Instructions: The purpose of this template is to help Participants and
OSHA staff share successes and best practices as a direct result of
participating in OSHA Challenge. Once completed, this form should be submitted
to OSHA’s Office of Partnerships and Recognition Outreach Coordinator
Danielle Gibbs.
*Note: Any information submitted may be posted to OSHA’s public web page or
used in other outreach activities.
I. General Information: Please complete the below table.
| Submitted By |
Company/Agency Name |
Email |
Phone |
| |
|
|
|
| NAICS |
|
#employees
covered: |
|
|
Year/Date Entered Challenge: |
|
Current Stage
(I, II, III, Graduate) |
|
- Success Story – A story that highlights successes resulting from
participating in the OSHA cooperative program such as reduced TCIR and DART
rates, increased workers’ compensation savings, increased employee involvement
and morale, increased management commitment, increased productivity, and the
overall impact of participating in the OSHA cooperative program.
- Best Practice – An innovative and effective method or system for
improving worker safety and health resulting in superior outcomes. (Example:
changing work processes to reduce ergonomic injuries resulting in improved
employee morale and reduced workers’ compensation costs.)
II. Success Story or Best Practice Narrative: Please check the
appropriate box or boxes below that your story includes, followed by your
narrative. Each narrative should include two or three paragraphs (at most).
Note: It is possible that a story may include all three categories.
- Quantitative (ex: reductions in illness and injury rates; workers
compensation savings)
- Anecdotal/Human Interest (ex: increased management commitment; increased
employee involvement, morale)
- Quote (quotes from employees, management, corporate leadership, union
officials)
|
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