It's been described as the equivalent of building two Terminal 5s in half the time. The transformation from scratch in six years of 2.5 square kilometres of industrial land in east London into performance space for the world's greatest athletes - including an 80,000-seater stadium, an Aquatics Centre to hold 17,500, plus a media hub for 20,000 of the world's press and accommodation for 17,000 competitors - is about as big a construction challenge as is available on the planet at the moment.

Added to that are the extra hurdles set by the Olympic Delivery Authority's (ODA) public statements that the 2012 project should be a cutting edge example of environmental management and the facilities must create a physical legacy that means they can be used after to sustain the regeneration the games will bring to one of the poorest areas of the capital. All this with no leeway for the project overrunning; the opening ceremony on 27 July 2012 is not a moveable feast.

No pressure, then, for the ODA's head of health and safety Lawrence Waterman, who is responsible for making sure there are as few accidents as possible during the project and, more specifically, for meeting another ODA target of no more than one injury reportable under RIDDOR (the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) for every million hours worked on site.

But, just as the programme seems to be on track so far (see box), so does Waterman and his dedicated team of 12. The project is nearing the end of the "dig, demolish, design" phase to clear and prepare the site, with the "big build" stage - constructing the 12 venues and more than 30 bridges - officially scheduled to start this August as the Olympic flame is handed to London at the end of the Beijing Olympiad.

In the past two years, Waterman has already overseen one of the biggest civil engineering projects in Europe, creating two 6km tunnels to re-route the overhead power lines that criss-crossed the site. This was completed with only two over-three-day accidents, both minor; an impressive result for a construction activity so hazardous that the rule of thumb was once that it cost a death a mile.

The 3000 workers currently on site have also demolished almost 220 buildings (recycling 90% of the waste) and shifted thousands of tonnes of earth, much of which needed remediating to remove the toxic reminders of the park's various former uses as a refuse tip and railway sidings. No light work, but the contractors have twice previously clocked up a million hours (around two months) with no RIDDOR injuries and at the end of April had achieved another two million hours in one go.

Bottom up

The vast scale of the 2012 project means that, even with a team of hundreds, Waterman couldn't hope to manage day-to-day site safety from the centre. The ODA's delivery partner CLM (a consortium comprising US programme managers CH2M Hill, Laing O'Rourke and Mace) is letting between 25 and 30 major construction contracts, involving hundreds of contractors and around 9000 workers at the project's peak.

"If we tried to micro-manage something like this it would fall apart," he agrees. "We are working in partnership with the principal contractors and the integrated design-and-build teams."

The mortar in that partnership is the ODA's Health, Safety and Environment (HS&E) Standard. The 80-page document lays down requirements for everything from contractor pre-qualification to welfare facilities provision. It says no work package or construction phase will  start until adequate health and safety plans and method statements are complete and signed off. Any supplier working on the site must sign up to the standard.

The ODA checks its supply chain is meeting the standard through several levels of assurance. Waterman says the first of these rests with the principal contractors - such as Sir Robert McAlpine, the construction partner in the "Team Stadium" design-and-build consortium - who appoint their own second tier contractors and below.

"Like all the major construction firms, McAlpine have fairly sophisticated systems for talking to and managing their own supply chain," he says, "and that involves a lot of monitoring, supervision and checking that things are being done in accordance with their standards which, of course, under contract, and by their open commitment, includes the ODA standard."

The principal contractors' own auditing and management programmes add another level of checking, he says, plus most are accredited to externally audited standards such as ISO 9000 or BS OHSAS 18001.

A further level comes from CLM, whose project managers and design managers are held to account for their projects' performance against the HS&E Standard. "At project board meetings, health and safety is the first item on the agenda," he says.

The final assurance stage (if you discount visits from HSE inspectors, who keep a keen eye on progress) is a Delivery Partner Assurance Team (DPAT) of seven people headed by Waterman's deputy Martin Holland, who functions as CLM's head of health and safety. The DPAT carries out audits and inspections across the project. Waterman says the team reports up to the ODA, but its function is also to flag up problems to contractors themselves.

Keeping score

The DPAT also audits monthly HS&E scorecards completed by all lead designers, senior CDM coordinators and principal contractors. The measures vary across the three disciplines but the principal contractors' card asks them to measure their previous month's performance against KPIs (key performance indicators) such as safety committee activity, initiatives to encourage near-miss reporting, speed of accident recording and measures to prevent recurrences.

One KPI Waterman points up as particularly valuable is the requirement (worth 10 of the scorecard's potential maximum of 95 points) for contractors to include a photo example of exemplary practice (such as housekeeping or use of control measures) on their patch, or a record of some creative answer to a problem.

"We are trying to turn health and safety away from just being reactive, addressing the negative, and using the scorecard to celebrate positive achievements," he says. "We use a monthly contractors' forum where the principal contractors and their supply chains are represented to identify good practice using the scorecards and the regular inspections."

The good practice examples also have a more lasting use. "We have a set of base standards, on edge protection for work at height etc, with photo illustrations," he explains, "and a lot of the photos are from the libraries that those of us that comprise the ODA and the delivery partner have brought with us from previous incarnations.

But progressively they are being replaced with good practice illustrations from our site. So we are able to say, 'Look, this is what someone is already doing on providing a safe walkway adjacent to a haul road, well lit, well segregated from transport movements etc.' "So there's no question of anyone saying 'We couldn't afford it' or 'It's too difficult'; it's already evidently practicable and that's one way of leveraging good practice across the whole site rather than having pockets of incipient failure."

Positive thinking

"I think what we are doing is changing the perception of health and safety as just addressing the negative," he reflects, "and looking more at the way that proactively managing it can lead to efficiency savings."

He believes that as major contractors have become better at managing basic risk, promoting best practice is what will bring the next performance improvements.

"You have to be much more proactive and positive and talk about what a good workplace should look like rather than 'there's an excavation that's not securely fenced, let's do something about it'," he suggests.

He says one aspect of this approach is to focus not just on hazards associated with work activities but on ones that come with the temporary nature of construction sites, where paths and steps are often makeshift.
"And people are used to that. And then they wonder why we get so many slips, trips and falls. It's because we are not providing absolutely the same standard and quality of working environment. And it's not because we are not capable of doing it; we are the industry that creates the working environment for everybody else.

"A lot of it is about creating an intolerance of conditions likely to create a problem. When you analyse site slips and falls you find an enormous number of them are people slipping on steps coming out of temporary accommodation. And you look at those steps and they are narrow, and wet in the winter."

The point is heartfelt; the event that started the clock on the current two million hours and counting without a RIDDOR-reportable accident, and which stopped it being three million, involved a worker slipping on the steps of a welfare cabin.

"A lot of what we are doing," he says is getting people at all levels to think about the level of excellence you need to achieve in different areas to achieve a couple of million man hours without someone even spraining their ankle. And achieving that means you are beginning to get construction work as safe as office work; safer than people driving to and from their workplace."

Which brings him back round to assurance that the thousands of workers on site are meeting the ODA's exacting standard. "Assurance on a project that results in no one seriously being hurt comes from every single operative looking out for the equivalent of a rucked-up carpet in an office and saying 'that's not acceptable'," he says.

"And that means you are much less dependent on a team of inspectors, because even with a hundred people walking round the site all day, what happens if something changes after they've walked past it? It's got to be the people doing the work making that change, and their supervisors and managers who drive it."

The evidence that he's right is those two-million-plus hours without an over-three-day injury and an overall accident frequency rate for the dig, demolish, design stage of 0.12, a 10th of the estimated construction industry average of 1.2 - plus the very low RIDDOR figure for the tunnelling operation.

Healthy interest

"It's about trying to give health the same profile as safety has had for some time in the construction industry," says Chris Pugh, head of the Park Health consortium which provides occupational health (OH) services to the 2012 workers.

Pugh's service is working to an ambitious standard, drawn up by Waterman and the ODA in consultation with bodies ranging from the Society of Occupational Medicine, HSE and IOSH to the Institution of Civil Engineers and including union and contractors' representatives.

"We asked the same question as about the health and safety standard," Waterman recalls. "Is what we are going to put in here best current practice? Not just good practice, but best? Is there anything we've missed?" The drive for an exemplary programme to match the HS&E Standard meant that the final specification included not just the predictable elements of OH provision, such as surveillance for conditions like hand-arm vibration and hearing loss, but a strong emphasis on health promotion and emergency support.

Pugh, heading the consortium that won the contract in summer 2007, had experience of providing OH support on a grand scale, having serviced the Terminal 5 project for BAA and worked on the Channel Tunnel. But Waterman says Park Health outshone the other bidders mostly because it was keen to push and adapt the specification beyond what the ODA had set.

"There's a problem in occupational health with clients who don't really understand risk saying, 'Well, what we want is these three things'," he says. "And the occupational health provider gets out their price list and says 'this is what we'll charge you' and that's the relationship. We want an organisation that says 'actually we think you ought to do it like this and here's the reason'."

Park Health will provide OH, paramedic and health-promotion services to all the contractors on the 2012 site who want it, until the end of the games, paid for by the ODA.

Better by design

Asked for an example of how Park Health has developed the original OH specification, Pugh says he has pushed the requirement to help remove health hazards at the design stage, to build on the requirements in the top-level HS&E Standard to design out safety hazards. This means talking to the architects and engineers about the risk implications of their choices of raw materials or configuration, which pays dividends later.

"It can be as simple as specifying the size of building blocks to help reduce musculoskeletal disorders," he explains. "Or when you are specifying formwork, to do it in a way that doesn't require the use of power tools or doesn't require things to be bonded together using toxic glues. It's a way of designing fixtures that, when you come to the M&E [mechanical and electrical] phase, don't require a lot of post drilling. You can cast things in a way that they don't require the use of power drills to drill holes in them. It's getting them to understand that use of power tools causes this condition, this condition is disabling and can destroy people's livelihood, so what can they do about it using their creativity?"

Park Health has provided the architects with a COSHH (Control of Substances Hazardous to Health) management database, "so if they are planning to use any substance, they can check its toxicity and it will point them towards less hazardous, less toxic materials."

The principle of OH as a pre-emptive rather than a reactive service is applied as workers first arrive on the site, when they all go through induction screening. Those slated for safety-critical work, operating mobile plant for instance, receive a thorough health risk assessment while others fill in a simple questionnaire. The screening is similar to that used in the Constructing Better Health (CBH) project to develop OH standards for the construction sector, which both Waterman and Pugh have been involved in. 

Pugh stresses the screening isn't designed to weed out the unfit. "Our figures, which were subsequently supported by CBH, are that about 25% of construction workers have health problems, but the vast majority of those problems are remediable with fairly simple treatment - hypertension or poor vision, for instance. We offer them treatment, such that they are then safe to under take safety-critical work in a way that doesn't put themselves or others at risk. So the issue of assessment hasn't been one of excluding, it's been one of correcting and improving health and wellbeing."

For that reason, he says, the construction unions' initial suspicion about the screening has shifted to enthusiastic acceptance.

Screen test

The assessments are carried out by the nine nursing staff who operate from a fully equipped medical centre which opened at the 2012 site in January. They will be joined by another four OH staff so they can offer a round-the-clock service as construction ramps up. Apart from the screening and health surveillance, Pugh says the team is heavily involved in health and wellbeing promotion, with activities "on almost a daily basis". Individual nurses develop programmes to raise awareness of testicular cancer or risks from sun exposure.

Some of the supporting materials have come from the Men's Health Forum charity. "Males have an inequality in health. Construction workers amongst males have a further inequality in health," he notes.

Most promotional work is done in canteens and welfare facilities, rather than asking workers to come to the medical centre. The mini roadshows usually combine offering a simple educative message with the offer of basic life screening. "So if we are talking about diet we'll do cholesterol measurement; if we are talking about cardiovascular disease we'll do some blood-pressure tests; if it's diabetes, we'll check their urine to see there's no glucose in it - obviously not in the canteen!"

The wellbeing work in the field often doubles up with more mainstream OH awareness raising on topics such as stress at work, dermatitis and noise-related hearing loss.

Both men recognise that the words wellbeing and construction workers may sit strangely in the same sentence for some people, but they insist that view is misconceived.

"They are very interested and very concerned about health matters," says Pugh of the workers, "but you have to win their trust first." He says the programme is designed to promote "behavioural change" to attitudes to health risk in everyone involved, from the designers, contractors and workers, since that's the only way the effect will be lasting.

"You are going from an adult-child type relationship, where you say 'You will wear your hearing protection', and as soon as the parent's away the child reverts, because there's no change in their attitude. It's the same with managers and designers, you have to get them to genuinely appreciate the risk, so it's a route they don't want to go down. That produces legacy."

And the games' legacy, a lasting positive effect after the athletes have gone home, is one of the ODA's big priorities. But Waterman notes that the benefits of health promotion can start before 2012, as well as stretching beyond.
"You can have an impact not starting with the games but with healthy options in site canteens," he says. "And by addressing general health status, we are dealing with a lot of men who are reluctant to go to the doctor; who may not even be registered with a GP. So for them,  access to good OH is the beginning of  access to a health service.

 "On that basis we think we can end up with a healthier workforce which means a workforce that's more likely to be there and working productively and earning its money and is better off than when they are off sick, so it's win-win."

Pugh says over the next year they will also be trying to show the contractors - who must meet the ODA's OH standards whether they use Park Health's free services or their own providers, or a mixture of the two - that all the OH and health-promotion effort makes for less sickness absence and a safer site: "It's about swinging them from 'oh God, we've got to do this', to 'this makes business sense'."

One of his challenges for the coming 12 months is to continue to offer the OH services to a fast-growing cohort of contractors. He also needs to ensure the team is able to guarantee fast emergency response across a very big site.
Waterman knows that his health and safety infrastructure will be tested by the rapid expansion in worker numbers and he's far from complacent.

 "We are only now beginning to do the real building work ... It's a load more people on site, and the risk profile changes," he says; and he must always have in the back of his mind that no Olympiad before has avoided worker fatalities. But the robustness and intelligence of the HS&E Standard, the contractors' willingness to embrace it, and its effectiveness to date, must give him comfort, and a belief in the possibility that the 2012 games will break the mould.