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Client Handling and Musculoskeletal Disorders
in the Health Care Sector

  • Issued: January 25, 2013
  • Content last reviewed: July 2019

Disclaimer: This resource has been prepared to help the workplace parties understand some of their obligations under the Occupational Health and Safety Act (OHSA) and regulations. It is not legal advice. It is not intended to replace the OHSA or the regulations. For further information please see full disclaimer.

The musculoskeletal system includes muscles, tendons and tendon sheaths, nerves, bursa, blood vessels, joints/spinal discs, and ligaments. Musculoskeletal Disorders (MSDs) are injuries and disorders of the musculoskeletal system and include back strains, tendonitis and carpal tunnel syndrome. They may be caused or aggravated by various hazards in the workplace such as force, repetition or awkward and sustained postures.

Client handling refers to activities such as lifting, transferring and repositioning a client (patient/resident), which commonly occurs in the health care sector. MSDs are the most prevalent injury among health care workers, and are primarily related to client handling.

The focus of this document is to provide information to workplace parties regarding compliance with regulatory requirements that may pertain to client handling activities. Employers, supervisors and workers have duties under the Occupational Health and Safety Act (OHSA). This extends to client handling and MSD hazards in the workplace.

Safe and healthy workplaces:

  • Identify and assess job-related MSD hazards related to client handling
  • Implement controls to reduce workers’ exposure to MSD hazards related to client handling
  • Advise and train workers about MSD and client handling hazards in their job and workplace
  • Encourage workers to participate in their workplace’s health and safety program through early reporting of MSD symptoms or concerns to their employer/supervisor
  • Follow up to ensure preventive measures are working.

There are some specific requirements from the OHSA and the Health Care and Residential Facilities Regulation (O. Reg. 67/93) that may apply to safe client handling. If client handling occurs in a workplace that is not covered under the Health Care and Residential Facilities Regulation, inspectors may use the general duty clause (clause 25(2)(h)) in the OHSA in order to ensure that employers are adequately protecting workers from MSD hazards.

The following summarizes some specific requirements in the OHSA and the Health Care and Residential Facilities Regulation that may apply to safe client handling and how compliance may be achieved.

A. Measures and procedures

Section 8 of O. Reg. 67/93 (Health Care and Residential Facilities) requires that measures and procedures for the health and safety of workers are developed, established, and put into effect by the employer in consultation with the Joint Health and Safety Committee (JHSC) or Health and Safety Representative (HSR). Subsection 9(1) of O. Reg. 67/93 requires that those measures and procedures are reduced to writing.

If client handling activities occur in a health care workplace to which the Health Care and Residential Facilities Regulation applies, written measures and procedures for client handling are required. The measures and procedures may include, but are not limited to:

  • Safe work procedures for each individual lift, transfer and reposition
  • Client mobility assessments including documentation of a client’s mobility status and review and revision as conditions change
  • The use of mechanical assists (such as ceiling lifts, portable lifts and sit-to-stand assists)
  • Safe storage of lift equipment and other mobility devices
  • Maintenance of lift equipment and other mobility devices
  • Pre-use inspection of mechanical devices.

When measures and procedures are being developed, important factors to consider include:

  • Following the manufacturer’s recommendations for the use of the lift (i.e. number of workers required to safely operate a mechanical assist, sling requirements, etc.)
  • Size/weight of the client when determining equipment needs, staffing needs, etc. (i.e. bariatric clients)
  • Medical history of the client (i.e. involuntary motions, history of falls, etc.)
  • Cognitive ability of the client (to comprehend the procedures), and
  • The availability of emergency back-up or additional equipment (i.e. when equipment is tagged out of service).

B. Education and training

Occupational Health and Safety Act

Under clause 25(2)(a) of the OHSA, employers are required to provide information, instruction and supervision to a worker to protect the health and safety of the worker. If client handling activities occur in the workplace, this includes protecting workers from MSD hazards related to client handling.

Health Care and Residential Facilities Regulation

Subsection 9(4) of O. Reg. 67/93 requires training and educational programs for workers relevant to the workers’ work in health and safety measures and procedures. The training and education programs shall be developed, established and provided by the employer in consultation with and in consideration of the recommendations of the JHSC or HSR.

When training for staff on measures and procedures for client handling is being developed, it is a good practice to consider two key components for the training:

  1. A classroom training session for workers on the written measures and procedures
  2. A practical hands-on training component in which workers can practice the measures and procedures and receive feedback on whether they are being completed correctly.

Training is required for all workers who perform lifts, transfers and repositions, including training for supervisors who need to ensure workers are adhering to the measures and procedures.

C. Workplace inspections

Monthly inspections of the workplace are required to be completed by the HSR (subsection 8(6) of the OHSA) or a worker member of the JHSC (subsection 9(26) of the OHSA).

A key to prevention is to ensure MSD hazards are a focus of workplace inspections. This could include: inspecting client handling mechanical assists, inspecting the condition of slings and other client handling devices, and observing workers performing tasks to ensure they are being performed correctly and in accordance with the measures and procedures. A checklist of MSD hazards that may be used at the time of the monthly inspection has been developed by Ontario’s health and safety system partners and is available in "Part 3B: Beyond the Basics" (PDF) in the MSD Prevention Guideline for Ontario.

D. Written notice of injury

Subsection 52(1) of the OHSA sets out the requirement of a notice after an accident, explosion, fire or incident of workplace violence at a workplace that causes a person to be disabled from performing his or her usual work or requires medical attention but is not fatally or critically injured. Specifically, the employer is required to give written notice of the occurrence containing prescribed information and particulars to the JHSC, the HSR, and the trade union, if any, and a Director, if required by an inspector, within four days of the event.

Where the Health Care Residential Facilities Regulation applies, subsection 5(2) of O. Reg. 67/93 describes the prescribed information that is required in the notice.

When a worker has a lost time injury, cannot perform his or her regular duties (e.g. the worker is on modified duties), or requires medical attention as a result of an MSD, the reporting requirements under the OHSA apply. The JHSC/HSR and trade union, if any, should receive a copy of the report required under the OHSA within four days of the incident.

Under O. Reg. 67/93, one of the requirements for reporting is to document “the steps taken to prevent a recurrence.” Undertaking changes is imperative to preventing future incidents. When musculoskeletal injuries occur, a review of recognized risk factors to identify necessary modifications should be undertaken. When an MSD occurs as a result of client handling, it is recommended that the employer investigate the incident and determine what corrective actions need to be taken in order to prevent future injuries. This could include implementing a mechanical assist, reviewing and revising measures and procedures, supervision, education or training.

For more information on client handling and MSDs visit:

Ministry of Labour Health and Safety Contact Centre

Call 1-877-202-0008 any time to report critical injuries, fatalities or work refusals.

Call 8:30 a.m. to 5 p.m., Monday to Friday for general inquiries about workplace health and safety. In an emergency, always call 911.

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Disclaimer: This web resource has been prepared to assist the workplace parties in understanding some of their obligations under the Occupational Health and Safety Act (OHSA) and the regulations. It is not intended to replace the OHSA or the regulations and reference should always be made to the official version of the legislation.

It is the responsibility of the workplace parties to ensure compliance with the legislation. This web resource does not constitute legal advice. If you require assistance with respect to the interpretation of the legislation and its potential application in specific circumstances, please contact your legal counsel.

While this web resource will also be available to Ministry of Labour inspectors, they will apply and enforce the OHSA and its regulations based on the facts as they may find them in the workplace. This web resource does not affect their enforcement discretion in any way.