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Slips, Trips, and Falls: Understanding, Preventing, and Mitigating Risks

By Gian Joseph, Safety Advisor

As we enter the rainy and cold season, we face several risks , which include slips , trips, and fall s in our day-to-day activities. It is important t o be aware of hazards around us and learn how to properly identify and assess any risks with each step.  

Slips, trips, and falls (STFs) are common accidents that can lead to severe injuries. These incidents occur in various settings, from homes and workplaces to public spaces , and i t is essential to understand the causes, consequences, and , most importantly, strategies for prevention and mitigation.   

1. Understanding the Dynamics of STFs. STFs are caused by the following .  

Insu fficient friction between the shoe and the walking surface. Common causes include wet or greasy floors, spills, and loose debris (Slip and Fall Accidents, 2021).  

When a person's foot collides with an object or an uneven surface, it caus es them to lose balance. Typical trip hazards include cluttered walkways, electrical cords, uneven flooring, and damaged or upturned mats (Slip and Fall Accidents, 2021).  

2. The Impact of STFs  

Slips, trips, and falls have far-reaching effects, affecting individuals and society . Personal i njuries range from minor cuts , bruises, sprains , and abrasions to fractures, dislocations, and head injuries (National Safety Council, 2021). The medical expenses associated with treating STF-related injuries can be substantial , including hospital stays, surgeries, rehabilitation, and ongoing care (National Safety Council, 2021). STFs can result in missed workdays and reduced productivity for both individuals and employers. Workers' compensation claims and absenteeism contribute to economic costs (National Safety Council, 2021). Lastly, t he physical and psychological consequences of STFs can limit mobility, independence, and overall quality of life, especially among older adults ( Sahyoun et al., 2020).  

3. Prevention and Mitigation Strategies  

Preventing and mitigating STFs involves a combination of awareness, environmental modifications, and education . H ere are some ways you can take precaution s against STFs in your daily activities;  

Clear Pathways: Maintain clear, unobstructed walkways by removing clutter and tripping hazards such as cords, toys, and loose rugs (Occupational Safety and Health Administration [OSHA], 2002).  

Adequate Lighting: Ensure proper lighting in all areas, both indoors and outdoors, to improve visibility and reduce the risk of tripping over obstacles (OSHA, 2002).  

Slip-Resistant Flooring: Install slip-resistant flooring materials, especially in areas prone to moisture, like bathrooms and kitchens (OSHA, 2002).  

Footwear: Encourage the use of proper footwear with good traction, especially in environments where slip hazards are prevalent ( Sahyoun et al., 2020).  

Handrails and Guardrails: Install and maintain handrails and guardrails on stairs, ramps, and elevated platforms to provide support and prevent falls (OSHA, 2002).  

Warning Signs: Use signage to alert individuals to potential hazards, such as wet floors or uneven surfaces (OSHA, 2002).  

Education and Training: Promote awareness and provide training to individuals on recognizing and avoiding STF hazards (National Institute for Occupational Safety and Health [NIOSH], 2015).  

Workplace Safety: Employers should implement safety protocols and conduct risk assessments in the workplace, addressing potential STF risks (NIOSH, 2015).  

Regular Maintenance: Routinely inspect and maintain buildings, walkways, and outdoor areas to identify and address potential hazards promptly (NIOSH, 2015).  

4. A Holistic Approach to STF Prevention  

Preventing and mitigating STFs require a collaborative approach involving individuals, organizations, and communities:  

Individuals : Exercise caution when walking, especially in unfamiliar or potentially hazardous environments. Wear appropriate footwear and take your time, especially in wet or slippery conditions ( Sahyoun et al., 2020).  

Employers: Create a safe work environment by identifying and mitigating STF risks. Provide training to employees on safety protocols and the proper use of equipment (OSHA, 2002).  

Property Owners and Managers: Ensure properties are well-maintained and free from hazards. Regularly inspect and address issues promptly (NIOSH, 2015).  

Government and Local Authorities: Enforce building codes and regulations that promote safety, especially in public spaces and commercial buildings (OSHA, 2002).  

Conclusion  

Slips, trips, and falls are preventable accidents that carry substantial personal, economic, and societal costs. By comprehending the causes, consequences, and prevention strategies, we can significantly reduce the incidence of STFs and mitigate their impact. Whether at home, at work, or in public spaces, prioritizing safety and fostering awareness about STFs is crucial for the well-being of individuals and communities. Let us strive collectively to create environments where everyone can move safely and confidently, free from the fear of falling.  

References:  

National Institute for Occupational Safety and Health (NIOSH). (2015). Preventing Slips, Trips, and Falls in Wholesale and Retail Trade Establishments. https://www.cdc.gov/niosh/docs/2015-100/pdfs/2015-100.pdf  

National Safety Council. (2021). Injury Facts. https://injuryfacts.nsc.org/work/overview/work-safety-introduction/work-...  

Occupational Safety and Health Administration (OSHA). (2002). OSHA Publication 3151-12R. Preventing Slips, Trips, and Falls in Wholesale and Retail Trade Establishments. https://www.osha.gov/Publications/osha3151.pdf  

Sahyoun , N. R., Pratt, L. A., & Lentzner , H. (2020). The Changing Profile of Nursing Home Residents: 1985-1997. Journal of Aging and Health, 12(3), 336-363.  

Slip and Fall Accidents. (2021). InjuryClaimCoach.com. https://www.injuryclaimcoach.com/slip-and-fall-accidents.html  

Please note that the sources cited are accurate as of the time of writing this article. For the most current information, consult authoritative sources and local health authorities.  

Go to the staff directory for individual contacts within EHS. You may also use the Weill Cornell Medicine online directory to search for faculty and staff.

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Prevention of Slips, Trips and Falls

On this page, how do falls happen, how to prevent falls due to slips and trips, what can you do to avoid falling at work.

Statistics show that the majority (67%) of falls happen on the same level resulting from slips and trips. The remaining 30% are falls from a height. This document will summarize information on "falls on the same level" (slips and trips). Falls from an elevation, such as falls from ladders, roofs, down stairs or from jumping to a lower level, etc., is discussed in other documents since each type of fall must be assessed as part of a fall prevention program .

Slips happen where there is too little friction or traction between the footwear and the walking surface. Common causes of slips are:

• wet or oily surfaces
• occasional spills
• weather hazards
• loose, unanchored rugs or mats
• flooring or other walking surfaces that do not have the same degree of traction in all areas

Trips happen when your foot collides (strikes, hits) an object causing you to lose balance and, eventually fall. Common causes of tripping are:

• obstructed view
• poor lighting
• clutter in your way
• wrinkled carpeting
• uncovered cables
• bottom drawers not being closed
• uneven (steps, thresholds) walking surfaces

Both slips and trips result from unintended or unexpected change in the contact between the feet and the ground or walking surface. This fact shows that good housekeeping, quality of walking surfaces (flooring), selection of proper footwear, and appropriate pace of walking are critical for preventing fall incidents.

Housekeeping

Good housekeeping is the first and the most important (fundamental) level of preventing falls due to slips and trips. It includes:

• cleaning all spills immediately
• marking spills and wet areas
• mopping or sweeping debris from floors
• removing obstacles from walkways and always keeping walkways free of clutter
• securing (tacking, taping, etc.) mats, rugs and carpets that do not lay flat
• always closing file cabinet or storage drawers
• covering cables that cross walkways
• keeping working areas and walkways well lit
• replacing used light bulbs and faulty switches

Without good housekeeping practices, any other preventive measures such as installation of sophisticated flooring, specialty footwear or training on techniques of walking and safe falling will never be fully effective.

For more information about effective housekeeping, visit the OSH Answers document on Workplace Housekeeping - Basic Guide .

Changing or modifying walking surfaces is the next level of preventing slip and trips. Recoating or replacing floors, installing mats, pressure-sensitive abrasive strips or abrasive-filled paint-on coating and metal or synthetic decking can further improve safety and reduce the risk of falling. However, it is critical to remember that high-tech flooring requires good housekeeping as much as any other flooring. In addition, resilient, non-slippery flooring prevents or reduces foot fatigue and contributes to slip-prevention measures.

In workplaces where floors may be oily or wet or where workers spend considerable time outdoors, prevention of fall incidents should focus on selecting proper footwear. Since there is no footwear with anti-slip properties for every condition, consultation with manufacturers is highly recommended.

Properly fitting footwear increases comfort and prevents fatigue which, in turn, improves safety for the employee. For more information on footwear visit the OSH Answers document on Safety Footwear .

You can reduce the risk of slipping on wet flooring by:

• taking your time and paying attention to where you are going
• adjusting your stride to a pace that is suitable for the walking surface and the tasks you are doing
• walking with the feet pointed slightly outward
• making wide turns at corners

You can reduce the risk of tripping by:

• keeping walking areas clear from clutter or obstructions
• keeping flooring in good condition
• always using installed light sources that provide sufficient light for your tasks
• using a flashlight if you enter a dark room where there is no light
• making sure that things you are carrying or pushing do not prevent you from seeing any obstructions, spills, etc.
• Fact sheet last revised: 2023-03-28

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Prevent Workplace Slips, Trips, and Falls—8 Safety Tips

Mopping up a spill or double-checking a guardrail might seem like simple common sense, but slips, trips, and falls are the second most common cause of death at work. These are life-saving procedures. Keep reading for practical tips to prevent workplace accidents.

• Slip, Trip, and Fall Hazards Listed
• Clarifying OSHA Standards
• Prevent Workplace Slips, Trips, and Falls

These are familiar scenarios at home: slipping on a wet floor in the kitchen and tripping over a toy left out by the kids. While annoying, these accidents are typically minor hazards in the home. You might stub your toe, but rarely are there severe consequences.

In the workplace, it’s a different and far more serious story. Slips, trips, and falls account for over 200,000 workplace injuries per year. In 2020, nearly one in five accidents leading to missed work was due to a slip, trip, or fall. They’re also the second-leading cause of workplace fatalities.

As a safety leader, you’re responsible for your company’s duty of care and for providing a safe workplace . This blog post will examine common hazards leading to slips, trips, and falls and the steps you can take to minimize injury risks for your team.

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What are slip, trip, and fall hazards in the workplace.

Accidents involving slips, trips, and falls are often grouped together. While they’re similar, it’s important to understand the distinction since they each have different causes and consequences.

Slips occur when someone’s footwear loses traction with the surface they’re on, causing a loss of balance. Under some circumstances, slipping can lead to a fall.

Trips happen when someone hits their foot or lower leg on an object. As their upper body continues moving forward while their lower body remains stationary, the person may lose their balance in the process.

Falls often result from slips or trips, but they can also happen on their own. For example, a worker on a ladder or scaffolding can lose their balance and fall without slipping or tripping. Falls are also possible on flat surfaces and can still cause serious injuries.

Once you understand the hazards that lead to each type of accident, you can identify and mitigate risks in your workplace. Here are some of the most common causes of slips, trips, and falls in the workplace:

Slip Hazards

• Spills of wet or dry substances
• The cleaning process during spill removal
• Employees rushing or not paying attention to workplace conditions, especially while carrying objects
• Slippery floor surfaces such as marble or laminate
• Wet surfaces
• Poor lighting that obscures hazards
• Inappropriate footwear for the environment
• Transitioning between different types of surfaces

Trip Hazards

• Objects or obstructions in walkways
• Uneven surfaces on flooring or concrete
• Cables, cords, and hoses that aren’t properly secured or organized
• Unmarked steps or ramps
• Irregular stairs or stairs without railings
• Carpet, rugs, or mats with wrinkles or lifted edges

Fall Hazards

• Improperly used or poorly maintained ladders
• Elevated surfaces without guardrails
• Floor and wall openings
• Working in elevated environments without a safety harness
• Ill-fitting or improperly used PPE, such as helmets and safety lines

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Are There OSHA Standards Related to Slips, Trips, and Falls?

Despite how common these injuries are, there is no specific OSHA standard on slips, trips, and falls. However, several OSHA rules indirectly address the same hazards.

The most important regulation to be aware of is 29 CFR 1910 Subpart D, which covers walking and working surfaces. OSHA updated the standard in 2017, introducing many upgrades to fall protection system requirements, improved employer-provided inspection guidelines, and a greater emphasis on safety training for employees.

For the construction industry, 29 CFR 1916 contains numerous fall-related regulations. Subpart M specifically addresses fall prevention, but other sections, such as Subpart L (scaffolds) and Subpart E (personal protective and lifesaving equipment), are also relevant. OSHA used 29 CFR 1916 as guidance when revising 29 CFR 1910, so the two guidelines now reflect many of the same OSHA violations .

As with any other workplace hazard or accident, OSHA recordkeeping requirements still apply in the event of a slip, trip, or fall incident. Internally, the reporting process is also an opportunity to review the details of the incident and determine how you can update your workplace safety policy to prevent similar accidents in the future.

How to Prevent Slips, Trips, and Falls in the Workplace

Many hazards that cause slips, trips, and falls are inevitable. However, injuries and accidents are not. To prevent slips, trips, and falls, train your employees to follow a three-step process:

• Recognize the hazard: Identify conditions that could lead to a slip, trip, or fall.
• Evaluate the hazard: Examine the situation and determine what level of risk it presents and who it affects.
• Control the hazard: Avoid the risk by removing the hazard (such as mopping up a spill) or implementing safety equipment and procedures (such as installing handrails on an elevated platform).

Here are eight workplace safety tips to prevent falls, trips, and slips.

1. Teach situational awareness

Since many causes of slips, trips, and falls are foreseeable, situational awareness in the workplace is one of the best preventative measures. Encourage your employees to pay attention to their surroundings and the risks they present:

• Look at walking surfaces for spills, obstacles, or other potential hazards
• Watch for signage that warns of increased hazards
• Be aware of conditions such as weather or time of day that might increase the risk of an accident
• Take shorter and more cautious steps on slippery surfaces

2. Encourage proper footwear

Like any other form of PPE, proper footwear can significantly reduce the risk of accidents. Research has found that slip-resistant shoes can reduce injury claims by 67% in environments with slippery work surfaces.

Employees should regularly inspect their shoes and make sure the soles aren’t worn out, as the lack of tread increases the danger of slipping. Additionally, anyone who works in conditions exposed to winter weather hazards should wear insulated boots. Cold temperatures can decrease muscle function, increasing the risk of slipping, tripping, or falling.

3. Utilize signage

Signage is an effective warning system for many workplace risks, but it can be especially effective in preventing slips, trips, and falls. There are two types of signs you can use to increase occupational safety:

• Temporary: Use warning signs while addressing a new hazard, such as cleaning up a spill, repairing a handrail, or replacing a ripped carpet. While temporary signage can help prevent injuries, you still need to address the actual hazard as quickly as possible.
• Permanent: For unavoidable hazards, such as slippery surfaces, a permanent sign can help warn employees to be careful. Use these sparingly, though, as it’s easy for people to ignore signs they see every day.

4. Keep floors clear and clean

Good housekeeping can help prevent most slips, trips, and falls. The details of keeping walking areas clean will vary widely by work environment, but there are a few common themes to encourage workplace safety:

• Report spills immediately, and warn nearby employees until someone can clean the contaminated surface
• Keep walkways clear of obstacles, loose objects, and anything that someone could trip over
• Place mats at entrances and exits so people can dry their shoes and avoid tracking water or other substances around the workplace
• Install handrails on stairways and elevated walkways

5. Apply non-slip mats and coatings

In some situations, keeping floors from becoming slippery is nearly impossible. Whether it’s liquid splashing or steam condensing, you must focus on mitigating the risk rather than avoiding it altogether.

For smaller or less demanding settings, non-slip mats can help employees maintain traction while walking around. In other cases, treating the floor with a permanent coating can help reduce slipping risks, even in the constant presence of liquids.

Who is at risk for slips, trips, and falls?

While all industries have some level of risk for a slip, trip, or fall, there are some industries where the risk is much higher, and the potential result could be much more dangerous. Here are some of the highest-risk industries:

• Construction
• Manufacturing
• Transportation/shipping/logistics
• Outdoor maintenance/groundskeeping
• Foodservice/hospitality

6. Ensure proper lighting

To identify slip, trip, and fall hazards, your employees need to be able to see their surroundings. Make sure that all of your work areas have proper lighting, especially in areas that are more prone to unsafe conditions.

While this can be a challenge in outdoor work environments, especially at night, it’s even more critical in those situations. Environmental conditions can lead to increased risks, and employees need to be able to see and avoid them. Adequate lighting should also extend to parking lots and walking areas around your facilities.

7. Develop safety programs

Your company’s safety plans and programs should include specific guidelines for preventing slips, trips, and falls. There are a few key topics to consider when developing these policies:

• The types of surfaces employees work and walk on and whether they present extra risks
• Seasonal or regional conditions that could heighten hazards, such as winter weather threats
• Specific OSHA regulations that apply to your workplace
• Potentially hazardous equipment training such as ladder safety
• Regular inspection plans to ensure your team is maintaining a safe work environment
• Policies to report hazards using your company’s two-way communication platform
• First aid training , so employees are prepared to respond safely should injuries occur

8. Provide Slips, Trips, and Falls Training

Lastly, training your employees to avoid slips, trips, and falls will help keep them safe. Provide specific guidance on the environments they’ll work in and the hazards they’ll face. For example, a slips, trips, and falls safety talk for food service workers should focus on wet floors and walking safely in crowded, fast-paced environments. Conversely, office workers could use extra reminders to watch for stray power cords and keep walkways clear of boxes, files, and other tripping hazards.

Working slips, trips, and falls into your safety topics for meetings is also helpful. Regular safety talks or safety moments are an excellent opportunity to remind your team about seasonal risks or update them on newly installed safety measures.

Don’t Let Your Safety Standards Slip

Slips, trips, and falls are some of the most common workplace injuries. Fortunately, you can usually prevent them with proper planning and safety measures.

By making slip, trip, and fall prevention a part of your company’s safety culture, you can ensure your employees are aware of their surroundings and ready to look out for each other’s safety. Enable them to report hazards easily, address risks quickly, and train them to avoid situations that are likely to cause injury.

With the right planning and prevention, even the most intense work environments can be as safe as a walk in the park.

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Workplace Safety Checklist

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Slips, Trips, and Falls toolbox talk

A simple, 5 minute outline of what to cover in a toolbox talk on Slips, Trips, and Falls.

Download a Slips, Trips, and Falls toolbox talk pdf

Slips, trips and falls are a common reason for many of the injuries in workplaces. They can cause minor injuries but can also lead to serious, long-term injuries. Many slip, trips and falls are avoidable and there are usually easy solutions a workplace can apply to control the risk, either by eliminating or minimising it. It could be as simple as cleaning up a spillage straight away, or moving a cord off a walkway which can prevent injuries from occurring.

Why run a Slips, Trips, and Falls Toolbox Talk?

• Prevent unnecessary injury from slip, trips and falls by improving awareness and training
• Fewer injuries means higher productivity
• Makes sure workers know what to look for and what to do about it to reduce the risk of an injury occurring

What to watch out for that are common causes of slip, trips and falls? 

• Poor housekeeping & messy sites 
• Poor lighting 
• Uneven walking surfaces 
• Clutter on site 
• Uncovered cords and cables 
• Weather conditions (e.g. rain, ice, dust) 
• Obstructed views 
• Unsuitable footwear 
• Distractions (e.g. cell phone, other workers) 

What can you do to help prevent slips, trips and falls occurring? 

• Keeping work areas clear & tidy from clutter, obstructions and rubbish 
• Any waste placed in designated bins 
• Clean up any leaks or spills immediately 
• Put tools and equipment away
• Wear suitable footwear (e.g. grippy, anti-slip) 
• Ensure work areas are well lit and sufficient light for work
• Keep cords and cables out of walkways, covered or secured 
• Be aware of your surroundings and focus on what you are doing 
• Work to the weather conditions 

What if a slip, trip or fall occurs or nearly occurs? 

• Report all slip, trip and fall accidents and near misses, with or without injury, this will help identify the hazards and implement control measures to prevent reoccurrence

Key takeaways 

• Simply cleaning up your work area as you go, can help reduce slip, trips and falls 
• Make sure you are always aware of your surroundings and look where you are walking  

If you see a hazard that has the potential to cause a slip, trip or fall then pick it up or fix it – don’t wait for someone else to do it. Do it yourself!

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Slip, Trip, and Fall Prevention for Healthcare Workers

December 2010, dhhs (niosh) publication number 2011-123.

According to the U.S. Bureau of Labor Statistics [2009], the incidence rate of lost-workday injuries from slips, trips, and falls (STFs) on the same level in hospitals was 38.2 per 10,000 employees, which was 90% greater than the average rate for all other private industries combined (20.1 per 10,000 employees). STFs as a whole are the second most common cause of lost-workday injuries in hospitals.

Slip, Trip, and Fall Prevention for Healthcare Workers pdf icon [PDF 979.73KB]

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1 st Reporting

Slips, Trips, and Falls: A Comprehensive Guide For The Proactive Manager (Part One – Regulatory Requirements)

Posted 11.05.23 by: Jeremy Shantz

Slips, trips, and falls in the workplace are common and the number one cause of workplace injuries. We’re not just talking about minor injuries, either. Believe it or not, something as simple as a carpet in your entranceway can cause severe trauma and, in rare cases, death.

Table of Contents

Understanding Impact

Slips, trips, and falls happen often. In fact, 27.4% of nonfatal workplace injuries in private industry were caused by slips, trips, and falls. If we look at the big data, in 2019 in the United States, there were 888,220 workplace injuries (reported), and 244,000 were slips, trips, and falls caused. ( source )

Statistically, these numbers are quite revealing. The median number of injuries one can expect is 2.8%. So, three of every 100 workers will have an injury at work this year, according to the injury statistics.

This guide will review all the ins and outs of slips, trips, and fall incident management. I’ll provide a roadmap for making management and prevention much easier for you. Stick with me to the end, and I’ll give you my favorite not-so-secret incident management tool advice so you can make your job easier too. Let’s get started.

Understanding Slips, Trips, And Falls

To create a safe and manageable work environment, we must understand exactly what slips, trips, and falls are. You know the common definition, but let’s examine how the authorities view such terms.

Definitions

Most countries in the G20 or UN follow a basic understanding of the incident definition. However, for the purpose of clarity, we’ll use OSHA (Occupational Safety and Health Administration in the United States) for our definitions.

According to OSHA, a slip is when a person loses balance due to a lack of friction between the floor and their footwear. Examples might include wet smooth tile or marble flooring, or if you live in the north, a typical slip scenario is ice on the ground.

Common Causes

• Oil or similar lubricating chemicals
• Wet surfaces

A trip is a scenario where a person loses balance due to a collision between a foot and an object. Practical scenarios might include a fold in a moveable floor rug, uneven flooring or steps, or even objects left on the floor. Trips are potentially dangerous not just due to the collision between foot and object but because they have a tendency to throw a person to the ground. Well, I don’t need to tell you how dangerous that can be when:

• Working at heights
• Working around sharp objects
• Working around moving equipment or vehicles

For obvious reasons, a trip can quickly escalate into a life-or-death severe scenario.

• Uneven flooring
• Objects in walkways

OSHA views a fall as the movement towards a lower level, typically at rapid speed or acceleration (gravity). You might go so far as to assume that the fall is the tail-end of the trip, and in many cases, you would be correct in making that assumption. However, the wording that OSHA uses to define a fall makes the assumption more evident that it intends to regard falling from a higher level to a lower level as the pre-emptive definition of a fall.

Examples of falls include falling off a loading dock edge, falling down some stairs, or falling off your chair (it happens more than you know).

• Unguarded work platforms
• Lack of fall prevention equipment
• Trips and slip events

I’ve provided a few causes of slips, trips, and falls in the workplace, but let’s define the more broad reasons to get the proper perspective.

Environmental Factors

As mentioned earlier, if you’re in North America, Europe, or another place that sees ice and snow in winter, you know that environmental factors can easily cause slips, trips, and falls. Ice, snow, and hail can easily make a person slip and fall.

Rain is also a factor in slipping on smooth surfaces. Naturally, we don’t have many smooth outdoor places where people might slip, but even a wood walkway outside can turn into a slippery surface in the right wet conditions.

Human Factors

Humans are notorious for making problems for each other, and often, it isn’t even intentional. Take a worker who is carrying some boxes and set them down for a moment to answer the phone. Maybe they get distracted and merely forget the box was placed in an aisle. Sure enough, if Murphy is afoot, then someone is going to trip over the box.

Human factors may not be limited to the common practice of leaving a parcel in a walkway. Some jobs require workers to instigate slippery conditions; just think of anyone who has to wash down a truck with soapy water, work with oily equipment, or any number of other common work scenarios that involve processes that could cause slippery conditions. A janitor mopping up a spill is the simplest human factor that comes to mind, especially if there are no slippery when wet floor signs are posted.

Equipment Factors

Although equipment can play a significant role in workplace slips, trips, and falls (in several ways), truth be told, each of the ways that equipment factors into slip, trip, and fall events all go back to a person in some way or another. Here are some of the ways people let 

equipment causes dangerous situations that can cause slips, trips, falls, and injury to people.

• Poor Maintenance: Equipment that people improperly maintain can create hazards. For instance, a machine can leak oil or other fluids, creating a slippery surface. Machines or other equipment might also have loose parts that could cause someone to trip.
• Improper Use: Misusing equipment can lead to accidents. For instance, if you use a ladder that’s too short, you might overreach and fall. Don’t stand on chairs or tables in the office instead of using a step stool or ladder. I have found in every job that one person thinks they can stand on a wheeled desk chair to reach something, but I warn you: Don’t do it. You aren’t Spiderman.
• Equipment Placement: The location of equipment can also cause accidents. Electrical cords and cabling are notoriously making people faceplant. If you have ever worked in maintenance (or entertainment), then you’ll know what I’m talking about. 
• Inadequate Safety Features: Some equipment may lack necessary safety features that could prevent slips, trips, and falls. For example, a ladder without non-slip feet can easily slide on a smooth surface, leading to a fall. 

Similarly, machinery without proper guardrails or other safety devices could put workers at risk of falling. Check your equipment for necessary safety features. Machinery should have proper guardrails or other safety devices to prevent falls. Furthermore, it would be best to insist on daily walk-around safety inspections for all your vehicles or equipment . Enacting smart safety protocols reduces the risk.

• Inappropriate Equipment: Sometimes, the equipment itself is not suited for the job or the environment, increasing the risk of slips, trips, and falls. For instance, forklifts used in an area with a slippery floor can lead to accidents.
• Personal Protective Equipment (PPE): The absence or misuse of PPE can also contribute to slips, trips, and falls. For instance, workers not wearing appropriate footwear for their environment (like non-slip shoes in a wet or oily environment) can easily slip and fall. Similarly, workers who don’t use precautions like a fall protection safety harness are asking for accidents to happen.

To mitigate these risks, ensure that regular maintenance and safety checks of all equipment are standard practice at your workplace. Workers should also have training in correctly using and placing all equipment, and appropriate PPE should be provided and used consistently.

Common injuries

Knowing something and doing nothing about it is pointless. If we look at the data, then we know that each year it is expected that 2.8% of workers will have an at-work accident. That’s 1.4 workers out of 50 (0.7 out of 25). With these numbers, a team of 12 can expect one worker every two years to have an at-work injury. Let’s see what injuries are most common.

Sprains And Strains

Workplace sprain and strain injuries happen most to the torso. In many cases, this means someone’s back. Nearly 40% of injuries in 2021 (In the US) involved the torso.

Not to put too fine a point on it, but the US Bureau of Labor Statistics said back in 2005 that sprains and strains accounted for 43%, and mostly back injuries, of private industry, lost time accidents. That is, 43% of the 1.3 million injuries and illnesses reported in 2003. Twenty years ago, and things haven’t changed much. 

According to the injury attorney Adam Skutner (no affiliation), you have a five percent chance of breaking a bone when you slip and fall. I’ve known three people who slipped, fell, and tried to put their hands out to stop the fall. Two of them broke their wrist; the third person sprained it. And that’s just off the top of my memory. So when I hear that five percent break bones, I’m not surprised it’s five percent; I’m surprised it isn’t more.

Dislocations

If you’ve ever dislocated something, then you know it’s as painful as a break. I think of the classic Mel Gibson in Lethal Weapon. He was known for dislocating his shoulder and painfully re-locating it with violent force against a wall or similar structure. However, nothing is entertaining about real-life dislocations, so it’s best to avoid them for obvious reasons.

Contusions And Abrasions

Contusions and abrasions are quite common in workplaces. Even office staff get paper cuts – no one is safe! However, in your business, it’s no laughing matter. A simple paper cut can lead to an infection that can lead to any number of complications. That’s why it’s critical to document everything, even a cut. 

At a former job I managed, we had a simple first-aid use form to complete any time a first-aid kit was opened. It was a simple way to document simple injuries like cuts and scrapes that did not require medical attention beyond the first aid kit.

Concussions And Head Injuries

Concussions and head injuries are the most serious concern for anyone in a slip-and-fall event. The healthiest of people can fall the wrong way, hit their head, and end their day (or life). 

According to the Washington Post , a study showed that the human skull can withstand 6.5 GPa of pressure. That’s compared to oak (wood) at 11, concrete at 30, aluminum at 69, and steel at 200. Therefore, I wouldn’t put my head in a fight against anything harder than my pillow.

Regulatory Requirements

It’s time to get into regulations. You are responsible for those under your charge as a manager or employer. Let’s see what OSHA has to say about the matter.

Occupational Safety and Health Administration (OSHA) standards

Navigating the landscape of safety protocols and OSHA standards can be overwhelming, but we’re here to break it down for you. The core standards you need to be aware of when it comes to preventing slips, trips, and falls in the workplace are these:

General Requirements (29 CFR 1910 Subpart D): It’s all about ensuring safe walking-working surfaces for your team. Make it a priority to keep these surfaces free from hazards like sharp objects, loose boards, leaks, or spills. Let’s not forget about seasonal hazards like snow and ice too!

Stairways and Ladders (29 CFR 1926.1052 and 1926.1053): These rules are a must-know if you’re in the construction industry. The focus here is on providing safe stairways and ladders to help prevent falls.

Fall Protection (29 CFR 1926.501): Another one for the construction folks out there. This standard mandates that employers provide fall protection systems when workers operate at heights of 6 feet or above a lower level.

Walking-Working Surfaces (29 CFR 1910.22): This one circles back to the general requirements but emphasizes cleanliness and orderliness. You must ensure that all walking and working surfaces are sanitary and well-maintained.

Personal Protective Equipment (29 CFR 1910 Subpart I): Here’s where the right gear comes in. OSHA requires employers to provide employees with appropriate personal protective equipment (PPE) and ensure its proper use. This could include non-slip footwear to help prevent slips and falls.

Remember, it’s not just about ticking boxes and meeting legal requirements. It’s about creating a safe working environment where your team members can perform their duties without fear of slips, trips, and falls. 

International Organization for Standardization (ISO) Guidelines

ISO has a specific standard that addresses occupational health and safety: ISO 45001. These standard guides organizations in creating robust health and safety management systems, which inherently involve the prevention of slips, trips, and falls. However, the standard doesn’t go into specific details about these incidents. Instead, it focuses on risk management and hazard identification that would help anticipate and prevent such accidents.

Industry-Specific Regulations

All industries must follow a basic duty standard to provide safe working conditions. However, some industries have specific regulations, which I will review a sample cross-section of below.

Construction Industry

OSHA’s construction safety standards (29 CFR 1926) include detailed requirements for fall protection (29 CFR 1926.501), stairways and ladders (29 CFR 1926.1052 and 1926.1053), and scaffolding (29 CFR 1926.451). These standards mandate using guardrails, safety nets, or personal fall arrest systems when workers are working at heights of 6 feet or above a lower level.

General Industry

OSHA’s walking-working surfaces standards (29 CFR 1910 Subpart D) apply to all general industry workplaces. They require employers to provide safe walking-working surfaces and keep them free from hazards such as sharp or protruding objects, loose boards, corrosion, leaks, spills, snow, and ice.

Healthcare Industry

While there’s no specific OSHA standard for slip, trip, and fall hazards in the healthcare industry, these workplaces must comply with the general industry standards, including the walking-working surfaces standards. OSHA’s guidelines for nursing homes recommend implementing a comprehensive safety and health program that includes an analysis of fall hazards and a plan to control these hazards.

Maritime Industry

For shipyards (29 CFR Part 1915), long shoring (29 CFR Part 1918), and marine terminals (29 CFR Part 1917), OSHA has specific regulations that include requirements for working surfaces, guarding floor and wall openings, and maintaining ladders, stairways, and scaffolds.

Company Policies And Procedures

We have covered what the regulations say, and now it’s time to put that information into action. Creating a health and safety manual is a requirement for most businesses. Although the regulations may vary from state to state or province to province, the concept remains the same: If you operate a business with employees, you should have a health and safety manual.

Along with your health and safety manual, it’s advisable to have job hazard analysis a part of every role within your company or organization. Furthermore, it’s easy to include standards to maintain by providing your team with instructions and procedures to follow within each role. For example, you could include in your housekeeping role manual to utilize wet floor signs and keep pace with any spills to ensure fast clean-up and reduced chances of incidents.

That’s it for part one of our Slips, Trips, and Falls guide for the proactive manager. Check out Part Two for even more about the processes you can implement to take control of slips, trips, and fall incidents at your place of business.

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Handbook of Human Motion pp 1–28 Cite as

Slips, Trips, and Falls

• Andrew Short 8 &
• Len Cubitt 9  
• Living reference work entry
• First Online: 01 September 2017

136 Accesses

Slips and trips started when primates evolved to take an upright stance and stood on two legs instead of four. This change meant the center of gravity for the primates instantly became higher. It also meant the level of support lessened creating an inherently unstable situation. Humans are the most likely animal to trip or slip because our world is full of distractions and we may not “see” small projections in our walking paths.

The early paths humans took probably followed animal trails which were made of earth and rock. This type of surface is self-repairing. That is, earth/dirt is quite malleable and easily made flat with foot traffic. It is also re-routable in that if a path becomes blocked, a new path can be formed. For millennia, animals have dealt with blocked paths by finding another route which they then similarly trod down. The establishments of these new paths were aided by nature: rain turned them into quagmires and heat then dried them up to create new more flattened surfaces.

In modern times, pedestrians in most urban environments generally walk down concrete and bitumen footpaths. The footpaths are a requirement for urban living and are more durable than a dirt path.

People walk at a speed according to predictable terrain. If there is an acute change in the level of the walkway that is not readily observable and is out of step with the preceding pattern, the risk of a trip increases. If there is an acute change in the friction on the surface of the walkway that is not readily discernible, the risk of a slip on the surface increases.

Lenard Cubitt has Retried

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Preventing Workplace Hazards: A Comprehensive Guide to Slips, Trips, and Falls Safety Training

• Ossian Muscad
• November 13, 2023
• No Comments

Last Updated on November 13, 2023 by Ossian Muscad

Workplace safety is a fundamental aspect of any organization’s operational standards. Ensuring a safe and hazard-free environment is legally required and crucial in maintaining productivity and morale among staff.

Slips, trips, and falls are significant contributors to workplace injuries and downtime. These incidents, often perceived as minor mishaps, actually account for a large proportion of workplace accidents and can result in severe injuries or even fatalities.

Consequently, an effective fall training program is essential in preventing such incidents. This article will delve into the necessity of such training and provide a comprehensive guide for implementing effective slips, trips, and falls safety training in your workplace to promote a safer, more productive environment.

Understanding Slips, Trips, and Falls

A slip occurs when there’s an unexpected change in the contact between the feet and the ground, often due to wet, oily, or smooth surfaces. A trip happens when a person’s foot contacts an object or unexpectedly drops to a lower level, causing them to be thrown off balance. 

A fall is an event that results in a person coming to rest inadvertently on the ground or at a lower level, not as a result of a major intrinsic event (e.g., stroke) or overwhelming hazard. All three incidents are relatively common in the workplace, and their severity can range from minor bruises to severe bone fractures or worse.

Types of Falls

There are three main types of falls: same-level, upper-level, and swing. Each type has specific causes and prevention measures; separating them into their designated categories allows for more effective training.

• Same-level Falls: These falls occur on the same level due to slips and trips. They can happen in various settings, such as workplaces, homes, or public spaces. Common causes include wet or slippery surfaces, uneven flooring, or obstacles in the walking path.
• Elevated Falls: These are falls from a height, such as a ladder, rooftop, or any elevated platform. They pose a significant risk of injury or even fatality. Factors that contribute to elevated falls include lack of fall protection equipment, improper use of ladders or scaffolds, or working in unstable or unsafe conditions.
• Swing Falls: A swing fall occurs in fall arrest situations. It happens when a person falls while wearing fall protection equipment, such as a safety harness, and the fall distance exceeds the free fall distance. Swing falls can occur due to improper anchorage, incorrect use of equipment, or inadequate training on fall arrest techniques. The longer fall distance in swing falls increases the risk of injury and may require additional precautions to ensure safety.

The Statistics and Financial Impact of Slips, Trips, and Falls

Slips, trips, and falls are a leading cause of accidents in the general industry, responsible for 15% of all accidental deaths. They come second only to motor vehicles as a cause of fatalities.

These alarming statistics, provided by the United States Department of Labor, highlight the significant impact of these mishaps. Additionally, employers bear a staggering financial burden, with approximately $70 billion spent annually on workers’ compensation and medical costs related to these incidents.

Common Causes and Contributing Factors

Various factors can cause slips, trips, and falls. These factors can range from environmental conditions to the individual’s behavior. A few common causes and contributing factors include:

Common Causes

• Wet or oily surfaces: Slippery surfaces due to water or oil increase the risk of falls.
• Weather hazards: Adverse weather conditions like rain, snow, or ice make walking surfaces slippery and hazardous.
• Loose, unanchored rugs or mats: Unsecured rugs or mats can easily slide or trip people.
• Flooring or other surfaces that don’t have the same degree of traction in all areas: Inconsistent traction on different surfaces can lead to slips and falls.
• Clutter or obstacles in walkways: Objects in walkways can impede movement and cause trips or falls.
• Missing or inadequate handrails on stairs and ramps: Lack of proper handrails on stairs and ramps can result in loss of balance and falls.
• Failure to use fall protection equipment when working at heights: Not using appropriate safety equipment when working at heights increases the risk of falling.
• Poor housekeeping practices: Untidy and poorly maintained environments can contribute to tripping hazards.
• Fatigue, distraction, or rushing while walking: Being tired, distracted, or in a hurry can affect coordination and increase the likelihood of falls.
• Age-related factors such as slower reaction times and decreased balance: Aging can lead to reduced reaction times and balance, making falls more likely.

Contributing Factors

• Poor lighting: Insufficient lighting can hide hazards and make navigation difficult. Inadequate illumination increases the risk of accidents, especially in dimly lit areas.
• Clutter: A cluttered workspace can lead to tripping hazards. Objects strewn on the floor or obstructing walkways pose a significant risk of trips and falls.
• Footwear: The type of footwear can play a significant role in slips and falls. Incorrect footwear can create extra hazards, especially in industrial settings. Wearing proper footwear with slip-resistant soles is crucial for maintaining stability and preventing accidents.
• Human Factors: Age, hurry, fatigue, carrying or moving cumbersome objects, or even wearing unsuitable footwear can lead to slips, trips, and falls. Awareness of these factors and taking necessary precautions can significantly reduce the risk of accidents.
• Environmental Factors: Poor weather, changes in temperature, and uneven lighting can all contribute to falls. Rain, ice, or sudden changes in lighting conditions can create hazardous situations, necessitating extra caution while walking or working.
• Inadequate Training: Lack of proper training on safety protocols and using safety equipment can contribute to accidents. Employees may not know how to navigate certain situations or use tools and machines safely, leading to slips, trips, and falls.
• Poor Communication: Inadequate communication about potential hazards can lead to accidents. Employees may not be aware of a wet floor, a loose carpet, or any change in the working conditions that poses a potential risk.
• Lack of Safety Policies and Procedures: An absence of or poorly implemented safety policies can result in an unsafe working environment. Employers must have strict policies for cleaning up spills, maintaining clean workspaces, and ensuring regular safety training.
• Improper Use of Equipment: Misusing tools or equipment or using them in poor condition can result in accidents. Ladders, for example, require specific safety protocols; failure to follow them can lead to falls.
• Hazardous Layouts and Designs: Poorly designed environments or structures with inherent challenges, such as narrow staircases, steep inclines, or low visibility areas, can contribute to slips, trips, and falls.

The Significance of Falls Training

Falls training is crucial to workplace safety, given the substantial risks and consequences associated with slips, trips, and falls. A comprehensive fall training program equips employees with the necessary knowledge to identify hazards and helps them adopt safe practices to mitigate these risks.

This includes understanding how to use safety equipment appropriately, maintain clean and safe workspaces, and navigate potential hazards. By emphasizing fall training, employers can significantly reduce the incidence and severity of workplace accidents, thereby protecting both the employees and the organization.

Legal and Regulatory Obligations

Abiding by legal and regulatory guidelines is essential to maintaining a safe working environment. These obligations protect employees and ensure the organization takes the necessary measures to prevent accidents. Key obligations include:

• Occupational Safety and Health Act: OSHA requires employers to ensure a safe and healthy environment for workers. This includes training employees to recognize and avoid unsafe conditions, including falls.
• Workers’ Compensation Laws: Various state laws require employers to pay for medical expenses and lost wages if an employee gets injured or ill due to work-related activities.
• Americans with Disabilities Act (ADA): This act mandates that employers accommodate employees with disabilities, which may include providing additional safety measures to prevent slips, trips, and falls.
• Building Codes: These codes set standards for the design and construction of buildings to ensure safety, including features to prevent falls, such as railings on stairs and ramps.

Benefits of a Well-Trained Workforce

Investing in comprehensive training programs yields significant benefits for employees and the organization. These include:

• Reduced Accidents and Injuries: Proper training helps employees recognize and avoid potential hazards, leading to fewer accidents and injuries.
• Improved Productivity: A safe workplace is a productive workplace. Employees who are not concerned about potential hazards can focus on their tasks more effectively.
• Lower Costs: By reducing the number of accidents, organizations can decrease costs associated with workers’ compensation claims, medical expenses, and lost work hours.
• Improved Morale: Employees who feel safe at work are more likely to be satisfied and engaged, leading to higher morale and improved performance.
• Legal Compliance: Adequate training ensures that organizations meet legal and regulatory obligations, helping to avoid penalties and potential legal issues.
• Enhanced Reputation: A strong safety record can improve an organization’s reputation among clients, investors, and potential employees.

Identifying Workplace Hazards

To minimize the risk of workplace slips, trips, and falls, it is critical first to identify the potential hazards that may cause these accidents. This involves recognizing these hazards, conducting thorough risk assessments, and encouraging active participation from employees in the identification process.

Recognizing Potential Hazards

Recognizing potential hazards forms the first step toward preventing accidents. This involves being aware of common slips, trips and falls sources such as wet surfaces, loose rugs, poor lighting, or cluttered workspaces. Employees must be trained to spot these hazards and report them to supervisors immediately to mitigate risks.

Conducting Risk Assessments

Regular risk assessments are essential in maintaining a safe work environment. This process involves identifying potential hazards, evaluating the risk level, and implementing necessary measures to control these risks. A detailed risk assessment should be integral to any fall training program.

Employee Involvement in Hazard Identification

Employee involvement in hazard identification is crucial, as employees are often the first to notice potential risks. Encouraging active participation in safety protocols, promoting open communication, and fostering a culture of safety consciousness can greatly enhance the effectiveness of falls training. This empowers employees to take ownership of their safety and that of their colleagues, making the workplace safer.

Elements of Falls Training

A comprehensive falls training program is not a one-size-fits-all solution but rather a concerted strategy tailored to a workplace’s specific needs and characteristics. It encompasses a wide range of elements, each playing a pivotal role in ensuring the safety of all employees.

Key Components of a Falls Training Program

A robust fall training program typically includes several key components designed to equip employees with the knowledge and skills necessary to prevent slips, trips, and falls. These components encompass:

• Hazard Identification: Training employees to recognize potential hazards and report them promptly.
• Risk Assessment Procedures: Teaching employees how to conduct thorough risk assessments of identified hazards.
• Preventive Measures: Providing instructions on proper usage of safety equipment and implementing best practices for maintaining safe workspaces.
• Emergency Response: Training employees on actions to take in the event of a slip, trip, or fall accident.
• Continuous Learning: Regularly update and refresh the training material to keep up with evolving risks and safety practices.

The Role of Supervisors and Managers in Falls Training

Supervisors and managers play a crucial role in falls training. They are responsible for:

• Setting Standards: Establishing and enforcing safety protocols and expectations.
• Facilitating Training: Ensuring all employees have access to and complete fall training.
• Promoting a Culture of Safety: Encouraging employees’ active participation and accountability in safety practices.
• Monitoring Compliance: Regularly checking to ensure that safety protocols are being adhered to.

Customizing Training for Different Industries

Different industries present unique hazards and risks, necessitating customizing fall training to suit their needs. Customized training might focus on the following:

• Industry-Specific Hazards: Identifying and addressing hazards unique to a specific industry.
• Specialized Equipment: Training on safely using industry-specific tools or machinery that may pose fall risks.
• Regulations Compliance: Educate employees about industry-specific safety regulations and standards.
• Best Practices: Sharing industry-related best practices and guidelines for maintaining workplace safety.

Practical Training Techniques

Falls training programs should strive for more than just theory-based learning; they should aim to incorporate practical, hands-on experiences that mirror real workplace situations. Here are some effective techniques that can significantly enhance the practical aspect of fall training:

Hands-On Training Exercises

Hands-on training exercises allow employees to apply their learned knowledge in a controlled, safe environment. This could involve identifying and evaluating potential hazards in a simulated workspace or demonstrating the use of safety equipment.

Simulations and Real-Life Scenarios

Through simulations and real-life scenarios, employees can practice responding to situations that could lead to slips, trips, or falls. This provides a better understanding of how to apply safety protocols in real-life situations, enhancing their ability to respond effectively in the event of an actual accident.

Interactive Training Tools and Resources

Interactive training tools and resources such as e-learning platforms, virtual reality equipment, and online safety games can make fall training more engaging and effective. They allow trainees to learn at their own pace and revisit topics as needed, aiding in better retention of information.

Tips for Successful Training

Success in fall training does not happen accidentally—it results from careful planning and execution. Here are a few tips to make your training more effective and impactful:

Engaging Employees in the Process

Employees are more likely to retain and apply what they’ve learned if they are actively engaged in the training process. Use a variety of training methods, solicit feedback, and encourage questions. Make training interactive and hands-on wherever possible, and ensure that training content is relevant to their roles and daily tasks.

Setting Clear Objectives and Goals

Ensure that each training session has clear, measurable objectives and goals. What should employees learn, and how will you measure their understanding and competency? Having clear objectives guides the training process and gives employees a clear idea of what is expected of them.

Tracking and Evaluating Training Effectiveness

Regularly evaluate the effectiveness of your fall training program. This can involve monitoring incident rates, conducting safety audits, or gathering participant feedback. Use this information to continually improve and update your training content and methods, ensuring they remain relevant and effective.

Regulatory Compliance

It’s crucial to be aware of and adhere to the US Occupational Safety and Health Administration (OSHA) and other relevant safety regulations. These rules are designed to protect employees and ensure a safe and healthy work environment. Some key regulations related to slips, trips, and falls include:

• OSHA 29 CFR 1910 Subpart D: This standard outlines requirements for walking-working surfaces to prevent fall hazards.
• OSHA 1910.132: A general requirement for using personal protective equipment in the workplace.
• ANSI/ASSE Z359: Known as the “Fall Protection Code,” this comprehensive set of standards covers a wide range of fall protection issues.
• OSHA 1910.178(l)(3)(i): This regulation pertains to the safe operation of powered industrial trucks, including forklifts.

Staying Up-to-Date with Changing Standards

In the ever-evolving landscape of workplace safety, it is imperative to stay current with changing standards and updates to existing regulations. Here are a few ways to accomplish this:

• Subscribe to OSHA Updates: OSHA offers email updates that provide timely information on new standards, training requirements, and compliance assistance resources.
• Attend Industry Training and Webinars: These events often cover recent changes to standards and provide practical advice for implementation.
• Join Professional Safety Organizations: Membership in organizations like the American Society of Safety Professionals (ASSP) can provide resources and networking opportunities.
• Review Industry Publications: Regularly reading safety journals and magazines can keep you informed of developments in the field.

Consequences of Non-Compliance

Failure to adhere to safety regulations can seriously impact employees and organizations. These can include:

• Injuries and Fatalities: The most immediate and severe consequence of non-compliance can be workplace accidents, resulting in injury or even death.
• Financial Penalties: Organizations can face heavy fines and penalties from regulatory bodies like OSHA for safety violations.
• Legal Repercussions: In severe cases, non-compliance can attract lawsuits and legal actions against the company.
• Damage to Reputation: Persistent non-compliance can negatively affect public image, potentially impacting customer trust and business partnerships.

Measuring the ROI of Falls Training

In a dynamically evolving business landscape, justifying the expenditure on fall training can be challenging. However, assessing the Return on Investment (ROI) can provide tangible proof of the financial benefits of such programs, making the case for their implementation and continuation.

Methods for Assessing the Return on Investment

Investing in fall training programs is not just about compliance; it’s about creating a safer work environment, which, in the long run, can save the organization considerable time and money associated with work-related accidents and injuries. To evaluate the ROI of your fall training, consider the following methods:

• Accident Cost Savings: Compare the costs associated with accidents, such as medical expenses, lost productivity, and insurance premiums, before and after implementing the training.
• Productivity Metrics: Measure the productivity improvements that result from fewer interruptions due to accidents.
• Employee Satisfaction: Use surveys to gauge whether the training has improved employee morale and job satisfaction, leading to lower turnover rates.
• Regulatory Compliance: Measure the savings from avoiding regulatory fines and penalties due to non-compliance.
• Insurance Premiums: Track reductions in insurance premiums due to fewer workplace accidents.

Demonstrating the Financial Benefits of Safety Training

Safety training particularly falls training, can offer significant financial benefits in the long term despite upfront costs. It is an investment that pays off by reducing the frequency and severity of workplace accidents, consequently decreasing downtime, workers’ compensation claims, and insurance premiums. 

• Reduced Accident Costs: Safety training leads to fewer accidents, which means less money spent on medical bills, compensation, and recovery.
• Greater Employee Productivity: Fewer accidents mean less downtime, increasing productivity.
• Decreased Insurance Premiums: Insurance companies may offer lower premiums as the incident rate decreases.
• Improved Reputation: An excellent safety record can enhance your corporate image, attracting more business and high-quality employees.

Encouraging Long-Term Commitment to Training Programs

Maintaining a long-term commitment to safety training is crucial for sustained returns. This necessitates ongoing evaluation and adjustments to the training programs, keeping up-to-date with the latest regulations, and continually demonstrating the benefits and value of the training to all stakeholders. 

It’s a proactive and continuous journey towards enhancing workplace safety, ultimately fostering a safer, healthier, and more productive work environment. In addition, promoting a culture of safety within the organization can also encourage long-term commitment to training programs. This includes actively involving employees in identifying potential hazards and providing continuous education and support for safe work practices.

Future Trends in Falls Training

Like many other sectors, Falls Training is experiencing a significant transformation through emerging technologies and innovations. These technologies enhance the efficiency and effectiveness of falls training initiatives, providing more engaging and interactive experiences that increase knowledge retention. Here are a few examples:

• Virtual Reality (VR) and Augmented Reality (AR): These technologies create immersive learning environments, allowing workers to experience hazardous situations without real-world risks.
• Artificial Intelligence (AI) and Machine Learning (ML): AI and ML can provide personalized training experiences, adapting content based on individual learning patterns.
• Low-Code Platforms: These platforms enable the rapid development and deployment of custom training applications with minimal coding requirements.
• Mobile Learning: Mobile learning solutions make training content accessible anywhere, anytime, fostering greater engagement and flexibility.
• Gamification: Incorporating game-like elements into training can enhance motivation and engagement, improving learning outcomes.

Advancements in Training Methodologies

Training methodologies are constantly evolving to keep pace with the changing nature of work and technological advancements. These methods shift from traditional, lecture-based formats to more interactive and learner-centric approaches. Some notable advancements in training methodologies include:

• Blended Learning: Combining online and in-person learning experiences allows for a more comprehensive and flexible training program.
• Microlearning: Short, focused lessons can improve knowledge retention and make learning more manageable for busy employees.
• Experiential Learning: Hands-on, practical experiences can promote deeper understanding and more effective skill development.
• Peer-to-Peer Learning: Encouraging employees to learn from each other fosters a culture of continuous learning and knowledge sharing.
• Scenario-Based Training: Simulating real-world situations helps learners apply their knowledge in practice, enhancing their problem-solving skills.

Preparing for the Evolving Workplace Landscape

The workplace landscape is continually evolving, driven by technological advancements, changing workforce demographics, and shifting business environments. To ensure fall training remains effective and relevant, organizations should consider the following:

• Embracing Digital Transformation: Technology is now an integral part of the workplace. Incorporating technology into fall training can enhance its reach and effectiveness.
• Fostering a Culture of Continuous Learning: As workplaces evolve, continuous learning becomes critical. Encourage employees to update their knowledge and skills regularly.
• Adapting to Remote Work Trends: With the rise of remote work, explore ways to deliver effective fall training to employees who may not be physically present.
• Considering Workforce Demographics: As the workforce becomes more diverse, training programs must be inclusive and accessible to all.
• Keeping Pace with Regulatory Changes: Regularly review and adjust training programs to comply with current regulations and standards.

Frequently Asked Questions (FAQs)

Q1: how often should fall training be conducted in the workplace.

Falls training should be an ongoing process, not just a one-time event. It is recommended to conduct formal sessions at least once a year. However, reminders, updates, and brief refreshers should regularly be part of safety meetings and toolbox talks.

Q2: What role do employees play in falls prevention in the workplace?

Employees play a crucial role in preventing slips, trips, and falls. They are often the first to observe potential hazards in their work environment. Hence, they should be encouraged to report these risks immediately. Additionally, adhering to the safety policies and procedures discussed during fall training sessions is vital.

Q3: How can we measure the effectiveness of our fall training program?

Measuring the effectiveness of a fall training program can be done through various methods. These include tracking incident rates and near misses, conducting regular safety audits, getting employee feedback, and assessing changes in employee behaviors and attitudes toward safety.

Streamline Slips, Trips, and Falls Training with DATAMYTE

DATAMYTE is a quality management platform with low-code capabilities. Our Digital Clipboard , in particular, is a low-code workflow automation software that features a workflow, checklist, and smart form builder. This tool lets you quickly create and deploy customized training applications that cater to your specific needs.

DATAMYTE also lets you conduct layered process audits, a high-frequency evaluation of critical process steps, focusing on areas with the highest failure risk or non-compliance. Conducting LPA with DATAMYTE lets you effectively identify and correct potential defects before they become major quality issues.

With DATAMYTE , you have an all-in-one solution for streamlining and enhancing your falls training program. From creating personalized training applications to conducting audits, DATAMYTE enables you to continuously improve your safety training efforts for a safer workplace. Book a demo now to learn more. 

Safety training, particularly in preventing slips, trips, and falls, is critical in ensuring a safe and productive workplace. By leveraging advancements in training technologies and methodologies, organizations can create effective training programs that are engaging, accessible, and tailored to the needs of their workforce. It’s paramount for organizations to prioritize safety and continuously strive for improvement, integrating learning into everyday work practices to nurture a culture of safety awareness. 

Embrace the evolving landscape of the modern workplace and take proactive steps towards enhancing your safety training initiatives, making falls prevention a shared responsibility. Doing so can collectively contribute to a safer working environment for everyone.

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• v.7(2); Mar-Apr 2022

Slips, Trips, and Falls: A Quality Improvement Initiative

Gene h. peir.

From the 1 Children’s National Hospital, Washington, D.C.

2 George Washington University School of Medicine and Health Sciences, Washington, DC.

Nick Mantasas

Jenhao j. cheng, katherine worten, rahul k. shah, associated data, introduction:.

Employee safety and the reduction of Days Away, Restricted, or Transferred are a focus of the Solutions for Patient Safety Network. One significant contributor to the Days Away, Restricted, or Transferred rate at Children’s National Hospital is employee slips, trips, or falls.

Children’s National Hospital implemented a multidisciplinary quality improvement with executive leadership vision and support. We implemented quality techniques (including Key Driver Diagrams, Pareto Charts, and continuous Plan-Do-Study-Act) and designed novel Environmental Services interventions.

Children’s National Hospital achieved a 44.3% reduction in monthly average reported slips, trips, or fall events from baseline and sustained over a 2-year study period.

Conclusion:

A leadership-driven multidisciplinary approach to quality initiatives with team leaders capable of making and enacting real-time policy changes led to novel interventions and a successful reduction of employee slips, trips, and falls events over time, which are broadly generalizable.

INTRODUCTION

Employee safety has trailed advances in patient safety. In the late 1980s, Paul O’Neill revolutionized employee safety by creating a system for reporting accidents and injuries and analyzing root causes to identify deficiencies. He believed and ultimately proved that a focus on employee safety would increase overall productivity and profitability. 1 , 2 In healthcare, serious, nonfatal workplace injuries total 2 billion dollars nationwide in workers’ compensation, with 6.8 work-related injuries and illnesses for every 100 full-time employees in 2011. 3 Groups such as the Institute for Healthcare Improvement have credited Mr. O’Neill for establishing the basic tenants of employee safety that continue to guide their philosophy today. 4 The Children’s Hospital’s Solutions for Patient Safety (SPS) Network includes 145+ member hospitals working together to eliminate serious harm across all children’s hospitals. 5 Excitingly, SPS partnered with and consulted with Mr. O’Neill to draw employee and staff safety in hospitals to the forefront of their work. As a result, SPS formally launched the work on employee and staff safety in 2016, where quality and safety leaders came together to accomplish several objectives, which included: creating awareness of the scientific evidence linking employee/staff safety to patient safety, reviewing best practices from other industries related to employee/staff safety work, and presenting and recommending SPS Network-wide goals. 6 One of the stated goals of the SPS collaborative is to achieve a 25% reduction in network Employee/Staff Days Away, Restricted, or Transferred rate, 6 a safety metric tracked by the Occupational Safety and Health Administration. 3 SPS recognizes Slips, Trips, and Falls as a focus area contributing to the overall Days Away, Restricted, or Transferred rate. 6

Previously published works have demonstrated the success of leadership-driven programs to improve patient safety and eliminate preventable harm. For example, Nationwide Children’s in 2008 developed the “Zero Hero” program to provide a face to their message of improving patient safety. 7 In 2017, following the footprint established by other institutions, Children’s National Hospital’s President and Chief Executive Officer, along with the Board of Directors and Executive Leadership encouraged and supported management to launch a centralized, hospital-wide Employee and Staff Safety (ESS) Program 8 to create a safer work environment for employees and decrease the institutional Days Away, Restricted, or Transferred rate, which at 1.48 8 was above the national benchmark of 1.15. 9 The group reviewed baseline data and identified five employee injury focus areas based on the frequency of events and staff most vulnerable to harm. The focus areas included sharps injuries, blood and body fluid exposure, workplace violence, slips, trips, falls, and overexertion injuries. 8 We have previously reported on the success of our broad employee staff safety work to create a safer work environment. 7

The prior article was overarching; it demonstrated the role of a system-wide programmatic effort to tackle the problem of employee staff safety and addressed sharps injuries, blood and body fluid exposures, workplace violence, overexertion, and slips, trips, and falls from a macro perspective. 8 The current report details the specific quality improvement initiative aimed to decrease the number of slips/trips/falls by 20% initially in the first 6 months of FY 18 and sustain for 1 year within Children’s National Hospital owned and operated facilities. The group chose a target of 20% as an attainable goal to target in the first 6 months. Anecdotally, it has become apparent that hospitals struggle in specific focus areas under the employee staff-safety work. Therefore, it is imperative to present shared learnings in this area of the employee staff-safety work. The results demonstrate the institutional leadership and multidisciplinary approach required to make significant improvements to employee safety, acknowledging that this work is generalizable within an organization’s employee safety operations other organizations.

This project was deemed exempt from Institutional Review Board approval as a quality improvement project. Children’s National Hospital, located in Washington, DC, is an urban, tertiary-care, 323-bed free-standing academic children’s hospital, with approximately 8000 employees.

The quality and safety initiatives at Children’s National Hospital have undergone many iterations, starting in 2006 and again embarking on the second iteration in 2012. 10 The framework in 2014 for patient safety led to significant organizational improvements in patient safety and quality. As a result, executive leadership challenged the organization to create similar employee and staff safety processes. Initially, the Employee and Staff Safety Steering (ESS) Committee 8 was created, tasked with advancing the safety culture at Children’s National Hospital, and reducing harm to employees. The multidisciplinary committee, chaired by the Vice President, Chief Quality and Safety Officer, and the Vice President, Chief Risk Officer, included representatives from Risk Management, Patient Safety, Workers’ Compensation, Nursing, Security, Environmental Services (EVS), Occupational Health, Human Resources, and Performance Improvement. As described previously, 8 the group highlighted five employee injury focus areas based on the frequency of events and staff most vulnerable to harm: sharps injury, blood, and body fluid exposure, workplace violence, slips/trips/falls, and overexertion. In addition, the committee chose team leads based on expertise and appropriate oversight for instituting change in real-time to address each area.

The ESS Committee named the Environmental Services (EVS) Director team lead of the slips/trips/falls focus area; team members included EVS managers and supervisor. The safety and quality team provided support, guidance, and insight. The team followed OHSA definitions: slip is the lack of traction between footwear and walking surface; a trip impedes lower extremity movement. A fall is a total loss of balance from the same or lower level. 3 Before inclusion in the data, the team leader carefully reviewed and evaluated the events. Ongoing injury data came from safety event reports, Occupational Health records, and Worker’s Compensation events.

At Children’s National Hospital, the ESS slips/trips/falls subgroup performed baseline analysis and identified 91 injury incidents in FY 2017. The team created a Pareto chart (Fig. ​ (Fig.1) 1 ) to categorize the areas of injury for intervention. In addition, they created key driver diagrams ( see figure 1, Supplemental Digital Content 1, http://links.lww.com/PQ9/A369 ) through data analysis, review of best practices, and staff feedback. The group met quarterly to assess intervention success; the team analyzed Pareto charts and developed subsequent Plan-Do-Study-Act cycles based on data gathered for the previous quarter. In addition, the EVS team met weekly to provide immediate feedback to the group leader.

Pareto chart FY 2017, slips/trips/falls

Based on initial data, wet floors caused 41% of slips, trips, and falls. Next, the team investigated individual cases and identified several areas for improvement and intervention (Table ​ (Table1). 1 ). First, the team installed large moisture mats at all transition points and extended outward and inward following PDSA re-evaluation to address entrances. Second, EVS placed stands with plastic bags strategically at main entrances; security officers instructed visitors to use those bags on PDSA re-evaluation. Third, we aggressively placed wet floor signage surrounding select high-traffic restroom areas. Additionally, we installed push button alert technology to report unsafe conditions in these areas. When pressed by the user, the button alerts the EVS staff to an area requiring attention, allowing faster response time. Finally, elevator areas utilized more mats and signage for transition points.

Wet Floor Injury Areas of Focus

In areas of active EVS cleaning, we implemented multiple interventions over several PDSA cycles. Initially, EVS workers placed wet floor signage at either end of the work area. Despite the signage, staff continued to enter work areas unintentionally through the alternative entrance and exit points within the work. EVS subsequently proceeded to rope off the entire work area, preventing this phenomenon. In addition, EVS informed the charge nurses of pending work to alert bedside staff in clinical areas. Finally, in addressing elevators, the EVS staff partnered with the security department to stop and rope off active areas until floors were dry to minimize the chances of injury.

The team launched the “Lid On” campaign to promote using lids on drink containers and saran wrap to cover all food and drink products, leaving the cafeteria area to address cafeteria slips. In addition, Saran wrap stations were increased and made more visible, and wet floor signs were proactively placed around the cafeteria to bring attention to the high-risk areas.

Other Areas

Obstacles causing injury were primarily parking garage speed bumps and uneven ground trips. We addressed these obstacles by painting the speed bumps bright yellow to make them more noticeable addressed old areas of uneven pavement. During the winter months, outdoor weather conditions related to icy conditions were especially prevalent at various outpatient outreach centers. These centers mainly were properties that the organization did not own; instead, they were leased. To address this, the group proactively reached out to landlords to request the salting of sidewalks before the known risk of snow and ice buildup. On the institutional campus, EVS proactively salted outdoor areas before the risk of snow and ice. The balance category included instances of injury where a review identified no modifiable cause, and the reason for the slip was human error.

Injury Prevention Kits

To augment the specific interventions, the EVS installed multiple “kits” to assist staff in high-risk areas to minimize the possibility of injury. The first was a “Spill Kit.” This kit consisted of rapidly deployable wet floor signs and absorbent pads to soak up wet areas until EVS staff arrived at the scene. In addition, the welcome desk staff deployed this kit at major entrances when necessary.

To address injury within the EVS staff during cleaning, we created a “Floor Care Kit.” When deployed to an area of interest, it included a checklist of items: nonslip shoe covers, wet floor signs, absorbent pads, caution tape, gloves, painter’s tape, and a mop head.

Organizational Awareness

In 2018, Children’s National Hospital launched a “Your Safety Matters Too” campaign to raise awareness of organizational commitment to reducing employee harm, similar to the concept established by the “Zero Harm” campaign. 7 Team leads and the ESS Steering Committee regularly rounded with staff to raise awareness. The Daily Check-In safety briefing incorporated reports on injury or safety events to increase awareness and escalate concerns. In addition, we integrated ESS content into new hire training, which ensured that all new staff, including select vendors, coming into the organization understood the importance of employee safety and the processes in place to minimize injury.

Statistical Analysis

A statistical process control c-chart tracked the monthly number of safety events and informed the progress. We started the process improvement in June 2018 using Nelson’s Shift Rule. 11 We use data points following the new process implementation to calculate a new centerline. We apply the Pareto Chart, an intuitive quality tool based on ordered frequencies and accumulation, to each fiscal year to identify the top reasons that caused the injuries. Finally, we used statistical tests based on Poisson distribution to compare the total number of events in a fiscal year to the total number in an earlier year to check if the difference (reduction or improvement) is statistically significant or not.

Outcome Measures

Children’s National Hospital had a 44.3% reduction in the average monthly count for the slips/trips/falls events after the baseline period of FY17 according to the centerline shift as noted on the c-Chart (Fig. ​ (Fig.2), 2 ), from 7.348 to 4.091 with a statistically significant difference of -3.257 (95% CI: −4.887, −1.627; P < 0.001). Of note, January and February 2019 saw a significant jump in falls in parking lots due to icy conditions caused by successive snowstorms. However, these incidents did not occur within the scope of a Children’s National Hospital-owned and managed facility and are excluded from the analysis.

Slips, trips, and falls c-chart

Process improvement was also compared with the overall count of slips, trips, and falls for different fiscal years, as shown in Table ​ Table2. 2 . The annual total count decreased from 91 in FY17 to 83 in FY18 by 8.8% and from 83 in FY18 to 61 in FY19 by 26.5% in stepwise increments with an insignificant difference of -8 (95% CI: −33.9, 17.9; P = 0.545) and marginal difference of −22 (95% CI: −45.5, 1.5; P = 0.067), respectively. The decrease from 91 in FY17 to 61 in FY19 by 33% is a statistically significant difference of −30 (95% CI: −54.2, −5.8; P = 0.015). We base the significance on Poisson distribution because the data are the counts of rarely occurring safety events.

Year to Year Comparison of Overall Slips/Trips/Falls

The makeup of injury events evolved over the 2-year study period as well. Compared with baseline data from FY17, as seen in Figure ​ Figure1, 1 , the Pareto charts for FY 18 (Fig. ​ (Fig.3) 3 ) and FY 19 (Fig. ​ (Fig.4) 4 ) detail the composition of the reason for falling. For example, initial data from FY 2017 showed that the highest percentage (50%) of injuries were attributable to wet floors; by FY2019, wet floors no longer caused the largest percentage of injury, accounting for only 16% of cases.

Pareto chart FY 2018, slips/trips/falls

Pareto chart FY 2019, slips/trips/falls

This report details a single free-standing Children’s Hospital experience improving organizational slips, trips, and falls. We accomplish this within a comprehensive Employee Staff Safety program driven by hospital leadership previously described. 8

Mitchell et al’s October 2012 commentary from the Institute of Medicine’s Best Practices Innovation collaborative highlighted the importance of high-functioning teams in health care. 12 They establish that shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes are the fundamental principles of team-based health care. 12 The importance of a multidisciplinary team structure cannot be overstated; it requires content expertise with authority to carry out real-time changes and quality experts providing guidance.

This concept is seen in Fred Lunenberg’s description of power and leadership. 13 He lays out the five sources of power in two categories: organizational power and personal power. 13 Organizational power contains three subtypes: legitimate power that comes from the position an individual holds within an institution and their authority over other members of the institution; reward power is a person’s influence over others’ behavior by providing them with things they want; coercive power is a person’s ability to influence others’ behavior by punishing them or by creating a perceived threat to do so. Personal power has two subtypes: expert power is a person’s ability to influence others’ behavior because of recognized knowledge, skills, or abilities; referent power is a person’s ability to influence others’ behavior because they like, admire, and respect the individual.

It is important to have a leader and members who possess various power forms to ensure the group is productive and successful in a multidisciplinary team structure. In this experience for slips/trips/falls, the Director of EVS oversaw the workgroup. His expertise in the area gave him expert power to make well-informed decisions. His direct supervision of managers and legitimate power that provided direct communication with EVS employees allowed for a real-time change in practice and feedback. This model can be applied to building a team to address any focus area within employee safety or, more broadly, across quality improvement initiatives hospital-wide, where an inefficient team can impede progress.

The EVS partnership with other disciplines, including nursing, security, and food services representatives, facilitated a unified and consistent message and a plan for slips/trips/falls prevention in high traffic areas of the hospital. The quality experts regularly reconvene the workgroup to review progress and update key driver diagrams in real-time to adjust the strategies effectively. In addition, due to this collaboration, the group was able to create “kits” to tackle areas of high injury rate, including the “Spill Kit” and “Floor Care Kit.”

As the work progressed over time, the impact was reflected in the total number of overall Slip/Trip/Fall injuries and the etiologies of those injuries. There was a natural evolution in the area’s initial focus, vis-a-vis the area with the highest percentage of injury, wet floor transitions. As such, it became clear the importance of continued analysis using Pareto charts to allow a more broad and real-time understanding of where the injuries continued to occur with the highest frequency. Key Driver Diagrams are modified to address these updated identified areas of interest. Overall, the process identified several critical areas tackled in a sequence of highest priority based on frequency as identified by Pareto chart analysis. It is crucial to constantly evolve the Key Driver Diagram to ensure it remains relevant and actionable.

Importantly, we believe this work is novel in its approach to addressing Slips/Trips/Falls; it is also generalizable to two broad areas: continued ESS work within the institution in other areas of employee injury outside of Slips/Trips/Falls and other institutions looking for a process map for making improvements to benefit employee safety. For example, at Children’s National Hospital, similar processes are taken to address sharps injuries, overexertion injuries, fluid exposures, and verbal and physical violence.

The limitations of this study include the inability of the group to control all aspects of the causes of injury, most notably injury attributed to an accident on the fault of the employee that was unrelated to the environment, as well as injury at locations where Children’s National Hospital was not the landlord and therefore had no direct ability to modify the environment. However, with an appropriate selection of group leaders able to directly intervene in the areas of interest and the support of a multidisciplinary group and quality improvement experts, change can be implemented to improve one domain affecting employee safety and sustained over a multiyear period.

ACNOWLEDGMENTS

There are no others who assisted with this study. There was no financial support or sponsorship of this study. The authors have no conflicts of interest to disclose. These data have not previously been presented.

The authors have no financial interest to declare in relation to the content of this article.

Supplementary Material

Published online March 30, 2022

Supplemental digital content is available for this article. Clickable URL citations appear in the text.

To cite: Peir GH; Fink A; Mantasas N; Cheng JJ; Worten K; Shah RK. Slips, Trips, and Falls: A Quality Improvement Initiative. Pediatr Qual Saf 2022;7:e550.

Luke Bryan Slips and Falls Onstage, Laughs It Off in Hilarious Video

Luke Bryan didn’t let an onstage fall keep him down. 

The country music hitmaker was spotted laughing after he hit the ground during his performance at the Coast City Country Festival in Vancouver this weekend. 

The fall occurred just as Luke Bryan was hyping the crowd up for his next song. As he was getting ready to start the song, Bryan slipped and hit the ground hard.

After laying there for a few seconds, Luke Bryan lifted his arms in the arm and sat up in a sitting position. He eventually saw what he slipped on, which was a cell phone.

When he handed the phone back to its owner, the country music star declared, “It’s ok. Hey, um, my lawyer will be calling.”

Luke then asked a fan who was recording the entire event if he could watch the video. He took the phone and held it up for everybody to see as he replayed the incident. 

“Alright let’s zoom in…” he stated on stage. “Alright here we go. There I am. There we go, I’m jumping, jumping, hyping the crowd.”

As he saw himself hitting the ground, Luke declared, “There we go… THERE IT IS.” 

A video of the incident was posted on TikTok. 

Luke Bryan has experienced some hilarious onstage falls over the years. As he was preparing to sing That’s My Kind of Night during a 2022 show, the country star fell. Instead of getting back up and continuing, he performed some of the hit track while lying on the ground.

He was eventually seen thrusting his hips up before a stage crew member helped him back up on his feet. 

Luke Bryan fell multiple times during his 2014 tour. 

Luke Bryan Explains Why His Eyes Have Been Red Lately – And It’s Not What You Think 

While chatting with Audacy last week, Luke Bryan spoke about why his eyes have been appearing to be red lately. He noted that he hasn’t been smoking marijuana. The eye redness is caused by an allergy – to bass. 

“If I touch a bass, my eyes will get red,” Bryan explained. “My hands will swell if I have to take the hook out. I’ll get in front of it. I’m like: I know I’m going to fish today,’ so I’ll take an Allegra in the morning.”

Luke Bryan also said he spent years going fishing with his father and experiencing the reaction. However, he never to and to together and assumed it had something to do with the nearby trees.

“I spent years not knowing,” he continued. “My dad would take me on these fishing trips and I would be in the back of the boat like wheezing, maybe in need of an epipen.”

“But my dad was just like [suck it up], we just thought it was allergies [to] like, the trees, but it’s actually touching the bass.” 

Biden-Trump Gaffe Tracker: Biden Confuses Gaza’s Rafah With Israeli City Haifa

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As concerns have grown that former President Donald Trump, 77, and President Joe Biden, 81, are too old to serve another term amid repeated rhetorical missteps since announcing their campaigns, here’s a list of the most notable recent gaffes.

US President Joe Biden speaks to reporters before boarding Air Force One at Hagerstown Regional ... [+] Airport in Hagerstown, Maryland, on March 5, 2024. (Photo by MANDEL NGAN/AFP via Getty Images)

Biden (April 17) Biden twice suggested during a visit to a Scranton, Penn., World War II memorial honoring his uncle, Ambrose Finnegan, that his body may have been eaten—by people, saying, “[H]e got shot down in New Guinea, and they never found the body because there used to be a lot of cannibals, for real, in that part of the New Guinea.” But the official military account of his death states that his Air Force plane crashed into the ocean off the coast of New Guinea and that neither his body nor the aircraft were recovered.

Biden (April 16) In an interview with a local CBS affiliate in Birmingham, Ala., Biden said, “I made it clear to the Israelis—don’t move on Haifa”—likely referring to Rafah, the southern Gaza Strip city where millions of Palestinians have taken refuge and the U.S. has warned Israel not to carry out a potentially devastating invasion. Haifa is a major port city in northern Israel.

Trump (March 25) Trump also claimed the “top person” at the NYSE was “very, very upset” and “mortified” that TMTG did not trade on the exchange, and claimed “he said ‘I’m losing business because of New York, because people don’t want to be in New York and they don’t want to go into the New York Stock Exchange,’” but, it is unclear who Trump is referring to, as both the exchange’s president, Lynn Martin, and board chair Sharon Bowen, are women.

Trump (March 25) At a press conference following a hearing for his hush money trial , Trump claimed that Trump Media & Technology Company, which owns his Truth Social network and went public after a deal was approved last week, decided not to trade on the New York Stock Exchange due to his ongoing court cases: “the New York Stock Exchange wants to have us badly, and I told them ’we can’t do the New York Stock Exchange, you’re treated too badly in New York,’” but Trump Media began trading on Tuesday on the Nasdaq stock exchange, which is also located in New York.

Trump (March 16): At a rally in Dayton, Ohio, Trump again mistakenly referred to former President Barack Obama, this time possibly confusing himself with Obama, though it remains unclear what he might have meant: “Joe Biden won against Barack Hussein Obama, has anyone ever heard of him?” Trump asked the crowd, before adding, “every swing state, Biden beat Obama but in every other state, he got killed.”

Trump (March 9): At a speech in Rome, Georgia, Trump claimed “the polls are rigged” while discussing his appeal to suburban housewives, before abruptly backtracking and saying “disregard that last statement, I love the polls so much.”

Biden (State of the Union speech, March 7): the president misidentified Laken Riley , the student murdered on the University of Georgia campus, calling her “Lanken,” while holding up a pin with her name on it.

Biden (State of the Union speech, March 7): the president briefly said the 2021 Capitol riot took place on July 6, before correcting himself and saying “January 6.”

Biden (State of the Union speech, March 7): after speaking about capping prescription drug prices, Biden made an off-the-cuff remark and invited Congress to fly with him and see lower prices for their medications in “Toronto, Berlin, Moscow—I mean, excuse me—well, even Moscow, probably.”

Trump (March 2): Trump seemed to confuse former President Barack Obama with President Joe Biden—alleging during a rally in Virginia Putin has “so little respect for Obama that he’s starting to throw around the nuclear word,” marking at least the eighth time in recent months it’s happened.

Trump (Feb. 24): In a speech at the Conservative Political Action Conference, Trump appeared to endorse Biden, telling the audience he agrees with Russian President Vladimir Putin in preferring Biden over Trump.

Trump (Feb. 24): In the same CPAC speech, Trump appeared to forget the name of his wife, Melania Trump, responding to loud applause in the crowd by saying “Mercedes, that’s pretty good!”—though his campaign claimed it was a reference to Mercedes Schlapp, a political commentator and the wife of American Conservative Union (CPAC organizer) chair Matt Schlapp, who he mentioned later in the speech.

Biden (Feb. 8): Biden referred to Egyptian President Abdel Fattah El-Sisi as “the president of Mexico,” ironically during a press conference where he contested a scathing report by Special Counsel Robert Hur that depicted Biden as an “elderly man with a poor memory.”

Biden (Feb. 7): Biden referred to German Chancellor Angela Merkel as the late German leader Helmut Kohl twice while speaking at campaign events in New York, days after confusing French President Emmanuel Macron with his late predecessor Francois Mitterrand during a speech in Las Vegas.

Trump (Jan. 19): Trump confused his sole remaining opponent in the GOP primary race, former South Carolina Gov. Nikki Haley, with former House Speaker Nancy Pelosi, D-Calif., during a New Hampshire campaign speech, telling the crowd “Nikki Haley was in charge of security” on Jan. 6, 2020, as he has repeatedly sought, without evidence, to allege that Pelosi rejected his offer to send more troops to the Capitol that day.

Biden (Nov. 20): The president mistakenly referred to Taylor Swift as “Britney [Spears]” while attempting a joke at the White House’s annual turkey pardoning ceremony, which took place on his 81st birthday.

Trump (Oct. 23): Trump confused the leaders of Turkey and Hungary in a New Hampshire campaign speech and botched a geographical reference, telling the crowd Hungary’s far-right Prime Minister Viktor Orbán is the leader of Turkey, and stating that Turkey shares a “front” with Russia (neither Hungary nor Turkey border Russia and Turkey’s president is Recep Tayyip Erdoğan).

Biden (Sept. 11): Biden falsely stated he was in New York on Sept. 12, 2001 while delivering an anniversary speech to troops in Alaska, claiming he surveyed the damage at Ground Zero the day after the attacks (then-Sen. Biden actually visited Ground Zero on Sept. 20, 2001).

Biden (June 27): Biden has repeatedly mixed up the wars in Ukraine and Iraq, including twice in 24 hours in June, after telling a crowd in Florida in November inflation was tied to “a war in Iraq,” then quickly corrected himself, saying “excuse me, the war in Ukraine,” a misstep that came moments before he wrongly stated his son Beau Biden, who served a year in Iraq in the Delaware Army National Guard, died there (Beau Biden died of brain cancer in the U.S. in 2015).

Key Background

Biden is the oldest president in history and Trump would be the second oldest if he were elected again in November. Though the two are just four years apart, polls consistently show Biden’s age is a far greater concern for voters than Trump’s, including a February Bloomberg/Morning Consult poll that found 82% of voters said Biden or both candidates were too old, compared to 47% who said the same about Trump or both candidates. The age concerns, exacerbated by the candidates’ various rhetorical missteps, have fueled calls for one, or both candidates, to drop out of the race, including a February op-ed and podcast by New York Times’ writer Ezra Klein.Trump—perhaps aware that criticizing Biden’s age could appear hypocritical—has repeatedly said Biden isn’t too old to be president, but is too “incompetent.” Biden, meanwhile, has sought to flip the script on concerns about his own age by highlighting Trump’s missteps on the campaign trail and making jokes about his own age. In an appearance on “Late Night With Seth Meyers” earlier this year, Biden took a jab at Trump for appearing to mix up Melania and Mercedes Schlapp, telling Meyers that Trump is “about as old as I am, but he can’t remember his wife’s name.”

Biden’s verbal missteps have been coupled with trips and falls throughout his tenure, often on the stairs of Air Force One, that have heightened concerns about his mental and physical fitness. In one particularly concerning incident, Biden took a hard fall on stage at an Air Force Academy graduation ceremony in Colorado in June last year, an incident his team blamed on a sandbag on stage.

What To Watch For

Biden and Trump are poised for a historic, and closely contested rematch, in November with polls showing Biden trailing Trump by less than half of a percentage point, according to Real Clear Politics’ polling average .

Experts have cautioned against reading into the candidates’ verbal slip-ups on the campaign trail, arguing they can’t necessarily be attributed to old age. "We make mistakes. The probability of slip-ups rises as we get older. That has nothing to do with judgment," S. Jay Olshansky, a professor in the School of Public Health at the University of Illinois at Chicago, told Reuters, adding “Someone commenting on Trump turning right when he should have turned left? Big deal. Tripping? Join the club. A misspoken word? It happens to all of us. None of us would survive a 24/7 camera."

Chief Critic

Biden, who has a penchant for gaffes dating back to his 36 years in the Senate, has argued his age is symbolic of his decades of experience, telling reporters in response to the Hur report “I know what the hell I am doing.” He released results of his annual physical exam earlier this year that found he is “a healthy, active, robust 81-year-old male, who remains fit” to serve as president, White House physician Dr. Kevin O’Connor wrote. The test did not include a cognitive exam, something White House Press Secretary Karine Jean Pierre argued wasn’t necessary, telling reporters “he passes a cognitive test every day,” referring to the rigors of the presidency. Trump, meanwhile, has claimed he purposely confuses Obama and Biden and Haley and Pelosi, claiming Haley and Pelosi are “interchangeable” and alluding to the unfounded right-wing conspiracy that Obama is secretly pulling the strings at the White House.

Surprising Fact

Trump and his allies have repeatedly called for Biden to undergo cognitive testing, but it’s unlikely any attempts to mandate the tests would pass legal muster, based on the qualifications laid out in the Constitution for holding the office of the presidency. Trump has said repeatedly he’s “aced” two cognitive exams, but he has not released the formal results of either report.

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