Updated WCHA Public Comment to OSHA on Heat Injury and Illness Prevention
Livestream of the OSHA hearing on the proposed heat illness prevention rule will begin 6/16, with WCHA comments on 7/2
Beginning June 16, 2025, OSHA is conducting a virtual public hearing on a proposed rule for heat illness prevention in the workplace. I am pleased to have the opportunity to speak at this hearing on behalf of Wisconsin Community Health Action. Our comments will support the new rule and offer suggestions to strengthen it, as well as highlighting the combined impacts of extreme heat, air quality, and infectious disease risks on worker health. My oral comment time is currently scheduled for July 2, the final day of the hearing. The OSHA rulemaking website will be updated with the link to the hearing livestream.
U.S. Department of Labor
Occupational Safety and Health Administration
200 Constitution Avenue, NW
Room Number N3626
Washington, D.C. 20210
May 23, 2025
Re: OSHA Heat Injury and Illness Prevention Public Hearing
Wisconsin Community Health Action (WCHA) is an informal group of Wisconsin-based educators, workers, and concerned citizens who are working to improve public health resources and policies. WCHA strongly supports OSHA's proposed rule on heat illness prevention, with the addition of comments below.
A 2024 Wisconsin Department of Health Services report on heat-related illness claims of Worker’s Compensation showed that there has been a progressive increase in denied claims, with nearly 78% of claims being denied in the most recent data from 2022.1 This clearly demonstrates the need for stronger workplace heat protection rules, both to prevent workplace heat illness in the first place as well as to improve appropriate compensation for workers who are injured due to a lack of adequate heat protection.
Much of the draft rule and supporting materials are based on the idea of a healthy worker, but common conditions such as high blood pressure, asthma, diabetes, autoimmune diseases, or pregnancy2 can increase the risk of severe consequences of heat exposure. In revising the rule, baseline thresholds and provisions should be adjusted to accommodate workers with health conditions that place them at higher risk of heat illness.
For example, heat illness poses very serious risks for patients undergoing routine maintenance dialysis. A 2024 study from researchers at University of Wisconsin and other institutions showed that the risk of death among adults receiving maintenance dialysis for kidney failure increased 18% during extreme humid-heat events.3 About one in four dialysis patients are able to work,4 and about 550,000 people receive dialysis in the US.5 Combining these estimates, nearly 140,000 working people in the US are on dialysis.
Extreme heat is a growing problem across a variety of workplaces, including schools, many of which are not air conditioned in the northern US. In a 2022 study, the Center for Climate Integrity estimated that between 1970 and 2025, there will be a 39 percent increase in the number of school districts that see 32 or more days over 80 degrees.6 Furthermore, over 10 million students attend schools in districts that will see three more weeks of school days over 80 degrees in 2025 than they did in 1970.6
In cities, areas of increased asphalt and cement can contribute to increased heat known as the heat island effect. There can be large differences in temperature depending on location within a city.7,8 Anyone who lives or works in the urban heat island neighborhoods can be impacted. Workers may be disproportionately impacted by heat while at work if they do not have access to cooler spaces overnight. This is because of the cumulative health effects of heat over the course of a workweek.9,10 Additionally, workers with lower incomes may not be able to afford air conditioning at home to offset this.
With this background in mind, WCHA offers the following recommendations to strengthen the proposed heat safety rule:
Incorporate up-to-date and comprehensive information about common health conditions of workers that may make them more vulnerable to heat.
To provide greater heat protection,11 to account for variability in temperature conditions within a geographic area,7 and to account for individual health impacts, consider lowering the heat index threshold for the “High Heat Trigger” or change to only one threshold at heat index 80 degrees F with the greater provisions of the “High Heat Trigger.”
The rule should be revised to prescribe what an employer is required to do to address broken air conditioning or power outages, including timelines for this action, and specifications around how long a worksite’s air conditioner can be out of order before additional employer actions must be taken.
The rule’s requirements for drinking water should be clarified to indicate the water should be cool rather than warm. Also, requirements for the employer to offer electrolytes should be added. This is an essential health protection when people are working outdoors in high heat and can rapidly lose electrolytes due to increased sweating. The rule should also prescribe access to additional tools to help workers determine whether they are dehydrated, such as providing guides to monitor urine color or education about early symptoms of dehydration.
The rule should be revised to provide more protections for indoor workers, including sedentary workers. Domestic workers and day laborers must be included.12 Air conditioning is absent in a great many indoor worksites, including schools and assisted living facilities. In such settings, should workers faint in high heat, they would be unable to care for vulnerable students and residents, compounding risks for other workers there. Workers who primarily work out of vehicles should also be given specific consideration within the rule. In some circumstances, air conditioning may be available, but employers may not allow its use unless temperatures exceed operating parameters of equipment, as noted in the public comment from WisCOSH.13
Use of personal protective equipment (PPE) to protect from occupational hazards is required in certain roles. Furthermore, use of PPE is commonplace to prevent the spread of infections, beyond specific roles or mandates. PPE can increase the risk of overheating, so safe conditions for breaks (free from occupational or infectious disease hazards) should be provided.
The rule should prescribe additional rest breaks if workers have elevated body temperature, early symptoms of heat-related illness,14 or conditions that may increase their heat sensitivity. Rest breaks should include parameters to prioritize recovery before returning to work. Requirements that employers offer their workers temperature check equipment, such as contactless forehead thermometers, could also be incorporated.
The proposed rule should mandate that workers are compensated for rest periods. This is a priority particularly for outdoor work requiring physical exertion, and frequent breaks are critical to preventing heat-related illness, such as heat exhaustion and heat stroke, during periods of extreme heat. These rest breaks should be mandatory and occur in cool or shaded areas. Workers should not fear loss of pay for observing rest periods to stay healthy in extreme heat.
The combined impact of high heat and poor air quality (including elevated ozone and PM 2.5), which has an even greater impact on patients with cardiovascular disease,15 should be considered within the draft rule.
Workplaces of 25 or more employees should be required to have an employee-employer health and safety team that trains workers and employers how to prevent, recognize and treat heat related illnesses. Employees should complete all training and participation during paid time. Training should include use of the OSHA NIOSH Heat Index phone App.
OSHA should revise the rule to include more stringent anti-retaliation protections to empower workers to report violations without the fear of job loss or other punitive actions. OSHA should establish clear reporting channels that are accessible to non-English speakers and workers in isolated settings.
Climate change impacts and the expectation of ongoing increases in risks of heat impact should be included. The rule should be written to be flexible to protect workers now and in the future. According to the Wisconsin Initiative on Climate Change Impacts 2021 Assessment Report, compared to the year 2000, by 2050 “Milwaukee will likely experience triple the number of days with a heat index above 105 degrees”[page 78].10
The rule should protect all workers fairly, in the context that certain disadvantaged workers may have compounding risks as time goes on, due to climate change. Per the Fifth National Climate Assessment: “Structural racism and discrimination against groups that have been marginalized play a direct role in health inequities and are public health crises. Existing and projected human health impacts of climate change affect populations that are already experiencing an unprecedented decline in life expectancy due to environmental, social, political, and economic conditions that determine community health and well-being.”16
We urge advocacy for the continuation of science to provide understanding of climate conditions and predictions and to guide mitigation and adaptation efforts. For example, we urge reinstatement of scientists working on the National Climate Assessment that provides key information to help guide national and local decision making.17,18 Full staffing of the National Weather Service is needed to provide the data for local and workplace-level decision making about the extreme heat.19
Thank you for the opportunity to provide this comment in support of strengthening workplace heat injury and illness prevention.
Sincerely,
Members of Wisconsin Community Health Action
References
1. Fall W, Thelen M, Modji K, McCoy K. Heat-Related Illness on the Job: A Look at Worker’s Compensation Claims in Wisconsin (2010–2022). Published online 2024.
2. CDC. Clinical Overview of Heat and Pregnancy. Heat Health. January 31, 2025. Accessed May 23, 2025. https://www.cdc.gov/heat-health/hcp/clinical-overview/heat-and-pregnant-women.html
3. Blum MF, Feng Y, Tuholske CP, et al. Extreme Humid-Heat Exposure and Mortality Among Patients Receiving Dialysis. Am J Kidney Dis. 2024;84(5):582-592.e1. doi:10.1053/j.ajkd.2024.04.010
4. Returning to work. November 4, 2021. Accessed May 23, 2025. https://www.kidneyfund.org/living-kidney-disease/balancing-work-family-travel/returning-work
5. Kidney Disease: Fact Sheet | National Kidney Foundation. Accessed May 23, 2025. https://www.kidney.org/about/kidney-disease-fact-sheet
6. Hotter Days, Higher Costs: The Cooling Crisis in America’s Classrooms.
7. DNR Shares Results From Summer 2022 Milwaukee Heat Mapping Campaign. Wisconsin DNR. Accessed May 23, 2025. https://dnr.wisconsin.gov/newsroom/release/66256
8. CAPA Strategies, LLC. Chicago Illinois Heat Watch Report. October 2023. Accessed May 23, 2025. https://www.chicago.gov/content/dam/city/depts/cdph/environment/heat_watch/Summary-Report-Heat-Watch-Chicago_CAPA-12.15.2023.pdf
9. Division of Occupational Safety and Health, California S of. Heat Illness Prevention | What Causes Heat Illness? Accessed May 23, 2025. https://www.dir.ca.gov/dosh/etools/08-006/whatcauses.htm
10. 2021 Assessment Report: Wisconsin’s Changing Climate | Wisconsin Initiative on Climate Change Impacts (WICCI). Wisconsin Initiative on Climate Change Impacts. Accessed May 23, 2025. https://wicci.wisc.edu/2021-assessment-report/
11. Barber G. The US Is Measuring Extreme Heat Wrong. Wired. Accessed May 23, 2025. https://www.wired.com/story/the-us-is-measuring-extreme-heat-wrong/
12. Domestic Workers and Day Laborers. Labor Occupational Safety and Health Program. Accessed May 23, 2025. https://losh.ucla.edu/domestic-workers-and-day-laborers/
13. Schultz J. Comment from Schultz, James; Wisconsin Committee on Occupational Safety and Health (WisCOSH, Inc.). Accessed May 23, 2025. https://www.regulations.gov/comment/OSHA-2021-0009-25220
14. CDC. Heat-related Illnesses. Heat Stress. September 23, 2024. Accessed May 23, 2025. https://www.cdc.gov/niosh/heat-stress/about/illnesses.html
15. CDC. Clinical Overview of Heat and Cardiovascular Disease. Heat Health. February 18, 2025. Accessed May 23, 2025. https://www.cdc.gov/heat-health/hcp/clinical-overview/heat-and-people-with-cardiovascular-disease.html
16. Fifth National Climate Assessment. Accessed May 23, 2025. https://nca2023.globalchange.gov/
17. Witze A. Trump gutted two landmark environmental reports — can researchers save them? Nature. Published online May 2, 2025. doi:10.1038/d41586-025-01395-3
18. Oliver M. Trump dismisses contributors to key US report on climate crisis preparedness. The Guardian. https://www.theguardian.com/us-news/2025/apr/29/trump-fires-climate-report-contributors. April 29, 2025. Accessed May 23, 2025.
19. Thompson A. The National Weather Service Is Understaffed and Facing Huge Cuts—That Could Cost Lives. Scientific American. Accessed May 23, 2025. https://www.scientificamerican.com/article/how-trumps-national-weather-service-cuts-could-cost-lives/