Construction workers in safety gear, tied off, on a roof

Available evidence suggests that the changing character of employment arrangements has significant implications for occupational health and safety, though research in this area is relatively thin (Boden, Spieler, and Wagner 2016; Howard 2017). Core topics in the literature include differences between safety outcomes for direct-hire employees and contract workers at the worksite, uncertainty regarding responsibility for training workers, and safety-related communication issues (Morris 1995). In addition, the use of contract workers and other nonstandard arrangements has made liability issues more complicated when accidents occur (Howard 2017; Rebitzer 1995).

Occupational Health and Safety in Triangulated Employment Arrangements

Much of the existing literature focuses on so-called triangulated employment arrangements in which a company contracts out its workers to a client. These contractors often work at the client’s worksite under the supervision of the client company’s managers. Temporary help workers are an important example of a triangulated arrangement.

The rise of such nonstandard arrangements has led to confusion among both workers and managers about where responsibility lies for different areas of workplace safety (Howard 2017). Under traditional employment arrangements, it was clear who was responsible for providing occupational safety and health training, for providing personal protective equipment, and for handling worker injury and accident reports. In today’s more layered employment arrangements, it is often unclear to workers whether they should report accidents to supervisors at the host plant or to their employer, who is the company contracting their services to the client firm. Host managers also often lack knowledge about contractors’ safety practices under these more complex arrangements (Rebitzer 1995).

Evidence suggests that contract workers indeed experience higher injury rates than workers in regular employment arrangements. Data from a medium-sized midwestern manufacturing plant indicate that temporary help workers’ injury rates were two to three times higher than those for permanent workers doing similar tasks (Morris 1995). Injury rates for temporary help workers remained significantly higher when the data were adjusted for the severity of the injuries. The true injury rate may be even higher, as temporary workers do not always report injuries out of fear that they will lose their jobs (Morris 1995). A report by Boden, Spieler, and Wagner (2016) for the U.S. Department of Labor concurred that temporary help workers are more vulnerable to workplace hazards. Although many factors influence the susceptibility of workers to injury, temporary workers in triangulated arrangements are particularly vulnerable (Boden, Spieler, and Wagner 2016).

Temporary help workers, managers, and temporary employment agency owners in manufacturing plants perceive health and safety issues differently, according to one study (Morris 1995). Workers identified a lack of training and job insecurity as stressors that may account for the higher injury rates of temporary help workers in manufacturing. On the other hand, staffing agency owners, as well as managers, reported that the “coemployment relationship” complicated their implementation of effective worker safety strategies. Owners and managers also believed that temporary help workers falsely report injuries to obtain workers’ compensation. Although managers reported that they provided training, workers reported a lack of training.

Communication challenges within workplaces are another factor that exacerbates safety issues Boden, Spieler, and Wagner (2016) argue that contract arrangements reduce the ability of workers to communicate with each other and with the firms most able to mitigate safety hazards. Interactions between workers in different arrangements can be difficult, because temporary workers perceive a lack of social support from the permanent workers, who could help improve safety outcomes (Morris 1995). In a study of outsourced hospital cleaners, Litwin, Avgar, and Becker (2017) also find evidence that outsourced workers feel isolated from their organizations and other workers. Their study shows that, despite the perception that the cleaning workers in hospitals were in “peripheral” function, their outsourcing led to an increase in hospital infections that endangered other workers as well as patients.

Finally, nonstandard arrangements also present health and safety–related legal issues for firms. In a study of safety in the petrochemical industry, Rebitzer (1995) finds that plant managers give the main responsibility for training workers to contractors to avoid liability. The study reports that contractors provided poorer-quality safety training than host plants. Furthermore, the study finds that attorneys often seek to prove that host plants were the direct employers of workers involved in accidents. This is often an appealing strategy for plaintiffs, because host firms typically have greater financial resources than temporary help agencies or other contract companies. Thus, the potential for legal liability incentivizes petrochemical firms to distance themselves from contract workers, further undermining the safety training they receive and perpetuating a vicious cycle.


Available evidence shows that contract workers, particularly temporary help workers, are highly vulnerable to workplace injury. As a result, the federal Occupational Safety and Health Administration has made these workers an enforcement priority (Boden, Spieler, and Wagner 2016). Studies of the petrochemical industry (Rebitzer 1995) and of the hospital industry (Litwin, Avgar, and Becker 2017) suggest that, owing to inadequate training of contract workers, their use may have broader adverse effects on safety and health. Further research is needed to generate reliable data on the health and safety implications of contract work and to provide policy guidance to address problems.


Boden, Leslie I., Emily A. Spieler, and Gregory R. Wagner. 2016. “The Changing Structure of Work: Implications for Workplace Health and Safety in the US.” Paper prepared for Future of Work Symposium, held in Washington, DC, December 9–11, 2015.

Howard, John. 2017. “Nonstandard Work Arrangements and Worker Health and Safety.” American Journal of Industrial Medicine 60(1): 1–10.

Litwin, Adam Seth, Ariel C. Avgar, and Edmund R. Becker. 2017. “Superbugs versus Outsourced Cleaners: Employment Arrangements and the Spread of Health Care–Associated Infections.” ILR Review 70(3): 610–641.

Morris, Judy A. 1999. “Injury Experience of Temporary Workers in a Manufacturing Setting: Factors That Increase Vulnerability.” AAOHN Journal 47(10): 470–478.

Rebitzer, James B. 1995. “Job Safety and Contract Workers in the Petrochemical Industry.” Industrial Relations: A Journal of Economy and Society 34(1): 40–57.