<< Back to OSHA Strategic Partnership Program
OSHA Success Story and Best Practice Submission Template
OSHA’s Office of Partnerships and Recognition (OPR) is seeking your Voluntary
Protection Programs (VPP) and/or OSHA Strategic Partnership Program (OSPP)
success stories and best practices. These submissions are vital to conveying the
positive impact that these cooperative programs have on workplace safety and
health. Once you have completed this form, please email it to your designated
National Office Lead within OPR. To see examples of VPP and OSPP success stories
and best practices on OSHA’s website, go to
OSHA Voluntary Protection Programs (VPP) and
OSHA Strategic Partnership Program (OSPP).
I. General Information: Please
check the appropriate box related to your submission and provide the information
below.
|
VPP |
|
Partnership |
Date Submitted: ____________________ |
Submitted By |
Phone # |
Origin (Region #) |
Name and Location of Organization (Focus of
Submission) |
|
|
|
|
Industry Description and NAICS Code |
|
#
employees |
|
# of employer/s |
|
Date Participant Entered VPP or Date OSP Agreement was signed: |
|
|
|
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 Results 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, and Transferred) Rate = (# 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 and OSPP!
|