What Control Measures Should I Use? Applying the Total Worker Health Hierarchy of Controls to Manage Workplace Fatigue.

Increased fatigue risk has been associated with safety-critical events such as work-related injuries. While control measures are needed to reduce these risks, the wide range and complexities of fatigue risk management strategies can make it difficult for organizations to prioritize efforts given limited resources and time. Given these challenges, the aims of this commentary are two-fold. The first is to conceptualize fatigue risk management strategies within the Total Worker Health (TWH) Hierarchy of Controls, a conceptual framework used to prioritize strategies to advance worker safety, health, and wellbeing. As an extension to the traditional Hierarchy of Controls, the TWH version presents strategies in order of effectiveness, ranging from "eliminate," "substitute," "redesign," "educate," and "encourage" categories. The second aim of this paper is to use the TWH Hierarchy of Controls to identify control measures which reflect the level of fatigue risk for adverse safety and health outcomes.