Centers for Disease Control and Prevention (CDC). (2020, May 28).
Nursing Homes and Assisted Living (Long-Term Care Facilities
[LTCFs]) Infection Prevention Tools. https://www.cdc.gov/longtermcare/prevention/index.html. (CDC, May 28, 2020).
Centers for Disease Control and Prevention (CDC). (2020, May 29).
Considerations for Preventing Spread of COVID-19 in Assisted Living
Facilities. https://www.cdc.gov/coronavirus/2019-ncov/hcp/assisted-living.html. (CDC, May 29, 2020).
Centers for Disease Control and Prevention (CDC). (2020, June 10).
Using Telehealth to Expand Access to Essential Health Services
during the COVID-19 Pandemic.https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html. (CDC, June 10, 2020).
Centers for Disease Control and Prevention (CDC). (2020, July 15).
Interim Recommendations for Emergency Medical Services (EMS) Systems
and 911 Public Safety Answering Points/Emergency Communication
Centers (PSAP/ECCs) in the United States During the Coronavirus
Disease (COVID-19) Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html. (CDC, July 15, 2020).
Centers for Disease Control and Prevention (CDC). (2020, August 19).
Using Personal Protective Equipment (PPE). https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html. (CDC, August 19, 2020).
Centers for Disease Control and Prevention (CDC). (2020, October
16). Interim Guidance for Implementing Home Care of People Not
Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19).
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html. (CDC, October 16, 2020).
Centers for Disease Control and Prevention (CDC). (2020, November
6). What Firefighters and EMS Providers Need to Know about COVID-19.
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Centers for Disease Control and Prevention (CDC). (2020, November
10). What do funeral home workers need to know about handling
decedents who had COVID-19? https://www.cdc.gov/coronavirus/2019-ncov/community/funeral-faqs.html. (CDC, November 10, 2020).
Centers for Disease Control and Prevention (CDC). (2020, November
13). Guidance for Pharmacies, Guidance for Pharmacists and Pharmacy
Technicians in Community Pharmacies during the COVID-19 Response.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pharmacies.html. (CDC,
November 13, 2020).
Centers for Disease Control and Prevention (CDC). (2020, December
2). Collection and Submission of Postmortem Specimens from Deceased
Persons with Confirmed or Suspected COVID-19, Postmortem Guidance.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-postmortem-specimens.html. (CDC, December 2, 2020).
Centers for Disease Control and Prevention (CDC). (2020, December
4). Guidance for Dental Settings: Interim Infection Prevention and
Control Guidance for Dental Settings During the Coronavirus Disease
2019 (COVID-19) Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. (CDC, December 4, 2020).
Centers for Disease Control and Prevention (CDC).(2020, December
16). Guidance for Direct Service Providers. https://www.cdc.gov/coronavirus/2019-ncov/hcp/direct-service-providers.html. (CDC,
December 16, 2020).
Centers for Disease Control and Prevention (CDC). (2020, December
17). Interim Additional Guidance for Infection Prevention and
Control Recommendations for Patients with Suspected or Confirmed
COVID-19 in Outpatient Hemodialysis Facilities. https://www.cdc.gov/coronavirus/2019-ncov/hcp/dialysis.html. (CDC, December 17, 2020).

Centers for Disease Control and Prevention (CDC). (2021a, February
16). Implementation of Mitigation Strategies for Communities with
Local COVID-19 Transmission. https://www.cdc.gov/coronavirus/2019-ncov/community/community-mitigation.html. (CDC, February 16, 2021a).
Centers for Disease Control and Prevention (CDC). (2021b, February
16). Interim Clinical Guidance for Management of Patients with
Confirmed Coronavirus Disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html. (CDC, February 16, 2021b).
Centers for Disease Control and Prevention (CDC). (2021, February
23). Interim Infection Prevention and Control Recommendations for
Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19)
Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html. (CDC, February 23, 2021).
Centers for Disease Control and Prevention (CDC). (2021, March 8).
Interim Guidance for Businesses and Employers Responding to
Coronavirus Disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html. (CDC, March 8,
2021).
Centers for Disease Control and Prevention (CDC). (2021, March 11).
Interim U.S. Guidance for Risk Assessment and Work Restrictions for
Healthcare Personnel with Potential Exposure to COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html. (CDC, March 11, 2021).
Centers for Disease Control and Prevention (CDC). (2021, March 16).
Infection Prevention and Control Assessment Tool for Nursing Homes
Preparing for COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/hcp/assessment-tool-for-nursing-homes.html. (CDC, March 16, 2021).
Centers for Disease Control and Prevention (CDC). (2021, March 17).
Healthcare Facilities: Managing Operations During the COVID-19
Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html. (CDC, March 17, 2021).
Centers for Disease Control and Prevention (CDC). (2021, March 23).
Ventilation in Buildings. https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html. (CDC, March 23, 2021).
Centers for Disease Control and Prevention (CDC). (2021, March 29).
Interim Infection Prevention and Control Recommendations to Prevent
SARS-CoV-2 Spread in Nursing Homes. https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html. (CDC, March 29, 2021).
Centers for Disease Control and Prevention (CDC). (2021, April 2).
Post Vaccine Considerations for Healthcare Personnel, Infection
Prevention and Control Considerations for Healthcare Personnel with
Systemic Signs and Symptoms Following COVID-19 Vaccination. https://www.cdc.gov/coronavirus/2019-ncov/hcp/post-vaccine-considerations-healthcare-personnel.html. (CDC, April 2, 2021).
Dignity Healthcare. (2021). Coronavirus (COVID-19) Resources.
https://www.dignityhealth.org/coronavirus-disease-2019. (Dignity
Healthcare, 2021).
Eastern Research Group, Inc. (ERG). (2021, February 9). COVID-19
Plans by NAICS. (ERG, February 9, 2021).
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Distancing Scenarios. (ERG, February 25, 2021).
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The Hospital Infection Control Practices Advisory Committee.
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Commission, 2021a).
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https://www.jointcommission.org/about-us/facts-about-the-joint-commission/. (The Joint Commission, 2021b).
The Joint Commission. (2021c). Accreditation and Certification.
https://www.jointcommission.org/accreditation-and-certification/.
(The Joint Commission, 2021c).
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and Updates: COVID-19 Testing and Care. https://www.hopkinsmedicine.org/coronavirus/testing-and-care.html. (Johns
Hopkins Medicine, 2021).
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COVID-19. https://www.medstarhealth.org/mhs/about-medstar/covid-19-info/. (MedStar, May 5, 2021).
Michigan Medicine, University of Michigan (Michigan Medicine U-M).
(2021, May 18). U-M COVID-19 Preparedness and Response Plan. https://ehs.umich.edu/wp-content/uploads/2020/05/UM-COVID-19-Preparedness-and-Response-Plan.pdf. (Michigan Medicine U-M, May 18, 2021).
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Practices in Human and Animal Medical Diagnostic Laboratories. MMWR
2012; 61(01); 1-101. https://www.cdc.gov/mmwr/preview/mmwrhtml/su6101a1.htm. (Miller et al., January 6, 2012).
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3). Guide for Household Members, Intimate Partners, and Caregivers.
https://www.nahc.org/wp-content/uploads/2020/03/Coronavirus-Caregiver-Guide-Customizable.docx. (NAHC, March 3, 2020).
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September 2004).
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COVID-19 Exposure, Risk Assessment, Contact Tracing, Testing, and
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Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L, and the
Healthcare Infection Control Practices Advisory Committee. (2007).
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et al., 2007).
World Health Organization (WHO). (2016). Guidelines on Core
Components of Infection Prevention and Control Programmes at the
National and Acute Health Care Facility Level. (WHO, 2016).

B. Economic Feasibility

I. Introduction
    This section presents OSHA's estimates of the costs, benefits, and
other impacts anticipated to result from the ETS. The estimated costs
are based on employers achieving full compliance with the requirements
of the ETS. They do not include prior costs associated with firms whose
current practices are already in compliance with the ETS requirements.
The purpose of this analysis is to:
     Identify the establishments and industries affected by the
ETS;
     Estimate and evaluate the costs and economic impacts that
regulated establishments will incur to achieve compliance with the ETS;
     Evaluate the economic feasibility of the rule for affected
industries; and
     Estimate the benefits resulting from employers coming into
compliance with the rule in terms of the reduction in COVID-19 disease
and resulting fatalities.
    In this analysis, OSHA is fulfilling the requirement under the OSH
Act to show the economic feasibility of this ETS. This analysis is
different from a benefit-cost analysis prepared in accordance with E.O.
12866 in that the agency is focused only on costs to employers when
evaluating economic feasibility. In a true benefit-cost analysis, the
costs to all parties (e.g., employees,

governments) are included. Throughout this analysis, there are places
where OSHA estimates there are no costs borne by employers. This does
not necessarily mean that there are no costs or burdens imposed on
others but, from the standpoint of establishing feasibility, these are
not being assessed as part of OSHA's analysis of economic
feasibility.\30\
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    \30\ For example, there are places in the analysis where OSHA
specifically accounts for costs being shifted away from employers
through tax credits and other programs aimed at responding to the
pandemic. While the direct costs to employers are reduced for
purposes of evaluating feasibility, those costs would be
attributable to the ETS in a true benefit-cost analysis.
---------------------------------------------------------------------------

    A standard must be economically feasible in order to be
``necessary'' under section 6(c)(1)(B) of the OSH Act. Cf. Am. Textile
Mfrs. Inst., Inc. v. Donovan, 452 U.S. 490, 513 n. 31 (1981) (Cotton
Dust) (``any standard that was not economically . . . feasible would a
fortiori not be `reasonably necessary or appropriate' under the Act'');
Nat'l Maritime Safety Ass'n v. Occupational Safety & Health Admin., 649
F.3d 743, 752 (D.C. Cir. 2011). A standard is economically feasible
when industries can absorb or pass on the costs of compliance without
threatening industry's long-term profitability or competitive
structure, Cotton Dust, 452 U.S. at 530 n. 55, or ``threaten[ing]
massive dislocation to, or imperil[ing] the existence of, the
industry.'' United Steelworkers of Am. v. Marshall, 647 F.2d 1189, 1272
(D.C. Cir. 1981) (Lead I). Given that section 6(c) is aimed at enabling
OSHA to protect workers in emergency situations, the agency is not
required to make the showing with the same rigor as in ordinary section
6(b) rulemaking. Asbestos Info. Ass'n/N. Am. v. OSHA, 727 F.2d 415, 424
n.18 (5th Cir. 1984). In Asbestos Information Association, the Fifth
Circuit concluded that the costs of compliance were not unreasonable to
address a grave danger where the costs of the ETS did not exceed 7.2%
of revenues in any affected industry. Id. at 424.
    OSHA's evaluation of the overall costs and benefits of the ETS has
been performed for the purposes of complying with requirements outside
of the OSH Act (e.g., Executive Orders 12866 and 13563, the Unfunded
Mandates Reform Act). ``[T]he Supreme Court has conclusively ruled that
economic feasibility [under the OSH Act] does not involve a cost-
benefit analysis.'' Pub. Citizen Health Research Grp. v. U.S. Dept. of
Labor, 557 F.3d 165, 177 (3d Cir. 2009); see also Asbestos Info. Ass'n,
727 F.2d at 424 n.18 (noting that formal cost benefit is not required
for an ETS, and indeed may be impossible in an emergency). The OSH Act
``place[s] the `benefit' of worker health above all other
considerations save those making attainment of this `benefit'
unachievable.'' Cotton Dust, 452 U.S. at 509. Therefore, ``[a]ny
standard based on a balancing of costs and benefits by the Secretary
that strikes a different balance than that struck by Congress would be
inconsistent with the command set forth in'' the statute. Id. While
this case law arose with respect to health standards issued under
section 6(b)(5) of the Act, which specifically require feasibility,
OSHA finds the same concerns applicable to emergency temporary
standards issued under section 6(c) of the Act. An ETS ``serve[s] as a
proposed rule'' for a section 6(b)(5) standard, and therefore the same
limits on any requirement for cost-benefit analysis should apply.
Indeed, OSHA has also rejected the use of formal cost benefit analysis
for safety standards, which are not governed by section 6(b)(5). See 58
FR 16612, 16622-23 (Mar. 30, 1993) (``in OSHA's judgment, its statutory
mandate to achieve safe and healthful workplaces for the nation's
employees limits the role monetization of benefits and analysis of
extra-workplace effects can play in setting safety standards.'').\31\
---------------------------------------------------------------------------

    \31\ To support its Asbestos ETS, OSHA conducted an economic
feasibility analysis on these terms. 48 FR 51086, 51136-38 (Nov. 4,
1983). In upholding that analysis, the Fifth Circuit said that OSHA
was required to show that the balance of costs to benefits was not
unreasonable. Asbestos Info. Ass'n, 727 F.2d at 423. As explained
above, OSHA does not believe that is a correct statement of the
economic feasibility test. However, even under that approach this
ETS easily passes muster.
---------------------------------------------------------------------------

    The scope of judicial review of OSHA's determinations regarding
feasibility (both technological and economic) ``is narrowly
circumscribed.'' N. Am.'s Bldg. Trades Unions v. OSHA, 878 F.3d 271,
296 (D.C. Cir. 2017) (Silica). ``OSHA is not required to prove economic
feasibility with certainty, but is required to use the best available
evidence and to support its conclusions with substantial evidence.''
Amer. Iron & Steel Inst. v. OSHA, 939 F.2d 975, 980-81 (D.C. Cir. 1991)
(Lead II); 29 U.S.C. 655(b)(5), (f). ``Courts, [moreover], `cannot
expect hard and precise estimates of costs.' '' Silica, 878 F.3d at 296
(quoting Lead II, 939 F.2d at 1006). Rather, OSHA's estimates must
represent ``a reasonable assessment of the likely range of costs of its
standard, and the likely effects of those costs on the industry.'' Lead
I, 647 F.2d at 1266. The ``mere `possibility of drawing two
inconsistent conclusions from the evidence,' or deriving two divergent
cost models from the data `does not prevent [the] agency's finding from
being supported by substantial evidence.' '' Silica, 878 F.3d at 296
(quoting Cotton Dust, 452 U.S. at 523).
    Executive Orders 12866 and 13563 direct agencies to assess the
costs and benefits of the intended regulation and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, and public health and
safety effects; distributive impacts; and equity). Executive Order
13563 emphasized the importance of quantifying both costs and benefits,
of reducing costs, of harmonizing rules, and of promoting flexibility.
OSHA has prepared this ETS and the accompanying economic analysis on an
extremely condensed timeline and has complied with E.O. 12866 and E.O.
13563 only to the extent practicable under the circumstances (see Exec.
Order No. 13999, Jan. 21, 2021, 86 FR 7211 (Jan. 26, 2021)). This rule
is an economically significant regulatory action under Sec. 3(f) of
Executive Order 12866 and has been reviewed by the Office of
Information and Regulatory Affairs in the Office of Management and
Budget, as required by executive order.
II. Healthcare Industry Profile
a. Introduction
    In this section, OSHA provides estimates of the number of affected
entities, establishments, and employees for the industries that have
settings covered by 29 CFR 1910.502. The term ``entity'' describes a
legal for-profit business, a non-profit organization, or a local
governmental unit, whereas the term ``establishment'' describes a
particular physical site of economic activity. Some entities own and
operate more than one establishment.
    Throughout this analysis, where estimates were derived from
available data those sources have been noted in the text. Estimates
without sources noted in the text are based on agency expertise.
b. Scope of the ETS
    The ETS applies to all settings where any employee provides
healthcare or healthcare support services except:
     The provision of first aid by an employee who is not a
licensed healthcare provider;
     the dispensing of prescriptions by pharmacists in retail
settings;
     non-hospital ambulatory care settings where all non-
employees are screened prior to entry and people with suspected or
confirmed COVID-19 are not permitted to enter those settings;

     well-defined hospital ambulatory care settings where all
employees are fully vaccinated and all non-employees are screened prior
to entry and people with suspected or confirmed COVID-19 are not
permitted to enter those settings;
     home healthcare settings where all employees are fully
vaccinated and all non-employees are screened prior to entry and people
with suspected or confirmed COVID-19 are not present;
     healthcare support services not performed in a healthcare
setting (e.g., off-site laundry, off-site medical billing); or
     telehealth services performed outside of a setting where
direct patient care occurs.
    In well-defined areas of covered settings where there is no
reasonable expectation that any person with suspected or confirmed
COVID-19 will be present, paragraphs (f), (h), and (i) do not apply to
employees who are fully vaccinated.
    Healthcare services are delivered through various means including,
but not limited to: Hospitalization, long-term care, ambulatory care
(e.g., treatment in physicians' offices, dentists' offices, and medical
clinics), home health and hospice care, and emergency medical response.
Healthcare support services include, but are not limited to, patient
intake/admission, patient food services, equipment and facility
maintenance, housekeeping, healthcare laundry services, medical waste
handling services, and medical equipment cleaning/reprocessing
services.
    In order to determine which employers are covered by the ETS, OSHA
identified both the occupations where workers would be providing
healthcare and healthcare support services and the setting where those
tasks would be done. For example, a social worker in a hospital may be
working in conjunction with healthcare providers and therefore
providing healthcare or healthcare support services. However, a social
worker working for a children and family services or social advocacy
organization would not be covered by the ETS since neither they nor
anyone else at their organization would be providing healthcare or
healthcare support services.
    OSHA's methodology for determining which establishments and
employees are covered by the ETS focuses on job tasks and settings.
OSHA did not assign costs to certain categories of job tasks because
they are excluded from the scope of the ETS by paragraph (a). These
include: Employees who are teleworking; employees who are providing
services via telehealth; employees providing healthcare support
services at off-site locations; employees who are in uncovered portions
of settings (e.g., retail stores with health clinics, schools with
school nurses) that are not fully covered by the ETS; and employees who
work in parts of hospitals that would meet the ambulatory care
exemption in paragraph (a)(2)(iv). Numerous employees of hospitals,
long-term care facilities, and nursing homes are likely to fall into
one of these categories. While these workers are included in Table
VI.B.3 as employees of covered establishments, OSHA has not assigned
employee-based costs to their employers in this analysis.
    Furthermore, OSHA has not determined how many non-hospital
ambulatory care providers will screen patients for COVID-19 infections
and symptoms, and therefore be fully exempt from this rule under
paragraph (a)(2)(iii). To the extent that providers meet these
exemption criteria, they will incur no costs for compliance with
respect to these settings. Therefore, for this subset of
establishments, the costs presented in OSHA's analysis will be dramatic
overestimates (i.e., OSHA assumes full costs where costs should be
zero). Overall, however, OSHA believes that the number of workers
estimated to be covered by the ETS is reasonable and leads to
reasonable aggregate estimates of the average costs of compliance for
employers in covered settings.
    Table VI.B.1 summarizes the individual North American Industry
Classification System (NAICS) codes, along with OSHA's estimated
percentage of entities and employees, covered by the ETS. The
percentage of entities covered were generally estimated as the
percentage of firms reporting having employees whose occupation would
have them providing healthcare and healthcare support services (see
Appendix VI.B.A). In some healthcare industries (e.g., many of those in
NAICS 62 Health Care and Social Assistance), 100 percent of entities
are estimated to be affected, but for industries outside of the
healthcare sector, no more than 25 percent of entities were estimated
to be covered by the ETS. The percent of employees covered by the ETS
in covered, non-healthcare entities is estimated based on the
percentage of employees in those industries who are reported to be
employed in the occupation categories identified in Appendix VI.B.A.
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[GRAPHIC] [TIFF OMITTED] TR21JN21.009

BILLING CODE 4510-26-C
    Only some state- and local-government entities are included in this
analysis. State- and local-government entities are specifically
excluded from coverage under the OSH Act (29 U.S.C. 652(5)). Workers
employed by these entities only have OSH Act protections if they work
in states that have an OSHA-approved State Plan. (29 U.S.C. 667).
Consequently, this analysis excludes public entities in states that do
not have OSHA-approved State Plans.

Table VI.B.2 presents the states that have OSHA-approved State Plans
and their public entities are included in the analysis.
[GRAPHIC] [TIFF OMITTED] TR21JN21.010

c. Affected Entities and Employees
    OSHA used data from the U.S. Census' 2017 County Business Patterns
(CBP) to identify private sector entities and employees, including for-
profit and non-profit entities affected by the ETS (U.S. Census Bureau,
November 21, 2019, U.S. Census Bureau, March, 2020); and uses the
Bureau of Labor Statistics' (BLS) 2017 Quarterly Census of Employment
and Wages (QCEW) to characterize state and local government entities
(BLS, May 23, 2018). For covered public fire departments and
firefighters cross-trained as EMTs, OSHA relied on data from the U.S.
Fire Administration (USFA) National Fire Department Registry (USFA,
2018).
    OSHA similarly obtained estimates of the number of employees in
entities from CBP and QCEW. OSHA used the BLS 2018 Occupational
Employment Statistics (OES), which provides NAICS-specific estimates of
employment by occupation, to determine the subset of employees
performing the tasks outlined in the scope of the ETS (BLS, March 29,
2019). Within the affected NAICS industries, OES includes approximately
700 unique occupations. Of these, OSHA identified 90 occupations
representing jobs where workers would perform healthcare or healthcare
support services (see Appendix VI.B.A). OSHA then calculated the
proportion of total employees that these occupations represented for
the NAICS industries that reported employing these occupations in OES
data, and applied those proportions to the CBP and QCEW employee
estimates for the covered entities. This results in an estimate of the
subset of employees by NAICS industry where workers are covered by the
ETS.
    For many regulatory economic analyses, the agency uses the most up-
to-date economic data as its baseline to describe the current state of
the economy. It then applies the anticipated changes due to the new
OSHA standard or regulation to that baseline. However, even the most
current data OSHA uses in a typical economic analysis--including
employment, number of establishments, revenue, etc.--represent economic
conditions from at least one calendar year in the past. Even with that
lag in the data due to reporting and compilation time, the idea is that
the basic structure of the economy changes slowly, so the recent past
is a good predictor of the near future.
    Given the unique circumstances of the pandemic and its economic
disruption, OSHA's usual approach is inappropriate for the present
analysis. The agency has therefore also made adjustments to the
baseline industry profile to account for the economic conditions that
are expected to persist during the time period in which this ETS will
be in effect. Specifically, OSHA takes the above data as the baseline
for 2019, the last full year before the onset of the pandemic.\32\ Then
the agency adjusted employment and revenue by industry in order to
capture the current adverse conditions and provide better estimates of
employment and revenue both currently and over the period in which the
ETS will be in effect. The detailed methodology for these adjustments
is presented in Appendix VI.B.D.
---------------------------------------------------------------------------

    \32\ This includes updating revenue numbers for inflation to
2019 using the GDP deflator.
---------------------------------------------------------------------------

    Table VI.B.3 summarizes the entities and employees covered by the
ETS. OSHA estimates a total of approximately 563,000 entities,
including approximately 749,000 establishments, and approximately 18.1
million total employees who are employed by establishments covered by
the ETS. All affected establishments are assumed to incur the
establishment-based costs of compliance. In addition, OSHA estimates
that there are approximately 10.3 million employees in those
establishments who would not meet any of the exemptions in paragraph
(a) and whose employers would therefore incur per-employee costs of
compliance as well. However, as shown in Table VI.B.3, the portion of
employees for whom OSHA took per-employee costs varies considerably by
NAICS industry.
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[GRAPHIC] [TIFF OMITTED] TR21JN21.011

d. Affected Small Entities and Employees
    While OSHA has determined that it is impracticable to comply fully
with the requirements of the Regulatory Flexibility Act (RFA) (see
Additional Requirements, Section VII of the preamble), the agency has
nevertheless examined the impact of the ETS on small and very small
entities as part of OSHA's analysis of feasibility. There are three
types of small entities under the

RFA: (1) Small businesses; (2) small non-profit organizations; and (3)
small governmental jurisdictions. The Small Business Administration
(SBA) uses characteristics of businesses classified using the NAICS as
a basis for determining whether businesses are small within a given
industry. SBA small entity size criteria vary by industry, but are
usually based on either number of employees or revenue (Table of Small
Business Size Standards (SBA, August 19, 2019)). A small non-profit
organization is any not-for-profit enterprise that is independently
owned and operated and not dominant in its field. A small governmental
jurisdiction is a government of a city, county, town, township,
village, school district, or special district with a population of less
than 50,000.
    To determine the number of private SBA-defined small entities, OSHA
relies on 2017 CBP data, which report total revenues by entity and
employment size. For those industries with a revenue criterion, OSHA
calculated the average revenue for each employment size class in the
Census data and identified the largest size class where average revenue
is less than the SBA-defined small entity threshold. For those
industries with employment criterion, OSHA calculated the average
employees per entity by employment size class and included all entities
below the SBA threshold.
    To estimate the subset of local government entities that are small,
OSHA uses additional QCEW data that are specified geographically by
county at the 4-digit NAICS level along with 2017 county-level
population data from the U.S. Census Bureau's (December 6, 2018)
American Community Survey. Using these data, OSHA estimates the
percentage of local government entities, by county, that are small
local governments (i.e., in counties with a population less than
50,000), for each affected setting. OSHA then applies these proportions
to the prior national estimates of all local government entities, by
NAICS industry. The RFA's definition of small nonprofits is those not
``dominant in their field.'' As OSHA customarily does, it assumes all
nonprofits are small based on this definition.\33\
---------------------------------------------------------------------------

    \33\ While the RFA definition suggests that some nonprofits
might not be small entities, there is no set definition for the term
``dominant'' or delineation of what should be considered a
nonprofit's ``field.'' A nonprofit that is the main entity of its
type in a given city is still unlikely to be the dominant nonprofit
of its type in its state or region and even less likely to be
dominant if the ``field'' encompasses the whole U.S. Given these
ambiguities, OSHA has opted to include all non-profits as small
entities.

---------------------------------------------------------------------------

[GRAPHIC] [TIFF OMITTED] TR21JN21.012

    Lastly, Table VI.B.5 presents estimates for very small entities
(those with fewer than 20 employees) affected by the ETS. OSHA
estimates that the ETS affects approximately 472,000 very small
entities, employing approximately 2.2

million workers. Of those, approximately 1.2 million are estimated to
be workers who are in scope and covered by the ETS.
[GRAPHIC] [TIFF OMITTED] TR21JN21.013

BILLING CODE 4510-26-C
e. Summary of Affected Firms, Establishments, and Employees by NAICS
Industry and Setting
    Table VI.B.6 presents a summary of the number of affected entities,
establishments, and employees by NAICS industry and setting. The cost
estimates presented in this analysis rely on assumptions that are
specific to the type of services provided in various healthcare
settings in each affected NAICS industry. Table VI.B.6 provides the
mapping between the affected NAICS industries and their typical setting
based on the type of services provided.

[GRAPHIC] [TIFF OMITTED] TR21JN21.014

[GRAPHIC] [TIFF OMITTED] TR21JN21.015

BILLING CODE 4510-26-C
III. Cost Analysis for the COVID-19 ETS
    In this section, OSHA provides estimates of the per-establishment
costs for the requirements of the ETS. Section 6(c)(3) of the OSH Act
states that the Secretary will publish a final standard ``no later than
six months after publication of the emergency standard.'' Costs are
therefore estimated over a six-month time period. However, during that
period, to the extent OSHA finds that a grave danger from the virus no
longer exists for the covered workforce (or some portion thereof), or
new information indicates a change in measures necessary to address the
grave danger, OSHA will update the ETS, as appropriate.
    In developing the cost estimates, OSHA estimates that some
establishments are already following at least some of the ETS's
requirements. The extent to which firms are already meeting the
requirements of this ETS is estimated based, in part, on data presented
in ERG (August 9, 2013), the infectious disease expert panel report
prepared for OSHA. Because the expert panel was conducted pre-pandemic,
OSHA determined that some compliance rates were likely too low given
the heightened awareness of infection control practices, the amount of
time since the pandemic started, and, especially, the outbreaks in
healthcare settings and recognition of the importance of infection
control measures for protecting workers and patients. In those limited
circumstances, OSHA constrained compliance to be no less than 75
percent for large and SBA-defined small entities and 50 percent for
very small entities. Where establishments are already meeting ETS
requirements, those costs are not attributable to the ETS. Throughout
this analysis, where OSHA provides no other estimate, the agency
assumes baseline compliance rates of 50 percent for very small entities
and 75 percent for all other entities.34 35 OSHA recognizes
that the estimated compliance rates are somewhat imprecise, but they
are intended to reflect the relatively widespread adoption by employers
of some of the practices required by the ETS in response to state OSHA
standards, state and local government ordinances, and CDC, OSHA or
other guidance. Exceptions to the 50 percent/75 percent compliance
rates have been made for a few requirements that are highly specific to
OSHA's ETS (like recordkeeping requirements, rule familiarization, and
paid medical removal). While it is likely that levels of current
compliance vary among the elements of this ETS, OSHA lacks data to make
such specific determinations for each provision in the limited time
available under these emergency circumstances. OSHA examined the impact
of lower levels of baseline compliance on costs in a sensitivity
analysis (see section VI.B.III.q).
---------------------------------------------------------------------------

    \34\ The term ``baseline compliance'' is used to describe
protective workplace measures that would be conducted in the absence
of this ETS, the issuance of which establishes the meaning of and
the parameters for ``compliance.''
    \35\ Note that the lower assumed compliance rate for very small
entities sometimes results in the presentation of higher costs for
very small entities than for larger entities. This result seems
counter-intuitive given that very small entities have fewer
employees than larger ones, and many of the costs in this analysis
are based on an average number of employees per entity. The very
small entities do, in fact, have lower costs when baseline
compliance rates are not taken into account. However, because OSHA
estimates that these employers are starting from a lower level of
current compliance, the tables, which incorporate baseline
compliance rates in their estimates, sometimes show higher (or only
negligibly lower) per-establishment costs for very small entities.
Another point on the tables which can seem counter-intuitive is that
average costs per establishment for the category ``all,'' which
includes large and very large entities (along with small and very
small entities) can be smaller (or not much larger) than for, say,
SBA-defined small entities. This is due, again, to the differing
compliance rates which can swamp, in the average, the higher costs
incurred by large and very large entities. Furthermore, because
there are often fewer large entities relative to the number of SBA-
defined small and very small entities in an industry, the average
costs for the smaller entities tend to result in lower average per
entity costs over ``all'' establishments than one might expect.
---------------------------------------------------------------------------

    Despite this estimated baseline compliance, employer compliance is
not so widespread, nor does it incorporate enough of the practices
required by this ETS, as to render this ETS unnecessary. As discussed
in Section V. Need for Specific Provisions of the ETS, OSHA emphasizes
that each of the infection control practices required by the ETS
provides some protection from COVID-19 by itself, but the controls work
best when used together, layering their protective impact to boost
overall effectiveness. The ``Swiss Cheese Model of Accident Causation''
(Reason, April 12, 1990) argues that each control has certain
weaknesses or ``holes.'' The ``holes'' differ between different
controls. By stacking several controls with different weaknesses on top
of one another, the ``holes'' are blocked by the strengths of the other
controls. In other words, if the controls are layered, then any
unexpected failure of a single control is protected against by the
strengths of other controls. This model also demonstrates the necessity
for high levels of compliance with all requirements of this ETS, since
failure to follow the requirements may leave the ``holes'' exposed and
lead to an increased risk of disease transmission in the workplace.
    It should be noted that this analysis deals strictly with averages
and estimates. For any given establishment, actual costs may be higher
or lower than the point estimate shown here, but using an average
allows OSHA to evaluate feasibility by industry as required by the OSH
Act. In addition, OSHA has limited data on many of the parameters
needed in this analysis and has estimated them based on the available
data, estimates for similar requirements for other OSHA standards,
consultation with experts in other government agencies, and internal
agency judgment where necessary. OSHA's estimates are therefore based
on the best evidence available to the agency at the time this analysis
of costs and feasibility was performed.
    Many ETS requirements result in labor burdens that are monetized
using the labor rates described in Section VI.B.III.a OSHA
differentiates per-establishment burden by establishment size for
large, SBA-defined small, and very small entities with fewer than 20
employees (which are a subset of SBA-defined small entities). In doing
so, OSHA accounts for the fact that, in most industries, a substantial
portion of the SBA-defined small entity population is also very small.
In most cases, OSHA assigned different unit cost burdens to entities
with fewer than 20 employees and to other SBA-defined small entities
(with 20 or more employees). Both of these groups are combined when
calculating average costs for all SBA-defined small entities.
    OSHA estimates that approximately 563,000 entities have employees
who provide healthcare and healthcare support services and would be
subject to the requirements of the ETS, including approximately 749,000
establishments, and 10.3 million employees (see Table VI.B.3).
    Section VI.B.III.a describes the wage rates used to estimate the
labor costs incurred by affected entities. Sections VI.B.III.b through
VI.B.III.o present the estimated costs for each of the requirements of
the ETS. Finally, section VI.B.III.p summarizes the total per-
establishment costs and total costs of the ETS.
a. Wage Rates
    OSHA estimated occupation-specific wage rates from BLS 2018
Occupational Employment Statistics data (BLS, March 29, 2019). For each
affected NAICS industry, OSHA used the BLS (March 29, 2019) data to
estimate the average wages across the workers in the affected

occupations listed in Appendix VI.B.A. OSHA estimated loaded wages
using a fringe benefit rate of 44.4 percent, the average rate for all
civilian workers in the healthcare and social assistance industries in
the BLS (December 14, 2018) Employer Costs for Employee Compensation
data, as well as OSHA's standard estimate for overhead of 17 percent
times the base wage. The loaded wage rate averages by NAICS industry
and setting are presented in Appendix VI.B.B.
    In addition to the wages of the healthcare providers and employees
in other covered occupations in the affected NAICS industries, the cost
analysis also uses an estimated wage rate for occupational health
specialists, training development specialists, and a blended wage rate
that reflects the mix of doctors and nurse practitioners.
[GRAPHIC] [TIFF OMITTED] TR21JN21.016

b. Rule Familiarization and COVID-19 Plan
ETS Requirements--Under Sec.  1910.502(c).
    The employer must develop, implement, and update a COVID-19 plan
that addresses the hazards identified in the hazard assessment required
by this paragraph. The COVID-19 plan must include policies and
procedures that minimize the risk of transmission of COVID-19 for each
employee. This provision also requires employers to coordinate and
communicate with other employers at sites with multiple employers in
order to ensure that each employee is protected. Employers must have
policies and procedures to ensure that employees who enter into private
residences or other physical locations controlled by those not covered
by the OSH Act are protected. Non-managerial employees must be given
the opportunity to provide input into the hazard assessment and the
COVID-19 plan. The plan must be written if the employer has more than
10 employees. In order for an employer to be exempt from providing
certain controls for fully-vaccinated employees in a well-defined area
of a workplace where there is no reasonable expectation that any person
with suspected or confirmed COVID-19 will be present, the COVID-19 plan
must include policies and procedures to determine employees'
vaccination status.
    This section of the feasibility analysis presents the estimated
costs for developing the plan, while the costs of implementing the plan
are presented in the subsequent sections (VI.B.III.c through
VI.B.III.o) of this report.\36\
---------------------------------------------------------------------------

    \36\ Estimates were based on the Infectious Diseases Panel
Report (ERG, August 9, 2013).
---------------------------------------------------------------------------

Cost Analysis Assumptions
    As part of the Infectious Diseases Small Business Advisory Review
(SBAR) Panel, OSHA estimated that the development of a full Worker
Infection Control Plan (WICP) that included written standard operating
procedures for all infectious disease transmission routes would take
between 20 and 40 hours to develop, depending on the setting (OSHA,
2014). For this ETS, which applies specifically to COVID-19, OSHA
estimates that the written plan, including the hazard assessment, would
take 25 percent of the time needed to develop a full WICP. The
exception is hospitals, which are assumed to need 40 hours to develop
their plans. OSHA has not included additional time for employee
participation and assumes that the time estimated to develop the COVID-
19 plan is extensive enough to account for this activity. In addition
to the costs for developing the COVID-19 plan, OSHA assumes that
establishments with fewer than 20 employees will incur a labor burden
of 1 hour for rule familiarization and larger establishments will incur
a labor burden of 1.5 hours for rule familiarization.
    OSHA also assumes an additional recurring daily labor burden to
monitor each workplace to ensure the ongoing effectiveness of the
COVID-19 plan. OSHA estimates this will take 10 minutes per day of
labor per large establishment on average, with 5 minutes per day for
SBA-defined small and very small entities. This burden is incurred
daily, seven days a week,\37\ for six months. OSHA notes that
surveillance on the efficacy of an infection control plan is not a
wholly new activity for healthcare settings (CDC, March 15, 2017). The
Core Infection Prevention and Control Practices for Safe Healthcare
Delivery in All Settings from the Healthcare Infection Control
Practices Advisory Committee (the federal advisory committee appointed
to provide advice and guidance to the Department of Health and Human
Services and CDC regarding the practice of infection control in
healthcare settings) includes performance monitoring as one of its core
elements. Specifically, healthcare providers should ``monitor adherence
to infection control practices'' and ``monitor the incidence of
infections . . . to detect transmission of infectious agents in the
facility'' (CDC, March 15, 2017). OSHA estimates that there will be
some additional burden due to the requirements of this ETS, but that it
would be a small amount of additional time added on to what is a
regular activity that would be undertaken regardless of the ETS.
---------------------------------------------------------------------------

    \37\ To the extent that businesses are open fewer than seven
days a week or do not have employees on the premises seven days a
week, there will be some tendency toward overestimating the cost of
complying with this provision.
---------------------------------------------------------------------------

    As part of the planning and on-going monitoring, some employers
will need to communicate with other employers whose employees are at
the site (e.g., contractors, vendors) about the specifics of their plan
and additional information as necessary on an on-going basis. OSHA
estimates that hospitals, nursing homes, and other long-term care
facilities will spend 30 minutes one time after the promulgation of
this ETS

to communicate with contractors and others regarding expectations for
their activities under the requirements of this ETS. Additionally, OSHA
estimates that hospitals, nursing homes, and other long-term care
facilities will spend, on average, 15 minutes every week engaging in
on-going communication with contractors under this provision. Other
settings are estimated to only rarely use contractors, and so their
time burden is set to zero for both initial and on-going communication.
    The total cost for this communication for hospitals, long-term care
facilities, and nursing homes is a product of:

 One-time labor burden (half an hour for applicable settings)
plus the on-going labor burden (0.25 hours weekly for 26 weeks)
 Wage rate (NAICS-specific wages)
Cost per Establishment, Rule Familiarization and COVID-19 Plan
    Table VI.B.8 presents a summary of the per-establishment rule
familiarization and COVID-19 plan development, daily monitoring, and
host employer communication time burdens and costs for all
establishments. The baseline compliance estimates in Table VI.B.8 are
based on the estimated compliance rates in ERG (August 9, 2013), the
infectious disease expert panel report prepared for OSHA, and adjusted
so that baseline compliance is no less than 50 percent for
establishments with fewer than 20 employees and no less than 75 percent
for larger establishments. The expert panel survey was done during non-
pandemic conditions, so OSHA assumes compliance may be higher in health
care settings today. See the introduction to this section for more
discussion. OSHA assumes zero current compliance for rule
familiarization. Table VI.B.9 presents the same costs as Table VI.B.8
by establishment size.
[GRAPHIC] [TIFF OMITTED] TR21JN21.017

[GRAPHIC] [TIFF OMITTED] TR21JN21.018

c. Patient Screening and Management
ETS Requirements--Under Sec.  1910.502(d)
    In settings where direct patient care is provided, employers must
limit and monitor points of entry, screen and triage all non-employees
entering the setting, and implement other applicable patient management
strategies.
Cost Analysis Assumptions
    As noted in Summary and Explanation (Section VIII of the preamble),
screening is a standard part of infection control practices. OSHA
expects that healthcare settings will ask about COVID-19 infections and
perform a quick check of existing symptoms or assessment for newly
emerged symptoms that might suggest the presence of a COVID-19
infection. This screening does not need to be a highly involved
procedure and can be completed through verbal questions and answers.
OSHA estimates the six-month incremental time burden per facility for
screening and triaging non-employees for COVID-19 illness and symptoms
of COVID-19 (for all establishments) as follows:

 General Hospitals: An incremental burden of 385.1 hours is
estimated based on a burden of 1 minute per patient each day for an
average of 1 patient per employee \38\ and a baseline compliance rate
of 81 percent. [385.1 = (1-0.81) * (666.3/60) * (365/2); where 81% is
the compliance rate, 666.3 is the number of patients (estimated as
being equal to the average number of employees per establishment),\39\
60 is the number of minutes in an hour (which allows OSHA to calculate
the burden in hours per day), and 365/2 is the number of days of
burden]
---------------------------------------------------------------------------

    \38\ According to AHA Data Hub 2015-2019 data, there were
785,235,256 outpatient visits, 19,418,138 outpatient surgeries, and
34,078,100 admissions in 2019 (AHA, 2021). These data came from
5,141 community hospitals, which results in an average of 447 visits
per day for each hospital. Thus, since OSHA estimates there are 492
healthcare workers per hospital across all types of hospitals, that
is approximately 1 patient per employee per day.
    \39\ The estimated average number of workers per hospital for
General Hospitals is greater than the average number across all
types of hospitals derived from the AHA data cited above.
---------------------------------------------------------------------------

 Other Hospitals: An incremental burden of 60.4 hours is
estimated based on a burden of 1 minute per patient each day for an
average of 1 patient per employee \38\ and a baseline compliance rate
of 81 percent. [60.4 = (1-0.81) * (104.5/60) * (365/2); where 81% is
the compliance rate, 104.5 is the number of patients (equal to the
average number of employees per establishment), 60 is the number of
minutes in an hour (which allows OSHA to calculate the burden in hours
per day), and 365/2 is the number of days of burden]
 Nursing Homes: An incremental burden of 20.4 hours is
estimated based on a burden of 1 minute per patient each day for an
average of 32 patients per facility \40\ and a baseline compliance rate
of 79 percent. [20.4 = (1-0.79) * (32/60) * (365/2); where 79% is the
compliance rate, 32 is the number of patients, 60 is the number of
minutes in an hour (which allows OSHA to calculate the burden in hours
per day), and 365/2 is the number of days of burden]
---------------------------------------------------------------------------

    \40\ The number of patients per facility for Nursing Homes and
other Long Term Care is estimated using a 2019 National Center for
Health Statistics study on long term care facilities and their
patients (Harris-Kojetin et al., February, 2019) and OSHA's
estimated number of facilities (estimated using BLS (May 23, 2018),
BLS (March 29, 2019), and U.S. Census Bureau (March, 2020)).
---------------------------------------------------------------------------

 Long Term Care (excluding nursing homes): An incremental
burden of 14.7 hours is estimated based on a burden of 1 minute per
patient each day for an average of 23 patients per facility
40 and a baseline compliance rate of 79 percent. [14.7 = (1-
0.79) * (23/60) * (365/2); where 79 percent is the compliance rate, 23
is the number of patients, 60 is the number of minutes in an hour
(which allows OSHA to calculate the burden in hours per day), and 365/2
is the number of days of burden]
 Other Patient Care: An incremental burden of 39.9 hours is
estimated as 30 minutes per day \41\ and a baseline compliance rate of
56 percent [39.9 = (1-0.56) * (30/60) * (365/2); where 56 percent is
the compliance rate, 30 is the minutes of burden per day, 60 is the
number of minutes in an hour (which allows OSHA to calculate the burden
in hours per day), and 365/2 is the number of days of burden]
---------------------------------------------------------------------------

    \41\ The number of patients at hospitals and ambulatory care was
estimated using AHA Data Hub 2015-2019 data (AHA, 2021).
---------------------------------------------------------------------------

 Correctional Facility Clinics: An incremental burden of 18.25
hours is estimated as 30 minutes per day and a baseline compliance rate
of 80 percent [18.25 = (1-0.80) * (30/60) * (365/2); where 80 percent
is the compliance rate, 30 is the minutes of burden per day, 60 is the
number of minutes in an hour (which allows OSHA to calculate the burden
in hours per day), and 365/2 is the number of days of burden]

    The baseline compliance estimates are based on ERG (August 9,
2013), the infectious disease expert panel report prepared for OSHA. As
noted above, the rate of compliance with the patient screening and
management requirements was estimated to be relatively high prior to
the COVID pandemic. It is possible that these compliance rates are even
higher now, given the emphasis on screening for symptoms over the
course of the pandemic. However, while OSHA has estimated that those
settings that were judged to have very low compliance pre-COVID are
likely complying with screening requirements more thoroughly now, the
agency has not adjusted those settings with higher rates of patient
screening pre-COVID since the agency lacks data to make these
adjustments. The estimated time spent to screen patients is based on
the agency's evaluation of the time necessary to ask standard COVID
screening questions.
Cost per Establishment, Patient Screening and Management
    Table VI.B.10 shows the average cost per establishment for patient
screening and management by setting and size and incorporates the
compliance rates as detailed above.

[GRAPHIC] [TIFF OMITTED] TR21JN21.019

d. Standard and Transmission-Based Precautions
ETS Requirements--Under Sec.  1910.502(e)
    Employers must develop and implement policies and procedures that
adhere to standard and transmission-based precautions.
Cost Analysis Assumptions
    OSHA estimates that any time spent on the development of policies
and procedures that are in accordance with standard and transmission-
based precautions is included in the cost of developing the COVID-19
plan discussed earlier. OSHA does not expect that employers will need
to deviate significantly from existing practice to account for these
precautions and practices, and any costs associated with following
standard and transmission-based precautions are covered under the cost
estimates for the other sections of this ETS (PPE, hygiene and
cleaning, etc.). Therefore, OSHA did not estimate the costs associated
with compliance with this provision separately.
e. Personal Protective Equipment
ETS Requirements--Under Sec.  1910.502(f)
    Employers are required to provide facemasks and ensure those
facemasks are worn by each employee over the nose and mouth when
indoors and when occupying a vehicle with other people for work
purposes. Employers must ensure that each employee changes their
facemask at least once per day, whenever the facemask is soiled or
damaged, and more frequently as necessary (e.g., patient care reasons).
Employers must provide respirators and other PPE for workers exposed to
people with suspected or confirmed COVID-19, for employees involved in
aerosol-generating healthcare procedures on people with suspected or
confirmed COVID-19, and as necessary to comply with standard and
transmission-based precautions under paragraph (e). Required PPE
includes gloves, an isolation gown or protective clothing, and eye
protection.
Cost Analysis Assumptions
    The total cost to establishments to provide PPE will vary based on
the type of care provided in a facility and the number of encounters
workers will have with patients during a given period. The cost of
implementing this PPE provision will also vary by the number of
employees and the number of patients that the facility sees, as well as
by whether employees are working with people who are suspected or
confirmed to have COVID-19. A small practice with few employees and low
patient volume may have very low costs for PPE while a large hospital
with hundreds of workers and patients on any given day will likely have
much higher costs for PPE.
    For the purposes of estimating costs for this provision, OSHA is
assuming that 25 percent of covered employees in hospitals and nursing
homes (which corresponds roughly with the percent of covered workers
estimated to work in areas of a hospital where patients with suspected
or confirmed COVID-19 infections would be seen) and three percent of
in-scope employees in other covered settings (identified in section
VI.B.II.b as being in the scope) will be provided with, and use,
disposable N95 respirators. These estimates are based on OSHA's best
professional judgment. All other workers in covered settings are
estimated to use two disposable facemasks (surgical masks) per shift.
    The general approach for estimating the total cost of PPE used by
employees who have exposure to persons with suspected or confirmed
COVID-19 involves the following steps:
    1. Estimate the percentage of healthcare providers and employees
providing healthcare or healthcare support services in each setting
that will use each given type of PPE;
    2. For each given type of PPE, estimate how many pieces of
equipment an employee will use over six months (e.g., estimate that
hospital workers need 1 N95 respirator per shift, work 3 shifts per
week on average, so they will need 78 N95 respirators over 6 months);
    3. Estimate the unit cost for each PPE item; and
    4. Calculate the product of (a) the number of covered employees,
(b) the percent that will use a given type of PPE (step 1), (c) the
number of items needed per affected worker over six months (step 2),
and (d) the unit cost (step 3).
    Table VI.B.11 presents the estimated percentages of employees who
will need the required PPE by setting.

[GRAPHIC] [TIFF OMITTED] TR21JN21.020

    Table VI.B.12 presents estimates for the units of PPE needed per
employee shift for the employees using a given type of PPE. OSHA
assumes that one N95 respirator and either one disposable face shield
\42\ or protective eyewear will be used per shift. The estimated number
of gowns and gloves needed per shift are based on estimates from Carias
et al., (April 10, 2015) and Swaminathan et al., (October, 2007).
---------------------------------------------------------------------------

    \42\ Employers may provide reusable face shields which may be
less costly on a per-use basis but require cleaning and storage
which are additional costs. As a simplifying assumption, OSHA has
assumed employers will provide disposable face shields which may
represent a source of overestimation of compliance costs.
[GRAPHIC] [TIFF OMITTED] TR21JN21.021

    For general hospital, nursing homes, and long-term care facilities,
OSHA estimates that employees work three twelve-hour shifts per week,
or 78 shifts over six months. For other settings, OSHA estimates that
employees work five eight-hour shifts per week, or 130 shifts over six
months. Table VI.B.13 presents the total units of PPE per establishment
that would need to be used over a six-month period, by setting and
worker type. These estimates combine the numbers of covered workers by
setting with the percentages presented in Table VI.B.11, the pieces of
equipment needed from Table VI.B.12, and the number of shifts per
worker that occur over 6 months, and were adjusted for baseline
compliance (80 percent for general hospitals and nursing home
respirator costs, 90 percent for all other PPE in general hospitals and
nursing homes, and 72 percent for other settings).
[GRAPHIC] [TIFF OMITTED] TR21JN21.022

    Table VI.B.14 presents the estimated PPE unit costs. Note that
these unit costs reflect typical costs when there is not a PPE
shortage.
[GRAPHIC] [TIFF OMITTED] TR21JN21.023

Cost per Establishment, Personal Protective Equipment
    The results from Table VI.B.14 and Table VI.B.13 are combined to
estimate the per-establishment compliance costs of additional PPE
presented in Table VI.B.15.
[GRAPHIC] [TIFF OMITTED] TR21JN21.024

Cost Analysis Assumptions, Respiratory Protection Program
    Under this section of the ETS, where employers are required to
provide respirators, they must be provided and used in accordance with
OSHA's Respiratory Protection standard (29 CFR 1910.134). Note that
costs related to optional respirator use under the mini respiratory
protection program (29 CFR 1910.504) are discussed in sections VI.B.IV
and VI.B.V below but are included in the total average costs presented
below in Table VI.B.20 below.
    OSHA estimates that 15 percent of nursing home employers and 50
percent of employers in NAICS 621111 Offices of Physicians who do not
currently have a respirator program would either be required by the ETS
to implement a respiratory protection program or would voluntarily
determine that their employees need additional respiratory
protection.\43\ Of those establishments, OSHA estimates that, at most,
25 percent would, as a result of the requirements in this ETS, need to
establish a full program under Sec.  1910.134 and the remainder would
be able to take advantage of the mini respiratory protection program
under Sec.  1910.504 (see section VI.B.IV.b Scope of the Mini
Respiratory Protection section of the ETS below for additional detail).
In establishments that already have a respirator program, OSHA
estimates that the ETS will cause more employees to be wearing
respirators and their employers will incur the additional costs related
to medical evaluation, fit testing, and training for those employees.
---------------------------------------------------------------------------

    \43\ While OSHA has no hard data on how many establishments have
or will need to develop a respiratory protection program, the agency
has been assisting numerous nursing homes to establish programs over
the course of the pandemic. OSHA expects that some additional
nursing homes and long term care facilities will still need to
establish a program after the promulgation of this ETS but that most
will have done so already. While most offices of physicians would
not have needed a respiratory protection program prior to the
pandemic, OSHA's estimate for this element reflects an assumption
that healthcare providers may decide to be cautious given the close
proximity to others that is required in order to provide healthcare
services.
---------------------------------------------------------------------------

    In this section, OSHA is evaluating the costs for program
development, medical evaluation, fit testing, and training related to
respiratory protection. As stated above, OSHA is estimating costs
assuming that all affected employees will use disposable N95
respirators only.

    Workers who need respiratory protection (i.e., those assumed to be
using N95 respirators) will need to have a medical evaluation, fit
testing, and training. These are one-time costs per affected worker.
That is, total costs are simply calculated as the number of affected
workers multiplied by the one-time per worker cost.
    The estimated average numbers of workers per establishment affected
by respiratory protection requirements under the ETS are presented
below in Table VI.B.16.
[GRAPHIC] [TIFF OMITTED] TR21JN21.025

    Table VI.B.17 presents the estimated percentage of baseline
compliance with the respiratory protection requirements by setting. The
baseline estimates are based on ERG (August 9, 2013), the infectious
disease expert panel report prepared for OSHA, but as explained in the
introduction to this section, are assumed to be at least 50 percent for
establishments with fewer than 20 employees and at least 75 percent for
larger establishments.
[GRAPHIC] [TIFF OMITTED] TR21JN21.026

    The per worker labor burdens and costs include those associated
with the medical examination and the fit testing, which are described
below.
Respiratory Protection Plan Development
    The respiratory protection standard requires employers to develop
and maintain a written respiratory protection program. OSHA estimates
that a physician or other licensed healthcare professional will spend 4
hours for establishments with fewer than 20 employees and 8 hours for
larger establishments (OSHA, 2018) to develop this plan.
Medical Evaluation
    The Respiratory Protection standard requires employers to provide a
medical evaluation to determine the employee's ability to use a
respirator before the employee is fit tested or required to use the
respirator in the workplace. 29 CFR 1910.134(e)(1); (OSHA, 2018).
    While OSHA's respiratory protection standard requires medical re-
evaluation under certain circumstances, OSHA believes that, given the
limited time this ETS will be in effect, there will not be sufficient
time for conditions to change and trigger the requirement for the re-
evaluation and therefore OSHA did not estimate any costs associated
with medical re-evaluation in this analysis.
    The preliminary medical evaluation (medical questionnaire) is
estimated to take 15 minutes of the worker's time and 5 minutes of a
physician or other licensed health care professional's (PLHCP) time.
OSHA estimates that a follow-up medical evaluation is needed 23 percent
of the time (OSHA, 2018). When a follow-up medical evaluation is
needed, OSHA estimates that this has a cost of $391 plus the cost
burden for the 1 hour of the worker's time (OSHA, 2018). In addition,
it is estimated that a travel cost of $5 plus a half hour of the
worker's time is incurred for all settings

except for hospitals (since the follow-up is assumed to occur off-site
for employees in settings other than hospitals).
Fit Testing and Training
    The Respiratory Protection standard requires that, before a worker
is required to use a respirator with a negative or positive pressure
tight-fitting face piece, the employee must be fit tested with the same
make, model, style, and size of respirator that will be used. Fit
testing costs and training are estimated as one hour of the workers
time, plus one half hour of the fit tester's time for fit testing, one
half hour per 10 employees of the fit tester's time for training, and
the cost of two N95 respirators (OSHA, 2018).
Summary of per Worker Respiratory Protection Costs
    Table VI.B.18 summarizes how the per worker respiratory protection
costs are estimated.
[GRAPHIC] [TIFF OMITTED] TR21JN21.027

Cost per Establishment, Respiratory Protection
    Table VI.B.19 presents a summary of the respiratory protection
costs per establishment, including plan development, fit testing,
training, and medical evaluation costs.
[GRAPHIC] [TIFF OMITTED] TR21JN21.028

    Table VI.B.20 presents a summary of the average per establishment
combined cost for PPE and respiratory protection. The costs included in
Table VI.B.20 also include the costs associated with the

Mini Respiratory Protection Program described in section VI.B.V.0
[GRAPHIC] [TIFF OMITTED] TR21JN21.029

f. Aerosol-Generating Healthcare Procedures on a Person With Suspected
or Confirmed COVID-19
ETS Requirements--Under Sec.  1910.502(g)
    When an aerosol-generating procedure is performed on a person with
suspected or confirmed COVID-19, the employer must limit the number of
employees present during the procedure to only those essential for
patient care and procedure support and ensure that the procedure is
performed in an existing airborne infection isolation room (AIIR), if
available. After the procedure is completed, the employer must clean
and disinfect the surfaces and equipment in the room or area where the
procedure was performed.
Cost Analysis Assumptions
    Any costs associated with PPE or enhanced cleaning required under
this provision are included in the sections addressing PPE and cleaning
and disinfection. Costs associated with assuring properly functioning
AIIRs are considered in section VI.B.III.j on ventilation, below.
g. Physical Distancing
ETS Requirements--Under Sec.  1910.502(h)
    The employer must ensure that each employee is separated from all
other people by at least six feet when indoors unless the employer can
demonstrate that such physical distancing is not feasible for a
specific activity. When six feet of distancing is not feasible, the
employer must ensure that the employees are as far apart as is
feasible. This provision does not apply to momentary exposure while
people are in movement (e.g., passing in hallways or aisles).
Cost Analysis Assumptions
    To implement physical distancing requirements, OSHA assumes
employers post signage encouraging physical distancing: 25 Signs on
average per large establishment, with 15 and 10 signs for SBA-defined
small and very small establishments, respectively. OSHA estimated a
unit cost per sign of $0.10, with the assumption that employers will
use free downloadable signs from the CDC and self-print those signs.
OSHA also includes costs for floor markings, based on the unit cost for
a roll of masking tape ($4.39 (Office Depot, 2020)), and assuming 3
rolls per large establishments, 2 rolls per SBA-defined small
establishment, and 1 roll per very small establishments. OSHA also
assumes 2 minutes of labor per sign, including printing and
installation by an employee.
Cost per Establishment, Physical Distancing
    Table VI.B.21 presents a summary of the physical distancing costs
per healthcare establishment, incorporating the baseline compliance
rates of 50 percent for very small entities and 75 percent for all
other entities. These include costs of the signs, the floor markings,
and the labor of installing them (calculated using the average loaded
wage shown in Appendix VI.B.B).

[GRAPHIC] [TIFF OMITTED] TR21JN21.030

h. Physical Barriers
ETS Requirements--Under Sec.  1910.502(i)
    The employer must install cleanable or disposable, solid barriers
at each fixed work location outside of direct patient care areas where
each employee is not separated from all other people by at least 6
feet. An exception is made for where the employer can demonstrate that
it is not feasible.
Cost Analysis Assumptions
    OSHA estimates that the ETS will result in additional clear plastic
barriers installed in 10 percent of general hospital, other hospital,
first aid and emergency care, and other patient care settings. Other
facilities in these settings are assumed to have installed these
barriers or an equivalent barrier prior to the ETS. OSHA estimates that
each setting will install 3 clear plastic barriers with a cost of $300
per barrier.\44\ This is an average. OSHA also assumes 15 minutes of
labor for 2 maintenance workers for the installation of each barrier.
---------------------------------------------------------------------------

    \44\ The cost of installing clear plastic barriers in response
to COVID-19 has been reported in the following news articles: (1)
Altoona company starts installing plexiglass cashier shields (Lim,
April 2, 2020)--$300 per barrier, and (2) Franklin County to get
prices on spit/sneeze shields, doors (Perry, April 21, 2020)--$140
per barrier. The higher cost estimate is utilized in the analysis.
---------------------------------------------------------------------------

    While OSHA has no data on the number of barriers that have been
purchased and installed or how many additional barriers will need to be
made, the agency has included what it has determined, based on agency
judgment, to be a reasonable estimate for this requirement. It is
likely that some workplaces will need more barriers than others; it is
also likely that many establishments will reevaluate their current
barrier set up as a result of this ETS and determine that they need
additional barriers. This is an average, so it also accounts for the
likelihood that some establishments will not need any barriers because
the nature of the work makes spacing feasible, or because barriers are
infeasible.
Cost per Establishment, Physical Barriers
    Table VI.B.22 presents the average total physical barrier costs for
establishments covered by the ETS by setting and incorporates the
baseline compliance rate of 90 percent as discussed above for
hospitals, first aid and emergency care, and other patient care.
[GRAPHIC] [TIFF OMITTED] TR21JN21.031

i. Cleaning and Disinfection
ETS Requirements--Under Sec.  1910.502(j)
    In patient care areas and resident rooms, and for medical devices
and equipment, the employer must follow standard practices for cleaning
and disinfection of surfaces and equipment in accordance with
applicable CDC guidelines. In other areas, the employer must clean
high-touch surfaces and equipment at least once per day. When an
employer is aware that a person who is COVID-19 positive has been in
the workplace within the last 24 hours, the employer must clean and
disinfect any areas, materials, and equipment under the employer's
control that have likely been contaminated by that person. The employer
must also provide alcohol-based hand rub or readily accessible hand
washing facilities.
Cost Analysis Assumptions
    In settings other than hospitals, nursing homes, and long-term care
facilities, OSHA assumes establishments will, in addition to their
current cleaning product purchases, need to purchase a six-month supply
of multipurpose cleaners and disinfectants, at a cost of $4.54 for each
(i.e., a supply of multipurpose cleaner and a supply of disinfectants/
virucides), for a total of about $9 per establishment (W.B. Mason,
2020).
    Hospitals are estimated to spend a total of $56 million annually on
soaps and cleaning products, and nursing homes and long-term care
settings are estimated to spend $60 million annually on these supplies
(BEA, November, 2018). OSHA estimates that spending on cleaning
products will increase by 5 percent as a result of the ETS, and
accounts for these increased cleaning product costs on a per employee
basis, which is equivalent to an additional $0.37 per hospital employee
and an additional $0.69 per nursing home and long-term care setting
employee. This increased spending also covers the costs of cleaning
associated with aerosol-generating procedures under paragraph (g) of
the ETS.
    OSHA expects that the majority of cleaning that would need to be
done to comply with this provision is already being done in response to
CDC guidelines or could be completed in nonproductive downtime without
affecting worker productivity. Given the emphasis on cleaning and
disinfection in healthcare settings (those in NAICS 622), the agency
believes that all necessary cleaning is being done at healthcare
establishments. However, outside of NAICS 622, OSHA has included a time
burden of 2 additional minutes per shift for 25 percent of covered
workers, for cleaning, in order to err on the side of being overly
inclusive of costs.
    This provision of the ETS also requires that the employer provide
alcohol-based hand rub (ABHR) or readily accessible hand washing
facilities. OSHA estimates that this ETS will result in a 10 percent
increase in the use of ABHR or an average incremental increase of
0.0067 ounces \45\ of hand sanitizer per use of ABHR (assumed to be 10
percent of the ABHR needed per use, which translates into a 10 percent
increase in use overall), with an estimated incremental cost of 0.335
cents per use.\46\ The estimated number of uses of ABHR is based on the
estimate for the number of gloves used (see Table VI.B.13), assuming
that there are two ABHR uses per pair of gloves used (i.e., using ABHR
before putting on and after taking off each pair of gloves).
---------------------------------------------------------------------------

    \45\ According to the makers of Purell, ``If used as directed,
which is to apply enough PURELL[supreg] Hand Sanitizer to thoroughly
cover hands, a consumer can get 29-30 uses out of a 2 fl. oz.
bottle''. Thus, OSHA assumes that each use of hand sanitizer would
be 2/30 = 0.067066667 fl oz. (GOJO US, 2020). Ten percent of
0.067066667 fl oz, is 0.0067 fl oz, which is the incremental
increase in ABHR use per use assumed to be attributable to the rule.
    \46\ The cost of bulk hand sanitizer is estimated as $0.50 per
ounce (W.B. Mason, 2020).
---------------------------------------------------------------------------

Cost per Establishment, Cleaning and Disinfection
    Table VI.B.23 presents the average cleaning and disinfection costs
for healthcare establishments by setting and establishment size and
incorporates the baseline compliance rates of 50 percent for very small
entities and 75 percent for all other entities.
[GRAPHIC] [TIFF OMITTED] TR21JN21.032

j. Ventilation
ETS Requirements--Under Sec.  1910.502(k)
    Employers who own or control buildings or structures with an
existing heating, ventilation, and air conditioning (HVAC) system, must
ensure that: The system is used in accordance with the manufacturer's
instructions and the design specifications; the amount of outside air
circulated through the system and the number of air changes per hour
are maximized to the extent appropriate; air filters are rated Minimum
Efficiency Reporting Value (MERV) 13 or higher, if compatible, or the
highest compatible filtering efficiency for the HVAC system(s); air
filters are maintained and replaced as needed; and intake ports are
cleaned, maintained, and cleared of debris. This provision does not
require installation of new HVAC systems or AIIRs to replace or augment
functioning systems. However, where an employer has an existing AIIR,
the AIIR must be maintained and operated in accordance with its design
and construction criteria. The regulatory text does include a note
encouraging additional ventilation measures; however, as they are not a
mandatory component of the ETS, costs have not been taken for those
additional measures.
Cost Analysis Assumptions
    For all settings, OSHA assumes each establishment will need an
average of 3 MERV 13 air filters for large establishments, with 2 for
SBA-defined small businesses, and 1 for very small establishments. The
unit cost is $21.50 per filter (Home Depot, 2020).\47\ OSHA assumes
filters are replaced every three months, and this replacement requires
10 minutes of labor per filter for an Installation, Maintenance, and
Repair (SOC 49-0000) employee every three months. For hospitals with 20
or more employees OSHA assumed that a larger filter would be used, with
a unit cost of $79 (HD Supply, 2021) and a replacement labor burden of
20 minutes of labor per filter.
---------------------------------------------------------------------------

    \47\ Employers will need to upgrade to the highest efficiency
filter compatible with their existing system. To the extent
employers are upgrading to something less efficient than a MERV 13
filter, there will be some tendency toward overestimating costs.
---------------------------------------------------------------------------

    While it is a good business practice to maintain the HVAC system in
good working order and OSHA believes that most establishments have HVAC
systems that meet the requirements of the ETS, OSHA estimates that some
small amount will need to have their HVAC systems serviced. In addition
to the cost of purchasing and installing new air filters, OSHA
estimates that large hospitals, nursing homes, and long-term care
settings will require four hours of a general maintenance and repair
worker's time to evaluate the condition of the HVAC system and to
complete any necessary maintenance. In all other settings, 30 percent
of large employers who need this maintenance will need 2 hours of
maintenance work and SBA-defined small employers who need this
maintenance will need 1 hour of maintenance work. OSHA assumes that
very small entities will be less likely to control the HVAC system in
their facility and therefore assigns no additional maintenance costs to
those establishments. Any necessary HVAC work could be done by an
outside source like an HVAC maintenance contractor or could be done by
in-house maintenance workers if they are available.
    The draft infectious disease cost analysis prepared for SBREFA
included engineering control costs for hospitals to maintain AIIRs to
manufacturer's specifications (OSHA, 2014). These costs were updated to
current dollars for the analysis of this ETS. And while the infectious
disease cost analysis included both initial costs and annual
maintenance costs, since the ETS is only effective for six months, OSHA
included in this analysis only maintenance costs to bring existing
AIIRs up to the manufacturer's specifications where they are not
already being maintained properly. OSHA estimates that most hospitals
(83 percent) that have AIIRs properly maintain them (ERG, August 9,
2013).
    Based on analyses performed in conjunction with OSHA's (1997)
proposed rule addressing occupational exposure to tuberculosis, 64 FR
54160 (Oct. 17, 1997), the agency estimates that there would be a one-
time cost of $8,143 to perform maintenance on an AIIR so that it
functions properly (e.g., maintains negative air pressure relative to
the surrounding areas, completes the recommended number of hourly air
exchanges) (WCG, November 14, 1994; updated to 2020 dollars). This is
based on an estimated cost per square foot to purchase and install
material, including ducting, fans, and HEPA filters, in an average
isolation room measuring 150 square feet (WCG, November 14, 1994;
updated to 2020 dollars). Note that since the analysis timeframe is 6
months, there are no on-going maintenance costs attributable to the
ETS.
Cost per Establishment, Ventilation
    Table VI.B.24 presents the average ventilation costs for healthcare
establishments by setting and size. These estimates incorporate the
baseline compliance rates of 50 percent for very small entities and 75
percent for all other entities, and a baseline compliance rate of 83
percent for maintenance of AIIRs in hospitals.

[GRAPHIC] [TIFF OMITTED] TR21JN21.033

k. Health Screening and Medical Management
ETS Requirements--Under Sec.  1910.502(l)
    The employer must screen each employee before each work day or
shift for COVID-19 symptoms and require employees to promptly notify
the employer when they are COVID-19 positive, have been told by a
healthcare provider that they are suspected to be COVID-19 positive, or
are experiencing certain specified symptoms of COVID-19. When an
employer is notified that a person who has been in the workplace is
COVID-19 positive, the employer must notify each employee who had, and
other employers whose employees had, close contact with that person in
the workplace. The employer must also notify any employee who worked
in, and any other employers whose employees worked in, a well-defined
portion of a workplace in which the COVID-positive person was present
during the potential transmission period.
    This paragraph also contains a requirement that the employer
immediately remove any employee who is positive for COVID-19. Removal,
which in the ETS refers to temporary removal from the workplace, must
continue until that employee meets the criteria for return to work. In
addition, the employer must remove any employee who has been told by
their healthcare provider that they are suspected to have COVID-19 and
any employee who is experiencing certain COVID-19 symptoms. The
employer must ensure that any such employee is kept out of the
workplace until they either meet the return to work criteria or they
test negative for COVID-19 based on a polymerase chain reaction (PCR)
test, which the employer must provide at no cost to the employee. In
addition, the employer must remove any employee who has had close
contact with someone in the workplace who is COVID-19 positive (unless
the employee has either been fully vaccinated or has recently recovered
from COVID-19). Employees who had close contact must be removed for 14
days or until they test negative for COVID-19 via a test provided at
least 5 days after the exposure and paid for by the employer. Employees
who had symptoms or were informed by a licensed healthcare provider
they are suspected to have COVID-19, but did not have close contact,
can return to work immediately if they test negative. Employees removed
because of close contact must stay away from work for at least 7
calendar days from the date of exposure, even if they test negative.
    When an employee is removed under the above criteria the employer
must continue to pay the employee's normal earnings, as though the
employee were still at their regular job, up to $1,400 a week for the
first two weeks. If employees remain sick after that first two-week
period and must stay out longer, employers with fewer than 500
employees are only required to pay two thirds of regular pay, up to
$200 per day, after the initial 10 working days. Pay during removal can
be offset with any employer or public benefits, such as paid leave or
workers' compensation, until the employee meets the return to work
criteria.\48\ The requirement to pay the employee terminates if the
employer offers a COVID-19 test at least five days after the exposure
and the employee refuses to take it. Employers may also require
employees who are removed from the workplace under this paragraph to
work remotely or in isolation when suitable work is available. These
employees would be paid as usual for their work. Employers with 10 or
fewer employees are required to remove employees from the workplace
under this paragraph but are not required to pay them during the time
they are removed.
---------------------------------------------------------------------------

    \48\ Recent legislation, the American Rescue Plan Act, Public
Law 117-2, section 9641, extends tax credits to many employers for
paid leave provided to employees through September 30, 2021 for
COVID-19 related reasons. These tax credits will cover leave
provided to employees removed from work under this ETS. This reduces
costs to employers by shifting those costs to taxpayers.
---------------------------------------------------------------------------

    The ETS does not require notification or removal of employees who
were wearing respirators, along with other required PPE, at the time
they had close contact with a person with COVID-19. In addition, an
employee's close contact with a patient with COVID-19 does not trigger
the notification requirements (and therefore does not trigger removal
requirements) if the patient with COVID-19 was in an area where such
patients are normally expected, such as an emergency room or COVID-19
clinic (as opposed to a maternity unit of a hospital, a physician's
office that screens out COVID-19 patients, a physical therapist's
office, etc.).
Cost Analysis Assumptions
    The health screening activities could include instructing employees
to perform a self-assessment for symptoms before they arrive to work.
The training on the elements of this self-assessment are included under
the cost of training and there is no cost to the employer for this
activity because it can be completed by the employee concurrent with
other

daily activities without taking time from those activities. Although
employers are not required to use temperature screening for employee
screening, OSHA assumes for purposes of this analysis that this may be
done as part of screening and estimates that it will take an average of
15 seconds per employee per day. OSHA also estimates that
establishments will purchase no-touch thermometers at a rate of 1 per
100 employees, on average, with a minimum of 1 per establishment and
unit cost of $29.50 per thermometer (Rice et al., December 18, 2020).
    OSHA also includes 5 minutes of General and Operations Manager (OES
11-1020) labor per case (i.e., each employee required to notify their
employer) to make arrangements for the employee per above, and an
additional 40 minutes per case to notify other potentially exposed
employees. This includes the time to identify which of the exposed
employees would be excluded from the notification and removal
requirements because they were wearing respirators and required PPE at
the time of the exposure.
Cost per Establishment, Health Screening and Notification
    In order to estimate the feasibility of the ETS and due to the
highly uncertain path of the pandemic over the period this ETS will be
in effect, OSHA examined feasibility based on historic numbers of cases
and fatalities from two periods: March 19, 2021 through April 19, 2021,
inclusive of the cases on the start and end dates (designated as the
``primary'' scenario) and a monthly average over April 1, 2020 through
April 1, 2021, inclusive of the start and end dates (called the
``alternative'' scenario). Using these scenarios, OSHA estimated cost
per establishment for the screening and notification requirements of
this provision under both scenarios. Costs per establishment are shown
below in Table VI.B.25 by setting and size. They incorporate the
baseline compliance rates of 50 percent for very small entities and 75
percent for all other entities.
[GRAPHIC] [TIFF OMITTED] TR21JN21.034

Medical Removal Protection and Medical Removal Protection Benefits
    There are two types of costs that employers can incur to comply
with the ETS requirements for medical removal: Payments to employees
who are removed from work and payment for testing to determine whether
those employees can return to work. OSHA developed cost estimates for
medical removal protection (MRP) benefits for the two scenarios
described above in section VI.B.III.k, Health Screening and
Notification. The estimates for each scenario (primary and alternative)
follow the same procedure.\49\ In order to estimate the cost to
employers of providing MRP benefits to their workers, OSHA needed to
make the following estimates:
---------------------------------------------------------------------------

    \49\ The provisions for MRP have an exemption for all
establishments with 10 or fewer employees, so these establishments
are not included in calculating the cost of MRP benefits.
---------------------------------------------------------------------------

     The number of workers who would need to be removed \50\
from the workplace;
---------------------------------------------------------------------------

    \50\ Includes workers who have or are suspected to have COVID-19
illness, those diagnosed to have COVID-19 by a licensed healthcare
provider, those who have specified symptoms, and those who have had
close contact at work with someone who is COVID-19 positive (unless
they have no symptoms and have either been fully vaccinated or
recently recovered from COVID-19).
---------------------------------------------------------------------------

     The number of removed workers who would be COVID-19
positive;
     The number of workers who would receive a COVID-19 test,
the number of workers who would test negative for COVID-19, and the
cost to the employer of those tests;
     The number of days COVID-19 positive employees and
employees who receive a negative COVID-19 test would be paid MRP
benefits;
     The daily wage paid to removed workers;
     The number of days that can be offset by other paid leave
benefits; and
     The impact of the tax credit for paid sick leave included
in the American Rescue Plan Act (ARP), Public Law 117-2, assuming 100
percent take-up for all

qualifying firms (i.e., those with fewer than 500
employees).51 52
---------------------------------------------------------------------------

    \51\ In estimating the costs and feasibility of an OSHA
standard, OSHA assumes that employers behave rationally to minimize
their costs and thus assumes all eligible employers would take the
tax credit. The agency examines the impact of less than 100 percent
take-up of the tax credit in the sensitivity analysis in section
VI.C.XVII.
    \52\ Note that certain government employers (mainly state and
local governments) are qualified for the tax credit regardless of
size.
---------------------------------------------------------------------------

Number of Workers Removed
    The base number of COVID-19 cases among workers is determined based
on historic infection data. OSHA's calculations of the number of COVID-
19 cases among workers affected by this ETS, based on the two
scenarios, are shown in the benefits section of this analysis (see
section VI.B.VIII.d for details of those estimates).
    As shown in Row A of of the Benefits section, OSHA identified
2,041,229 COVID-19 cases during the period of March 19, 2021 through
April 19, 2021, which serves as the basis for the ``primary'' scenario,
and 2,507,290 cases as the monthly average over the year beginning
April 1, 2020 and ending April 1, 2021, which serves as the
``alternative'' scenario.
    As explained in the Benefits analysis, OSHA then adjusted that
number of cases by removing cases that were outside of the range of
working age adults (18-64 years) and then including a further reduction
to account for a percentage of that population that is not employed
(See Benefits, Rows B and C). Using the primary scenario as an example,
there were 1,047,145 remaining cases (See Benefits, Row C). OSHA then
removed an additional 228,797 cases to account for teleworkers, who in
this analysis do not receive any benefit from the ETS nor incur any
costs for the employer. The remaining number of cases (818,348, as
shown on Row E of Benefits) is one month of cases among workers
expected to be in the physical workplace. While OSHA begins its
analysis with the same data as presented in Benefits, the Benefits and
Cost analysis diverge at this point because the Benefits remove
additional cases to account for community spread (see, Row F), while
those cases are not removed for costs because employers will incur
removal costs for those workers regardless of whether they were
infected at work or elsewhere.
    Because this analysis is examining the effect of six months of the
ETS, OSHA multiplied that 818,348 by six months to produce a product of
4,910,088 total cases of workers in the workplace over 6 months. Based
on OSHA's industry analysis, 13 percent of all employees in the
workforce are covered by 29 CFR 1910.502 (see the Benefits analysis).
OSHA assumes that the number of cases would be allocated according to
those percentages, so during the entire period of the ETS the number of
workers under the ETS who have COVID-19 are, respectively, 625,933
(primary), and 768,848 (alternative).53 54 In Table VI.B.26,
for convenience, OSHA presents the cases discussed in the following
text.
---------------------------------------------------------------------------

    \53\ Primary = 13% (rounded) of 625,933 cases in the workplace
over 6 months; Alternative = 13% (rounded) of 768,848 cases in the
workplace over 6 months.
    \54\ The products are accurate--13 percent is a rounded number.
These numbers do not include teleworkers since they are not in the
workplace and hence do not qualify for MRP, but they do include
workers at the physical workplace who actually become infected
through community spread rather than at work.
[GRAPHIC] [TIFF OMITTED] TR21JN21.035

    Like the benefits analysis, the cost analysis further reduces the
number of cases to account for vaccinations. Due to the prioritization
of healthcare workers for vaccinations, OSHA assumes a vaccination rate
of 75 percent for the healthcare sector.\55\ Since the original CDC
data reflect cases that occurred during periods with a reduced but
positive vaccination rate, the calculation to adjust the data for the
increase to a 75 percent vaccination rate is slightly complicated. It
is explained later in the Benefits section. The final result is that
for the primary scenario OSHA estimates that 62.9 percent of the cases
remain after all adjustments are incorporated, and for the alternative
scenario, 40.4 percent of cases remain. The reduction in the number of
cases prevented through vaccination ultimately means that fewer
employees will need to be temporarily removed from the workplace per
the requirements of the ETS (with a corresponding reduction in
benefits). OSHA thus estimates that under the primary scenario there is
an adjusted total of 393,662 COVID-19 cases (those cases remaining
after the additional number of cases are reduced to reflect cases
prevented by vaccination--75 percent) are removed: (625,933 *

0.629)). The adjusted number of cases under the alternative scenario is
310,637 (768,848 * 0.404).
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    \55\ OSHA had no direct estimates of healthcare workers who have
been vaccinated but based this estimate on the following sources.
Workforce COVID-19 vaccination rates among 8 top U.S. hospitals
(Masson, February 22, 2021) found vaccination rates of about 60 to
85% among hospital personnel in February 2021. Early COVID-19 First-
Dose Vaccination Coverage Among Residents and Staff Members of
Skilled Nursing Facilities Participating in the Pharmacy Partnership
for Long-Term Care Program--United States, December 2020-January
2021 (Gharpure et al., February 5, 2021) found vaccination rates of
about 37.5% among nursing home staff. Given the time that has passed
since these studies and the fact that, in the benefits analysis,
there is no way to determine job category or industry, OSHA believes
an overall rate of 75 percent for healthcare workers is a reasonable
average for the job categories and industries being considered here.
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    Finally, the agency adjusts MRP cases to account for a gradual
reduction in the need for MRP as the comprehensive protections of the
standard lower the number of transmissions at the workplace (e.g.,
working with distance or barriers, etc.). Most other costs of the ETS
do not include this type of adjustment because they are not dependent
on reductions in workplace transmission (e.g., barriers would still be
required regardless of whether some workplace transmissions are
prevented). As in the Benefits analysis, OSHA assumes that the
effectiveness rate in the workplace will be an overall 75 percent,
meaning that 75 percent of the infections would be prevented over the
6-month course of the ETS. The final number of cases for the primary
scenario is therefore reduced to 98,445 (393,662 * (1-0.75)), and for
the alternative scenario it is reduced to 77,659 (310,637 * (1-0.75)).
Note that the effectiveness would be higher except that OSHA assumes,
as it does in Benefits, that 20 percent of the cases will be worker
infections resulting from community transmission outside the workplace
and therefore not reduced by the provisions of the ETS. However, unlike
Benefits, those community spread cases are not subtracted from the
total number of remaining cases because the employers will still bear
the same cost for addressing them as if the worker had been infected at
the workplace. For example, whether the employee was infected in the
workplace or outside the workplace, once the employer learns that the
employee has tested positive for COVID-19 the employer must still
remove that employee from the workplace in order to protect its other
employees and must provide MRP benefits to the removed employee.
    OSHA estimates that in half of these cases (49,208 for the primary
scenario) workers will know they are COVID-19 positive through a COVID-
19 test or via diagnosis by a licensed healthcare provider of suspected
or confirmed COVID-19 (OSHA assumes this group diagnosed by a
healthcare provider is then confirmed by a positive test). The other
half will have symptoms as described in the ETS (before being tested
and confirmed positive).
    Beyond the positive cases, other workers will need to be removed
from the workplace because they are exposed to someone at the workplace
who has COVID-19, or develop the symptoms specified in Sec.
1910.501(i)(2)(iii) or (iv), even though they are not actually infected
with COVID-19 and ultimately test negative (but must still be
temporarily removed from the workplace pending the testing results). To
estimate this number of removed workers, OSHA assumes that for every
worker who has symptoms and who will eventually test positive for
COVID-19 there will be an equal number (49,208 for the primary
scenario) of workers who will have symptoms but who will test negative
and not be infected (Kim et al., Jan 25, 2021, Tostmann et al., April
23, 2020). OSHA further assumes that for every potential COVID-19 case
reported to an employer (based on a test, diagnosis, or symptoms) there
will be 1.5 workers who will have close contact at work with a person
with COVID-19.\56\ The ETS exempts workers who are wearing respirators
and other required PPE from being removed due to close contact with a
person with COVID-19. OSHA assumes 25 percent of the workers are
wearing N95 respirators and the other required PPE (section VI.B.III.e
of this analysis) and therefore would not need to be notified of such
contact nor removed from work as a result of it. This is support for
the assumption that on average 1.5 people covered by the ETS will need
to be removed because they have close contact with an infected person
at work. Thus, focusing just on the primary scenario from above for the
purposes of illustration, with 98,415 COVID-19 cases there will be an
additional 147,263 workers (98,415*1.5) who would need to be removed
from work because they had close contact at work with someone who has
COVID-19.
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    \56\ OSHA examines the effects of varying this assumption in a
sensitivity analysis (see section VI.B.III.q).
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Number of Workers Who Would Receive a COVID-19 Test
    When testing is an option, OSHA expects employers to have employees
tested so that the employees can return to their work as quickly as
possible. For workers with suspected COVID-19 illness with symptoms,
which includes cases diagnosed by a licensed healthcare provider that
are then tested and found to be negative, the employer can offer the
test immediately. If the test is negative, the worker can immediately
return to work upon receipt of the test results. If the test is
positive, the employee would continue removal according to either
guidance from a licensed healthcare provider or CDC's isolation
guidance.
    For workers who are removed due to close contact, OSHA has made
several assumptions. Workers removed due to close contact with a
primary worker who is COVID-19 positive will either be removed for 14
calendar days or the employer can provide a COVID-19 test 5 days after
the workplace exposure. If the results of the test are negative, the
worker removed due to close contact can return to work 7 calendar days
after exposure. If the results of the test are positive, the worker
will continue for the full removal of 14 days. The cost of the test is
estimated to be a $10 administrative fee plus $5 in travel costs (this
is an average--some employees will not require any travel
reimbursement, while others may have higher travel costs); all other
costs of testing are assumed to be borne by insurance or other third-
party payers. Note that for testing after an employee is removed there
is no need to factor in lost work time because the employee is not
working and is already compensated for that time.
Number of Days of MRP Benefits
    If a worker is COVID-19 positive, OSHA assumes they will be removed
from the workplace on average for 10 working days,\57\ based on
following CDC guidelines on isolation days and accounting for the
severity of the cases.\58\ The CDC guidelines recommend 10 calendar
days minimum for isolation absent a continued fever.
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    \57\ OSHA acknowledges that some workers do not work a standard
5-day work week but, for the purposes of this analysis, the agency
assumes all employees who will be removed under MRP do so.
    \58\ See CDC (February 18, 2021).
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    Workers who are removed from work before they know if they have
COVID-19 fall into two groups: Workers who are removed because they
have specific symptoms, and workers removed because they have been in
close contact with someone at work who is COVID positive. For workers
in this first group (with symptoms) who are provided tests by their
employers but test negative, OSHA estimates they will be tested on the
first day they are removed and will be removed from work for an average
of two days. For workers in the second group, who are removed due to
close contact with a COVID-19 case in the workplace, the employer may
provide the employee with a test at least five days after the exposure
to the COVID positive employee. The regulatory text (paragraph
(i)(4)(iii)(2)(i) also states that an employee removed due to close
contact who tests negative can return to work after 7 calendar days
from exposure. OSHA therefore estimates that employees in the second
group (removed due to having close contact) will be tested five days
after exposure and, if their test comes back negative, they will return
to work after 7 calendar

days (which translates to 5 working days of paid removal).
    If their test comes back positive, OSHA assumes employees in both
groups (symptoms and close contact) will on average complete the
remainder of a 10-working day (14 calendar days) period of removal
before returning to work.\59\
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    \59\ As support for an average of 14 calendar days for isolation
OSHA drew on several studies to estimate this average based on a
breakdown of cases to asymptomatic, mild/moderate, severe without
hospitalization, and severe with hospitalization. First is the
equation, showing shares of various cases multiplied by their
expected days out, and then an explanation of each term:
    (17% * 10) + (66.4% * 12) + (7% * 20) + (9.6% * 35.5) [ap] 14
calendar days.
    Where broken down term by term: The first term is asymptomatic
cases where CDC guidelines have a minimum of 10 calendar days for
isolation (CDC, March 12, 2021). The seventeen percent is from
Byambasuren et al., (December 11, 2020). The second term is for mild
to moderate cases which may need a couple of extra days above the
minimum of 10 days (CDC, March 12, 2021). The 66.4 percent comes
from a study finding that approximately 80 percent of symptomatic
COVID-19 cases are mild to moderate (Wu and McGoogan, April 7,
2020). That 80 percent was multiplied by the remaining cases after
removing the asymptomatic cases: (0.8 * (1-0.17) = 0.664). The last
term is for hospitalizations, where the total of 35.5 days is from
both a study by Emory University that found second surge
hospitalization cases had an average length of stay as 8.2 days
(Meena et al., March 1, 2021) and another study that found that the
median number of days to return to work after hospitalization was 27
days (Chopra et al., November 11, 2020). The 9.6 percent is from
Grave Danger (Section IV.A. of this preamble). Finally, the third
term is for severe, but without hospitalization, cases, where the
maximum number of days CDC expects is 20 days (CDC, March 12, 2021).
The 7 percent is the percentage left for severe without
hospitalization after subtracting out the percentages for other
types of cases.
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Daily MRP Benefits Paid to Removed Workers
    The ETS includes a $1,400 weekly cap on MRP payments, except that
employers with fewer than 500 workers need not pay more than $200 per
day (\2/3\ of the worker's regular pay, up to $200 per day) after the
first two weeks. Since OSHA uses average wage rates in this analysis,
this analysis necessitated the calculation of a truncated average wage
with a weekly limit of $1,400 as prescribed in paragraph
(i)(5)(iii)(A). The wage data used for this analysis do not have the
kind of detail needed to calculate an exact truncated average wage, so
the agency employed a relatively rough estimate using the median,
rather than the average, wage (since with right-tailed data like wage
distributions the median is below the mean) and then truncating the
median wage at $1,400 for a full-time, 40-hour work week, if needed.
This maximum wage is therefore $35 an hour ($1400/40). Note that this
may overestimate the costs given that wages are capped at \2/3\ of
regular pay (up to $200/day) after the first two weeks for employers
with fewer than 500 workers.
Other Paid Leave Offsetting MRP Benefits
    OSHA also considered how much of the MRP payments can be offset by
other payment sources. For this analysis, OSHA only considered the
availability and cost offset due to sick leave and payroll tax credits
for qualifying leave payments made for removal that are part of the
recently enacted ARP (see Pub. L. 117-2, section 9641).
    For this analysis, OSHA assumed a 100 percent take-up of the tax
credit for sick leave paid under provisions in the ARP for all eligible
employers (i.e., establishments with fewer than 500 employees) while
these provisions are in effect. Hence, for firms with fewer than 500
employees, all the wage costs associated with providing MRP benefits
are assumed to be zero while the credits are available. These tax
credits will generally be claimed on employers' tax returns, which in
most cases are filed quarterly, although employers may be able to
access funds early in anticipation of claiming the credits. The agency
estimates that approximately three months of the ETS will be in place
while the ARP tax credit will not be unless the tax credit is extended
(these ARP provisions are currently slated to cover leave provided
through September 30, 2021) and so OSHA includes \3/6\ of MRP costs to
account for the three months of costs that would not be reimbursed
through the tax credit.
    For cases where the employer applies an employee's sick leave to
days where the employee is both removed from work and is unable to work
at home, OSHA calculated the average number of sick days the employee
will have at the time of the removal and deducted those days in
calculating the wage payments the employer makes. BLS data show that,
overall, 78 percent of workers have access to paid sick leave with an
average length of available leave of 8 days.60 61 Assuming
workers have used, on average, 50 percent of their available paid sick
leave for other reasons by the time the leave is needed during the ETS,
the average employee would have 3.12 days of paid sick leave available
(0.78 * 0.5 * 8). Because there is the possibility of multiple removal
periods for a single individual (in which case the worker would likely
have no sick leave available the second time), OSHA adjusted the
available paid sick leave days per worker down from 3.12 to 3 days.
Hence, for workers who are removed for symptoms or close contact and
tested but ultimately found to not be infected, employers will not have
to pay any quarantine wage costs if the employees are out 3 work days
or fewer. If they are out longer, the employer would have to pay for
each of the days the employee is out after the first 3 work days. For
example, if an employee who was removed for a total of 7 days and
tested negative, the cost to the employer would be for 4 days of
removal following the 3 days of sick leave. For employees who are
COVID-19 positive and must be removed from the workplace for 10 work
days (14 calendar days), the employer will incur costs to pay wages to
those employees for 7 work days, on average, after adjusting for the 3
days of sick leave. The analysis assumes that employers will either
take the tax credit or apply employee sick days to offset medical
removal costs. Because it does not calculate the additional savings
available to the employer if it both applies employee sick days and
takes the tax credit, the estimate of the offsets available may be an
underestimation.
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    \60\ See Scalia and Beach (September, 2020), Tables 31 and 34.
These data include a breakdown by employment size class: For
employment 1-49, 7 days leave and 66% access to leave rate;
employment 50-99, 7 and 76%; employment 100-499, 8 and 83%;
employment 500+, 9 and 90%. (Days of leave is for 5 years of
service. Both 1 year and 10 years are also shown, where days of
leave are usually the same, at most differing by one day.)
    \61\ While smaller employers may offer less sick leave than
average, the exact amount of sick leave workers have available does
not impact the estimated costs of this provision because the tax
credit will entirely offset the cost of MRP benefits.
---------------------------------------------------------------------------

    While workers' compensation insurance might offset some costs under
this provision, OSHA did not consider any reduction in costs to
employers due to this insurance. The workers' compensation system
differs by state so it is hard to generalize the overall offset of this
insurance. Some states have moved towards mandating payment for COVID-
19 quarantines for certain types of workers (first responders, health
care) but, at this point, there are few such mandates in place and
generally workers' compensations systems have been reluctant to pay
claims for COVID-19 illnesses.\62\ To the extent that workers'
compensation payments are available to workers removed due to COVID-19,
the costs to employers estimated in this analysis will be overstated.
---------------------------------------------------------------------------

    \62\ For one overview from the National Conference on State
Legislatures see Cunningham (December 9, 2020).
---------------------------------------------------------------------------

    Due to a lack of sufficient data, OSHA has assumed no baseline
compliance

with MRP benefits. To the extent that employers are currently paying
for workers with suspected or confirmed COVID-19 infections to take
leave, this analysis would have some tendency to overstate the cost of
this provision.
    An important caveat is that this analysis deals strictly with
averages and estimates: OSHA has made no attempt to model clustering of
infections. Over the year prior to this ETS, there have been multiple
incidents where multiple employees in a single workplace were infected,
but the methodology in this analysis assumes independence across
infections. This means that the cost and feasibility determinations do
not consider situations where a single employer has multiple infections
among their employees. Conversely, in a situation where infections are
clustered, that would mean that, since some employers would be seeing
more cases among their employees than the average, other employers
would have a below-average number of, or even zero, infections. The
effects of modeling clusters of infections on industry-wide feasibility
are unclear, but OSHA believes a methodology that assumes the average
number of infections for all employers is reasonable as part of the
analysis supporting the feasibility of this ETS.
    OSHA also notes that, from the standpoint of an analysis that
estimates the costs and benefits to society, much of MRP benefits would
be considered a transfer payment from one party to another, which is
not actually a cost to society as a whole. Since this analysis is
focused on determining economic feasibility, which involves a
determination of costs borne by employers, the nature of these payments
is not taken into account.
    This analysis also does not attempt to forecast the course of the
pandemic or the effect this ETS will have on the pandemic. To the
extent that the historical data do not represent the course of the
pandemic over the period the ETS is in effect, and that various
interventions alter the course of the pandemic beyond the adjustments
made for vaccination status, these costs may be overstated or
understated.
Cost per Establishment, Medical Removal Protection and Medical Removal
Protection Benefits
    Costs per establishment for medical removal and medical removal
protection benefits are shown below in Table VI.B.27.
[GRAPHIC] [TIFF OMITTED] TR21JN21.036

l. Vaccination

ETS Requirements--Under Sec.  1910.502(m)
    The employer must support COVID-19 vaccination for each employee by
providing reasonable time and paid leave (e.g., paid sick leave,
administrative leave) to each employee for vaccination and any side
effects experienced following vaccination.
Cost Analysis Assumptions
    The ETS does not require any employer to make a vaccine available
to employees.
    Based on the discussion in section VI.B.III.k, OSHA estimates that,
on average, employees will have three days of paid sick leave available
before the employer has to pay any additional cost for sick leave. This
leave will be more than enough to cover the time needed to receive a
vaccine and any needed time off to recover from the side effects of the
vaccine.\63\ Therefore, OSHA estimates that employers will incur no
costs under this provision.\64\
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    \63\ See CDC (2021b), Possible Side Effects After Getting a
COVID-19 Vaccine (explaining that vaccine side effects should go
away in a few days and some people have no side effects at all).
    \64\ In addition, OSHA notes that, to the extent individual
employees do not have sufficient available paid sick leave to cover
this time, ARP allows employers with fewer than 500 employees to
recover the costs for the paid time they must provide, via tax
credits. Although this funding applies only to leave provided
through September 2021, OSHA anticipates that most workers who
decide to get vaccinated will have done so before then, particularly
in healthcare where most employees became eligible for vaccination
earlier and current vaccination rates are higher than in the rest of
the workforce. Although non-governmental employers with 500 or more
employees are not eligible for the tax credits under ARP, employees
of large employers are also more likely to have paid sick time
available to them. See Scalia and Beach (September, 2020),
``National Compensation Survey: Employee Benefits in the United
States, March 2020,'' BLS, Bulletin 2723, September 2020, Tables 31
and 34. As noted above, this source indicates that for employers
with 500 or more employees, 90% of employees have access to sick
leave, with an average of 9 days available. These figures are higher
than for smaller employers; for example, 66% of employees in firms
with 1-49 employees have paid sick leave, with an average of 7 days
of leave.

---------------------------------------------------------------------------

m. Training
ETS Requirements--Under Sec.  1910.502(n)
    Employers must ensure that each employee receives training, in a
language and at a literacy level the employee understands, on topics
such as: COVID-19 transmission, symptoms, and ways to reduce risk;
patient screening and management; and workplace tasks and situations
that could result in COVID-19 infection. The training must also cover
employer policies and procedures related to preventing the spread of
COVID-19; PPE; cleaning and disinfection; health screening and medical
management, including medical removal; and sick leave. Employees must
be provided with information on multi-employer agreements related to
infection control and on the employer's COVID-19 plan, as well as the
identity of the safety coordinator for the COVID-19 plan. Additional
training is required whenever changes occur that affect the employee's
risk, policies or procedures are changed, or there is an indication the
necessary skill or understanding was not retained. The employer must
also inform employees about the anti-retaliation requirements under
paragraph (o).\65\ Finally, the employer must ensure that the training
is conducted by a person knowledgeable about the covered subject
matter, and that employees being trained have an opportunity to ask
questions and get answers from a person knowledgeable about the covered
subject matter.
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    \65\ Although the requirement to provide employees with
information about the anti-retaliation provision is in a separate
paragraph from the other training requirements (see paragraph (o)),
OSHA assumes that employers will include it as an element of their
training program to comply with the ETS and is including it with the
other requirements of paragraph (n) for cost purposes.
---------------------------------------------------------------------------

Cost Analysis Assumptions
    Based on the infectious disease expert panel report (ERG, August 9,
2013), OSHA estimates that training is already being provided 84
percent of the time for workers in hospitals, 68 percent of the time
for workers in home healthcare, and 74 percent of the time for workers
in long-term care and nursing homes. Estimates of current compliance
were constrained to be no lower than 75 percent for large or SBA-
defined small entities or 50 percent for very small entities in other
settings, as explained in the introduction to this section.
    The costs include those associated with the training development
and providing the training to employees, as discussed in the sections
below.
    OSHA estimated for the infectious diseases SBAR Panel that it would
take a total of 30 hours for the individual who would be training
workers exposed to infectious agents to develop training materials. And
the initial training was estimated to take either two or three hours,
depending on the job tasks of the workers.
    OSHA estimates that developing training materials and providing
training under this ETS will take less time than the training required
under the infectious diseases draft regulatory framework since that
training was more extensive. This ETS also allows training completed
prior to the effective date of the ETS to count towards compliance,
provided it meets the relevant training requirements under this
section. OSHA estimates that, for large establishments, hospitals,
nursing homes, and long-term care settings of all sizes, it will take
\2/3\ of that 30-hour estimate to develop training materials under this
ETS; it will take \1/2\ or slightly less than \1/2\ of 30 hours for
SBA-defined small entities (15 hours for hospitals, nursing homes, and
long-term care settings and 12 hours for other settings); and very
small entities will need 7 hours to develop their training materials.
OSHA also estimates that it will take \1/2\ the time for employees to
receive the training. Delivering the training to workers is estimated
to take between 1 and 1.5 hours depending on the job tasks of the
workers.
    As described above, development of the training materials is
assumed to be a one-time cost burden between 7 and 20 hours per
establishment, depending on size and type of facility. The cost per
establishment to develop this training is estimated as the product of
the one-time labor burden and wage rate ($52.73 for a training
development specialist). The baseline adjustments discussed are then
applied to these costs.
    OSHA estimates the training cost burden assuming 1.25 hours (i.e.,
the average of 1 hour and 1.5 hours) for each covered employee's time
and an average of 12 employees in each instructor-led training session
(i.e., about 0.1 hours of the instructor's time per covered employee,
estimated at the cost of a training development specialist's loaded
wage or $52.73 per hour).
    The total training development costs are estimated as the product
of:
     The number of establishments affected; and
     The average cost per establishment.
    The total costs to deliver training are estimated as the product
of:
     The number of workers covered; and
     The average cost per worker who receives the training.