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OSHA’s Office of Partnerships and Recognition (OPR) is seeking for your success stories and best practices to show the positive results and benefits of participating in OSHA Challenge. Once you have completed this form, please email it to your Administrator. A list of Administrators and their contact information may be found by clicking on this link.

I. General Information: Please complete the below table.

Submitted By

Phone #

Origin (Region #)

Name and Location of Organization (Focus of Submission)
       

Industry Description and NAICS Code

  

# employees

 

# of employer/s

  

Date entered Challenge

  

Current Stage of Challenge
(I, II, III, Graduate)

  

 
 

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.
   
 

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.)
 

 

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.
   
 

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).
   
 

Quote/Testimonial from employees, employers, management, executive leadership, union officials, OSHA field office staff, etc.
   
 

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.

 

*TCIR

**DART
Rate

Number of Fatalities

Dollar Value of Worker Compensation Claims

Year 1:

        

Year 2:

        

Year 3:

        
3-Year Rate (Avg.)        
Bureau of Labor Statistics’ (BLS) National Average for Most Recent Year Available (Year)***        
Percentage Difference between BLS and Most Recent Year in Program        

* 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 OSHA Challenge!