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Safety Initiative Effectiveness in Hong Kong - One Size Does Not Fit All

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Hong Kong is experiencing a massive increase in construction output. However, the cost of work-related accidents and ill-health in the construction industry account for as much as 8.5% of project costs when social, direct and indirect costs are included. The industry in general is receptive to change and becoming more OHS conscious but the forces driving change in the industry are opposing. The research found that institutional barriers exist to a concerted improvement effort and the best performing contractors, clients, consultants and subcontractors attain standards of excellence comparable with the best in the world but there is a wide range of organizational maturity, and so performance, throughout the industry. In this research study the following issues have been identified where new initiatives need to be developed: Developer attitude: a culture change is required: Client insurance;
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Safety Initiative Effectiveness in Hong Kong
One Size Does Not Fit All
Steve Rowlinson, Brenda Yip and S W Poon
Department of Real Estate & Construction, The University of Hong
Kong
Address all correspondence to:
steverowlinson@hku.hk
Safety Initiative Effectiveness in Hong Kong
One Size Does Not Fit All
ABSTRACT
Hong Kong is experiencing a massive increase in construction output. However, the cost
of work-related accidents and ill-health in the construction industry account for as much
as 8.5% of project costs when social, direct and indirect costs are included. The industry
in general is receptive to change and becoming more OHS conscious but the forces
driving change in the industry are opposing. The research found that institutional barriers
exist to a concerted improvement effort and the best performing contractors, clients,
consultants and subcontractors attain standards of excellence comparable with the best in
the world but there is a wide range of organizational maturity, and so performance,
throughout the industry. In this research study the following issues have been identified
where new initiatives need to be developed:
Developer attitude: a culture change is required:
Client insurance;
“Can do” attitude;
Use of data;
Maturity of Organisations;
Health issues
KEYWORDS: Safety initiatives, effectiveness, Hong Kong, action research,
organizational maturity
1. CONTEXT
An underlying theme running throughout the research has been the need for
empowerment of the industry to manage itself effectively. In order to do this many
industry participants have recognized the need for capability development within
individual firms and development of a sustainable industry. As far as safety is concerned
initiatives have been, in the main, very successful on larger, public projects but a plateau
in the improvement trend has now been reached. In order to further reduce accident rates
a different approach needs to be adopted and the industry as a whole needs to examine
the skills required industry wide for further successful accident rate reduction.
More importantly there is a serious problem in relation to the expected increase in output
within the next two years with the onset of the 10 major infrastructure projects and the
West Kowloon Cultural Development. Accident rates can be seen to mirror output in the
construction industry (see Figure 1) and, hence, we should anticipate a significant
increase in the accident rate with the increase in output. Thus, this study was undertaken
to informing planning, now, for the expected.
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Construction Accident Rates and Construction GDP in Hong Kong
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Figure 1 - Construction Accident Rates and Construction GDP in Hong Kong
Source: Census and Statistics Department & Labour Department, Hong Kong.
Approach
The objectives of this study wee to assess what are effective strategies for all sectors and
sizes within the industry. In order to consider these strategies the following needed to be
addressed:
an audit of the current situation, with problems identified and targeted, the current
issues study reported here;
capabilities and costs identified and change focused on effectiveness, the cost
effectiveness study and cost calculator, reported elsewhere;
in order to see improvement change needs to be implemented at all levels and in all
sectors of the real estate and construction industry.
Background to the research
Hong Kong has moved away from prescriptive safety legislation towards performance
based management of safety and health over the past decades (Lingard and Rowlinson
1994). This move has obviously met with some success as the accident rate in the
construction industry has continued to fall over this period. Figure 2 indicates how a
series of initiatives, commencing with the promulgation of the safety management system
approach, has led to a steady and consistent decline in accident rate. The decline has been
such that the accident rate in Hong Kong‟s construction industry is now apparently less
than that in the United States (see endnote), and is also now lower than that of the
catering industry in Hong Kong. Hence, at least in parts of the industry, something has
been done effectively and performance has improved. In order, to maintain this
downward trend it is necessary to review existing initiatives as well as develop new ones.
The Hong Kong context
One of the issues to bear in mind in this research is that organisations are all different.
What works effectively in one organisation may not be as effective in another
organisation. Hence, it has been important to widely survey different sectors of the
industry and different levels within organisations in order to draw together a report that
provides a good understanding of what makes initiatives effective. Examples of good
practice have been drawn from work in the United Kingdom whereby workers are
empowered to improve safety performance through worker engagement groups. Such an
initiative, which may perhaps be started through the site safety work cycle, could well be
effective in Hong Kong and should be investigated. Also, culture is an important issue.
Not just the national culture but the culture within the organisation. All countries and
organisations exhibit different cultures and in order to make use of these cultural traits
there is a need to focus on the partnership between worker and company and between
company and industry and to develop the concept of relationship management and the
sharing of common goals in order to improve safety performance. Additionally, the
multi-layered sub-contracting system adopted in Hong Kong has been seen to be an
impediment to safety. This was indicated in the Tang report and is being addressed by the
Construction Industry Council. Hence, these structural and cultural issues must be
included in the safety management process in order for effectiveness to be properly
gauged.
The issue of 'Design for Safety' has been regularly raised as an important concern. The
fact that risk assessments related to method statements are now commonplace on Hong
Kong projects has undoubtedly contributed to improvements in safety. However, the
process of involving the client and consultants in the early stages of the project in
considering safety is fraught with difficulty, as the UK has found out (and to a greater
extent the EC with its model) in attempting to implement the UK Construction Design
and Management Regulations. Recent reports have indicated that this approach is flawed
and needs to be remodelled in order to become effective. Work in progress in Australia
(by Lingard et al, 2008, Federal Safety Commissioner , 2006 & 2007) that investigates
why simplistic design OHS provisions are unworkable in the complex, socio-technical
process of construction design has informed this research. This is one area that needs to
be carefully considered and an industry consensus derived so that such an approach can
be effectively implemented. A whole life cycle view may well be the answer.
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Construction Accident Rates and Safety Schemes in Hong Kong
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Figure 2 - Construction Accident Rates and Safety Schemes in Hong Kong
Source: Labour Department and HKU research team
Existing initiatives
Of the initiatives which have been undertaken in order to improve construction site safety
one might categorise these into four types. These are:
Statutory, based on the Hong Kong Ordinances with the Occupational Safety and Health
Ordinance being an example which introduced safety management systems to the
industry;
Financial, which are to do with providing incentives to safe performance such as the
Pay for Safety Scheme' introduced by Works Bureau contracts in 1994;
Procedural, these initiatives are based around processes that are included in the
construction contract and these might include the Housing Authority PAS Scheme, the
Safety Work Cycle and other similar initiatives;
Punitive-administrative, examples of this would be the Works Bureau's approach to
safety performance, whereby contractors who experience serious injuries on their sites
are brought before a committee, who can advise voluntary suspension from tendering.
The Housing Authority's Superleague might fall into this category.
These initiatives have been assessed in order to form the framework within which the
findings of this research are explained and presented: things that have worked well;
things that need improvement; things which have been ignored but need to be addressed.
2. Work Undertaken
Potential issues that can be used as drivers for improvements were identified. The
research approach used to do this is discussed below.
Research Programme
The research adopted a participative approach in which the results of the surveys were
fed back to managers and the effects of the safety initiatives and the perceptions of
managers on the safety performance perceived by employees and other stakeholders were
explored in participating organisations. This provided a valuable benchmarking exercise
for the participating organisations and provided them with an opportunity to explore new
directions in order to improve their performance. It also provided the researchers with the
opportunity to compare and contrast these effects in different industry sectors and,
through collaboration with Australian and UK researchers, highlighted significant
differences that may be brought about by different cultures.
Safety Effectiveness Qualitative Study
A series of face to face interviews were conducted among 30 different stakeholders in the
construction industry to collect their opinions on the effectiveness of different safety
initiatives. The participants were strategically selected to include but not limit to
developers, main contractors of Groups A, B and C, sub-contractors, suppliers and
insurers. The positions of the interviewees mainly include directors, project managers and
safety management. During the interviews, the interviewees were asked to share their
experience and express their opinions on the current safety initiatives; as well as suggest
new initiatives or areas for future improvement. The interviews were conducted
continuously until the interview contents were saturated.
The map that appears here in Figure 3 indicates the range of issues which surfaced during
the detailed study of perceptions of safety initiatives and safety management in Hong
Kong. The map was derived from a series of interviews with a wide range of
professionals, managers, workers and administrators in the industry (contracting,
consulting, developer and insurance sectors) and the questioning was informed from a
detailed analysis of accident statistics. Each of these issues will be dealt with briefly here
but two underlying issues need to be highlighted in order to put the issues into context.
3. Results
Maturity is an important issue
It became apparent during the study that a major issue for the industry was the maturity
of organisations. If we were to take a five level maturity system then one might argue
that only the top ten contractors could be classed as level five maturity. Indeed, much of
the industry is seen to be at a maturity level one or two whereby their main focus in terms
of safety management is compliance as opposed to the continuous improvement
philosophy of the top contractors. Such a view could also be applied to the private
developers, in that perhaps less than ten of these can be seen to be adopting a mature
attitude to safety management on their projects. Hence, in terms of future strategy this
leads us to the situation whereby a three-pronged approach to improving accident rates is
necessary. Briefly, this means that three different foci of attention should be provided for
those contractors, and developers, falling into the three categories of immature, maturing
and mature. This approach is illustrated in Table 1 and points to the need to develop
quite separate strategies for the “three levels” of participants in the industry; one size
does not fit all.
Table 1 - Maturity of Organisations
Level
Nature
Commitment
Focus
Level 1 - Initial
Immature
Compliance
Compliance
Level 2 - Repeatable Managed
Maturing
Continuance
Norm
Level 3 - Defined
Normative
Level 4 - Quantitatively Managed
Mature
Affective
Continuous
Improvement
Level 5 - Optimizing
(Source: adapted from the Capability Maturity Model: http://valuebasedmanagement.net/methods_cmm.html)
Figure 3 - Current issues in safety management in Hong Kong
Education and training
The current green card system could usefully be revamped but is not the cause of the
problem addressed here the green card system sits at the bottom of the whole range of
training needs of the industry. There is an urgent need, as noted above, to develop an
OH&S competence framework for the industry as a whole in order that management may
exercise effective leadership. This view was reported from a number of sources. The
basic problem for the green card is twofold, and at one level reflects similar criticism of
the Construction Skills Certification Scheme in the UK too (http://www.cscs.uk.com).
Firstly, the syllabus of the green card scheme needs to be reviewed so that it may be more
carefully structured and address skill and safety issues at a more detailed level,
particularly focussing on hazard identification rather than knowledge of legislation; the
former being essential for the front line worker. Secondly, there appears to be an over
provision of underperforming providers of accreditation courses and this issue needs to
be addressed by the industry as a whole..
Whilst recognising that it is important to reach consensus on this an important issue to
bear in mind here is that the green card system was devised in order to provide only a
basic, introductory course which is to be supplemented by contractors‟ own in-house
training system. However, in comparison with the UK, the Hong Kong course emphasises
regulations and knowledge of their implementation as opposed to hazard recognition; a
very different focus. Hence, any review of the system should focus on the effectiveness
of and need for teaching regulations as opposed to hazard recognition and action. A more
practical focus of the course content might lead to a significant improvement.
Education and training at tertiary and professional levels
The coverage of occupational health and safety issues at tertiary institutions can be
improved quite considerably. A whole series of professions are educated in Hong Kong‟s
tertiary institutions, such as civil engineers, builders, facility managers, building services
engineers, structural engineers, architects, etc. and there is no common syllabus in terms
of occupational health and safety and there are no courses designed at integrating the
design and management of construction projects, excepting MIDIM at Hong Kong
University. This is an issue that should be addressed by both the universities and the
professions. It is now a cause for failure in Institution of Civil Engineers (UK)
professional assessments if the candidate does not show adequate knowledge of
occupational health and safety. Such an approach could be mandated for all of the
professions within Hong Kong.
People issues
Communication is a problem in safety improvement. It was reported by a number of
respondents that communicating safety management ideas, procedures and instructions is
often a difficult task. A major issue here is the overwhelming of middle management with
documentation and systems whereas at the worker level it is the problem of maintaining a
consistently focused message to the workers. Technologies such as visualisation, video
on phone, sms, etc are now all readily available and provide simple, functional and
effective means of promoting safety messages and explaining safe practice. Many
expressed the view that language wasn‟t so much a barrier as the means of
communication. A different view that addresses this issue is presented in Hare and
Cameron‟s (2007) paper.
Ageing workforce
In a related point, there was also a belief that the ageing workforce and ingrained ideas
and attitudes were difficult to change because of this demography. In their reports,
Leaviss, Gibb and Bust (2008a; 2008b; 2008c) highlight the issue of older workers in the
construction industry and list the following key issues in relation to their “value”, which
have also been raised by contractors‟ directors in Hong Kong (see Table 2). Given the
likely upsurge in output in the near future leveraging the positive values in “inducting”
new staff and addressing the negative values through training and job re-design are
essential new initiatives.
In addition Leaviss et al. (2008a) point out the financial benefits of reducing work-related
ill-health in the construction industry. A UK study estimated the cost of work-related
accidents and ill-health in the construction industry to account for 8.5% of project costs
(HSE 1997). This includes the costs of delays, absenteeism, health and insurance charges.
Quite worryingly, there appears to be a worldwide trend for construction workers to retire
early due to health issues: this both deprives the industry of skills developed and
knowledge gained over many years and also adds to the social cost that the industry
generates for society at large.
Table 2 Value: Older Workers in Construction
Positive Value
Negative Value
Trade skills and knowledge
Lack of fitness
Experience
Lack of safety behaviour
Work ethic
Resistance to change
Workmanship
Cost to project
Potential Issues which can be used as Drivers for Improvements
Developer attitude. Following on from the previous point, it is important to
recognize that developers as well as contractors exhibit different levels of maturity.
Such a problem needs to be addressed at an institutional level in that the
organizations representing developers and government departments interacting with
them need to lay down basic principles and procedures they are expected to follow.
Client insurance. The insurance industry plays an important role in the real estate
and construction industries. However, the Insurance Industry Ordinance does not
allow for the active and comprehensive sharing of information on construction
industry performance. Hence, an experience rating modification system is difficult to
implement in Hong Kong at the present time. This is an institutional barrier to
progress which would allow better performing contractors to experience lower
premiums and so higher competitiveness. Indeed, one mechanism for addressing this
might be to put the insurance in the hands of the clients and so focus clients‟ attention
on occupational health and safety management.
“Can do” attitude. One of Hong Kong construction industry‟s distinctive
competences is its “can do” attitude. The ability to construct high-rise buildings on
four day floor cycles cannot be matched in many places worldwide. However, this
“can do” attitude comes at the cost of flooding sites with plant and equipment and a
focus on long working hours in arduous conditions leading to stress all round. This is
an issue which needs to be reviewed and the industry needs to be educated to take a
more mature attitude to this problem. The ability to say no to unreasonable client
demands for speed needs to be developed and the Housing Authority‟s initiatives in
the 1990s in this area are an excellent, successful example.
Use of data. The industry as a whole and the Labour Department in particular collect
a massive amount of data on construction site accidents and their effects. A program
should be put in place to make better use of this data in order to inform contractors
and developers of trends in accident causation. This work could be let competitively
to an organisation outside of the Labour Department in order to ensure an unbiased
opinion. Examples of issues which have been identified but not so far addressed are
the occurrence of high rate of accidents in the summer months and the existence of
two peaks in accident occurrence at different times of the day. Evidence from the UK
indicates that interventions in terms of workers diet can be effective in this respect.
Frank auditing. Independent auditors are placed in an ambiguous position in that
they strive to provide frank audits and yet are under pressure to ensure that their
auditees actually achieve a passing grade. Hence, there is a tendency to underplay
faults in audited safety management systems in order to address this ambiguity.
However, the mature contractors and developers expect to be given feedback from
audits which will allow continuous improvement within their organizations. Thus,
there needs to be a careful review of the existing system to protect the integrity of the
auditors and provide best value for the auditees.
4. Conclusions
The industry in general is receptive to change and becoming more OHS conscious but
the forces driving change in the industry are opposing. Currently, institutional barriers
exist to a concerted improvement effort and these need to be addressed and removed.
The best performing contractors, clients, consultants and subcontractors attain
standards of excellence comparable with the best in the world but there is a wide
range of maturity, and so performance, throughout the industry. In this research study
the following issues have been identified where new initiatives need to be developed.
Developer attitude: a culture change is required and a move towards open
disclosure of OHS performance
Client insurance: a move to a territory wide insurance modification system
where the best performing contractors and developers are rewarded
“Can do” attitude: one of Hong Kong‟s strengths is also one of its weaknesses
we drive ourselves and our co-workers beyond the limit of what can be reasonably
expected.
Use of data: the data collected on accidents and incidents should be reviewed
for its content and its use more can be made of the data
Frank auditing focus on improvement: a mechanism has to be developed to
allow independent auditors to be freed from the commercial pressure they feel to
bowdlerise their audit reports.
Maturity of Organisations: the best contractors in Hong Kong are world
leaders in OHS management and performance. A concerted effort is required to
enable the less mature organizations to develop and grow despite their limited
resources;
Health issues: these are not dealt with adequately in Hong Kong at the
moment. One third of construction workers suffer from health issues.
Endnote
Incident rate is calculated as number of accidents multiplied by 200,000 and divided
by the number of employees‟ hours worked. This is intended to be equivalent to the
accident rate per 100 workers assuming a 40 hour week for 50 weeks in a year. In
Hong Kong the average working week in the construction industry is 48 hours, six
days per week, over 50 weeks. Hence, taking the 2007 figures for both jurisdictions
(the most readily available and reliable figures) the US rate of 5.4
(http://www.bls.gov/iif/oshwc/osh/os/ostb1921.pdf, accessed June 1, 2011) would
compare with a Hong Kong rate of 4.3 (op cit). However, such comparisons are
fraught with difficulty due to, in addition to the calculation regime, different reporting
protocols and mechanisms and the worldwide phenomenon of under-reporting, the
scale of which is difficult to assess in any jurisdiction. Suffice it to say that the ten
year improvement from 1997-2006 in Hong Kong has been substantial and brought
accident rates back in line with western nations. Figures show over 1000 fatalities in
total in the US industry in 2007 compared with 40 in Hong Kong; note, these are not
rates.
References
Federal Safety Commissioner‟s Safety Principles & Guidance, Department of
Employment and Workplace Relations, (2006) Australian Government, September,.
Federal Safety Commissioner‟s Leader in Safety, Department of Employment and
Workplace Relations, (2007) Australian Government, May,.
Hare, B. and Cameron I. (2007) Effective worker engagement, CII-HK Conference
2007, Never Safe Enough: A Wider Look at Construction Safety and Health, Hong
Kong, 20th November, 2007.
Leaviss, J.C., Gibb, A.G.F. and Bust, P.D. (2008a) Growing old in construction,
workers' expectations of physical ill-health, Gainsville, Florida, USA, 9-11 March
2008.
Leaviss, J.C., Gibb, A.G.F. and Bust, P.D. (2008b) Ageing in construction work, how
can equipment use prevent early retirement from the industry? Ergonomics Society
Annual Conference, Nottingham, UK, 1-3 April 2008.
Leaviess, J.C., Gibb, A.G.F. and Bust, P.D. (2008c) Strategic promotion of ageing
research capacity understanding the older worker in construction, Loughborough
University, January 2008.
Lingard, H., Blismas, N., Wakefield, R., Jellie, D. and Fleming, T. (2008) „Safer
construction‟: The development of a guide to best practice, Third International
Conference, Cooperative Research Centre for Construction Innovation, 12-14 March
2008, Gold Coast, Australia.
Lingard, H. (2007) The development of a guide to best practice for safer construction,
CII-HK Conference 2007, Never Safe Enough: A Wider Look at Construction Safety
and Health, Hong Kong, 20th November, 2007.
Lingard, H. and Rowlinson, S. (1994) Construction Site Safety in Hong Kong.
Construction Management & Economics, 12 (6), pp. 501-510.
... With ageing, there will be a general deterioration in physical capacity and an increase in the risk of work-related disabilities [3]. Occupational disability has been found to be the prime reason contributing to the early dropout of construction workers worldwide [4]. To reduce the premature loss of construction workers as a result of work-related disability, the concept of work ability measurement has been increasingly used in recent years as an important tool to develop suitable interventions [5][6][7][8]. ...
... Supported H1. 3 Leisure-time physical activity will be positively associated with the WAI. Supported H1. 4 Sleep quality will be positively associated with the WAI. Supported ...
... Supported H4. 3 Job control is positively associated with the WAI. Supported H4. 4 Social support is positively associated with the WAI. Supported ...
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The structural characteristics of the Hong Kong construction industry, most notably its elaborate system of subcontracting and the casual basis on which labour is employed, pose serious problems for safety managers. By international standards, Hong Kong's construction industry performs very badly in the area of safety. Recent work in the UK and Finland highlights the effectiveness of behavioural techniques to improve safety performance on construction sites. Work is currently under way to test these techniques in the Hong Kong construction setting. The structural properties of the Hong Kong construction industry have been taken into consideration and labour commitments to the group and to the organization have been identified for additional consideration in research. It is expected that these variables will intervene in the application of behavioural techniques to determine their effectiveness. This paper investigates the theoretical background to commitment at the group and organizational level and presents a site level research model which is illustrative of the possible effects that group and organization level commitment may be found to have on the use of behavioural techniques.
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In Australia, an average 49 building and construction workers have been killed at work each year since 1997-98. Building/construction workers are more than twice as likely to be killed at work, than the average worker in all Australian industries. The ‘Safer Construction’ project, funded by the CRC-Construction Innovation and led by a task force comprising representatives of construction clients, designers and constructors, developed a Guide to Best Practice for Safer Construction. The Guide, which was informed by research undertaken at RMIT University, Queensland University of Technology and Curtin University, establishes broad principles for the improvement of safety in the industry and provides a ‘roadmap’ for improvement based upon lifecycle stages of a building/construction project. Within each project stage, best practices for the management of safety are identified. Each best practice is defined in terms of the recommended action, its key benefits, desirable outcomes, performance measures and leadership. ‘Safer Construction’ practices are identified from the planning to commissioning stages of a project. The ‘Safer Construction’ project represents the first time that key stakeholder groups in the Australian building/construction industry have worked together to articulate best practice and establish an appropriate basis for allocating (and sharing) responsibility for project safety performance.
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The construction industry has a heavy physical workload, which can accelerate the ageing process. In addition natural ageing causes a decline in physical fitness. Incidence of injury and ill-health in the construction industry is high, and can result in early retirement. This has consequences for the industry itself and society as a whole. This study aimed to explore how the use of equipment and design of work process for older construction workers could prevent injuries and ill-health, and how it could assist ageing workers as their physical fitness naturally declines. The study used semi-structured interviews and small focus groups with equipment designers, equipment rental firms, older workers, site managers, and construction health and safety managers. Participants revealed the kinds of equipment currently available to ease the physical burden of construction tasks for older workers. Participants also reported barriers to the use of this equipment. These issues related to individual attitudes, financial implications, organisational structure, and training. In addition, changes in work processes were suggested. Solutions are needed to overcome these barriers to uptake of safe work practice including better provision and design of equipment. Interventions to encourage more frequent use are also required. Design of equipment and interventions designed to promote safe practice should be inclusive. Goals should include the protection of workers before they suffer injuries and ill-health related to a career in construction in order to prevent early retirement from the industry.
Strategic promotion of ageing research capacity understanding the older worker in construction
  • J C Leaviess
  • A G F Gibb
  • P D Bust
Leaviess, J.C., Gibb, A.G.F. and Bust, P.D. (2008c) Strategic promotion of ageing research capacity understanding the older worker in construction, Loughborough University, January 2008.
Effective worker engagement, CII-HK Conference Never Safe Enough: A Wider Look at Construction Safety and Health
  • B Hare
  • I Cameron
Hare, B. and Cameron I. (2007) Effective worker engagement, CII-HK Conference 2007, Never Safe Enough: A Wider Look at Construction Safety and Health, Hong Kong, 20 th November, 2007.
The development of a guide to best practice for safer construction, CII-HK Conference Never Safe Enough: A Wider Look at Construction Safety and Health
  • H Lingard
Lingard, H. (2007) The development of a guide to best practice for safer construction, CII-HK Conference 2007, Never Safe Enough: A Wider Look at Construction Safety and Health, Hong Kong, 20 th November, 2007.
Never Safe Enough: A Wider Look at Construction Safety and Health
  • B Hare
  • I Cameron
Hare, B. and Cameron I. (2007) Effective worker engagement, CII-HK Conference 2007, Never Safe Enough: A Wider Look at Construction Safety and Health, Hong Kong, 20 th November, 2007.
Growing old in construction, workers' expectations of physical ill-health
  • J C Leaviss
  • A G F Gibb
  • P D Bust
Leaviss, J.C., Gibb, A.G.F. and Bust, P.D. (2008a) Growing old in construction, workers' expectations of physical ill-health, Gainsville, Florida, USA, 9-11 March 2008.