**5. Conclusions**

In summary, newly hired manufacturing workers who visited an on-site occupational health center for reasons consistent with an occupational injury experienced increased risk employment termination within 60 days from the date of hire. In addition, the incidence rate of occupational health center visits within 60 days from the date of hire was substantially greater than that observed over longer time frames. Together, these results suggest that management of workplace safety and health hazards to prevent the occurrence of occupational injury may reduce turnover rates.

Finally, the end of the study observation period (November 2016) corresponds approximately with a major shift in strategic production management practices at the study facility. Specifically, starting in early 2017, the facility has adopted the "world-class manufacturing (WCM)" model attributed most commonly to Hayes and Wheelwright [26], reformulated by Schonberger [27], and further refined and formalized by large, multi-national manufacturing enterprises such as Fiat Chrysler Automobiles. A key component of WCM is an organizational commitment to safety, such that "WCM cannot be implemented when the company is not assuring a robust safety system" [28] (p. 600). We hope to revisit the analyses described in this manuscript after complete roll-out and maturation of the WCM systems and procedures in order to evaluate the effect of WCM on occupational injury rates and employee turnover.

**Author Contributions:** Conceptualization, N.C.H. and N.B.F.; Methodology, N.C.H., N.B.F., J.A.D. and F.G.; Formal analysis, N.C.H., N.B.F. and F.G.; Investigation, N.C.H. and N.B.F.; Resources, N.B.F.; Data curation, N.C.H., N.B.F. and J.A.D.; Writing—original draft preparation, N.C.H. and N.B.F.; Writing—review and editing, N.C.H., N.B.F., J.A.D. and F.G.; Visualization, N.C.H. and N.B.F.; Project administration, N.B.F.; Funding acquisition, N.B.F.

**Funding:** This research was supported by a grant from the National Institute for Occupational Safety and Health (NIOSH) for the Heartland Center for Occupational Health and Safety at the University of Iowa, grant number T42OH008491. Additional support was provided by the NIOSH-funded Healthier Workforce Center of the Midwest at the University of Iowa, grant number U19OH008868.

**Acknowledgments:** The authors wish to thank the workers and management at the study facility for their support of this project.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
