**Nathan C. Huizinga 1, Jonathan A. Davis 1,2 , Fred Gerr <sup>1</sup> and Nathan B. Fethke 1,3,\***


Received: 14 December 2018; Accepted: 31 January 2019; Published: 2 February 2019

**Abstract:** Few longitudinal studies have examined occupational injury as a predictor of employment termination, particularly during the earliest stages of employment when the risk of occupational injury may be greatest. Human resources (HR) records were used to establish a cohort of 3752 hourly employees newly hired by a large manufacturing facility from 2 January 2012, through 25 November 2016. The HR records were linked with records of employee visits to an on-site occupational health center (OHC) for reasons consistent with occupational injury. Cox regression methods were then used to estimate the risk of employment termination following a first-time visit to the OHC, with time to termination as the dependent variable. Analyses were restricted to the time period ending 60 calendar days from the date of hire. Of the 3752 employees, 1172 (31.2%) terminated employment prior to 60 days from date of hire. Of these, 345 terminated voluntarily and 793 were terminated involuntarily. The risk of termination for any reason was greater among those who visited the OHC during the first 60 days of employment than among those who did not visit the OHC during the first 60 days of employment (adjusted hazard ratio = 2.58, 95% CI = 2.12–3.15). The magnitude of effect was similar regardless of the nature of the injury or the body area affected, and the risk of involuntary termination was generally greater than the risk of voluntary termination. The results support activities to manage workplace safety and health hazards in an effort to reduce employee turnover rates.

**Keywords:** turnover; employment duration; occupational injury; manufacturing; newly-hired workers
