LAUSR

Objectives In 2014, US Occupational Safety and Health Administration (OSHA) updated a rule requiring employers to directly report all hospitalisations, amputations and eye enucleations to OSHA within 24 hours and within 8 hours for fatalities and multiple injury events. Past studies have shown that employers under-report injuries and illnesses for numerous reasons. Methods This study evaluated the completeness of required immediate reporting of severe injuries and illnesses by employers to OSHA by linking cases reported to OSHA with hospital data from 1 January 2017 to 31 December 2023. We evaluated factors associated with failure to report severe injuries or illnesses to OSHA using multivariable logistic regression. Results We identified 7578 non-fatal occupational injuries and illnesses and an additional 160 fatalities treated in Illinois hospitals that were not reported to OSHA. The cumulative reporting rate for non-fatal injuries was 39.7%, while non-fatal illnesses (excluding COVID-19 cases) was 25.1%. There was no significant change in reporting rates over the 7-year period for non-fatal injuries and illnesses. Failure to report serious injuries and illnesses was associated with hospitalisations involving acute illnesses (adjusted OR (aOR)=2.60), female workers (aOR=1.29) and incidents occurring on weekends (aOR=2.21) and holidays (aOR=1.98). We also identified factors associated with improperly reporting cases that did not meet the OSHA reporting criteria. Conclusions We estimate that failure to report these hospitalisations obscured up to 2122 violations in Illinois workplaces that could have led to remediation to protect other workers from injury. This analysis informs compliance assistance programmes that address reporting practices and record-keeping policy.