VPP Success Story and Best Practice Submission Template for
State Plan States
Voluntary Protection Programs (VPP) success stories and best practice
submissions are vital to conveying the positive impact that the programs have on
workplace safety and health. Once you have completed this form, please email it
to Jaclyn Schede,
Office of State Programs, OSHA’s National Office. To see examples of VPP success
stories and best practices on OSHA’s website visit
Voluntary Protection Programs (VPP) Web Page.
I. General Information: Please
provide the information below.
Date Submitted: ____________________ |
Submitted By |
Phone # |
Origin (Region #) |
Name and Location of Organization (Focus of
Submission) |
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Industry
Description and NAICS Code |
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# employees |
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# of
employer/s |
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Date Participant Entered VPP |
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Success Story – A story that highlights successes
resulting from participating in the programs, such as: a reduced Total Case
Incident Rate (TCIR) and/or Days Away, Restricted, and Transferred (DART) rate;
cost savings; improved workplace safety and health culture; and increased
employee involvement and management commitment. |
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Best Practice – An innovative method or system within
the SHMS that resulted in successful outcomes, such as changing work practices
to reduce ergonomic injuries and improving employee morale and productivity. |
II. Success Story or Best Practice
Narrative: Please check the appropriate below box or boxes that
your submission includes, followed by your narrative. (Each narrative should
include two or three paragraphs. It is possible that a story may include more
than one of the below categories.)
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Quantitative Results – percentage of reductions in TCIR
and/or DART rates; workers compensation savings; # of employees, managers, and
supervisors that received specific safety and health training over the past
year. |
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Anecdotal/Human Interest – stories where the results may
not have been measured numerically but present examples of how the workplace’s
safety and health culture improved (e.g., increased management commitment and
employee involvement). |
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Quote/Testimonial from employees, employers, management,
executive leadership, union officials, OSHA field office staff, etc. |
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Photos of OSP signings, VPP ceremonies, program
participants, etc. If possible, please make sure you provide each person’s name,
title, and organization affiliation in the photo. |
III. Quantitative Data:
If your submission highlights percentage and/or number reductions, please use
the below table and provide data for the past three years, if possible. You do
not need to complete every column – just what relates to your submission.
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*TCIR |
**DART
Rate |
Number of Fatalities |
Dollar Value of Worker Compensation Claims |
Year 1: |
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Year 2: |
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Year 3: |
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3-Year Rate
(Avg.) |
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Bureau of Labor Statistics’ (BLS)
National Average for Most Recent Year Available (Year)*** |
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Percentage Difference between BLS and
Most Recent Year in Program |
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* TCIR:(Total Case Incident Rate) = (# of injuries x 200,000) / total hours
worked
** DART: (Days Away, Restricted, Time away) = (# of lost time injuries x
200,000) / total hours worked
***For the respective industry related to the submission.
Thank you for taking the time to help promote
the value of VPP!