Demystifying OSHA Inspections

By Debra Gordick, Total Medical Compliance


An OSHA inspection can be a scary experience. One reason is that they are always a surprise. You’re going about your day and suddenly you have an inspector at the front desk. Another reason is that you may not know what to expect or what to do. Being informed about the process before it happens can help you focus and minimize the impact of an inspection.

How does your practice get chosen?

The most common trigger for an OSHA inspection is a report from an employee, ex-employee or patient saying you’ve violated OSHA regulations. This is called a “for cause” inspection. These are usually limited in scope to the area or areas reported. The inspector can expand the scope if they notice something wrong during their visit.

The second kind of inspection is a “random” inspection. A surprising number of violations found at health care companies in recent years resulted in some states adding dental practices to their permanent list for random inspections. Unlike the “for cause” inspections, random inspections are full scope. The inspectors will look at all areas of regulations.

What happens during the inspection?

When OSHA decides to inspect your practice, the inspector(s) will show up at your door without notice. The front desk staff should ask the inspector to have a seat in the lobby while they notify management. Before you greet the inspector, take no more than 20 minutes to walk through the office and correct any problems that can be handled quickly, such as replacing full sharps containers or securing gas cylinders.

An inspection can take from one hour to multiple days. The inspector will begin by asking for information about your business, such as your tax ID and unemployment insurance numbers, policy and procedure manuals, and Hepatitis B vaccination records. You should be told if this is a random inspection or if you were reported. If that information isn’t volunteered, ask.

The inspector will then walk through the practice and inspect various areas. Under HIPAA regulations they cannot enter an occupied treatment room unless you get permission from the patient beforehand. Accompany them at all times and ask questions, including what they are photographing and why. Take your own pictures to record their actions.

Answer their questions, keeping in mind that OSHA inspections are performance-based. They may be trying to determine if your practices match your policies and procedures. It’s within their right to talk to employees without management present.

There are several things you can do during the inspection to minimize citations and lower fines. Always be polite and courteous. Answer questions truthfully, but do not volunteer information. By law they must inspect any area you bring up. If asked a question you don’t know the answer to, ask for clarification. It is easier to stop a citation from being written than to get it removed later.

At no point should an inspector ask for money. Report this to OSHA immediately. This person is likely a scam artist.

After the inspection is over, the inspector will have a closing meeting with their supervisor to cover the preliminary findings. This list of issues is not the official citation list as it may include issues that are noted but so minor that they will not end up on the official list. Start fixing the problems identified immediately.

What happens after the inspection?

After the closing meeting the inspector will write up their results and submit them to their manager, who will create an official citation letter listing each issue, the regulation that was involved, the amount of the fine for each citation, and how much time you have to fix the problems identified. This letter is usually sent within two weeks.

OSHA divides citations into “serious” and “non-serious.” Non-serious violations can be minimally fined but or not fined at all. Each serious violation starts at $12,675. If OSHA notes that this is a repeated violation from a previous inspection, or if they determine that it is a “willful” violation, the fine starts at $126,749. Fines can be reduced by 60 percent for small businesses, 10 to 45 percent if you have an OSHA program in place.

Once you receive the citation letter, you will have to submit the included form back to OSHA to prove that you’ve fixed the problems within the time frame allotted. This is called abatement. Abatement should include a short explanation, supporting documents and even pictures. Failure to abate the citations by the stated date can result in a fine of $12,675.

You also have the right to contest the citations. The first step is an informal conference, which often takes place over the phone. If that doesn’t resolve your complaints you can request a formal hearing, which takes place before an administrative judge.

Your best protection from OSHA citations is a strong and continuing OSHA program. Your program should include policies, procedures, strong documentation, good records, and thorough training. Having these things in place can make your next inspection less painful for your pocketbook and practice.