutlet cutter

· Meat grinder with mixer and lifter

· Table meat grinder

· Knives

· Hoist and track

All the equipment in use, except for platforms, manual transpallets and roll trainers, is subject to Pres. Decree 459/94 (Machines Directive). Therefore the equipment purchased after 21/9/96 must be in compliance with the essential safety requirements stated in Annexe I of the above-mentioned law.

This compliance must be shown by the CE mark and declaration of compliance.

Equipment in use and in particular manual equipment generally show poor maintenance.

Chapter 3 – “The risk factor”

Safety risks related to the type of equipment, tools and machines used:

· Risk of cutting of hands during the manual cutting of the meat, the use of machines (bone saw), the boning, the cleaning of tools or cutting machines

· Risk of burns on the machines for packaging the portions of meat due to contact with the high temperature plate

· Risks of merchandise falling onto the workers (One particular case of accidents belonging to this group is the unhooking of sides of beef, with traumatic injuries to the worker. This occurs due to the lack of securing systems on transport trolleys)

· Risks of improper movements or excessive physical effort

· Risks of hitting against furniture and fittings

· Risks of falling due to slipping

· Electric risks due to contact with electrically powered equipment

· Fire risk

Health and environmental risks due to physical and chemical agents:

- Risks from physical agents due to exposure to poor microclimatic conditions

- Risks due to the use of detergent and disinfectant substances for the cleaning of work counters and of the equipment

- Risks due to the possible presence of fumes produced by automatic packaging machines;

Indirect or organisational risks due to the characteristics of the work activity and of the organisation of the work:

· Risks related to the manual handling of loads

· Risks related to ergonomic factors due to repetitive movements of upper limbs

For the estimate of safety risks see the general chapter on accident trends. The specific analysis of safety risks was not made in this phase since workers in the preparation of meat also intervene directly in other phases of the work cycle (unloading of goods, storage in the warehouse, preparation of shelves).

The analysis of accidents was made using the accident registers of 34 supermarkets, from 1986 to 1990.

For the description of the fire risk see the attached report on “Fire prevention”.

Risks due to poor microclimatic conditions are related to the preparation of meat in premises kept at a maximum temperature of 12°C; furthermore the internal temperature of the meat must exceed of 7°C is handling operations last less than one hour and of 4°C if they exceed one hour (Pres. Decree 1/3/92 N. 277 implementation of the regulation implementing Directive 88/657 EEC).

In this department, temperatures of 12°C with relative humidity of 80% were observed, while the meat taken from the refrigerator has an internal temperature of 0°C. Furthermore workers often suffer from temperature changes when passing in the sales area (20°C) or in the refrigerators (0°C).

Risks due to the use of detergent and disinfectant substances can have some importance should the workers not use adequate personal protection devices (gloves).

Risks due to the presence of fumes from the automatic packaging machines are only potential, since at normal temperature operating temperatures the plastic film used (PVC, polyethylene) does not emit fumes. In any case, today these machines are generally equipped with local aspiration.

Estimate of the risks from handling of loads

The operations involving risks include both actions of manual lifting and the pulling of loads.

For the assessment of the risks from lifting of loads the NIOSH formula was used.

With regard to pulling, reference was made to the limits proposed by “The Ergonomics Group-Health and Environment Laboratories-Eastman Kodak Company”: 22.5 Kg at the start of the pulling, 18 Kg during the route, 36 Kg at stopping. A comparison with the tables of Snook and Ciriello (1991) also seems useful.

The following operations involving risks were analysed:

- Unhooking of carcass

- Hooking of boned carcass

- Lifting crates of meat for grinding

- Repositioning/removal from shelves of the refrigerator

Risks from lifting: assessment according to the NIOSH

- Unhooking of carcass

The carcass weighing 70-100 Kg, hung on a hook attached to the chain at 150 cm from floor level, is unhooked and moved to the work table 90 cm from floor level.

Applying the formula of the NIOSH we obtain a recommended maximum weight (PR)= 6 Kg, there being an angular dislocation 180° and poor holding potential. (IR: 11.6 – 16.6)

- Hooking of boned carcass

The boned carcass, weighing 50-70 Kg, is lifted from the work table 90 cm from floor level to the double hook 115 cm from floor level.

Applying the formula we obtain a recommended maximum weight (PR)=3.27 Kg, there being an angular dislocation 180°, a distance from the body of 64 cm and poor holding potential.

IR = 15.2 – 21.4

- Lifting crates of meat for grinding

The crates placed on a trolley a 25 cm from floor level, with weight ranging from 25 to 35 Kg, are lifted to the loading level of the meat grinder at 120 cm with a 90° rotation of the trunk.

Applying the formula we obtain a recommended maximum weight (PR)=5.5 Kg. IR>3

The second operation of grinding involves the lifting of the meat from 78 cm (output level of the first ground meat) to the loading level (120 cm) without angular dislocation.

Applying the formula we obtain a maximum recommended weight (PR) = 9.9 Kg. IR >1 or >3

- Removal of packages from shelves in refrigerators

The shelves attached to the ceiling require workers to place or remove packages, with a weight ranging from 1 to 3 Kg, under the most unfavourable conditions at a height of 2 metres.

Applying the formula the recommended weight is 8.9 Kg, since the boxes are of suitable shape.

All the weights lifted manually are shown to be much higher than the NIOSH limits.

The risk due to the locomotion apparatus of the workers employed in the operations described is therefore very high, both for acute and chronic events.

The risk from repetitive movements of upper limbs is connected with the repetition of similar movements, always involving the same groups of muscles, in particular in the cutting operations.

The extent of the risk is mainly determined by the frequency of the movements, the effort applied and the overall duration of the operations involving repetitive movements. The risk is in any case always significant in this work phase.

In the case, for example, of the cutting of semi-frozen meat, the effort required, taking into account a series of factors (possible positions of the wrist, use of gloves etc.), it is quite near to the maximum force possible. The repetition many times per minute, for several hours per shift, of this type of operation of cutting, could involve the appearance of fatigue or muscle pain in most of the women and in 50% of the men.

The inadequacy of the hilts of knives, concentrating the effort on the smallest groups of muscles, undoubtedly contributes to increasing the risk to the joints and muscle-tendon structures.

Chapter 4 – “Expected harm”

· Contusions, sprains, fractures, injuries from cutting, piercing and lacero-contusion, crushing, shock and burns from electricity, burns due to contact with the heating plate of the automatic packaging machine.

· Hypothetical harm from physical and chemical agents.

· Pathologies of the muscle-skeletal system, with particular reference to the rachis, from the manual handling of loads.

· Tendonitis, tenosynovitis, scapula-humerus periarthritis (Duplay syndrome), carpal tunnel syndrome due to repetitive movements.

Report on harm ascertained

Accident trends are described in the chapter already quoted with reference to the entire work sector.

Although there are no specific data in literature we can hypothesise the possible occurrence of pathologies of the upper and lower respiratory tract, the osteoarthromuscular system and the skin due to exposure to poor microclimatic conditions, to packaging machine fumes and to detergent and disinfectant substances. In particular, contact with detergent and disinfectants, i.e. irritating and/or allergy-producing substances, can trigger the appearance of eczema dermatitis in the employees.

Poor microclimatic conditions (cold, continuous changes of temperature) can favour the occurrence of diseases of:

- The respiratory tract (infections of the upper tract, chronic bronchitis);

- The osteo-articular system;

- The circulatory system (Raynaud syndrome).

With regard to harm deriving from the manual handling of loads and repetitive movements of upper limbs see the chapter “Health monitoring”.

The data shown there refer to the entire group of workers in supermarkets and include all the phases of the work cycle; these cannot be broken down since the same workers can rotate in the various phases on a variable basis. The workers assigned permanently to one phase, in the sample taken into consideration in our surveys, formed an overly small number to allow statistical and epidemiological analysis.

Psychological drawbacks deriving from the organisation of work and in particular from monotonous and repetitive activities were not assessed during our surveys.

Chapter 5 – “Intervention”

The prevention of safety risks of the workers involves various intervention regarding equipment, the environment and the organisation of the work.

The workers must be equipped with adequate aids for the handling of merchandise, routes must be adequately marked and distinguished for persons and vehicles, space must be sufficient for the handling of the merchandise.

Suitable PPD (gloves, footwear) must be available, and the personnel must be informed and trained on their use.

All the machines put on sale after 21/9/96 must comply with the essential safety requirements stated in Annexe I of Pres. Decree 459/96 (Regulation of implementation of the Machines Directive). Compliance with the aforesaid requirements is certified by the manufacturer through the CE mark on the machine or equipment and the required “declaration of compliance”. The manufacturer must furthermore provide a complete instruction manual with all the safety information necessary for a correct use of the machine.

The machines already present before 21/9/96 must be in compliance with the previously existing regulations with particular reference to Pres. Decree 547/55. In case of sale or purchase of machines already in use before 21/9/96, the seller must provide a certificate of compliance with previously existing regulations.

The meat, once unloaded from the trucks is stored in the refrigerators. In the more modern ones, the system of hooks to which the sides of meat are hung is controlled electrically. This mechanism favours the handling both inside the refrigerator and between the refrigerator and the meat preparation department. The tracks must be equipped with systems for preventing the detaching of hooks.

Slicer machines

Standard EN 1974 (a harmonised regulation since 1998) sets for the safety and hygiene requirements that the slicers must have.

It should be recalled that Pres. Decree 459/96 identifies the harmonised regulations as the technical instrument for ensuring safe machines; the respecting of the harmonised standard allows the declaration of compliance with the essential safety requirements of Annexe I.

The aforesaid harmonised standard is definitely also a point of reference for solutions to apply to machines manufactured before 21/9/96, in particular indicating the essential protection to apply (blade cover, protection for the hilt etc.) and their size characteristics.

Automatic packaging machine

1) Protection heating plate

2) Checking of the temperature of the plate (less than 80°C)

3) Use of means of protection such as thermal gloves.

In the case of automatic packaging machines, the speed of advancement of the plastic film should be reduced, in order to reduce the possibility of breakage or blocking of the running of the film, and thus avoid continuous interventions on the machine by personnel.

Bone saw machine

In general it is necessary to improve the protection of the blade and to adopt suitable “pushing” tools so that the butcher does not need to hold the piece with his hands.

For this machine, harmonisation is under way for a European standard that is still available as prEN (prEN 12268). Also this standard, like the one already quoted for the slicers, provides specific indications on the types of protection to provide and their size characteristics.

In the use of this machine, it is important to adopt adequate procedures, above all in the most dangerous operations such as, for example, the cutting of joints. In this specific case the isolated cutting of the joint should be avoided, and the bone should be cut lengthwise according to the following sequence:

a) Joints must never be sawed first and thus isolated from the bone;

b) Grasp the bone at the end opposite the joint to be cut and make a longitudinal cut in the neck of that bone;

c) Hold the bone at a sufficient distance from the saw blade and procede to cut the joint with the help of the pushing device;

d) Conduct the same operation at the other end of the bone.

In some supermarkets, in the meat department the number of accidents from cutting was reduced by purchasing the pieces of meat already prepared.

In this case, avoiding the preliminary phase of boning and cutting the large pieces, the butcher exclusively prepares the meat in smaller pieces using just metallic net gloves.

Various types of protective gloves are on the market, and are almost always considered by the workers to be very uncomfortable.

One type of glove involving the protection of just three fingers is considered slightly more comfortable by the butchers surveyed with respect to the other one which, though protecting the entire hand, limit movement and reducing holding capacity.

Improvement of microclimatic conditions

The adequate design and maintenance of air conditioning plant is essential to guarantee a proper temperature for the workers. Some measures considered necessary are described below.

Primary air and air inlets:

*The inlet of primary air must at least guarantee a volume of 30 cu.mt./hour per person, considering the maximum estimated crowding. This rate must be verified under normal operating conditions of the plant.

*The number of air changes (volumes of rooms/hour) can be low, although in any case there should be at least 1-2 air changes/hour.

*The air inlets must be positioned in areas far from sources of pollutants, at a height of at least mt. 6 from road levels where there is vehicle traffic.

*The filters installed must guarantee high efficiency in order to prevent the accumulation of small particles in the conduits. It is likewise advisable to verify that the areas where the filters are located are airtight in order to avoid the direct passage of the air into the distribution zone.

*During checking of the plant, sight inspection inside the conduits may involve, in different cases, the need to request extraordinary internal cleaning.

*In case of plant failure, normal activity on the premises must be prohibited.

-Temperature and velocity of the air:

*The temperature in the work zones must comply with the limits recommended for thermal comfort (PMV and PPD indexes) in relation to energy outlays and the thermal resistance of clothing. The relative humidity must be between 40 and 60 %

*There must not be temperature differences of the air in the various areas, either horizontally or vertically (it should be recalled that the ISO standard 7730 indicates the value of 3°C as the maximum range of air temperature variation in the vertical direction).

*The radiating temperature must also be homogeneous in the various directions (the aforesaid ISO standard states that the variation of the radiating temperature caused by the presence of windows or of other cold vertical services must be less than 10°C).

*The velocity of the air in the workplaces must be less than the value of 0.15 m/sec.

*The laminar flows on the access zones must prevent the formation of air currents with considerable temperature differences with respect to environment air and the presence of significant positive or negative radiation.

-Pollutants:

*Checking must be conducted to verify the presence of fibrous insulation materials in the conduits. In case of presence of this material the inside of the conduits must be cleaned and overhauled.

*The humidification basins must be periodically emptied and cleaned. It does not seem sufficient just to adopt particular products added to the water, which have the function of preventing the proliferation of bacteria and/or fungi.

*The plant must be subjected to periodical cleaning and maintenance. Furthermore, the replacement of filters and the cleaning of outside air inlet grilles must take place regularly.

The colder the room, the greater the dispersion of heat for personnel, and the more clothing is required to contrast this dispersion.

The insulating power of the clothing is radically modified by their rate of humidity.

The humidity can come both from outside water (dew or rain) and from condensation of the water vapour that emerges from the skin in the form of perspiration and from the breath.

It therefore follows that external clothing must allow perspiration in order to prevent the accumulation of humidity inside clothing due to perspiration.

If the work tasks assigned to workers require them to pass to and from cold and normal temperature areas, the workers must ensure that their clothes are not damp with perspiration.

If their clothes are damp, the workers must change into dry clothes before entering the cold area. The workers must change their socks and regularly replace show soles and/or use shoes providing protection against humidity.

The ideal frequency of replacement must be determined empirically and varies from one individual to another according to the type of shoes work and according to the rate of perspiration of the feet. Therefore, it is indispensable to have an area at normal temperature next to the meat preparation room to be used as a changing room.

Furthermore, the following protection is required:

- For the hands: in order to avoid direct contact of the skin with the metal, the workers can wear a cotton glove under the metallic net glove used for the protection of the hands from accidents;

- For the head.

The workers employed in operations in areas with low temperature must be provided with suitable personal protection devices and work must be organised in order to avoid the continuous exposure to temperature changes. It is therefore recommended that the operations at low temperatures be conducted on a continuous basis, without interruption, possible limiting the number of hours of this work.

During access to the refrigerator cell, the workers must wear suitable protective clothing. In the situations examined this procedure is not often followed since the workers tend to consider it a waste of time to put on protective clothing if the stay in the cold area does not last a significant amount of time.

For the transport of the meat to be cut or already prepared, transpallets or trolleys with adjustable height must be used.

With regard to the storage of the meat in the refrigerators the basic suggestion is that the weights, like those currently handled, require the adoption of mechanical aids in transport and during hooking. For this operation pneumatic hooks may be useful. The meat is delivered already cut in pieces weighing less than 20 - 25 Kg without particular aids.

Knives

In the choice of the type of knife to be used the following considerations apply.

a) The hilt of a professional knife must guarantee safe use; it must therefore have slip-proof coating. Measurements suited to the workers hands greatly contribute to improving safety conditions of holding, improving adherence and grasping of fingers on the hilt.

b) The hilts must have sizes suited to the various workers.

c) The knife must guarantee comfort. For the same type of work, the type of model adopted for specific operations, through variations of the shape of the hilt and the blade, will ensure reduction of muscular activity with consequent decrease of tendon strain and probably also of the specific pathologies.

From laboratory studies (EMG) aimed at the definition of which of the shapes described are most suited to ergonomic criteria, models B-B1-B2 (Fig. 1) show optimal requisites. It should be recalled that the material coating the hilt of the knife must be slip-proof and washable.

It should furthermore be recalled that measurements of hilt diameter less than 2.5 cm reduce the force developed by the grasping of the hand by 40%. It is thus important to use hilts with a diameter between 3 and 5 cm.

Also the use of gloves reduces pressing strength by about 20% with the use of kitchen-use rubber gloves and 26% with the use of heavy cotton garden-use gloves.

The presence during the work of slight turning of the wrist towards the thumb (radial side) or the little finger (ulnar side) further reduces the force of grasping by 25% and 40% respectively.

Taking into account these reductions, the force required, for example, to cut semi-frozen meat, is quite near the maximum force possible (110 N).

Repeating this type of cutting many times per minute, over several hours per shift could involve the appearance of fatigue or muscle pain in most of the women or in 50% of the men (EASTMAN KODAK COMPANY).

For continuous cutting work there should be a break of 5 minutes for every hour of work.

For the cutting of semi-frozen meat select he gloves with the lowest interference in the force of grasping, with an adequate range of sizes to allow the workers to choose the size best suited to their hand.

To conclude this important, but not very well known chapter, it seems useful to provide a check-list of general suggestions as provided by the most recent literature.

General suggestions

A) Design of the workplace, equipment and operational procedures.

- Distribute the workload on as many groups of muscles as possible, in order to prevent the overloading of the smallest groups of muscles.

- Design the operations in order to allow for the use of the fingers and palm rather than the index finger and the thumb.

- Avoid extreme bending-extensions of the wrist. Design the work area so that the height, orientation and depth enable the joints to remain as near as possible to their “neutral” position during the phases of maximum effort.

- Use little force during the rotations or bending of the joints; use a mechanical aid if much force is required. Avoid work requiring repetitive operations of holding.

B) The organisation of the work in operations with repetitive movements

- Rotate the workers in work involving various outlays of force so than no single worker will be exclusively and continuously assigned to the heaviest tasks during the entire work shift.

- If it is not possible to have shifts, alternate the main work with numerous lighter operations to allow a break for the muscles and joints most used and under strain.

- Teach the workers to promptly recognise the signs of affection due to repetitive work and to refer them immediately to health personnel, in order to be assigned to a less stressing job until the disappearance of the symptoms; this can reduce the risk more serious problems and also reduce the period of work lost.

- Study the best way to perform the most difficult repetitive operations in order to minimise the effort of the joints, tendons and muscles.

- When a worker is newly assigned to a task with repetitive operations or resumes work after several weeks of absence, he should be rotated to various tasks involving the different use of the various anatomical structures.

In case of highly repetitive work, should muscular-skeletal problems arise in the first days, it is advisable to limit the work to a maximum of 2 hours per shift.

Chapter 6 – “Contracting to outside firms”

In the sample of enterprises examined by us, all the work of this phase is conducted by dependent employees of the supermarket, with various types of contract (part-time, limited term etc.), without the use of external contracting.

Chapter 7 – “Legislative references”

· Pres. Decree 547/55 – Regulations for the prevention of accidents at the workplace

· Pres. Decree 303/56 – General regulations for occupational health

· Leg. Decree. 277/91 – Implementation of Directives N. 80/1107/EEC, N. 82/605/EEC, N. 83/477/EEC, N. 86/188/EEC and N. 88/642/EEC, regarding protection of the workers against risks deriving from exposure to chemical, physical and biological agents during work, pursuant to Art 7 of Law 30 July 1990 N. 212

· Leg. Decree. 626/94 and subsequent amendments, to implement Directives N. 89/391/EEC, N. 89/654/EEC, N. 89/655/EEC, N. 89/656/EEC, N. 90/269/EEC, N. 90/270/EEC, N. 90/394/EEC and N. 90/679/EEC regarding the improvement of the safety and health of workers at the workplace

· Leg. Decree. 475/92 – Implementation of the Directive N. 89/686/EEC of the Council of 21/12/1989, regarding the harmonisation of legislation of Member States regarding personal protection devices

· Pres. Decree 459/96 – Regulation due to the implementation of Directives N.89/392/EEC, N. 91/368/EEC, N. 93/44/EEC and 93//68/EEC concerning the harmonisation of legislation of Member States regarding machines

· Leg. Decree 155/97 – Implementation of Directives 93/43/EEC and 96/3/EEC concerning hygiene in food products

· Leg. Decree. 156/97 – Implementation of Directive 93/99/EEC concerning supplementary measures for the official control of food products

· Municipal regulations on health and building

Regulations of good practice and guidelines

· Guidelines of application of Leg. Decree 626/94 by the Co-ordination of Regions and Autonomous Provinces- October 1996

· NIOSH “Work practices guide for manual lifting”, NIOSH technical report, N. 81-122 U.S., 1981

· European Standard EN 1974 “Machines for the Food Industry – Slicers – Safety and hygiene requirements”

· Draft European Standard prEN 12268 “Machines for the Food Industry – Rotary saws – Safety and hygiene requirements”

SECTOR: SUPERMARKETS

1. WORK PHASE: SALES PERSONNEL

2. INAIL CODE: 130

3. RISK FACTOR:

SAFETY RISKS DUE TO STRUCTURES, EQUIPMENT, TOOLS AND MACHINES;

HEALTH AND ENVIRONMENTAL RISKS DUE TO PHYSICAL AND CHEMICAL AGENTS

INDIRECT OR ORGANISATIONAL RISKS DUE TO THE ORGANISATION OF WORK AND ERGONOMIC FACTORS

4. RISK CODE

5. N. EMPLOYEES: 400

Chapter 1 – “The work phase”

The areas of sales personnel show different characteristics according to the products handled:

· Delicatessen: mainly sales with cutting and weighing of food products at the counter (cheese, salami etc.); to a lesser extent, some gastronomic items consisting of products of animal and other origin are prepared and sold; these are next to the refrigerator and the kitchen. The kitchen is used to prepare and cook food or just to heat pre-cooked foods.

· Bakery goods: the sale of bread and pastry products purchased from third party suppliers, with final baking, on premises with characteristics and fittings typical of bakeries, of bread produced and pre-cooked elsewhere, and the baking of some pastry products (brioches and other rolls).

· Fish counter: the merchandise is distributed and displayed on counters after removal from the adjacent refrigerator.

Chapter 2 – “Equipment and machines”

· Slicer

· Rotary oven

· Fixed water cleaner

· Kneading machine

· Kneading machine with lifter

· Dishwasher

· Ice machine

· Mixer

· Cream whipper

· Egg whipper

· Cream pasteuriser

· Soldering iron for basins

· Soldering iron for thermal foil

· Knives

· Slicer

· Knife steriliser

· Microwave and electric ovens

· Cheese grater

· Potato peeler

All the equipment in use, except for platforms, manual transpallets and roll trainers, is subject to Pres. Decree 459/94 (Machines Directive). Therefore the equipment purchased after 21/9/96 must be in compliance with the essential safety requirements stated in Annexe I of the above-mentioned law.

This compliance must be shown by the CE mark and declaration of compliance.

Equipment in use and in particular manual equipment generally show poor maintenance

Chapter 3 – “The risk factor”

Safety risks related to the type of equipment, tools and machines used:

· Risk of cutting of hands during the manual cutting of the merchandise, the boning, the cleaning of tools or cutting machines

· Risk of burns

· Risks of merchandise falling onto the workers

· Risks of improper movements or excessive physical effort

· Risks of hitting against furniture and fittings

· Risks of falling due to slipping

· Electric risks due to contact with electrically powered equipment

· Fire risk

Health and environmental risks due to physical and chemical agents:

- Risks from physical agents due to exposure to poor microclimatic conditions

- Risks due to the use of detergent and disinfectant substances for the cleaning of work counters and of the equipment.

Indirect or organisational risks due to the characteristics of the work activity and of the organisation of the work:

· Risks related to the manual handling of loads

· Risks related to ergonomic factors due to repetitive movements of upper limbs

For the estimate of safety risks see the general chapter on accident trends. The specific analysis of safety risks was not made in this phase since workers in the sales department also intervene directly in other phases of the work cycle (unloading of goods, storage in the warehouse, preparation of shelves).

The analysis of accidents was made using the accident registers of 34 supermarkets, from 1986 to 1990.

For the description of the fire risk see the attached report on “Fire prevention”.

The risks related to poor microclimatic conditions derive from the fact that all supermarkets have air conditioning plant which is indispensable not just to guarantee comfortable microclimatic conditions for the clients, but also due to the characteristics of the buildings used by supermarkets (very large premises without normal ventilation and lighting). The risks for health of workers are related to the malfunctioning of plant due to inadequate design and/or maintenance. The situations most often occurring are as follows:

- Underdimensioning of the plant with respect to the number of persons present, with an insufficient change of air

- Outside air inlets too far from the aspiration device with significant loss of volume;

- Wrong positioning of the outside air intake grille (near sources of pollution) with contamination of the air in the work environment

- Imbalances in the distribution of the air through le the inlets or the anemostats, created by zones with low temperature due to the display of frozen or fresh food and the aspiration from specific departments such as roast food department and the distribution of fresh fish.

- Poor maintenance and cleaning of plant with possible inlet of chemical and/or biological pollutants. It should be recalled that poor cleaning of plant could favour the proliferation of microorganisms in the humidifiers.

The employees at the fish counter are exposed to temperature changes due to frequent passing between the sales area (20°C.) and the refrigerators (4-8°C).

In the case of the workers in the bakery area, poor microclimatic conditions are above all due to the presence of ovens that cause the room temperature to rise.

Estimate of the risks from handling of loads

This work phase, with regard to the need for the handling of loads, differs in the various supermarkets according to the departments involved. In the delicatessen department, where workers are almost constantly present, the handling of loads can be important and regards above all the transport and lifting of large pieces of ham and cheese. The sale of fish involves carrying it from refrigerators in large crates with ice. The difficulty of the operation can thus be increased by the low temperature of the crate and lack of adequate handles. In the case of meat sales personnel, the operations involving risks are some of those described for the preparation of meat, i.e. lifting of crates of meat for grinding, putting meat on and removing it from the refrigerator shelves.

The risk from repetitive movements of upper limbs is connected with the repetition of similar movements, always involving the same groups of muscles, in particular during the operations of preparing counters for the display of the merchandise.

The continuous grasping of objects and/or the transport of loads with unsuitable handles can be harmful to the joints and muscle-tendon structures of the hands.

The inadequacy of the hilt, concentrating the effort on the smallest groups of muscles, undoubtedly contributes to increasing the risk to the joints and muscle-tendon structures.

The extent of the risk is determined by the frequency of the movements, the effort applied and the overall duration of the operations involving repetitive movements.

Also in this case the extent of the risk varies from one supermarket to another according to the type of departments present.

Chapter 4 – “Expected harm”

· Contusions, sprains, fractures, injuries from cutting, piercing and lacero-contusion, crushing, shock and burns from electricity.

· Hypothetical harm from physical and chemical agents

· Pathologies of the muscle-skeletal system, with particular reference to the rachis, from the manual handling of loads.

· Tendonitis, tenosynovitis, scapula-humerus periarthritis (Duplay syndrome), carpal tunnel syndrome due to repetitive movements

Report on harm ascertained

Accident trends are described in the chapter already quoted with reference to the entire work sector.

Although there are no specific data in literature we can hypothesise the possible occurrence of pathologies of the upper and lower respiratory tract, the osteoarthromuscular system and the skin due to exposure to poor microclimatic conditions, to packaging machine fumes and to detergent and disinfectant substances. In particular, contact with detergent and disinfectants, i.e. irritating and/or allergy-producing substances, can trigger the appearance of eczema dermatitis in the employees.

With regard to harm deriving from the manual handling of loads and repetitive movements of upper limbs see the chapter “Health monitoring”.

The data shown there refer to the entire group of workers in supermarkets and include all the phases of the work cycle; these cannot be broken down since the same workers can rotate in the various phases on a variable basis. The workers assigned permanently to one phase, in the sample taken into consideration in our surveys, formed an overly small number to allow statistical and epidemiological analysis.

Psychological drawbacks deriving from the organisation of work and in particular from monotonous and repetitive activities were not assessed during our surveys.

Chapter 5 – “Intervention”

The prevention of safety risks of the workers involves various intervention regarding equipment, the environment and the organisation of the work.

The workers must be equipped with adequate aids for the handling of merchandise, routes must be adequately marked and distinguished for persons and vehicles, space must be sufficient for the handling of the merchandise.

Suitable PPD (gloves, footwear) must be available, and the personnel must be informed and trained on their use.

All the machines put on sale after 21/9/96 must comply with the essential safety requirements stated in Annexe I of Pres. Decree 459/96 (Regulation of implementation of the Machines Directive). Compliance with the aforesaid requirements is certified by the manufacturer through the CE mark on the machine or equipment and the required “declaration of compliance”. The manufacturer must furthermore provide a complete instruction manual with all the safety information necessary for a correct use of the machine.

The machines already present before 21/9/96 must be in compliance with the previously existing regulations with particular reference to Pres. Decree 547/55. In case of sale or purchase of machines already in use before 21/9/96, the seller must provide a certificate of compliance with previously existing regulations.

It should be recalled that packaging does not have adequate means of grasping, easily slipping from the hands and, above all the heavier ones that can cause serious accidents to the lower limbs (crushing of fingers, etc.). The use of safety shoes for this type of activity is hard to make the workers accept, since they prefer to wear comfortable and light shoes. In any case, should the remaining risk not be completely eliminable, suitable protective shoes shall be provided, as well as control over the real use of these PPD. The best solution would be to modify the packaging systems of merchandise currently adopted to facilitate the holding of the load, and thus reduce the risk of harm to the osteoarticular system.

Automatic packaging machine

4) Protection heating plate

5) Checking of the temperature of the plate (less than 80°C)

6) Use of means of protection such as thermal gloves.

In the case of automatic packaging machines, the speed of advancement of the plastic film should be reduced, in order to reduce the possibility of breakage or blocking of the running of the film, and thus avoid continuous interventions on the machine by personnel.

Machines slicers

Standard EN 1974 (becoming a harmonised regulation in 1998) sets forth the safety and hygiene requisites that the slicers must have.

Standard EN 1974 (a harmonised regulation since 1998) sets for the safety and hygiene requirements that the slicers must have.

It should be recalled that Pres. Decree 459/96 identifies the harmonised regulations as the technical instrument for ensuring safe machines; the respecting of the harmonised standard allows the declaration of compliance with the essential safety requirements of Annexe I.

The aforesaid harmonised standard is definitely also a point of reference for solutions to apply to machines manufactured before 21/9/96, in particular indicating the essential protection to apply (blade cover, protection for the hilt etc.) and their size characteristics.

Improvement of microclimatic conditions

The adequate design and maintenance of air conditioning plant is essential to guarantee a proper temperature for the workers. Some measures considered necessary are described below.

Primary air and air inlets:

*The inlet of primary air must at least guarantee a volume of 30 cu.mt./hour per person, considering the maximum estimated crowding. This rate must be verified under normal operating conditions of the plant.

*The number of air changes (volumes of rooms/hour) can be low, although in any case there should be at least 1-2 air changes/hour.

*The air inlets must be positioned in areas far from sources of pollutants, at a height of at least 6 mt. from road levels where there is vehicle traffic.

*The filters installed must guarantee high efficiency in order to prevent the accumulation of small particles in the conduits. It is likewise advisable to verify that the areas where the filters are located are airtight in order to avoid the direct passage of the air into the distribution zone.

*During checking of the plant, sight inspection inside the conduits may involve, in different cases, the need to request extraordinary internal cleaning.

*In case of plant failure, normal activity on the premises must be prohibited.

-Temperature and velocity of the air:

*The temperature in the work zones must comply with the limits recommended for thermal comfort (PMV and PPD indexes) in relation to energy outlays and the thermal resistance of clothing. The relative humidity must be between 40 and 60 %

*There must not be temperature differences of the air in the various areas, either horizontally or vertically (it should be recalled that the ISO standard 7730 indicates the value of 3°C as the maximum range of air temperature variation in the vertical direction).

*The radiating temperature must also be homogeneous in the various directions (the aforesaid ISO standard states that the variation of the radiating temperature caused by the presence of windows or of other cold vertical services must be less than 10°C).

*The velocity of the air in the workplaces must be less than the value of 0.15 m/sec.

*The laminar flows on the access zones must prevent the formation of air currents with considerable temperature differences with respect to environment air and the presence of significant positive or negative radiation.

-Pollutants:

*Checking must be conducted to verify the presence of fibrous insulation materials in the conduits. In case of presence of this material the inside of the conduits must be cleaned and overhauled.

*The humidification basins must be periodically emptied and cleaned. It does not seem sufficient just to adopt particular products added to the water, which have the function of preventing the proliferation of bacteria and/or fungi.

*The plant must be subjected to periodical cleaning and maintenance. Furthermore, the replacement of filters and the cleaning of outside air inlet grilles must take place regularly.

Reduction of the risks from the manual pulling of loads

In order to reduce the physical effort in operations of manual pulling the following is required:

* The surface of the floor must be smooth and without irregularities;

* The composition of the outside coating must be rigid since the greater is the hardness, the less force is required;

* Wheels of adequate diameter must be used; generally, the greater the diameter, the less force is required;

* Periodical maintenance of the wheels ( both the bearings and the outer coating). The preparation of periodical planning of maintenance is advisable;

* If manual trolleys are used, the weight pulled should not exceed 230 Kg. The maximum distance of the route is 16 m. for the three-wheel trolleys, and 33 m four-wheel trolleys;

* If manual transpallets are used, the weight pulled should not exceed 680 Kg. The maximum recommended distance is of 33 m.

* No exceeding of the upper limits of the horizontal force necessary to start up (22.5 Kg), maintain (18 Kg), and stop (36 Kg) a manual trolley.

It is necessary to plan the procedures for storage in warehouses for the prevention of harm to the locomotion capacity of workers, and for safety problems.

With regard to the first point, the full pallets just unloaded from trucks should be placed not on the ground but preferably on specific shelves at a height of 60-65 cm from ground level (above knee height).

It is advisable to request suppliers not to stack merchandise on pallets at a height exceeding 70-80 cm; this will allow the worker, once the pallet has been placed at above knee height, to remove the highest packages at a height less than that of the shoulders (135-140 cm). If the worker is allowed to lift of the load within these two heights (min. 65, max 135), useless and harmful bending the trunk can be avoided, allowing for the lifting of loads with weight exceeding 5-6 Kg. allowed by the NIOSH if the load is lifted in an improper position.

The delivery pallets on which the packages are loaded must have height regulation. This will allow the workers not only to take the package, but also to put it down keeping their backs substantially straight.

When the packages are lifted from the storage area to place them on the pallet, avoid turning the trunk only (twisting), but making the movement using the lower limbs.

In order to avoid shifting the load by turning 180°, the transpallet can be placed in such a way that the worker turns 90° only.

With regard to the unit weights of packages, these should not exceed 20-25 Kg.

The packages having a size or shape not allowing for easy handling (e.g. sacks) must always be lifted (especially for weight exceeding 20 Kg.) by two workers.

In general the maximum measures recommended for a container are 51 cm long, 36 cm deep and 15 cm high.

Increasing the sizes, the weight they contain must be reduced.

In general the lifting and transfer of loads with a weight less than 10 Kg. require only some simple design and organisational measures: frequent handling of weights of 20-25 Kg. can be allowed only when there is suitable ergonomic design of the workplace (absence of bending-twisting of the trunk, weight very near to the body, very low speed). It is therefore advisable to ask supplies for merchandise in packages with unit weights possibly equal to or less than 10 Kg.

Reduction of risks from repetitive movements of upper limbs

· The availability of adequate handles is of great importance. The various packages to be handled should already have them at the time of their manufacturing. It is thus important for supermarket management to request these in general when ordering from their suppliers.

The measurements for handles allowing correct holding are indicated in Figure 1 (from Ergonomic Design for people at work - Chap. 20 - Vol. 2 - Eastman Kodak Company - 1986).

· It could be useful to provide the workers with gloves having a protective layer in the palm, to be used when lifting objects with handles with an overly small diameter; an overly small handle can be harmful for the hand: However, it must first be ascertained that this solution does not reduce the effectiveness of the hold.

· Avoid carrying for distances over a few metres, weights (equipped with handles) over 10 Kg. with one hand only, and for longer distances use trolleys.

· For the transport of crates (e.g. crates fruit) these should be equipped with handles, like the ones shown in Figure 1.

· Avoid frequent holding with the palm in pronation (e.g. cans without handles; Fig. 2) this is dangerous if used often. It is a strain on the structures of the hand because the strain is almost exclusively on the small inner muscles of the fingers. Using this type of lifting, in order not to fatigue the structures of the hand, there should be no repeated varying of objects weighing over 1/2 Kg.

· In general it is preferable to pull the object as near as possible, without lifting it; if it is equipped with handles use these, otherwise lift it, as far as is possible, with both hands.

· Distribute the workload on as many groups of muscles as possible, in order to avoid the overloading of the smallest groups of muscles.

· Design the operations in order to allow for the use of the fingers and palm rather than the index finger and the thumb.

· Avoid extreme bending-extensions of the wrist. Design the work area so that the height, orientation and depth enable the joints to remain as near as possible to their “neutral” position during the phases of maximum effort.

· Use little force during the rotations or bending of the joints; use a mechanical aid if much force is required. Avoid work requiring repetitive operations of holding.

· Rotate the workers in work involving various outlays of force so than no single worker will be exclusively and continuously assigned to the heaviest tasks during the entire work shift.

· If it is not possible to have shifts, alternate the main work with numerous lighter operations to allow a break for the muscles and joints most used and under strain.

· Teach the workers to promptly recognise the signs of affection due to repetitive work and to refer them immediately to health personnel, in order to be assigned to a less stressing job until the disappearance of the symptoms; this can reduce the risk more serious problems and also reduce the period of work lost.

· Study the best way to perform the most difficult repetitive operations in order to minimise the effort of the joints, tendons and muscles.

· When a worker is newly assigned to a task with repetitive operations or resumes work after several weeks of absence, he should be rotated to various tasks involving the different use of the various anatomical structures.

In case of highly repetitive work, should muscular-skeletal problems arise in the first days, it is advisable to limit the work to a maximum of 2 hours per shift.

With regard to the cutting operations, the use of properly designed knives adequately is definitely helpful in the reduction of the appearance of symptoms in users.

In the choice of the type of knife to be used the following considerations apply.

a) The hilt of a professional knife must guarantee safe use; it must therefore have slip-proof coating. Measurements suited to the workers hands greatly contribute to improving safety conditions of holding, improving adherence and grasping of fingers on the hilt.

The choice of the colour of the hilt can contribute significantly to safety; colours enabling easy distinction of the knife from the worktable and showing up the part to hold with respect to the part nearest the blade (e.g. red = danger) can themselves prevent accidents from cutting

b) Hygiene must be respected; the coating of the hilt must be washable at high temperature, without cracks that are points of bacteria growth hard to eliminate.

c) The hilt must be adaptable to the different hand sizes.

d) Comfort should be ensured. For the same type of work, the type of model adopted for specific operations, with variations of the shape of the hilt and the blade, can ensure the reduction of muscle activity with consequent decrease in tendon overloading and probably also of specific pathologies.

It should furthermore be recalled that measurements of hilt diameter less than 2.5 cm reduce the force developed by the grasping of the hand by 40%. It is thus important to use hilts with a diameter between 3 and 5 cm.

Also the use of gloves reduces pressing strength by about 20% with the use of kitchen-use rubber gloves and 26% with the use of heavy cotton garden-use gloves.

The presence during the work of slight turning of the wrist towards the thumb (radial side) or the little finger (ulnar side) further reduces the force of grasping by 25% and 40% respectively.

Taking into account these reductions, the force required, for example, to cut semi-frozen meat, is quite near the maximum force possible (110 N).

Repeating this type of cutting many times per minute, over several hours per shift could involve the appearance of fatigue or muscle pain in most of the women or in 50% of the men (EASTMAN KODAK COMPANY).

For continuous cutting work there should be a break of 5 minutes for every hour of work.

Chapter 6 – “Contracting to outside firms”

In the sample of enterprises examined by us, all the work of this phase is conducted by dependent employees of the supermarket, with various types of contract (part-time, limited term etc.), without the use of external contracting.

Chapter 7 – “Legislative references”

· Pres. Decree 547/55 – Regulations for the prevention of accidents at the workplace

· Pres. Decree 303/56 – General regulations for occupational health

· Leg. Decree. 277/91 – Implementation of Directives N. 80/1107/EEC, N. 82/605/EEC, N. 83/477/EEC, N. 86/188/EEC and N. 88/642/EEC, regarding protection of the workers against risks deriving from exposure to chemical, physical and biological agents during work, pursuant to Art 7 of Law 30 July 1990 N. 212

· Leg. Decree. 626/94 and subsequent amendments, to implement Directives N. 89/391/EEC, N. 89/654/EEC, N. 89/655/EEC, N. 89/656/EEC, N. 90/269/EEC, N. 90/270/EEC, N. 90/394/EEC and N. 90/679/EEC regarding the improvement of the safety and health of workers at the workplace

· Leg. Decree. 475/92 – Implementation of the Directive N. 89/686/EEC of the Council of 21/12/1989, regarding the harmonisation of legislation of Member States regarding personal protection devices

· Pres. Decree 459/96 – Regulation due to the implementation of Directives N.89/392/EEC, N. 91/368/EEC, N. 93/44/EEC and 93//68/EEC concerning the harmonisation of legislation of Member States regarding machines

· Leg. Decree 155/97 – Implementation of Directives 93/43/EEC and 96/3/EEC concerning hygiene in food products

· Leg. Decree. 156/97 – Implementation of Directive 93/99/EEC concerning supplementary measures for the official control of food products

· Municipal regulations on health and building

Regulations of good practice and guidelines

· Guidelines of application of Leg. Decree 626/94 by the Co-ordination of Regions and Autonomous Provinces- October 1996

· NIOSH “Work practices guide for manual lifting”, NIOSH technical report, N. 81-122 U.S., 1981

· European Standard EN 1974 “Machines for the food industry – Slicers – Safety and hygiene requirements”

· Draft European Standard prEN 453 “Machines for the food industry – Kneading machines for food products – Safety and hygiene requirements”

· Draft European Standard prEN 454 “Machines for the food industry – Mixing machines – Safety and hygiene requirements”

· Draft European Standard prEN 1673 “Machines for the food industry – Rotary ovens– Safety and hygiene requirements”

· Draft European Standard prEN 1674 “Machines for the food industry – Slicers for bread and pastry making – Safety and hygiene requirements”

1 SECTOR: SUPERMARKETS

WORK PHASE: CASH REGISTERS

INAIL CODE: 130

RISK FACTOR:

SAFETY RISKS DUE TO STRUCTURES, EQUIPMENT, TOOLS AND MACHINES;

HEALTH AND ENVIRONMENTAL RISKS DUE TO PHYSICAL AGENTS

INDIRECT OR ORGANISATIONAL RISKS DUE TO THE ORGANISATION OF WORK AND ERGONOMIC FACTORS

RISK CODE

N. EMPLOYEES: 600

Chapter 1 – “The work phase”

The payment of the merchandise by customers takes place in the “cash register area”, generally situated near the entrance.

The main work tasks at the cash registers are the registration of the merchandise, acceptance of payment and handing over of the receipt.

Chapter 2 – “Equipment and machines”

· Counter

· Seat

· Scanner

· Keyboard

· Cash register

· Shelf for placing the money

· Rollers

All the equipment in use is subject to Pres. Decree 459/94 (Machines Directive). Therefore the equipment purchased after 21/9/96 must be in compliance with the essential safety requirements stated in Annexe I of the above-mentioned law.

This compliance must be shown by the CE mark and declaration of compliance.

Considering the type of equipment used, there are no specific accident risks connected with their use.

Chapter 3 – “The risk factor”

Safety risks due to the characteristics of the work areas and the organisation of work:

· Risks of hitting against furniture and fittings

· Fire risk

Health and environmental risks due to physical agents:

- Risks from physical agents due to exposure to poor microclimatic conditions

- Risks related to the inadequacy of the lighting system;

Indirect or organisational risks due to the characteristics of the work activity and of the organisation of the work:

· Risks related to ergonomic factors due to the prolonged seated position

· Risks related to ergonomic factors due to repetitive movements of upper limbs

· Psychological factors due to monotonous and repetitive activity

For the estimate of safety risks see the general chapter on accident trends.

The analysis of accidents was made using the accident registers of 34 supermarkets, from 1986 to 1990.

For the description of the fire risk see the attached report on “Fire prevention”.

The risks related to poor microclimatic conditions derive from the fact that all supermarkets have air conditioning plant which is indispensable not just to guarantee comfortable microclimatic conditions for the clients, but also due to the characteristics of the buildings used by supermarkets (very large premises without normal ventilation and lighting). The risks for health of workers are related to the malfunctioning of plant due to inadequate design and/or maintenance. The situations most often occurring are as follows:

- Underdimensioning of the plant with respect to the number of persons present, with an insufficient change of air;

- Outside air inlets too far from the aspiration device with significant loss of volume;

- Wrong positioning of the outside air intake grille (near sources of pollution) with contamination of the air in the work environment;

- imbalances in the distribution of the air through le the inlets or the anemostats, created by zones with low temperature due to the display of frozen or fresh food and aspiration of specific departments such as the roast food department and the distribution of fresh fish;

- Poor maintenance and cleaning of plant with possible inlet of chemical and/or biological pollutants. It should be recalled that poor cleaning of plant can favour the proliferation of micro-organisms in the humidifiers;

For the employees at the cash registers, annoying drafts directly affecting the workers have been observed.

The risks related to the inadequacy of the lighting system are due to the continuous passing of moving objects and the lighting conditions, with possibility of complete or relative dazzling, since the cash registers are positioned near external windows.

The risks from the sedentary posture are a significant aspect. Work at the cash registers requires the workers to remain seated for periods of time that may exceed 4 hours, with few possibilities of changing posture.

The stationary posture is an element of risk for the spinal column since it prevents the change of “loading” and “unloading” conditions on intervertebral discs, inhibits the correct nutrition of these discs.

In addition, the fact that the workplace, due to often inadequate characteristics, forces workers to adopt unsuitable postures.

These are the main problems observed in the situations surveyed:

n The lack of space for legs: above all the height of the work counter/ seat level is insufficient due to the presence of items under the level of the work counter (drawer for the money, control box etc.). This involves the need for most people to adopt unsuitable postures;

n The location of some work instruments too far beyond the reach of personnel (shelf for placing money, receipt printer);

n Unsuitability of the seat;

n Lack of a footrest necessary for the shorter persons and required for the correct position lower limbs.

The posture at the cash registers furthermore often involves stretching the arms forward for the handling of loads weighing up to 9-10 Kg. Often these movements are performed with the trunk twisted.

This type of lifting, extremely unfavourable for the lumbar vertebrae, in these conditions produces loads on the discs far exceeding 500 Kg. This means long periods with heavy strain, which can cause in the medium and long term, the occurrence of chronic alterations, with the appearance of the classical “backache” and with the consequent reduction of the mobility of the trunk.

The risk from repetitive movements of the upper limbs is connected with the continuous handling of items by personnel at the cash registers: taking the object from the roller, handling it for the selection of the side with the barcode, passing it over the scanner and placing the object on the end portion after the cash register.

The inadequacy of holding, concentrating the effort on the smallest groups of muscles, undoubtedly contributes to increasing the risk to the joints and muscle-tendon structures

The extent of the risk is caused by the frequency of movements, the effort applied and the overall duration of the operations involving repetitive movements. The risk is in any case always significant in this work phase.

The estimate of the risk deriving from psychological factors is not easy to assess, also due to the lack of specific surveys.

Chapter 4 – “Expected harm”

v Contusions.

v Hypothetical harm due to poor microclimatic conditions.

v Asthenopia syndrome due to inadequate lighting.

v Muscle pain of the scapula-humerus system, cervical pain, lumbago, cervical and lumbrosacral spondylarthropathy (SAP).

v Tendonitis, tenosynovitis, scapula-humerus periarthritis (Duplay syndrome), carpal tunnel syndrome due to repetitive movements.

v Neurosis, psychological symptoms.

Report on harm ascertained

Accident trends are described in the chapter already quoted with reference to the entire work sector.

Although there are no specific data in literature we can hypothesise the possible occurrence of pathologies of the upper and lower respiratory tract and the osteoarthromuscular system due to exposure to poor microclimatic conditions.

With regard to harm to sight and from unsuitable postures, due to the prolonged sedentary position and repetitive movements of upper limbs, see the chapter “Health monitoring”.

The data shown there refer to the entire group of workers in supermarkets and include all the phases of the work cycle; these cannot be broken down since the same workers can rotate in the various phases on a variable basis. The workers assigned permanently to one phase, in the sample taken into consideration in our surveys, formed an overly small number to allow statistical and epidemiological analysis.

Psychological drawbacks deriving from the organisation of work and in particular from monotonous and repetitive activities were not assessed during our surveys.

Chapter 5 – “Intervention”

The prevention of safety risks of the workers is possible through the ergonomic design of the workplace at the cash registers, which besides reducing the risks from fixed postures, also solves the problem of accidents due to hitting against furniture and fittings.

Improvement of microclimatic conditions

The adequate design and maintenance of air conditioning plant is essential to guarantee a proper temperature for the workers. Some measures considered necessary are described below.

Primary air and air inlets:

*The inlet of primary air must at least guarantee a volume of 30 cu.mt./hour per person, considering the maximum estimated crowding. This rate must be verified under normal operating conditions of the plant.

*The number of air changes (volumes of rooms/hour) can be low, although in any case there should be at least 1-2 air changes/hour.

*The air inlets must be positioned in areas far from sources of pollutants, at a height of at least 6 mt. from road levels where there is vehicle traffic.

*The filters installed must guarantee high efficiency in order to prevent the accumulation of small particles in the conduits. It is likewise advisable to verify that the areas where the filters are located are airtight in order to avoid the direct passage of the air into the distribution zone.

*During checking of the plant, sight inspection inside the conduits may involve, in different cases, the need to request extraordinary internal cleaning.

*In case of plant failure, normal activity on the premises must be prohibited.

-Temperature and velocity of the air:

*The temperature in the work zones must comply with the limits recommended for thermal comfort (PMV and PPD indexes) in relation to energy outlays and the thermal resistance of clothing. The relative humidity must be between 40 and 60 %

*There must not be temperature differences of the air in the various areas, either horizontally or vertically (it should be recalled that the ISO standard 7730 indicates the value of 3°C as the maximum range of air temperature variation in the vertical direction).

*The radiating temperature must also be homogeneous in the various directions (the aforesaid ISO standard states that the variation of the radiating temperature caused by the presence of windows or of other cold vertical services must be less than 10°C).

*The velocity of the air in the workplaces must be less than the value of 0.15 m/sec.

*The laminar flows on the access zones must prevent the formation of air currents with considerable temperature differences with respect to environment air and the presence of significant positive or negative radiation.

-Pollutants:

*Checking must be conducted to verify the presence of fibrous insulation materials in the conduits. In case of presence of this material the inside of the conduits must be cleaned and overhauled.

*The humidification basins must be periodically emptied and cleaned. It does not seem sufficient just to adopt particular products added to the water, which have the function of preventing the proliferation of bacteria and/or fungi.

*The plant must be subjected to periodical cleaning and maintenance. Furthermore, the replacement of filters and the cleaning of outside air inlet grilles must take place regularly.

The priority measure is undoubtedly the ergonomic design of the workplace at the cash registers.

These are the main aspects which should be taken into consideration on the basis of the observations in our survey:

· The seat

· Enabling shorter persons to rest their feet on the floor

· Ensuring leg space under the scanner, for the taller persons.

The surveys have furthermore highlighted a number of other aspects that can affect the comfort of the workplace:

· The position of the scanner

· The angle and location of the keyboard

· The size and location of the cash drawer

· The location of the receipt printer

· The area where the customer stands during payment

· The “right-hand” or “left-hand” position of the cash register

· The depth of the workplace (distance between the internal edge of the bottom of the cash register and the guide of the subsequent cash register)

· The width of the workplace (distance between the objects laterally defining the workplace)

· The possibility of working alternatively in a standing and a seated position.

In order to allow an assessment of the various possible types of the cash register workplace, the figures and tables from 1 to 11 show the main parameters that must be taken into consideration to guarantee a correct seated posture and the performance of movements according to physiological requirements.

The possibility of working alternatively in a standing and a seated position together with rotation in various operations that require different postures enables workers to avoid an excessively fixed posture.

The rotation of personnel is also an element useful for contrasting possible harm to the upper limbs from repetitive movements and psychological problems due to the monotony and fragmentation of the work.

In order to reduce the risks from repetitive movements it is likewise important to intervene with the adequate design of the workplace so that this and the height, orientation and depth allow the joints of the upper limbs to remain as close as possible to the “neutral” position during the phases of maximum effort.

Finally, the presence of adequate handles or holding point objects to move enables the best distribution of the workload on many groups of muscles, avoiding the overloading of the smallest groups of muscles.

Chapter 6 – “Contracting to outside firms”

In the sample of enterprises examined by us, all the work of this phase is conducted by dependent employees of the supermarket, with various types of contract (part-time, limited term etc.), without the use of external contracting.

Chapter 7 – “Legislative references”

· Pres. Decree 547/55 – Regulations for the prevention of accidents at the workplace

· Pres. Decree 303/56 – General regulations for occupational health

· Leg. Decree. 277/91 – Implementation of Directives N. 80/1107/EEC, N. 82/605/EEC, N. 83/477/EEC, N. 86/188/EEC and N. 88/642/EEC, regarding protection of the workers against risks deriving from exposure to chemical, physical and biological agents during work, pursuant to Art 7 of Law 30 July 1990 N. 212

· Leg. Decree. 626/94 and subsequent amendments, to implement Directives N. 89/391/EEC, N. 89/654/EEC, N. 89/655/EEC, N. 89/656/EEC, N. 90/269/EEC, N. 90/270/EEC, N. 90/394/EEC and N. 90/679/EEC regarding the improvement of the safety and health of workers at the workplace

· Leg. Decree. 475/92 – Implementation of the Directive N. 89/686/EEC of the Council of 21/12/1989, regarding the harmonisation of legislation of Member States regarding personal protection devices

· Pres. Decree 459/96 – Regulation due to the implementation of Directives N.89/392/EEC, N. 91/368/EEC, N. 93/44/EEC and 93//68/EEC concerning the harmonisation of legislation of Member States regarding machines

· Leg. Decree 155/97 – Implementation of Directives 93/43/EEC and 96/3/EEC concerning hygiene in food products

· Leg. Decree. 156/97 – Implementation of Directive 93/99/EEC concerning supplementary measures for the official control of food products

· Municipal regulations on health and building

Regulations of good practice and guidelines

· Guidelines of application of Leg. Decree 626/94 by the Co-ordination of Regions and Autonomous Provinces- October 1996

NIOSH “Work practices guide for manual lifting”, NIOSH technical report, N. 81-122 U.S., 1981

1. SECTOR: SUPERMARKETS

2. WORK PHASE: PREPARATION OF FRUIT AND VEGETABLES

3. INAIL CODE: 130

4. RISK FACTOR:

SAFETY RISKS DUE TO STRUCTURES, EQUIPMENT, TOOLS AND MACHINES;

HEALTH AND ENVIRONMENTAL RISKS DUE TO PHYSICAL AND CHEMICAL AGENTS

INDIRECT OR ORGANISATIONAL RISKS DUE TO THE ORGANISATION OF WORK AND ERGONOMIC FACTORS

5. RISK CODE

6. N. EMPLOYEES: 200

Chapter 1 – “The work phase”

The fruit and vegetable department is usually adjacent to the refrigerator and the sales area to allow easy loading of the counter. The employees remove the crates of merchandise from the refrigerators. The fruit and the vegetable are cleaned, sorted, prepared in portions and pre-wrapped; then they are brought to the counters in the sales area. In part, the crates of fruit and vegetables, after the sorting, are directly brought to the self-service sales area.

Chapter 2 – “Equipment and machines”

· Automatic packaging machine fruit and vegetables

· Knives

All the equipment in use, except for the platforms of manual transpallets and roll trainers, is subject to Pres. Decree 459/94 (Machines Directive). Therefore the equipment purchased after 21/9/96 must be in compliance with the essential safety requirements stated in Annexe I of the above-mentioned law.

This compliance must be shown by the CE mark and declaration of compliance.

Equipment in use and in particular manual equipment generally show poor maintenance.

Chapter 3 – “The risk factor”

Safety risks related to the type of equipment, tools and machines used:

· Risk of cutting of hands during the preparation of portions of fruit and vegetables

· Risk of burns on the machines for packaging the portions of fruit and vegetables due to contact with the high temperature plate

· Risks of merchandise falling onto the workers

· Risks of improper movements or excessive physical effort

· Risks of hitting against furniture and fittings

· Risks of falling due to slipping

· Fire risk

Health and environmental risks due to physical and chemical agents:

- Risks from physical agents due to exposure to poor microclimatic conditions

- Risks due to the use of detergent and disinfectant substances for the cleaning of work counters and of the equipment

- Risks due to the possible presence of fumes produced by automatic packaging machines;

Indirect or organisational risks due to the characteristics of the work activity and of the organisation of the work:

· Risks related to the manual handling of loads

· Risks related to ergonomic factors due to repetitive movements of upper limbs

For the estimate of safety risks see the general chapter on accident trends. The specific analysis of safety risks was not made in this phase since workers in the preparation of fruit and vegetables also intervene directly in other phases of the work cycle (unloading of goods, storage in the warehouse, preparation of shelves).

The analysis of accidents was made using the accident registers of 34 supermarkets, from 1986 to 1990.

For the description of the fire risk see the attached report on “Fire prevention”.

Risks due to poor microclimatic conditions are related to low winter temperatures (environment temperature 12-15°C), and the access of workers to refrigerators; the employees are exposed to temperature differences between the sales area (20°C.) and the refrigerators (4-8°C).

Risks due to the use of detergent and disinfectant substances can have some importance should the workers not use adequate personal protection devices (gloves).

Risks due to the presence of fumes from the automatic packaging machines are only potential, since at normal temperature operating temperatures the plastic film used (PVC, polyethylene) does not emit fumes. In any case, today these machines are generally equipped with local aspiration.

Estimate of the risks from handling of loads

The operations involving risks especially include actions of manual lifting of loads.

For the assessment of the risks from lifting of loads the NIOSH formula was used.

The main operations involving risks during this phase are as follows:

- Removal of vegetable crates from pallets

- Removal of light and heavy cardboard boxes of fruit from pallets

- Lifting of containers to the sorting level

- Repositioning of packages on the trolley

Risks from lifting: assessment according to the NIOSH

- Removal from pallets of vegetable crates: this takes place from an initial position ranging from a minimum of 20 cm up to 195 cm from floor level with repositioning on the floor or on the trolley (50 cm), with angular dislocation of 90° and rates of six movements per minute for a period of 2 to 8 hours.

The weight of the containers ranges from 7 to 20 Kg. with holding quality considered sufficient.

Applying the formula we obtain the recommended maximum weights (PR) of 0.92-1.5 Kg.

IR: >3!

- Removal of light and heavy cardboard boxes of fruit from pallets: this takes place from an initial position ranging from a minimum of 0 cm up to 107 cm from floor level with repositioning on the floor or on the trolley (50 cm), with angular dislocation of 180°, distance from the body 60-65 cm and rates of six movements per minute for a period of 2 to 8 hours.

The weight of the containers ranges from 7 a 12 Kg. with poor holding quality.

IR:>?

Applying the formula we obtain recommended maximum weights (PR) of 0.62-0.78 Kg.

- Lifting of containers to sorting level: this takes place from an initial position of 0 to 50 cm, with angular dislocation of 90-180° and repositioning at the 90 cm of the packaging level.

The weight of the containers ranges from 7 to 20 Kg.

Applying the formula we obtain the recommended maximum weights (PR) of 1.7 to 2.2 Kg.

IR: > 3 !

- Repositioning packages in the trolley: the packages, weighing from 1 to 5 Kg, are moved from the packaging level (90 cm) to the trolley level (50 cm).

Applying the formula we obtain the recommended maximum weights (PR) of 3.9 Kg.

IR: < 0.75 > 1

This type of operation, although intrinsically the weights are not excessive, involves a risk

This is because the weights are lifted from floor level and involve bending of the trunk.

The risk from repetitive movements of upper limbs is connected with the repetition of similar movements, always involving the same groups of muscles, in particular during the packaging operations.

continuous grasping of objects and/or the transport of loads with handles having unsuitable sizes can be harmful for the structure of the upper limbs.

The inadequacy of the handles, concentrating the effort on the smallest groups of muscles, undoubtedly contributes to increasing the risk to the joints and muscle-tendon structures.

The extent of the risk relevant in the operations of preparation of products, is caused by the frequency of the movements, the effort applied and the overall duration of the operations involving repetitive movements.

Chapter 4 – “Expected harm”

· Contusions, sprains, fractures, injuries from cutting, piercing and lacero-contusion, crushing, burns due to contact with the heating plate of the automatic packaging machine.

· Hypothetical harm from physical and chemical agents

· Pathologies of the muscle-skeletal system, with particular reference to the rachis, from the manual handling of loads.

· Tendonitis, tenosynovitis, scapula-humerus periarthritis (Duplay syndrome), syndrome of the carpal tunnel from repetitive movements.

Report on harm ascertained

Accident trends are described in the chapter already quoted with reference to the entire work sector.

Although there are no specific data in literature we can hypothesise the possible occurrence of pathologies of the upper and lower respiratory tract, the osteoarthromuscular system and the skin due to exposure to poor microclimatic conditions, to packaging machine fumes and to detergent and disinfectant substances. In particular, contact with detergent and disinfectants, i.e. irritating and/or allergy-producing substances, can trigger the appearance of eczema dermatitis in the employees.

With regard to harm deriving from the manual handling of loads and repetitive movements of upper limbs see the chapter “Health monitoring”.

The data shown there refer to the entire group of workers in supermarkets and include all the phases of the work cycle; these cannot be broken down since the same workers can rotate in the various phases on a variable basis. The workers assigned permanently to one phase, in the sample taken into consideration in our surveys, formed an overly small number to allow statistical and epidemiological analysis.

Psychological drawbacks deriving from the organisation of work and in particular from monotonous and repetitive activities were not assessed during our surveys.

Chapter 5 – “Intervention”

The prevention of safety risks of the workers involves various intervention regarding equipment, the environment and the organisation of the work.

The workers must be equipped with adequate aids for the handling of merchandise, routes must be adequately marked and distinguished for persons and vehicles, space must be sufficient for the handling of the merchandise.

Suitable PPD (gloves, footwear) must be available, and the personnel must be informed and trained on their use.

All the machines put on sale after 21/9/96 must comply with the essential safety requirements stated in Annexe I of Pres. Decree 459/96 (Regulation of implementation of the Machines Directive). Compliance with the aforesaid requirements is certified by the manufacturer through the CE mark on the machine or equipment and the required “declaration of compliance”. The manufacturer must furthermore provide a complete instruction manual with all the safety information necessary for a correct use of the machine.

The machines already present before 21/9/96 must be in compliance with the previously existing regulations with particular reference to Pres. Decree 547/55. In case of sale or purchase of machines already in use before 21/9/96, the seller must provide a certificate of compliance with previously existing regulations.

It should be recalled that packaging does not have adequate means of grasping, easily slipping from the hands and, above all the heavier ones that can cause serious accidents to the lower limbs (crushing of fingers, etc.). The use of safety shoes for this type of activity is hard to make the workers accept, since they prefer to wear comfortable and light shoes. In any case, should the remaining risk not be completely eliminable, suitable protective shoes shall be provided, as well as control over the real use of these PPD. The best solution would be to modify the packaging systems of merchandise currently adopted to facilitate the holding of the load, and thus reduce the risk of harm to the osteoarticular system.

Automatic packaging machine

7) Protection heating plate

8) Checking of the temperature of the plate (less than 80°C)

9) Use of means of protection such as thermal gloves.

In the case of automatic packaging machines, the speed of advancement of the plastic film should be reduced, in order to reduce the possibility of breakage or blocking of the running of the film, and thus avoid continuous interventions on the machine by personnel.

Improvement of microclimatic conditions

The adequate design and maintenance of air conditioning plant is essential to guarantee a proper temperature for the workers. Some measures considered necessary are described below.

Primary air and air inlets:

*The inlet of primary air must at least guarantee a volume of 30 cu.mt./hour per person, considering the maximum estimated crowding. This rate must be verified under normal operating conditions of the plant.

*The number of air changes (volumes of rooms/hour) can be low, although in any case there should be at least 1-2 air changes/hour.

*The air inlets must be positioned in areas far from sources of pollutants, at a height of at least mt. 6 from road levels where there is vehicle traffic.

*The filters installed must guarantee high efficiency in order to prevent the accumulation of small particles in the conduits. It is likewise advisable to verify that the areas where the filters are located are airtight in order to avoid the direct passage of the air into the distribution zone.

*During checking of the plant, sight inspection inside the conduits may involve, in different cases, the need to request extraordinary internal cleaning.

*In case of plant failure, normal activity on the premises must be prohibited.

-Temperature and velocity of the air:

*The temperature in the work zones must comply with the limits recommended for thermal comfort (PMV and PPD indexes) in relation to energy outlays and the thermal resistance of clothing. The relative humidity must be between 40 and 60 %

*There must not be temperature differences of the air in the various areas, either horizontally or vertically (it should be recalled that the ISO standard 7730 indicates the value of 3°C as the maximum range of air temperature variation in the vertical direction).

*The radiating temperature must also be homogeneous in the various directions (the aforesaid ISO standard states that the variation of the radiating temperature caused by the presence of windows or of other cold vertical services must be less than 10°C).

*The velocity of the air in the workplaces must be less than the value of 0.15 m/sec.

*The laminar flows on the access zones must prevent the formation of air currents with considerable temperature differences with respect to environment air and the presence of significant positive or negative radiation.

-Pollutants:

*Checking must be conducted to verify the presence of fibrous insulation materials in the conduits. In case of presence of this material the inside of the conduits must be cleaned and overhauled.

*The humidification basins must be periodically emptied and cleaned. It does not seem sufficient just to adopt particular products added to the water, which have the function of preventing the proliferation of bacteria and/or fungi.

*The plant must be subjected to periodical cleaning and maintenance. Furthermore, the replacement of filters and the cleaning of outside air inlet grilles must take place regularly.

Reduction of the risks from the manual pulling of loads

In order to reduce the physical effort in operations of manual pulling the following is required:

* The surface of the floor must be smooth and without irregularities;

* The composition of the outside coating must be rigid since the greater is the hardness, the less force is required;

* Wheels of adequate diameter must be used; generally, the greater the diameter, the less force is required;

* Periodical maintenance of the wheels ( both the bearings and the outer coating). The preparation of periodical planning of maintenance is advisable;

* If manual trolleys are used, the weight pulled should not exceed 230 Kg. The maximum distance of the route is 16 m. for the three-wheel trolleys, and 33 m four-wheel trolleys;

* If manual transpallets are used, the weight pulled should not exceed 680 Kg. The maximum recommended distance is of 33 m.

* No exceeding of the upper limits of the horizontal force necessary to start up (22.5 Kg), maintain (18 Kg), and stop (36 Kg) a manual trolley.

It is necessary to plan the procedures for storage in warehouses for the prevention of harm to the locomotion capacity of workers, and for safety problems.

With regard to the first point, the full pallets just unloaded from trucks should be placed not on the ground but preferably on specific shelves at a height of 60-65 cm from ground level (above knee height).

It is advisable to request suppliers not to stack merchandise on pallets at a height exceeding 70-80 cm; this will allow the worker, once the pallet has been placed at above knee height, to remove the highest packages at a height less than that of the shoulders (135-140 cm). If the worker is allowed to lift of the load within these two heights (min. 65, max 135), useless and harmful bending the trunk can be avoided, allowing for the lifting of loads with weight exceeding 5-6 Kg. allowed by the NIOSH if the load is lifted in an improper position.

The delivery pallets on which the packages are loaded must have height regulation. This will allow the workers not only to take the package, but also to put it down keeping their backs substantially straight.

When the packages are lifted from the storage area to place them on the pallet, avoid turning the trunk only (twisting), but making the movement using the lower limbs.

In order to avoid shifting the load by turning 180°, the transpallet can be placed in such a way that the worker turns 90° only.

With regard to the unit weights of packages, these should not exceed 20-25 Kg.

The packages having a size or shape not allowing for easy handling (e.g. sacks) must always be lifted (especially for weight exceeding 20 Kg.) by two workers.

In general the maximum measures recommended for a container are 51 cm long, 36 cm deep and 15 cm high.

Increasing the sizes, the weight they contain must be reduced.

In general the lifting and transfer of loads with a weight less than 10 Kg. require only some simple design and organisational measures: frequent handling of weights of 20-25 Kg. can be allowed only when there is suitable ergonomic design of the workplace (absence of bending-twisting of the trunk, weight very near to the body, very low speed). It is therefore advisable to ask supplies for merchandise in packages with unit weights possibly equal to or less than 10 Kg.

Reduction of risks from mechanical overloading of upper limbs

The continuous grasping of objects and/or the transport of loads with handles having unsuitable sizes can be harmful for the structure of the hand. It could be useful, although not a complete solution, to implement the following suggestions:

* Avoid carrying for distances over a few metres, weights (equipped with handles) over 10 Kg. with one hand only, and for longer distances use trolleys;

* Transport of weights equipped with very narrow handles can be harmful for the structure of the hand. Handles of cans should be equipped adequately at the time of manufacturing;

* it could be useful to provide the workers with gloves having a protective layer in the palm, to be used when lifting objects with handles with an overly small diameter; however, it must first be ascertained that this solution does not reduce the effectiveness of the hold;

* For the transport of crates (e.g. fruit crates), these should also be provided with suitable handles;

* Grasping with the palm facing downwards (e.g. cans without handles) is dangerous if used often. It is a strain on the structures of the hand because the strain is almost exclusively on the small inner muscles of the fingers. Using this type of lifting, in order not to fatigue the structures of the hand, there should be no repeated varying of objects weighing over 1/2 Kg. (from Ergonomic Design for people at work -Chap. 20 - Vol. 2- Eastman Kodak Company).

It is therefore preferable to:

- Pull the object as close as possible to the packaging place, without lifting it;

- If it has handles, use them to lift it;

- If it does not have handles, lift it as far as is possible with both hands.

Knives

In the choice of the type of knife to be used the following considerations apply.

a) The hilt of a professional knife must guarantee safe use; it must therefore have slip-proof coating. Measurements suited to the workers hands greatly contribute to improving safety conditions of holding, improving adherence and grasping of fingers on the hilt.

b) The hilts must have sizes suited to the various workers.

c) The knife must guarantee comfort. For the same type of work, the type of model adopted for specific operations, through variations of the shape of the hilt and the blade, will ensure reduction of muscular activity with consequent decrease of tendon strain and probably also of the specific pathologies.

It should furthermore be recalled that measurements of hilt diameter less than 2.5 cm reduce the force developed by the grasping of the hand by 40%. It is thus important to use hilts with a diameter between 3 and 5 cm.

Also the use of gloves reduces pressing strength by about 20% with the use of kitchen-use rubber gloves and 26% with the use of heavy cotton garden-use gloves.

The presence during the work of slight turning of the wrist towards the thumb (radial side) or the little finger (ulnar side) further reduces the force of grasping by 25% and 40% respectively.

For continuous cutting work there should be a break of 5 minutes for every hour of work.

To conclude this important, but not very well known chapter, it seems useful to provide a check-list of general suggestions as provided by the most recent literature.

General suggestions

A) Design of the workplace, equipment and operational procedures.

- Distribute the workload on as many groups of muscles as possible, in order to prevent the overloading of the smallest groups of muscles.

- Design the operations in order to allow for the use of the fingers and palm rather than the index finger and the thumb.

- Avoid extreme bending-extensions of the wrist. Design the work area so that the height, orientation and depth enable the joints to remain as near as possible to their “neutral” position during the phases of maximum effort.

- Use little force during the rotations or bending of the joints; use a mechanical aid if much force is required. Avoid work requiring repetitive operations of holding.

B) The organisation of the work in operations with repetitive movements

- Rotate the workers in work involving various outlays of force so than no single worker will be exclusively and continuously assigned to the heaviest tasks during the entire work shift.

- If it is not possible to have shifts, alternate the main work with numerous lighter operations to allow a break for the muscles and joints most used and under strain.

- Teach the workers to promptly recognise the signs of affection due to repetitive work and to refer them immediately to health personnel, in order to be assigned to a less stressing job until the disappearance of the symptoms; this can reduce the risk more serious problems and also reduce the period of work lost.

- Study the best way to perform the most difficult repetitive operations in order to minimise the effort of the joints, tendons and muscles.

- When a worker is newly assigned to a task with repetitive operations or resumes work after several weeks of absence, he should be rotated to various tasks involving the different use of the various anatomical structures.

In case of highly repetitive work, should muscular-skeletal problems arise in the first days, it is advisable to limit the work to a maximum of 2 hours per shift.

Chapter 6 – “Contracting to outside firms”

In the sample of enterprises examined by us, all the work of this phase is conducted by dependent employees of the supermarket, with various types of contract (part-time, limited term etc.), without the use of external contracting.

Chapter 7 – “Legislative references”

· Pres. Decree 547/55 – Regulations for the prevention of accidents at the workplace

· Pres. Decree 303/56 – General regulations for occupational health

· Leg. Decree. 277/91 – Implementation of Directives N. 80/1107/EEC, N. 82/605/EEC, N. 83/477/EEC, N. 86/188/EEC and N. 88/642/EEC, regarding protection of the workers against risks deriving from exposure to chemical, physical and biological agents during work, pursuant to Art 7 of Law 30 July 1990 N. 212

· Leg. Decree. 626/94 and subsequent amendments, to implement Directives N. 89/391/EEC, N. 89/654/EEC, N. 89/655/EEC, N. 89/656/EEC, N. 90/269/EEC, N. 90/270/EEC, N. 90/394/EEC and N. 90/679/EEC regarding the improvement of the safety and health of workers at the workplace

· Leg. Decree. 475/92 – Implementation of the Directive N. 89/686/EEC of the Council of 21/12/1989, regarding the harmonisation of legislation of Member States regarding personal protection devices

· Pres. Decree 459/96 – Regulation due to the implementation of Directives N.89/392/EEC, N. 91/368/EEC, N. 93/44/EEC and 93//68/EEC concerning the harmonisation of legislation of Member States regarding machines

· Leg. Decree 155/97 – Implementation of Directives 93/43/EEC and 96/3/EEC concerning hygiene in food products

· Leg. Decree. 156/97 – Implementation of Directive 93/99/EEC concerning supplementary measures for the official control of food products

· Municipal regulations on health and building

Regulations of good practice and guidelines

· Guidelines of application of Leg. Decree 626/94 by the Co-ordination of Regions and Autonomous Provinces- October 1996

· NIOSH “Work practices guide for manual lifting”, NIOSH technical report, N. 81-122 U.S., 1981