Construction Workers at Highest Risk of Brain Injury

Construction Workers at Highest Risk of Brain Injury

Construction workers face a significant risk of injury in their jobs, including the risk of acquiring a traumatic brain injury (TBI). The construction industry has the highest number of TBIs across US workplaces, with over 2,200 deaths recorded between 2003 and 2010 (NIOSH, 2016). Within the industry, this injury accounts for 25% of all construction fatalities (2016).

Traumatic brain injuries in the construction industry continue to be a significant concern. Even TBIs that are not fatal can create considerable challenges for employees who stay at work or return to work after acquiring an injury. It is the responsibility of the employer to make the workplace as safe as it can be so that such injuries can be avoided. In the event that a TBI does occur, it is important that employees are supported in their recovery and ability to return to work.

Hazards in the Construction Industry

The most common causes of occupational TBI deaths are falls, motor vehicle accidents, assault and violent acts, and contact with objects and equipment, according to the National Institute for Occupational Safety and Health. In their 2016 report, they found that falls, especially from roofs, ladders, and scaffolds led to more than 50% of fatal work-related TBIs. In 2018, slips, trips, and falls was the third highest injury event reported to the Workplace Safety and Insurance Board (WSIB) and accounted for 20.6% of allowed lost time claims (Government of Ontario, 2019).

To protect the health and safety of workers, Ontario has implemented health and safety initiatives to educate workplaces and enforce regulations through the use of inspections. In 2019, the ministry assessed workplaces for slip, trip, and fall hazards. Common hazards can include slippery floors, unsafe use of ladders, debris or obstructions in walkways, dirty or cluttered work areas, poor lighting, and changes in walkway levels and slopes. In 2020, the focus was on the lack of and misuse of personal protective equipment, such as headwear, footwear, and high visibility clothing.

The results of these inspection blitzes revealed that some of the most frequently issued orders included the following: failure to wear protective headwear and footwear; failure to provide guardrails to protect workers against falls; failure to provide a portable ladder that meets design requirements; and failure to ensure the completion of a working at heights training program for both workers and supervisors.

One of the most recent campaigns, running from May 1, 2022, to June 30, 2022, is focused on high-risk traumatic hazards, specifically struck by, motor vehicle, and mobile equipment hazards. The inspections will occur across all sectors and focus on employees who drive for work, work around vehicles, or operate mobile equipment.

Mental Health and Brain Injury

In addition to the cognitive and physical effects one might experience after a brain injury, industry advocates warn of the negative mental health effects for construction workers. TBIs are linked to many mental health issues, such as depression, anxiety, PTSD, suicidal thoughts, substance dependencies, and obsessive-compulsive disorder. Between 25 percent and 50 percent of TBIs are followed by major depression in the first year after the event (LHSFNA, 2022).

Construction workers are at higher risk of depression because of the worker demographic, which mostly consists of older men and those who are more likely to have previous concussions/brain injuries, such as military veterans and former school athletes (2022). People who die by suicide are also twice as likely to have previously suffered a TBI, and construction workers have the highest rate of suicide among all occupations (2022). Because of the potential mental health effects, brain injuries can have even more devastating impacts beyond the initial injury and symptoms. A focus on prevention and planning for recovery is incredibly vital to the construction industry and all workplaces where brain injury is a risk.

What Can Employers Do?

For prevention:

  • Be aware of hazards in the workplace and educate employees of the occupational risks.
  • Provide employees with proper instruction and supervision.
  • Conduct regular assessments of workplace hazards and ensure that you are meeting health and safety standards.
  • Assign someone to correct identified hazards in the workplace.
  • Provide employees with the right selection of personal protective equipment for the task at hand, such as proper headwear and footwear.
  • Provide and maintain adequate fall prevention equipment, such as guard rails, ladders, harnesses, etc.
  • Provide training on the use of equipment and what to do if someone falls or is injured.

For recovery:

  • Notice the signs of traumatic brain injury.
  • Provide workers with resources and access to healthcare professionals to get the care they need for their mental, cognitive, and physical health.
  • Complete a Functional Cognitive Assessment for the employee to identify if the employee is experiencing any cognitive limitations after their injury.
  • Consider work accommodations that compensate for cognitive limitations (e.g., scheduling, energy management, microbreaks/pacing).
  • Work with an Occupational Therapist to create a plan to gradually reintegrate the employee back into the workplace.
  • Get help from an Occupational Therapist to assess the employee and implement the above strategies.

How Can Gowan Consulting Help?

We strive to be the leading providers of sustainable health and disability management in the workplace. We genuinely care and want your business to be healthy and safe, resulting in more productive employees. Our team of highly trained Occupational Therapists can help individuals who have acquired brain injuries in the workplace. Whether it’s a matter of an accommodation, return to work, or a functional cognitive assessment, our team works in collaboration with employers to ensure all employees are set up for success and maximum productivity.

You may also be interested in our training services, such as our Cognitive Demands Analysis Certificate Program. This training provides step-by-step skill training to complete a CDA and create a return to work plan. If you would like further information on our services, please contact us! We would love to work together for your healthy business!


“Traumatic brain injuries in construction,” Srinivas Konda, NIOSH Science Blog, Centers for Disease Control and Prevention, March 21, 2016,

“Inspection blitz results: Slips, trips and falls,” Government of Ontario,

“Compliance initiative results: personal protective equipment,” Government of Ontario,

”Supporting workers following a concussion or traumatic brain injury,” Nick Fox, Laborers’ Health & Safety Fund of North America, January 2022,

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