Prevention Through Design to Address Continuing Construction Workplace Deaths and Injuries

Posted on by Amber Trueblood, Babak Memarian, Trudi McCleery, Douglas Trout, G. Scott Earnest

Nearly 1 in 5 of all workplace fatalities occur in the construction industry (BLS, 2024). In 2022 there were 1,092 fatalities in the construction industry (BLS, 2024); in 2021 and 2022 there were 144,480 cases of construction industry workers missing days away from work from a non-fatal injury or illness (BLS, 2023). These and other statistics show that construction remains one of the most dangerous industries for workers. What if we could “design out” or minimize hazards and risks to prevent injury and death in construction?  That is the goal of Prevention through Design or PtD.

Prevention through Design

An important way to prevent occupational injuries in all industries, including construction, is by implementing prevention measures based on the hierarchy of controls. PtD is reflected at the top of the hierarchy and is the process of designing OUT a hazard early in a project’s life cycle. PtD is the most reliable and effective way to protect workers. Since 2007, the National Institute for Occupational Safety and Health (NIOSH) has led the PtD National Initiative which has the goal of preventing or reducing occupational injuries and fatalities by promoting prevention designs that protect workers. PtD is also referred to as ‘design for safety,’ ‘design for construction safety,’ and ‘safety by design.’

Some examples of engineering out hazards in construction include installing embedded safety features such as anchor points and parapet walls to prevent falls, installing a prefabricated staircase rather than use of fixed ladders, and installing skylights with shatterproof glass or permanent guarding.

Prevention through Design in Action

The Port of Portland* used PtD as part of a large Parking and Rental Car Center construction project, a $325 million construction of five facilities. They also implemented an integrated design-safety process to reduce inherent risks during the facilities’ life cycle, including construction, operations, and maintenance.

Some of the important elements identified by the Port of Portland to achieve project success were:

  • Contract specifications included PtD requirements – for example, the use of the PtD pilot credit for the U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED) certification;
  • Direct collaboration and interactions among design teams, constructors, building operators, and building maintainers – among other things this increased the likelihood of a smooth transition between constructing the facility and occupancy; and
  • Use of preventive design features that provided protection beyond that required by enforceable standards.
photo showing skylight on the roof which followed an international design standard using shatterproof glass to eliminate fall hazards
Photo courtesy of Port of Portland

Specific PtD practices used by the Port of Portland include roofing designs expected to decrease fall risks, design features to reduce ladder use, and design elements and engineering controls to aid future facility maintenance workers.

The Port of Portland project has a massive, nine-acre roof with multiple skylights for natural lighting. Traditionally guardrails, fall arrest systems, anchors, or skylight covers are used to prevent workers from falling though skylights. Much of this roof was prefabricated off site and lifted into place and skylights in the roof followed an international design standard using shatterproof glass to eliminate fall hazards. This unique skylight system provides the equivalent protection of a traditional skylight cover, significantly enhancing worker safety, while meeting the design requirements.

In 2023, the Port of Portland, won the third annual PtD Award for this effort, demonstrating outstanding leadership in reducing workplace hazards using design methods and demonstrating real world success in PtD efforts to protect workers. The NIOSH PtD annual award recognizes individuals, teams, businesses, and other organizations that have eliminated or reduced hazards through design or re-design efforts or have contributed to the body of knowledge that enables PtD solutions.

Nominations for the 2024 Prevention through Design (PtD) Award are being accepted through      Friday, March 1, 2024. For instructions on how to submit a nomination, visit the PtD Award website. Re-submissions of previous nominations are allowed.

The American Industrial Hygiene Association (AIHA) is joining NIOSH, the National Safety Council (NSC), and the American Society of Safety Professionals (ASSP) as a PtD Award partner. AIHA is hosting the 2024 PtD Award ceremony at AIHA Connect in Columbus, Ohio, May 20-22, 2024.

Resources for Getting Started

Practical resources for implementing PtD are available at the Center for Construction Research and Training (CPWR) Prevention through Design Resources website. The resources include readily available information and tools for construction industry project team members regarding approaches to eliminate common construction hazards. These documents address the Focus Four hazards including falls, struck-by, electrocution, and caught-in/between hazards. A spreadsheet of best practices and innovations (from a past CPWR webinar) is available to help others implement PtD measures. CPWR has also developed a Pre-Task Planning resource package to help contractors design, implement, assess, and continuously improve Pre-Task Planning process to reduce hazards. The package contains checklists, templates, and practical examples.

A recent article addresses the challenges engineering firms face in implementing PtD related to inconsistent PtD experiences and varying legislation and building codes across jurisdictions (Coleman and Thomas 2023). The authors describe ways to promote changes early in the construction design process to reduce or eliminate hazards throughout the life of the structure. The PtD process was successfully applied to a large railway project in the United Kingdom.

We want to hear from you. Please respond to the following questions in the comment section below.

  • Does your workplace have success stories or problems with implementing PtD to prevent injuries and fatalities at construction worksites?
  • What steps are needed to increase implementation of PtD among architects, designers, engineers, and others who can design hazards out of construction sites and buildings?
  • How should PtD concepts be translated and communicated with specialty trades (e.g., electrical contractors or others) who typically do not interact directly with designers or engineers?


Amber Trueblood, DrPH, is the Director of the Data Center at CPWR – The Center for Construction Research and Training.  

Babak Memarian, PhD, CSP, CHST, is the Director of Safety Research at CPWR – The Center for Construction Research and Training.  

Trudi McCleery, MPH, is a Health Communications Specialist for the NIOSH National Personal Protective Technology Laboratory.

Douglas Trout, MD, MHS, is the Deputy Director, Office of Construction Safety and Health at NIOSH.

G. Scott Earnest, PhD, PE, CSP, is the Associate Director, Office of Construction Safety and Health at NIOSH.



Bureau of Labor Statistics (BLS) [2024]. Census of Fatal Occupational Injuries (2011 Forward) Database.

Bureau of Labor Statistics (BLS) [2023]. Employer-reported Workplace Injuries and Illnesses – 2021-2022.

Coleman R and Thomas I [2023]. A new behavioural approach for the sustainable design of the built environment. Proceedings of the Institution of Civil Engineers – Civil Engineering, 176(4): 184–192 .

*The Port of Portland is the port authority responsible for overseeing the Portland International Airport and operating other transportation infrastructure in Portland, Oregon.

Posted on by Amber Trueblood, Babak Memarian, Trudi McCleery, Douglas Trout, G. Scott Earnest

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Page last reviewed: February 5, 2024
Page last updated: February 5, 2024