National

Institutes of Health

Heat Stress Program

DivisionofOccupationalHealth&Safety

May2013

Thisdocumentprovidesinformationandguidelinesfortheeffectivepreventionofinjuriesorillnessrelatedto
heatstressactivities.

Table of Contents

Purpose ..3

Scope ..3

Responsibilities .3

References... ..4

Program ....4

Definitions..9

Appendices.......10

1.0

1.0

PURPOSE

The Heat Stress Program has been developed to provide guidance and oversight for the activities
involving elevated temperatures during occupational activities at the National Institutes of Health
(NIH).
2.0

SCOPE
The Heat Stress Program applies to all NIH employees, contractors and students working at
official NIH facilities.

3.0

RESPONSIBILITY
3.1 Division of Occupational Health and Safety
A. Assign resources to identify and manage elevated heat work areas
B. Ensure the management of a heat stress program
3.2 Heat Stress Program Manager
A. Assist in the identification of elevated heat work areas
B. Ensure the proper testing, monitoring, and documentation for suspect and known
elevated heat work areas
C. Ensure all equipment used for testing and monitoring is appropriate and in proper
working condition
D. Document the program to manage the occupational activities in elevated heat work
areas
E. Maintain an inventory of elevated heat work areas
F. Provide or ensure the training as necessary to/of NIH personnel required to work
elevated heat work areas
G. Assist in the development of localized administrative, engineering or PPE controls and
measures to reduce or eliminate heat stress conditions
H. Conduct periodic review of the NIH heat stress program to ensure it is in compliance
with federal guidelines, regulations and best practices.
3.3 Supervisors
A. Assist in the identification of elevated heat work areas
B. Monitor suspect locations for elevated heat conditions
C. Notify the Heat Stress Program Manager or representative of suspect hazardous work
conditions involving elevated heat conditions
D. Implement required engineering controls, instrumentation changes, or work practice
changes requested to reduce heat load
E. Maintain a copy of this written program in the workplace
F. Ensure that employees required to work under suspect elevated heat conditions are
trained in the heat stress program
G. Ensure that workers visit the Occupational Medical Service (OMS) upon
experiencing signs and symptoms of thermal stress
3

3.4 Non-supervisory Employees:

A. Assist in the identification of elevated heat work areas
B. Attend required training(s) as specified by a supervisor, Heat Stress Program
Manager, or Safety Officer
C. Comply with procedures as required by the Heat Stress Program, and all other heat
stress related guidance as deemed appropriate by a supervisor
D. Use all personal protective equipment as specified in prescribed training or required
by a supervisor, Heat Stress Program Manager, or Safety Officer.
E. Immediately notify a supervisor, Heat Stress Program Manager, or Safety Officer.
of any hazards encountered.
F. Report to OMS in the event of an injury related to heat stress or other condition
leading to injury, disease or impairment
3.5 Contractors / NIH Project Officers
A. Contractors must comply with all NIH programs and Federal regulations, and any
stipulations as required by their respective NIH Project Officer
B. Contractors are required to ensure the safety of their employees working on NIH
property
C. NIH Project Officers are required to convey all hazardous conditions to contractors
working in or around those locations
D. NIH Project Officers are responsible for managing contractor work and obtaining all
necessary documentation as required by the Heat Stress Program Manager or Safety
Officer
4.0

REFERENCES
TED 01-00-015, (OSHA) OSHA Technical Manual, Chapter III: Heat Stress
29 CFR 1910.132, Personal protective equipment
U.S. Army Corps of Engineers: Safety and Health Requirements Manual, Inclement Weather and
Heat/Cold Stress Management
United States Council of Governmental Industrial Hygienists (ACGIH), TLV for Chemical
Substances and Physical Agents and Biological Exposure Indices, 2012

5.0

PROGRAM
5.1 Heat Stress Safety Program
The Heat Stress Program was established to promote health and safety of occupational activities
in locations where elevated temperatures and humidity exist. The heat stress program is
administered by the Division of Occupational Health and Safety (DOHS) through the Heat Stress
Program Manager.
Thermal heat stress includes injuries or illnesses caused when a person is working in, or exposed
to elevated temperature conditions directly affecting an individuals ability to function in a
4

normal manner. A potential exists for thermal stress at the NIH. As an example cage wash
areas associated with animal care facilities are suspect for elevated temperature due to the size
and type of equipment used. These cage wash areas typically reach temperatures as high as
100F under significantly humid conditions. These temperatures may be exacerbated at times by
summer heat wave conditions.
The intent of the program is to ensure a core body temperature of individuals as close to normal
(typically within 1 Celsius). The program functions by limiting the amount of work time an
individual is exposed to elevated temperatures while completing specific types of work load
(low, medium, high). A key element of the program involves identifying sources of heat load
and planning and measures to reduce or eliminate that heat load where possible.
5.2 ACGIH Guidelines
Table 1. Acclimatized and Non-acclimatized Work Load Type per Temperature
Acclimatized
Work / Rest Ratio (per hour)
6 /0
4 / 15
3 / 30
1 / 45
Non-acclimatized
Work / Rest Ratio (per hour)
6 /0
4 / 15
3 / 30
1 / 45

Temperature for Type

of Work Load (C / F)
Light
3 / 88
3 / 88
3 / 89.5
32.5 / 90.5
Temperature for Type
of Work Load (C / F)
Light
2 / 82.5
28.5 / 83.5
29.5 / 85
3 / 86

Temperature for Type of

Work Load (C / F)
Medium
2 / 82.5
2 / 84
3 / 86
31.5 / 89
Temperature for Type of
Work Load (C / F)
Medium
2 / 77
2 / 79
2 / 80.5
2 / 84

Temperature for Type of

Work Load (C / F)
High
2 / 79
27.5 / 81.5
2 / 84
30.5 / 89
Temperature for Type of
Work Load (C / F)
High
22.5 / 72.5
2 / 75
25.5 / 78
2 / 82.5

Table 1: Provides the administrative method for ensuring that typical individuals do not overexceed a stress level that might trigger a hazardous physiological response to elevated
temperatures. Table 1 requires the use of a Wet Globe Bulb Thermometer (WBGT) to integrate
various measures of heat load.
5.3 Monitoring
A. Upon notification by a NIH employee or NIH Project Officer for contractors, the
Heat Stress Program Manager will complete or assign heat stress monitoring of
suspect location(s).
B. To complete monitoring the completing individual will:
1. Work with an knowledgeable individual who can adequate describe the
perceived sources of heat load and time periods that are both typical and worse
case for the suspect location

2. Retrieve a WBGT instrument that is within calibration, see photograph below

ii

i
iii
a. WBGT components:
i. Wet bulb (white with wick) used to measure the effects o
humidity on temperature
ii. Dry bulb (white) used to measure the normal dry air
temperature
iii. Globe bulb (black) used to measure the effects of solar radiation
on temperature
3. Setup the WBGT in the suspect location allowing for a 15 minute warm up
period before logging values,
a. Ensure that the reservoir for the wet bulb is full
4. Begin documenting the readings from the instrument on Appendix A:
Monitoring Sheet,
5. Allow the unit to run for an appropriate period of time to adequately capture the
heat intensity that is created by either natural environmental conditions or
equipment/instrumentation that adds heat load,
6. Provide technical feedback to the Supervisor or representative of the work area
to allow an immediate response to ensure the safety of personnel,
7. Maintain the Appendix A sheet as historical record.
5.4 Heat related conditions
A. Minor conditions:
1. Heat edema presents with swelling and discomfort of the hands and feet.
Individuals may complain that their shoes feel tight or are ill fitting. The exact
cause is unknown but generally involves dilation of the blood vessels and shifts
in fluid within the body. The condition is self-limiting and symptoms typically
resolve within a few days.
2. Miliaria rubra, also known as prickly heat or heat rash occurs when sweat
gland pores become blocked. Sometimes a secondary infection may occur.
Skin with Miliaria rubra cannot sweat effectively. Therefore the risk of heat
illness is increased in proportion to the amount of skin involved.
3. Sunburn impairs sweating and predisposed to heat injury from systemic effects,
including fever, that influence thermoregulation. When sunburn occurs over
6

5% of the body surface area, the effected individual should be kept from
significant heat strain until the burn has healed.
4. Heat tetany may result when an individual hyperventilates after being exposed
to heat stress. Symptoms include muscle spasms and numbness and tingling
around the mouth. It generally occurs before heat acclimatization.
5. Syncope is a temporary circulatory failure due to pooling of the blood in the
peripheral veins. Symptoms range from lightheadedness to loss of
consciousness. Victims typically recover rapidly once they sit or lay supine.
Syncope occurring more than five days after heat exposure may indicate
dehydration or heat exhaustion.
6. Heat cramps are brief, recurrent, often painful skeletal muscle cramps. The
cramps are usually preceded by muscle fasciculations which may be seen or felt
on the muscle surface. Cramps produce a hard lump in the muscle. There are
no systemic symptoms.
B. Major conditions:
1. Heat Exhaustion is the most common heat related cause of illness. It occurs
when the heart cannot pump quickly enough to sustain the needs of the skin
blood flow to maintain body temperature along with the metabolic needs of the
body for muscle and vital organ activity. Dehydration, reduced blood volume
and constricted blood vessels are all contributing factors. The signs and
symptoms of heat exhaustion include:
a. Generalized weakness
b. Headache
c. Nausea
d. Fatigue
e. Dizziness
f. Increased heat rate and muscle cramps
g. Sweating persists and may even be profuse, and the individual may
become disoriented. Treatment should begin immediately in order to
prevent progression to a more severe heat injury. The more severe
assessment of heat stroke should be assumed in anyone who experiences a
change in mental status such as disorientation.
2. Heat Stroke is characterized by elevated body temperature (>104 F) and
dysfunction of the central nervous system resulting in delirium, convulsions or
coma. Two types of heat stroke may occur, exertional and classical.
a. Exertional heat stroke occurs in physically active individuals who are
producing substantial metabolic heat. It is the most common form in
workers and athletes and can occur in both hot and temperate conditions.
b. Classical heat stroke occurs in vulnerable populations such as the young,
the elderly and those without potable water. This type often presents as an
epidemic during summer heat waves.
c. For up to an hour prior to the onset of heat stroke one may experience:
i. Headache
ii. Dizziness
iii. Drowsiness
iv. Restlessness
v.
Confusion
7

vi.

Irrational or aggressive behavior

5.5 Heat measures for employees

A. Administratively rotating the workload among workers
B. Shortening the duration of exposure
C. Increasing rest time or frequency of rest periods (rest periods should be in a cooler
shaded area in relation to the work area)
D. Utilizing air conditioned rest areas
E. Minimizing direct heat sources by insulation or installing reflective screening
F. Using additional fans in the work area
G. Providing cool drinking water
5.6 Heat Stress Safety Training
All supervisors of employees who work in elevated heat areas should ensure that heat stress
training is available. Types of training include a formal presentation by the Heat Stress Program
Manager, DOHS personnel, or OMS personnel; Tool-box talks led by the supervisor, or
computer based training. Training should incorporate both identifying heat related conditions
and measure to overcome elevated heat conditions.
5.7 Medical Surveillance
Employees who routinely work under heat stress conditions should be required to have an annual
physical Contact Occupational Medical Services (OMS) for specific requirements. Factors that
must be considered before assigning an employee to work under heat stress conditions include:
A. Acclimatization
1. Adaptation to new surroundings or conditions
2. Under heat stress conditions, gradually increase the work time over the first two
weeks. (Individuals are most susceptible to heat stress during their initial two
week period of work in hot and humid conditions).
3. Acclimatization can be affected by:
a. Medical condition or Prescription Medication, inform your supervisor
or the OMS prior to beginning work under heat stress conditions.
b. Allergy medicine (prescription or non-prescription
c. Sunburn likely to reduce work capacity under heat stress conditions.
B. Muscular activity and work capacity
C. Age / physical condition
D. Prescription drug use
Individuals who believe that they require a medical evaluation concerning their work in elevated
temperature conditions should make a request through their respective supervisor. All medical
evaluations will be conducted by OMS. In the event of any accidents or incidents the user must
undergo and immediate evaluation by OMS located on the sixth floor of building 10, Room
6C306. The phone number for OMS is (301) 496-4411.

6.0

DEFINITIONS

Acclimatization- A physiologic adjustment process occurring when a healthy worker accustomed to a

temperate environment begins to work in a hot environment. These adjustments may occur over a

period of days to several weeks. During this time period time spent in an area may be gradually

increased.

Action Limit In evaluating thermal stress at the NIH, Action Limits are used. These are temperature

cutoffs, or temperature index cutoffs which, when reached, require a supervisor to initiate action to

prevent thermal illness or injury.

(See Appendix C Thermal Hazard Assessment)

American Conference of Government Industrial Hygienists (ACGIH) A professional society

consisting of government employees and academia. This organization has developed the Wet Bulb

Globe Temperature (WBGT) Index as a threshold limit value which is used to establish guidelines for

working under heat stress conditions. In cold stress situations, the ACGIH wind chill index can be used.

The NIH uses these values to determine appropriate action limits.

Apparent Temperature - A measure of relative discomfort due to combined heat and high humidity. It

was developed by R.G. Steadman (1979) and is based on physiological studies of evaporative skin

cooling for various combinations of ambient temperature and humidity.

Heat Index The heat stress index is a specialized temperature / humidity index. It is also called the

apparent temperature, and is a measure of how hot weather is perceived by the average person at varying

temperatures and relative humidity.

Heat Wave A Heat Wave occurs when the apparent temperature exceeds 108 F or is 15 to 20 degrees

higher than the noon, midsummer apparent temperature.

APPENDIX
Appendix A: Monitoring Sheet

AppendixA:MonitoringSheet

Location:____________________________________________________Date:___________________________

WORK/REST GUIDELINES IN INDUSTRIAL ENVIRONMENTS

LightWork
ModerateWork

**Work/Rest ***Water
Work/Rest
WaterIntake
HeatCategory *WBGT
Temperature Cycle
Intakein
Cyclein
(Qts./Hour)
(Min./Hour) (Qts./Hour)
(Min./Hour)
Rangein
Degrees
Fahrenheit(oF)
Caution
77.086.9
Nolimit
0.5
45/15
0.75
Danger
87.089.9
NoLimit
0.75
30/30
0.75
Extreme
Above90
50/10
1.0
15/45
1.0
Danger
NOTE:Followtheguidelinesfor(chooseeitherlight/moderate/heavy)Work/RestCycles

HeavyWork
Work/Rest WaterIntake
Cycle
(Qts./Hour)
(Min./Hour)

40/20
20/40
10/50

0.75
1.0
1.0

Temperaturesshouldbereadhourlystartingatthebeginningofshiftandcommenceattheendofshift

WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________
WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________
WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________
WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________
WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________
WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________
WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________
WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________
WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________
WBGTTemperature_____________HeatCategory:__________________Time:____________Initials__________