OSHA Strategic Partnerships Program > Region II

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Printing Instructions

PARTNERSHIP AGREEMENT
BETWEEN

DEPARTMENT OF LABOR
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION
WILKES-BARRE AREA OFFICE

AND

MICHAEL FOODS, INC.
KLINGERSTOWN, PENNSYLVANIA

Opening Statement

In a cooperative effort to foster safe and healthful worksites and meet the Occupational Safety and Health Administration’s (OSHA) strategic goal of improving the safety, health, and well-being of the nation’s workforce, OSHA and Michael Foods, Inc., Klingerstown, Pennsylvania (Michael Foods, Inc.) have agreed to the joint implementation of this Safety Partnership.

The primary goal of this partnership is to develop a cooperative relationship with Michael Foods, Inc. to assist it in creating safety and health management systems at the worksite that will insure its employees are protected from injuries and illnesses and will encourage the company’s application to VPP. The partnership is to be established with Michael Foods, Inc. for a two-year period.

I. Identification of Partners
Wilkes-Barre OSHA Area Office
Michael Foods, Inc., Klingerstown, Pennsylvania

II. Background, Purpose and Scope

By entering into this agreement, OSHA and Michael Foods, Inc. agree to work cooperatively to improve the safety and health program at Michael Foods, Inc. and to eliminate the hazards at the site that are cause of injuries and illnesses to its workers.

Employee rights which are guaranteed under the OSH Act shall not be infringed upon as a result of this partnership. This partnership does not preclude employees and/or employers from exercising any right provided under the OSH Act, nor does it abrogate any responsibility to comply with rules and regulations adopted pursuant to the Act.

It is anticipated that routine worker involvement in the day to day implementation of worksite safety and health programs will be assured, including worker participation in team meetings, job hazard analyses, safety and health program reviews and accident investigations.

III. Goals, Strategies, Measures (See Appendix B for full statement).

Michael Foods, Inc. and OSHA will work in partnership to achieve the following goals:

Promote, institute and maintain a safety and health management system based on OSHA’s 1989 Guidelines which incorporates these four basic program elements: Management Leadership and Employee Involvement; Worksite Analysis; Hazard Prevention and Control; Training.

Reduce or maintain injury and illness rates to/at levels that would meet eligibility requirements for VPP (3 year average TCIR and DART Rates (or equivalent rates) are below at least 1 of the most recent 3 years BLS rates for the established NAICS code).

Encourage Michael Foods, Inc.’s participation in OSHA’s Voluntary Protection Program (VPP)*.

IV. Partnership Management

The Partnership Management Team (PMT) will facilitate the direction of the Partnership. The PMT will consist of the representatives listed in Appendix A. OSHA’s representative will serve in an advisory capacity to the PMT and will perform duties as outlined in Section VI.

The PMT will perform a variety of activities to facilitate the success of the Partnership, including:

Using the OSHA Challenge Program Stages for General Industry (Appendix C) as a guide, select and assign the steps and duties needed to carry out Michael Food Inc.’s commitments under the partnership agreement.

Encourage Michael Foods, Inc.’s participation in VPP.

Meet at least quarterly to track Michael Foods, Inc.’s progress under the agreement and to make adjustments as needed.

Resolve partnership conflicts and issues.

Communicate partnership activities, including best practices and successes, throughout Michael Foods, Inc.

Prepare an annual evaluation with final approval by OSHA. The evaluation will be due each year on the effective date of the partnership, and will follow the written format shown in Appendix D.

V. Michael Foods, Inc. agrees to:

Visibly lead in the design, implementation, and continuous improvement of the site’s safety and health policies and activities.

Implement safety and health programs with a commitment that routinely extends beyond what is required by OSHA regulation.

Provide the necessary resources of staff, time and money to ensure that all persons on the worksite are protected from injury and illness hazards.

Ensure that all employees, from the top-level management down, have clearly written and defined safety and health responsibilities.

Ensure that written safety and health management systems are implemented that effectively address worksite hazards by identifying and tracking them to guarantee their correction and control.

Ensure training programs are implemented that help employees clearly understand their occupational hazards and how to control them.

Conduct baseline safety, health and employee surveys and share results with OSHA.

Share ongoing measurement data with OSHA needed to evaluate the partnership’s effectiveness.

VI. OSHA agrees to:

Work cooperatively with Michael Foods, Inc. to provide safety and health information, technical assistance and training (as resources allow), to facilitate safety and health management system improvements.

Conduct an initial evaluation of the Michael Foods, Inc.’s safety and health management system and report the findings to the PMT to help it determine the best steps to take to carry out the partnership agreement and work toward VPP application. (Note: OSHA’s onsite non-enforcement policy for partnerships will apply during any site walk around by an OSHA Compliance Assistance Specialist. See Section VII.)

Meet at least quarterly with the PMT to track Michael Foods, Inc.’s progress under the agreement, review its injury and illness experience and to make adjustments as needed.

VII. Onsite Non-enforcement Verification:

During an onsite non-enforcement verification, OSHA conducts a review of the partner’s worksite in a non-enforcement capacity to assess the implementation of the partnership agreement. During such visits, if OSHA personnel identify serious hazards that site management refuses to correct, the OSHA Compliance Assistance Specialist will make a referral to the Area Office for an enforcement inspection.

OSHA will conduct at least one onsite non-enforcement verification visit at Michael Foods, Inc. The purpose of the visit is to continue to support the company’s efforts to improve its safety and health management system and to prepare the required annual evaluation to gauge the effectiveness of the partnership.

In addition to a walk around by an OSHA Compliance Assistance Specialist (CAS), documentation will be selected for review that relates to the agreement’s goals, objectives and stated measures and will include a review of injury and illness data and survey results.

VIII. Benefits:

Michael Foods, Inc. at the Klingerstown, Pennsylvania facility is granted a six month deferral from programmed inspections upon entry into the partnership.

OSHA will designate an experienced safety and health staff person to serve as a resource and liaison to Michael Foods, Inc. to provide training and technical assistance as outlined in the agreement, and to serve as an advisor to the Partnership Management Team.

OSHA will not issue penalties for other-than-serious violations, provided the violations are abated during the inspection.

When calculating initial penalty reductions, OSHA may provide an additional 10% penalty reduction for good faith over and above what is allowed by the FIRM. This additional reduction will not apply to high gravity serious, willful, failure to abate or repeat citations. In cases where Michael Food’s total penalty reduction is 100 percent or more, the minimum penalty provisions of OSHA’s FIRM will apply.

IX. Formal Complaints and OSHA Investigations:

OSHA personnel will continue to conduct investigations resulting from formal complaints, referrals, fatalities, catastrophes, other accidents or significant events at this partnering worksite. These investigations will be conducted outside of this partnership agreement in accordance with established OSHA enforcement policy. Violations documented during such investigations may result in the issuance of citations and penalties.

X. Evaluation:

An annual evaluation will be prepared by the PMT and OSHA with final approval by OSHA. The evaluation will be due each year on the effective date of the partnership, and will follow the written format shown in Appendix D.

XI. Termination:

This agreement will terminate two years from the date of the signing. If either OSHA or Michael Foods, Inc. wishes to withdraw its participation prior to the established termination date, the agreement will terminate upon receiving a written notice of the intent to withdraw from either signatory.

OSHA will terminate the partnership if Michael Foods, Inc. is issued a citation related to workplace hazards which resulted in a fatality.

XII. Paperwork Reduction Act Notice:

Paperwork Reduction Act Notice Form Approved OMB# 1218-0244 Expires 01-31-2009. Public reporting burden for the time needed to develop the Partnership requirements, craft agreement language, and conduct an internal review process is estimated to be an average of 11 burden hours per respondent.

Mark Stelmack
Area Director
Wilkes-Barre Area Office
Occupational Safety and Health Administration

Date

Frank Anonia
General Manager
Michael Foods, Inc.

Date

* VPP is administered separately from OSHA’s Strategic Partnership Program. Participation in the partnership is not a guarantee of acceptance into VPP.

Appendix A – Partnership Management Team

Management Employees -
Mike Troutman - Safety Manager
Jack Hallick - Human Resources Manager
Tim Pacilio - Maintenance Manager
Steve Sprenkle - Utility Maintenance Supervisor
Tom Smith - Production Maintenance Supervisor
Brian Shepherd - Cooked Supervisor

Hourly Employees -
Dave Messenger - Production Maintenance Lead
Becky Rummel - Cooked Lead
Karen Wolfe - Administrative Assistant
Vicky Bingaman - Forming Room
Belinda Wiest - Quality Assurance
Jim Diamond - Maintenance Mechanic

Appendix B – Goals, Strategies, Measures

Goals	Strategies	Measures
Promote, institute and maintain a safety and health management system based on OSHA’s 1989 Guidelines which incorporates these four basic program elements: Management Leadership and Employee Involvement; Worksite Analysis; Hazard Prevention and Control; Training. Reduce or maintain injury and illness rates to/at levels that would meet eligibility requirements for VPP (3 year average TCIR and DART Rates (or equivalent rates) are below at least 1 of the most recent 3 years BLS rates for the established NAICS code). Encourage Michael Foods, Inc.’s participation in OSHA’s Voluntary Protection Program (VPP).	1st Year of Agreement: As soon as the agreement is signed, OSHA will conduct an initial evaluation of Michael Foods, Inc.’s safety and health management system and report the findings to the PMT. The evaluation will include a walk around of the facility and a review of the appropriate paperwork. OSHA’s onsite non-enforcement partnership policy will apply during the evaluation. Quarterly, or as soon as possible, OSHA will train the PMT and designated company management and employees in the duties and responsibilities under each of the four basic safety and health program elements. As soon as each training module is completed, the PMT will assign responsibilities and create a written timeline to carry out the appropriate steps for the Challenge Stages in each of the four program elements. Notes: Emphasis for the OSHA training is on the immediate, practical application of the four basic elements, not on introductory VPP background information and justification or theory. Training should be tied to the OSHA Challenge Stages shown in Appendix C. PMT focus is on conducting the baseline assessments and surveys needed for early identification of the top causes of injuries and illnesses through a review of the site’s injury and illness experience and other supporting documentation. Additional focus is on adopting protocols to address the top causes of injuries and illnesses and to abate hazards. Additional focus is also on developing a system for tracking, reporting and recording near misses.	1st Year of Agreement: Completed Challenge Stages TCIR and DART rates
	2nd Year of Agreement: PMT meets at least quarterly with OSHA to track progress in completing Challenge Stages, review safety and health program system and injury and illness experience and make adjustments as needed to meet partnership goals. OSHA representative and VPP Association mentor conduct mock VPP inspection. Michael Foods, Inc. completes VPP application if possible under guidance of VPP Association mentor. The OSHA representative will review for completeness.	2nd Year of Agreement: Completed Challenge Stages TCIR and DART rates Mock VPP inspection with results reported to company by 3rd quarter of the 2nd year of partnership. Completed VPP application by end of agreement.

Appendix C – Challenge Stages

Challenge Stages at a Glance

1. Management Leadership
Element	Stage I	Stage II	Stage III
1.1 Management Commitment
Mission and Policy Statements	Develop S&H Mission Statement, with input from employees, and a S&H Policy Statement.	Communicate statements; incorporate into new employee/contractor orientation.	Take proactive steps to ensure understanding by all employees and contract workers and that they become a routine part of regular communication.
Leadership by Example	Begins to participate in S&H activities and follow S&H rules.	Continue; increase frequency of manager participation in S&H activities.	Continue; ensure total involvement of all executives, managers, & supervisors
Resources	Commit initial resources to control identified hazards. Begin integrating S&H into other aspects of management planning.	Provide additional resources for S&H activities, including access to certified S&H and licensed health care professionals, and improve integration of S&H into other planning processes.	Continue committing and ensuring the utilization of adequate resources. Ensure integration of S&H into all planning processes in the site.
Goals and Objectives	Establish & communicate annual S&H goals & objectives based on findings from baseline hazard and trend analyses; and assessment of the site’s safety and health practices.	Review the site’s progress towards achievement of S&H goals & objectives; establish & communicate new goals, as appropriate.	Review, revise, and continue communicating S&H goals and objectives. Ensure S&H goals and objectives are routinely considered in site’s activities and programs.
Responsibility, Authority, and Accountability	Develop a safety and health accountability plan for managers, supervisors, and non-supervisory employees.	Enforce accountability plan.	Fully implement accountability system for all workers, including incorporation of S&H responsibilities into job descriptions and performance plans. Assign additional responsibilities to non-supervisory employees as appropriate.
Communication	Establish clear lines of communication with employees & provide reasonable access to top management re: S&H issues.	Maintain clear lines of communication with employees re: S&H issues	Encourage open dialogue between management staff and employees.
Disciplinary Plan	No action required	Develop & begin implementing disciplinary plan for managers and employees.	Ensure discipline is equability enforced, ensure higher levels of compliance.
Annual Self-Evaluation	No action required	No action required	Develop system and written procedures to annually evaluate the total site’s S&H management system. Complete at least one annual self-evaluation of the site’s safety and health management system.
1.2 Employee Involvement
Employee S&H Perception Survey	Conduct baseline employee S&H practices perception survey.	No action required	Conduct follow-up employee S& H perception survey.
S&H Practices Change Plan	Develop an action plan to address findings from the baseline employee S&H practices perception survey.	Implement steps defined in the site’s action plan to improve S&H culture.	Continue; ensure significant improvement in S&H culture
Employee Notification	Notify all employees of their S&H rights, the site’s participation in Challenge, & VPP principles.	Notify new employees of their S&H rights, site participation in Challenge, & VPP principles. Incorporate into new employee/contractor orientation.	Continue for new employees. At least annually, reenforce for all employees. Encourage freely reporting workplace hazards without reprisal.
Meaningful Employee Involvement	Establish a few key S&H teams; begin involving employees in S&H activities.	Increase participation on teams, and/or form additional teams. Involve employees in safety and health activities (e.g., accident/near-miss investigations).	All needed teams are functioning and meaningfully contributing to S&H. Ensure regular teams are routinely conducting audits, accident/incident investigations, self-inspections, and job hazard analyses. Improve and continue the site’s hazard reporting system.
1.3 Contract Worker Coverage
Adherence to Rules	Require contractors and their employees to comply with OSHA and site S&H rules.	Improve and continue to enforce policy for S&H violations.	Improve and continue- enforce policy for safety and health violations.
Contractor Selection	No action required	Consider contractors’ safety and health performance in the bidding process, including a review of injury/illness rates.	Fully establish and use selection criteria. Encourage contractors to develop their own S&H management systems & decrease high rates.
Contractor Hazards	Contractor ensures correction of any hazards in their work areas.	Develop & implement a formalized method including assignment of responsibility to identify, correct, & track hazards in contractors’ work areas.	Include responsibility for hazard correction in writing, in the contracts.
Removal Policy	No action required	Develop & implement contractor policy for S&H violations, including removal and other penalties.	Penalty policy is understood by all contractors, described in their contracts, and adhered to.
2. Worksite Analysis
Element	Stage I	Stage II	Stage III
Baseline Safety and IH Hazard Analysis	Conduct the baseline analysis (may use outside sources), including a chemical inventory and evaluation of typical safety and health hazards.	No action required	Re-do baseline survey, if warranted by significant changes in tasks, equipment, or processes.
Hazard Analysis of Routine Jobs, Tasks, And Processes	No action required	Conduct hazard analysis and recommend controls for routine jobs, tasks, & processes that have had associated injuries/illnesses or significant incidents or near-misses; are perceived as high-hazard; or are required by a regulation or standard; observe guidelines.	Conduct hazard analysis and recommend controls for routine jobs, tasks, and processes that have written procedures, have been recommended for more indepth analysis, or are determined by the Challenge participant to warrant hazard analysis
Hazard Analysis of Significant Changes	No action required	No action required	Conduct hazard analysis for significant changes (e.g., non-routine tasks or new processes, materials, equipment and facilities) and recommend controls prior to the activity or use.
Pre-use Analysis	No action required	No action required	Conduct pre-use hazard analysis of new equipment, chemicals, facilities, or significantly different operations or procedures. and recommend controls prior to the activity or use.
IH Program	No action required (See Baseline Hazard Analysis).	Follow up on results of baseline IH study. Conduct more in-depth analysis if warranted to determine actual employee exposures. Establish, document, & implement future sampling schedule, strategy, and rationale.	Continue to follow the written IH program; take proactive steps to improve control of health hazards to prevent occupational disease.
Routine Self-inspections	No action required	Develop a documented system for routinely scheduled self-inspections of the workplace; conduct inspections with S&H staff; covering entire worksite, at least semi-annually.	Continue to conduct routine self-inspections. Increase frequency to at least monthly, with the entire worksite covered at least quarterly.
Employee Hazard Reporting System	No action required	Develop & begin implementing hazard-reporting system for employees (maybe anonymous),	Encourage more active reporting; ensure regular feedback, using different media, to all employees on status of hazards reported.
Investigation of Accidents and Near-Misses	Develop and implement system to report and investigate accidents. Determine root causes and track correction to completion.	Expand system to include reporting and investigation of near misses. Continue investigating accidents, begin investigating near-misses, and making corrective actions.	Thoroughly report and investigate all accidents and near-misses.
Trend Analysis	Conduct trend analysis of injury & illness history (previous 3 years of OSHA 200/300 logs) and begin developing a plan for conducting analysis of other S&H-related information	Conduct trend analysis of other S&H information not yet studied; conduct one of injury & illness history if a year has gone by since initial analysis.	Trend analysis takes place regularly (at least annually) for all types of S&H information, and is utilized in setting future goals to address identified trends.
3. Hazard Prevention & Control
Element	Stage I	Stage II	Stage III
Certified Professional Resources	(see Management Commitment)	(see Management Commitment)	(see Management Commitment)
Hazard Elimination & Control Methods	Develop an action plan to prioritize and implement controls for hazards identified, through the baseline S&IH study, trend analysis of OSHA logs and accident investigations. Implement controls or (interim protection if long-term abatement) for top priority hazards before moving onto Stage II.	Complete long term abatement projects from Stage I. Develop an action plan to prioritize and implement controls for hazards identified through self-inspections, employee reports of hazards, and nearmiss investigations. Implement hazard controls (or interim protection) for top priority hazards before moving onto Stage III.	Complete long term abatement projects from Stage II. Continue to pro-actively identify, prioritize, and implement controls for hazards identified through all means (hazard analysis, trend analysis, accident and near miss investigation, self-inspections, employee reports of hazards, pre-use analysis, etc) so that there is a continuous loop of hazard id and control.
Hazard Control Programs	Inventory existing hazard control programs required by OSHA standards. Develop missing programs or modify existing programs.	Implement hazard control programs developed or modified in Stage I and train all workers on these programs.	Review hazard control programs annually and updated as new processes, jobs, and tasks are begun.
Documented System for Hazard Correction Tracking	Develop and begin implementing a hazard tracking system for hazards identified through the baseline hazard analysis, trend analysis of OSHA logs, and accident investigations.	Expand tracking system to include hazards identified through hazard analysis of routine jobs; self-inspections; employee reports of hazards; and near miss investigations.	Tracking system is fully functioning and includes hazards identified through all methods.
Preventive Maintenance	Conduct an inventory of equipment and machinery requiring preventive maintenance.	Review equipment inventory. Establish and implement preventive maintenance schedule.	Ensure schedule is routinely observed and preventive maintenance is regularly conducted.
Occupational Health Care Program	Conduct records review of previous three years OSHA 200/300 logs. Compare with insurance claims forms and ensure records are in order. Provide physician services for emergencies (see below).	Continue to provide access to licensed health care providers, health services, physician care, and emergency medical care. Arrange for services based on the outcomes of the baseline safety and health analysis.	Continue providing services listed in Stage I and II. In addition- Health Care providers visit the site, and assist in identifying causes and symptoms of injury/illness. Care provided in within the scope of licensure.
Emergency Preparedness and Response	Establish & communicate written procedures for responding to all types of emergencies; Make emergency services available on all shifts including: ambulances, EMT’s, emergency clinics, or hospital emergency rooms. Provide at least one employee trained in first aid & CPR for each shift or an equally effective alternative. Conduct at least one evacuation drill & assess its effectiveness.	Continue providing emergency medical services. Establish an Emergency Response Team including first aid and CPR trained employees. Conduct at least one drill and assess it’s effectiveness and follow-up on recommendations to improve emergency evacuation drills.	Continue providing emergency medical services. Establish a Haz. Mat. Team if necessary. Consult with local fire department to ensure adequate coverage for fire, explosion, or chemical release. Conduct evacuation drills at least annually and assess their effectiveness. Provide AED and training on its use for those on the Emergency Response Team.
4. Safety and Health Training
Element	Stage I	Stage II	Stage III
General guidelines	Observe OSHA guidelines in providing training for required programs.	Continue observing OSHA VPP guidelines in providing training.	Continue observing OSHA VPP guidelines in providing training.
Training for all workers	Provide training to all workers on their S&H rights, Challenge, VPP fundamental principles, hazards in the workplace, PPE, emergency evacuation procedures, and individual emergency responsibilities.	Continue providing training to all workers, including new workers, on their S&H rights, Challenge, VPP fundamental principles, hazards in the workplace, PPE, emergency evacuation procedures, and individual emergency responsibilities.	Take proactive steps to improve & continue providing training to all workers, including new workers, on their S&H rights, Challenge, VPP fundamental principles, hazards in the workplace, PPE, emergency evacuation procedures, and individual emergency responsibilities
Training for specific groups of workers	Provide specific training to managers and supervisors, to designated S&H staff and others with S&H responsibilities, and to contract workers to equip them with knowledge & skills needed to perform their S&H responsibilities in Stage I (i.e., hazard recognition, accident investigation and root cause analysis, hazard controls, OSHA standards, and VPP requirements).	Provide specific training to managers and supervisors, to designated S&H staff and others with S&H responsibilities, and to contract workers to equip them with knowledge & skills needed to perform their S&H responsibilities in Stage II.	Take proactive steps to provide specific training to all employees and contract workers to equip them with the knowledge & skills they need to perform their S&H responsibilities in Stage III.

Appendix D

OSHA STRATEGIC PARTNERSHIP PROGRAM
ANNUAL PARTNERSHIP EVALUATION REPORT

Cover Sheet

Partnership Name

Purpose of Partnership

Goals of Partnership
Goal	Strategy	Measure

Anticipated Outcomes

Strategic Management Plan Target Areas (check one)
Construction		Amputations in Manufacturing
General Industry
Strategic Management Plan Areas of Emphasis (check all applicable)
Amputations in Construction		Oil and Gas Field Services
Blast Furnaces and Basic Steel Products		Preserve Fruits and Vegetables
Blood Lead Levels		Public Warehousing and Storage
Concrete, Gypsum and Plaster Products		Ship/Boat Building and Repair
Ergo/Musculoskeletal		Silica-Related Disease
Landscaping/Horticultural Services

Section 1

General Partnership Information

Date of Evaluation Report
Evaluation Period
Start Date		End Date

Evaluation Contact Person
Originating Office

Partnership Coverage
# Active Employers		# Active Employees

Industry Coverage (note range or specific SIC and NAICS for each partner)
Partner	SIC	NAICS

Section 2

Activities Performed

Note whether an activity was provided for by the OSP and whether it was performed
	Required	Performed
a. Training
b. Consultation Visits
c. Safety and Health Management Systems Reviewed/Developed
d. Technical Assistance
e. VPP-Focused Activities
f. OSHA Enforcement Inspection
g. Offsite Verifications
h. Onsite Non-Enforcement Interactions
i. Participant Self-Inspections
j. Other Activities

2a. Training (if performed, provide the following totals)
Training sessions conducted by OSHA staff
Training sessions conducted by non-OSHA staff
Employees trained
Training hours provided to employees
Supervisors/managers trained
Training hours provided to supervisors/managers
Comments/Explanations (briefly describe activities, or explain if activity required but not performed)

2b. Consultation Visits (if performed, provide the following total)
Consultation visits to partner sites
Comments/Explanations (briefly describe activities, or explain if activity required but not performed)

2c. Safety and Health Management Systems (if performed, provide the following total)
Systems implemented or improved using the 1989 Guidelines as a model
Comments/Explanations (briefly describe activities, or explain if activity required but not performed)

2d. Technical Assistance (if performed, note type and by whom)
	Provided by OSHA Staff	Provided by Partners	Provided by Other Party
Conference/Seminar Participation
Interpretation/Explanation of Standards or OSHA Policy
Abatement Assistance
Speeches
Other (please specify)
Comments/Explanations (briefly describe activities, or explain if activity required but not performed)

2e. VPP-Focused Activities (if performed, provide the following totals)
Partners/participants actively seeking VPP participation
Applications submitted
VPP participants
Comments/Explanations (briefly describe activities, or explain if activity required but not performed)

2f. OSHA Enforcement Activity (if performed, provide the following totals for any programmed, unprogrammed, and verification-related inspections)
OSHA enforcement inspections conducted
OSHA enforcement inspections in compliance
OSHA enforcement inspections with violations cited
Average number of citations classified as Serious, Repeat, and Willful
Comments/Explanations (briefly describe activities, or explain if activity required but not performed)

2g. Offsite Verification (if performed provide the following total)
Offsite verifications performed
Comments/Explanations (briefly describe activities, or explain if activity required but not performed)

2h. Onsite Non-Enforcement Verification (if performed provide the following total)
Onsite non-enforcement verifications performed
Comments/Explanations (briefly describe activities, or explain if activity required but not performed)

2i. Participant Self-Inspections (if performed provide the following totals)
Self-inspections performed
Hazards and/or violations identified and corrected/abated
Comments/Explanations (briefly describe activities, or explain if activity required but not performed)

2j. Other Activities (briefly describe other activities performed)

Section 3

Illness and Injury Information*

Year	Hours	Total Cases	TCIR	# of Days Away from Work Restricted and Transferred Activity Cases	DART
2008
2009
2010
Total
Three-Year Rate (2008-2010)
BLS National Average for 2006
Baseline

Comments

*Sample Chart – not required format
Section 4	Partnership Plans, Benefits, and Recommendations

Changes and Challenges (check all applicable)
	Changes	Challenges
Management Structure
Participants
Data Collection
Employee Involvement
OSHA Enforcement Inspections
Partnership Outreach
Training
Other (specify)
Comments

Plans to Improve (check all applicable)
	Improvements	N/A
Meet more often
Improve data collection
Conduct more training
Change goals
Comments

Partnership Benefits (check all applicable)
Increased safety and health awareness
Improved relationship with OSHA
Improved relationship with employers
Improved relationship with employees or unions
Increased number of participants
Other (specify)
Comments

Status Recommendation (Check one)
Partnership Completed
Continue/Renew
Continue with the following provisions:

Terminate (provide explanation)

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