Contents lists available at ScienceDirect Safety Science journal homepage: www.elsevier.com/locate/safety Focus on the fatal-four: Implications for construction hazard recognition Alex Albert ⁎ , Bhavana Pandit, Yashwardhan Patil North Carolina State University, Department of Civil, Construction and Environmental Engineering, 2501 Stinson Drive, Raleigh, NC 27607, United States ARTICLEINFO Keywords: Construction safety Hazard recognition Hazard identification Occupational safety Fatal injuries Injury prevention Hazard management ABSTRACT Much effort has been devoted to improving hazard recognition in the construction industry. One such effort is the training outreach program pioneered and promoted by the Occupational Safety and Health Administration (OSHA) – commonly known as the Construction Focus Four or the Construction Fatal Four program. This program which is integrated in much of the training efforts offered in the construction industry seeks to promote hazard recognition and management by focusing on the four leading causes of fatal incidents – namely falls, caught-in/ between, struck-by, and electrocution (i.e., fatal-four) hazards. Given the emphasis of these hazards in most training efforts, the objective of the current research was to explore if there are any performance disparities among workers in recognizing hazards that fall under the fatal-four and the non-fatal-four hazard categories. To accomplish this research goal, more than 280 workers were recruited from 57 construction workplaces in the United States to participate in a hazard recognition activity. The results of the study reveal that workers fail to recognize a disproportionate number of safety hazards in both the fatal-four and the non-fatal-four hazard ca- tegories. However, workers are relatively more proficient in recognizing hazards in the fatal-four hazard cate- gory than the non-fatal-four hazard category. More specifically, on average, the participating workers roughly recognized 57% of the fatal-four safety hazards while only recognizing 18% of the non-fatal-four safety hazards. Collectively, these findings suggest that apart from focusing on the fatal-four hazards, training efforts must also focus on the non-fatal-four safety hazards – given the relative poor performance. 1. Introduction High injury rates are a persistent issue in the construction industry. Most nations, including the United States, the United Kingdom, Australia, and others consistently report an unacceptable number of safety incidents from construction workplaces (Bureau of Labor Statistics, 2018; Health and Safety Executive; Safe Work Australia, 2018). For example, in the United States, in 2017, the construction industry reported more than 970 fatal and 200,000 non-fatal incidents (Bureau of Labor Statistics, 2018). These injuries and illnesses cause much pain to workers and their families, while also leading to losses and injury claims that exceed $49 billion every year (Ahmed et al. 2006). One reason for these high injury rates is the prevalence of poor hazard recognition in the construction industry. When workers fail to recognize and manage relevant safety hazards, the likelihood of unin- tended hazard exposure, injuries, and catastrophic safety incidents in- creases (Carter and Smith 2006; Jeelani et al. 2016). Unfortunately, recent investigations suggest that workers may fail to recognize up to 57% of safety hazards in typical work environments (Albert et al. 2017; Bahn 2013; Carter and Smith 2006; Jeelani et al. 2019; Perlman et al. 2014). To address this persistent issue, researchers, employers, and reg- ulatory bodies have invested much effort into developing and dis- seminating promising interventions. One of the most influential inter- ventions has been the Construction Focus Four program – more popularly known as the Construction Fatal Four program – pioneered and pro- moted by the Occupational Safety and Health Administration. (OSHA). This program seeks to improve hazard recognition and reduce injury rates by increasing the attention devoted to the most common causes of fatal incidents – namely falls, caught-in/between, struck-by, and elec- trocution hazards (OSHA 2011). Apart from being integrated into the official training material of OSHA (e.g., OSHA 10-hour or 30-hour training programs), the Construction Focus Four program has been adopted in much of the training efforts undertaken within the construction industry. For ex- ample, hazards associated with falls, caught-in/between, struck-by, and electrocution are regularly integrated into the training efforts of em- ployers, apprenticeship programs, and trade unions (Taylor 2015; Williams Jr et al., 2010). The Construction Focus Four program elements are also commonly discussed as part of tool-box meetings initiated and led by workers themselves. https://doi.org/10.1016/j.ssci.2020.104774 Received 23 August 2019; Received in revised form 28 February 2020; Accepted 11 April 2020 ⁎ Corresponding author. E-mail addresses: alex_albert@ncsu.edu (A. Albert), bkpandit@ncsu.edu (B. Pandit), yspatil@ncsu.edu (Y. Patil). Safety Science 128 (2020) 104774 Available online 21 April 2020 0925-7535/ © 2020 Elsevier Ltd. All rights reserved. T