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UTCANJ – OSHA
Construction Industry Safety Partnership
1 Executive Summary
1.1 The goal of this program is to develop a statewide industry partnership between the construction industry, labor and government, that will encourage New Jersey's contractors to improve their safety and health performance, assist them in their efforts, and recognize contractors with exemplary safety and health programs.
1.2 Specifically, the program has two overriding goals:
1.2.2 To accomplish this goal in an environment of cooperation among the participating organizations.
1.4 Expected outcomes of the program include: allowing OSHA to focus resources toward contractors who have ineffective safety and health programs for their employees; developing criteria for a model contractor safety and health program; mentoring of others in the state of New Jersey's construction industry by partnering with member contractors; and making new safety and health materials available to all contractors who are members of this partnership.
1.5 The partnership will provide incentives to participating contractors who voluntarily improve their safety and health performance. Incentives will include special recognition from OSHA, commensurate with their level of safety and health achievement.
1.6 This partnership program is consistent with OSHA's long-range efforts to develop a business/labor/government partnership approach to safety management. The partnership allows for better use of OSHA resources, fosters innovation in safety management, and encourages more participation in the safety process by employees and the New Jersey Heavy-Highway construction community.
1.7 Perhaps most importantly, this program will help create private and public sector incentives for improved safety. Owners may choose contractors who are participants in the partnership and have demonstrated their commitment to safety for their projects.
2 Utility and Transportation Contractors' Association of New Jersey (UTCANJ) – OSHA Construction Industry Safety Partnership (C.I.S.P.)
2.1 Program Expectations
2.2 Employers, Labor and other organizations are encouraged to endorse and participate as signatory partners in the C.I.S.P. They are encouraged for the following reasons:
2.2.2 This agreement provides incentives for construction contractors that voluntarily participate in the C.I.S.P. and demonstrate implementation of effective safety and health programs.
2.2.3 This agreement will not in any way affect employees' exercise of rights under the OSH Act and OSHA regulations including protection from discrimination for exercising such rights.
Utility and Transportation Contractors Association of New Jersey and the United States Department of Labor, Occupational Safety and Health Administration have a history of cooperative efforts, strategic alliances, and partnerships dedicated to improving safety and health among contractors in New Jersey.
UTCANJ and OSHA have worked cooperatively, with other agencies and organizations, to establish the nationally recognized New Jersey Highway Workzone and New Jersey Pilot Silica Partnerships. The UTCANJ continues to work cooperatively in the development of the New Jersey Silica Engineering Control Research Alliance, the first of its kind in the Nation.
UTCANJ and OSHA believe jointly that cooperative efforts, willingness to listen to concerns of interested parties, willingness to learn from previous efforts and efforts to understand each partner's concerns, requirements and philosophy, will benefit the industry, the regulators, and ultimately will provide a safer and healthier work environment for the entire New Jersey heavy, highway, utility, marine and environmental remediation Construction Industry.
The expectations of the Partnership are:
4.1 To reduce by 4% annually the number of injuries and fatalities affecting participant employers, with an emphasis on reducing injuries and fatalities resulting from the four focused construction hazards (falls, struck-by, caught-in\between, and electrocutions).
4.2 Decrease contractors' EMR rates and/or workers compensation costs from the time of application throughout the term of the partnership.
4.3 Increase the implementation of effective contractor safety and health programs.
4.4 Increase accessibility to quality safety and health training and education, thereby raising safety and health awareness for both employees and contractors by:
4.4.2 Providing the OSHA 10-hour Construction Safety & Health course to a minimum of 10 % of all workers per year throughout the term of the partnership.
4.6 Allow OSHA to better focus resources on firms that require increased assistance, rather than firms that have implemented effective, meaningful safety and health programs for their employees.
All parties will be consulted on a continuing basis to assess progress in achieving these goals.
5 UTCANJ Commitment/Role
5.1 Representative(s) from the UTCANJ will administer this program as outlined herein and will serve as the primary safety and health resource, supporting the participating contractors and employees. To fulfill this Partnership, the UTCANJ will also provide the following services:
5.1.2 Provide up-to-date publications, brochures, and other informational materials (from OSHA, OSHA's New Jersey On-Site Consultation Services, and other appropriate organizations) to the UTCANJ Partnership members.
5.1.3 Foster improvement and promotion of worker safety and health among UTCANJ membership by facilitating communications between OSHA and employers.
5.1.4 Assist contractors of all sizes, especially small contractors, in understanding OSHA's requirements and emerging issues impacting workers' safety and health.
5.1.5 Together with Participant Contractors, provide leadership, guidance, and a positive example to other contractors on issues relating to safety and health.
5.1.6 Develop and build written safety and health policies and programs for participating contractors, including emphasis on contractor/employee responsibilities.
5.1.7 Promote construction safety and health excellence through an annual UTCANJ-OSHA Partnership Safety and Health Recognition Program.
5.1.8 Notify OSHA on a regular and recurring basis of the name(s) of contractor(s) that have met the partnership criteria.
5.1.9 Conduct periodic audits to determine the impact and effectiveness of this partnership with OSHA.
6.1 OSHA Incentives For All Platform Level Participant Contractors
6.1.2 To the extent resources allow, OSHA will provide training and technical support to partner contractors to assist them in developing safety and health management systems.
6.1.3 To the extent resources allow, OSHA, through the New Jersey Department of Labor and Workforce Development-OSHA Consultation Program will provide free on-site consultation to those employers who qualify, to assist them in developing safety and health management systems.
6.1.4 Other than Regulatory violations (e.g., 29CFR 1903 and 1904), no penalties will be assessed for other-than-serious violations provided they are abated the same day as the inspection.
6.1.5 Participating contractors will receive the maximum allowable good-faith penalty discount as OSHA policy allows.
6.1.6 Participating contractors will be given a penalty reduction for the "Quick Fix" of violations in accordance with OSHA Directive CPL 2.112.
188.8.131.52 Will be eligible for a 35% discount on penalties, through the established OSHA Region 2 Expedited Informal Settlement Agreement (EISA) policy, instead of the 25% offered to some non-participants.
184.108.40.206 In the event an OSHA inspection does occur, WHITE Platform Level Participant Contractors will be eligible for "Focused" inspection s in accordance with established OSHA policies for Focused Inspections (CPL 2.103, September 26, 1994, FIRM, Chapter II section A.1.b and OSHA Guidance to Compliance Officers for Focused Inspections, August 22, 1994 (Revision 2 (9/20/95)).
220.127.116.11 BLUE Platform Level Participant Contractors within the jurisdiction of the OSHA Area Offices participating in this partnership, will not receive a programmed inspection within the twelve months following their verification inspection. BLUE Platform Level Participant Contractors who are General Contractors will qualify for construction site inspection deferrals if the conditions described in section 7.1.3 are met.
18.104.22.168 During an OSHA inspection of other contractors at a site where a BLUE Platform Level Participant Contractor is not the General Contractor, the BLUE Platform Level Participant Contractor whose program has been verified by an OSHA inspection within the last twelve months will not be included unless the Compliance Officer documents that the participant is responsible for any employee exposures to serious hazards such as fall, struck by; caught in/between or electric hazards.
22.214.171.124 Participants participating for two years or more at the BLUE Platform Level will be encouraged to apply for participation in the OSHA Challenge program or OSHA's VPP Program if the participant so desires.
6.5.2 OSHA agrees that a copy of each non-formal complaint/referral related to work sites of participating contractors will be forwarded by fax to the UTCANJ and the appropriate contractor.
126.96.36.199 A written response outlining the investigation findings and any corrective action taken will be faxed to OSHA and UTCANJ within two workdays.
188.8.131.52 Failure to meet these time frames will place the complaint/referral beyond the scope of this partnership and OSHA will respond as it would any complaint/referral of a similar nature.
For employers with multiple worksites, OSHA will conduct verification inspections at at least 10% of participants' worksites with a minimum of one inspection in the event the employer has less than 10 worksites. The minimum number of On-Site verification inspections needed for verification shall be based on the number of active worksites at which the partner currently performs work within the UTCANJ jurisdictional boundary:
OSHA will conduct verification inspections as indicated in the table below:
*In the event the participating contractor successfully undergoes eight (8) enforcement verification inspections and OSHA determines that the contractor is effectively implementing their safety and health management system at all locations and no serious hazards are observed, OSHA may opt to discontinue conducting further verification inspections and recommend the contractor be accepted into the partnership at the Blue Level.
OSHA understands that unannounced inspections may result in the absence of key personnel important to a full and fair evaluation. OSHA will cooperate to allow the participant to have such personnel participate in the inspection(s). Additionally, OSHA will endeavor to conduct its verification inspections within 30 workdays of acceptance by the committee of a Blue Level Participant Contractor. Upon completion of the inspection(s), OSHA will either accept or reject the contractor's application for inspection deferral and participation at the BLUE Inspection Defferal Level.
Blue Level partners must re-apply and receive on-site verification inspections annually to maintain partnership with OSHA and to be eligible for partnership benefits.
6.8.2 Blue Level partners must re-apply and receive on-site verification inspections annually to maintain partnership with OSHA and to be eligible for partnership incentives.
6.8.3 Prior to qualifying for full site inspection deferrals where the participating BLUE Platform Level Participant Contractor is the General contractor at a site, in addition to the requirements in 6.8.1 above:
184.108.40.206 The participating contractor requires each subcontractor on site to have implemented a written comprehensive site-specific safety and health program.
7 UTCA-OSHA Partnership Advisory Committee Commitment/Role
7.1 The UTCANJ and OSHA will form a UTCANJ-OSHA Partnership Advisory Committee (PAC) consisting of representatives from both the UTCANJ and OSHA. This role of this committee is to oversee partnership progress and activities, make recommendations of changes for partnership improvement and to take disciplinary action against participants if warranted. The PAC will meet quarterly to assess the progress of the partnership, discuss partnership activities and determine and schedule future partnership activities.
7.2 If necessary, the UTCANJ-OSHA Partnership Advisory Committee will terminate contractors from the partnership, if findings indicate unacceptable performance or submission of falsified application documentation. (Note: At the discretion of the UTCANJ-OSHA Partnership Advisory Committee, a participating contractor may be permitted to correct deficiencies within 30 days of notification and apply to the UTCANJ Partnership Advisory Committee for continued recognition as a partner in good standing before termination would take effect.)
7.3 The UTCANJ-OSHA Partnership Advisory Committee has the discretion to veto contractors from participating for just cause. OSHA also has the discretion to unilaterally veto contractors from participating in this Partnership, for just cause, upon providing notification and explanation to the UTCANJ-OSHA Partnership Advisory Committee.
8 Participating Contractor Commitment / Role
The UTCANJ partnership is a Multi-Platform Programs consisting of three levels or classifications based on each participant's level of achievement relating to safety and health. The three participant levels of the UTCANJ Partnership program: RED, WHITE and BLUE.
8.1 Eligibility Requirements for the Multi-Platform Program: RED, WHITE and BLUE. Listed below you will find the eligibility requirements for each phase of the partnering program: RED, WHITE and BLUE Platforms:
220.127.116.11 Conduct weekly employee safety meetings;
18.104.22.168 Conduct and document self-audits under direction of a competent person*
Competent person is defined by OSHA in 29CFR1926.32(f): A "competent person" means one who is capable of identifying existing and predicable hazards in the surroundings or working conditions which are unsanitary, hazardous, or dangerous to employees, and who has the authorization to take prompt corrective measures to eliminate them.
22.214.171.124 Achieve a score of 94-108 points on their self-audit checklist.
126.96.36.199 Assign at least one competent person, who has had training equivalent to the OSHA 30-Hour Construction Safety and Health Outreach program, and who has the responsibility for employee safety and health;
188.8.131.52 Ensure designated safety personnel at each site conduct and document daily inspections to identify and correct safety and health hazards;
184.108.40.206 Conduct an orientation of all new employees on the contractor's safety and health programs and show evidence of effective employee training for avoidance of hazards specific to the contractor's work site(s);
220.127.116.11 Conduct weekly employee safety meetings which, to the extent possible, include employee representatives;
18.104.22.168 Show evidence of employee involvement in the safety and health program; for example, participation in self-audits, site inspections, job hazard analyses, safety and health program reviews, safety training, and accident investigations;
22.214.171.124 Provide all field construction supervisory personnel with training equivalent to the OSHA 10-Hour Construction Safety training course;
126.96.36.199 Maintain a Lost Workday Incidence Rate at or below the national average for their specific Standard Industrial Classification (SIC) as per the Bureau of Labor Statistics;
188.8.131.52 Achieve a score of 109-125 from Part III of the Application Packet – Self Evaluation scoring at least half of the points available for each section.
184.108.40.206 Assign a minimum of one competent person who will administer the contractor's safety and health program. This person must have attended the OSHA 500 Train the Trainer Course for the Construction Industry or equivalent within the previous four years;
220.127.116.11 Designated site safety personnel, through training and experience, must be able to recognize hazards associated with various phases of construction and shall have the authority to take prompt corrective action. Training curriculum equivalent to the OSHA 30-Hour Construction Safety and Health Training Course will be deemed satisfactory;
18.104.22.168 Implement a 6-foot Fall Protection Policy or a 100% Fall Protection Policy at the prescribed heights in accordance with specific OSHA Regulations;
22.214.171.124 Have no Willful violations within the last three years;
126.96.36.199 Have no Repeated Serious violations within the last three years;
188.8.131.52 Have no fatalities or catastrophes within the past three years that resulted in Serious, Willful or Repeat citations related to the incident;
184.108.40.206 Maintain an Experience Modification Rate at or below a 1.00.
220.127.116.11 Achieve a score of 126-150 from Part III of the Application Packet for Self Evaluation scoring at least half of the points available for each section.
In order to qualify for a complete site inspection deferral, the participant must be the General Contractor and assume a controlling contractor's role:
18.104.22.168 General Contractors shall involve subcontractors (and subcontractors of subcontractors) in identification and correction of safety and health hazards and concerns. General Contractors shall assure that root causes of fatalities and disabling injuries are identified and preventative action taken;
22.214.171.124 General Contractors shall perform and document comprehensive safety and health audits of all subcontractors. Comprehensive audits shall address all aspects of all subcontractors' safety and health management programs including the extend of employee participation;
126.96.36.199 General Contractors shall establish an effective policy for dealing with non-complying contractors. Hazards will be documented including time, dates, contractor name and representative, and what action was taken to gain compliance. The general contractor must ensure that hazards with a high probability of causing serious injury are immediately corrected and action taken to ensure the condition does not recur;
188.8.131.52 General Contractors agree to require that subcontractor's management officials participate during safety meetings and site inspections;
184.108.40.206 General Contractors shall have at least one on-site safety coordinator with his/her only duties being safety and health compliance.
8.2.2 All applicants shall:
220.127.116.11 The first part will request company information.
18.104.22.168 The second part will request safety statistical data from the summary of the contractor's OSHA 200 log (for the year 2000 only and OSHA 300 log for calendar years beginning 2001) and 300 logs for the past three calendar years. If the employer has not been in business for the past three calendar years it may submit OSHA 300 data for the calendar years they have been in business. All applicants must have been in business long enough to have complete OSHA 300 data for at least one full calendar year.
22.214.171.124 The third part will be a self-audit checklist, related to the company's written safety program.
126.96.36.199 The fourth section of the application packet is to document that employee participation is an integral part of the employer's comprehensive safety and health management system.
188.8.131.52.2 Applicant contractors who do not have agreements with recognized labor groups for work conducted under this partnership must certify that employee participation is an integral part of their safety and health management system by completing Part IV-B of the application packet.
RED Level: 94-108 points
WHITE Level: 109-125 points
BLUE Level: 126-150 points
184.108.40.206 Additionally, each participating contractors will supply a list of pending and active sites annually to the UTCANJ. The UTCANJ will forward the BLUE Platform Level Participant Contractors' site locations to OSHA.
220.127.116.11 Review applications submitted by perspective Platform Participants and determine their eligibility for the program. These applications shall be reviewed by the UTCANJ-OSHA Partnership Advisory Committee.
18.104.22.168 Termination of a participant's current status and re-designation to the appropriate status, if any, in the even the UTCANJ discovers information that significantly contradicts the representations made by the participant in its application.
22.214.171.124 Recommend program improvements to Platform Participant Contractors.
126.96.36.199 Once the participant has been identified by the UTCANJ as a BLUE Platform Level Participant Contractor, the UTCANJ will provide to OSHA for each participant:
188.8.131.52.2 A copy of the applicant's self-audit/evaluation forms used by the UTCANJ to verify BLUE status.
184.108.40.206.3 A list of active sites for BLUE Platform Level Participant Contractors only. This list is not needed by the UTCANJ-OSHA Partnership Advisory Committee for the application review process and therefore will not be provided to the committee. The list will be provided directly to OSHA by the UTCANJ upon acceptance of the employer as a potential BLUE Platform Level Participant by the committee prior to the OSHA on-site verification inspection.
8.4.2 RED and WHITE participants wishing to elevate to the next level (RED to WHITE or WHITE to BLUE) must re-apply.
9.1 Information submitted by contractors as part of the application or renewal process, as well as obtained by virtue of the contractor's application or participation in the program, will be held in strict confidence within the confines of the partnership program. Information will be used only to measure the effectiveness of the partnership program.
10 Partnership Evaluation
10.1 It is the responsibility of the UTCANJ designated representative to gather required participant data to evaluate the overall success of the program. Aggregated data will be reported to the OSHA Area Directors during the quarterly meetings discussed in Sections 6.1.1 and 7 above.
10.1.1.2 The number of 10 or 30 hour newly trained UTCANJ member's employees within the State of NJ during the previous year;
10.1.1.3 The number of supervisory employees of participating members trained to the OSHA 30hr level;
10.1.1.4 The number of participating UTCANJ members who have established written safety and health programs;
10.1.1.5 OSHA 300 data from all participating contractors at all levels. This data shall included the aggregate totals for all OSHA Log columns for each calendar year as well as the aggregate total number of hours worked for each calendar year;
10.1.1.6 Contractor Experience Modification Rate (EMR) aggregate average.
10.3 Participant aggregate Lost Workday Incidence Rates and Fatality Rates will be compared with participant baselines and BLS published data to determine if the goals have been met.
10.4 Participant incidence of injuries resulting fro the four leading construction hazards (falls, struck-by & caught between, excavations and electrocutions) will be measured and compared against the baseline established in the first year of the partnership.
10.5 If all signatory partners agree, partnership criteria may be revised annually based on recommendations for continuous improvement.
11 Contractor Termination
11.1 A contractor's participation will be referred to the UTCANJ-OSHA Partnership Advisory Committee for termination or reduction in platform level by the UTCANJ and OSHA will be informed, if one or more of the following occurs:
11.1.2 The contractor has falsified information on the application or supporting records;
11.1.3 If the contractor is a BLUE platform participant, the contractor's Lost Workday Incidence Rate rises above the most current national average for the SIC or NAIC classification to which the contactor belongs;
11.1.4 The contractor takes other actions inconsistent with the goals and intent of this program.
11.2.2 The notice will include an explanation of the reasons for termination;
11.2.3 The contractor will have an opportunity to reply to the written notice within a period of thirty (30) days;
11.2.4 The contractor will have the right to appear before the UTCANJ-OSHA Partnership Advisory Committee.
11.4 Any contractor may terminate participation in the program at any time.
12 Contractor/Employee Rights
12.1 As an integral part of an effective safety and health program, the ability of employees to exercise rights guaranteed under the OSH Act and other applicable regulations, (such as, but not limited to, the right to file a safety and health complaint and the right to information collected pursuant to OSHA requirements) will not be infringed.
12.2 Contractors retain all rights guaranteed under the OSH Act, including but not limited to the right to appeal or contest violations issued by OSHA.
12.3 Routine employee involvement in the day-to-day implementation of worksite safety and health programs is to be assures, including employee participation in contractor self-audits, site inspections, job hazard analysis, safety and health program reviews and near miss investigations.
13 Termination or amendment of this Partnership
13.1 This agreement will terminate 3 years from the date of signing. If any signatory of this agreement wishes to terminate their participation prior to the established termination date, the agreement will terminate upon receiving a written notice of the intent to withdraw from either signatory. However, individual BLUE participants seeking deferral from programmed inspections must have their programs verified through an on-site OSHA verification inspection each year to remain eligible for OSHA incentives.
13.2 OSHA may terminate the partnership with any individual contractor at any time via notification in writing to the management and labor representatives. However, the observation by OSHA from any public place of an imminent danger situation resulting in the issuance of a citation may result in the termination of any partnership with that contactor. OSHA's final decision on the status of the partnership with this contractor will take into account the recommendations of UTCANJ and the UTCANJ-OSHA PAC.
13.3 For non-signatory participants of this strategic partnership, OSHA may terminate the participant's involvement at any time with written notice. Additionally, any participant may withdraw their participation from the strategic partnership at any time with a written notice of the intent to withdraw to OSHA.
13.4 The UTCANJ-OSHA Partnership Advisory Committee may terminate an individual participant contractor from the partnership if the contractor fails to meet the qualifications or otherwise violates the terms and conditions of this Partnership.
13.5 Any party may propose modification or amendment to this Partnership subject to concurrence by all parties to the Partnership.
13.6 If OSHA chooses to withdraw its participation in the partnership, the entire agreement is terminated. Either party may also propose modification or amendment of the agreement.
14 Partnership Participant Annual Renewal.
14.1 Once accepted into partnership by all parties, contractor incentives will be effective for one year. Contractors must re-apply annually to maintain status in the partnership program. This re-application and acceptance process will be identical to the process stated in the above agreement and is based on the conditions set forth in this program. Contractors seeking re-application must do so sixty days prior to the expiration date of their current partnership agreement. Failure to re-apply within the sixty-day period will forfeit all incentives until all requirements of the above partnership are fulfilled and accepted by the UTCANJ, the UTCANJ-OSHA Partnership Advisory Committee and OSHA.
14.2 It is understood that BLUE level participants who seek deferral from OSHA planned inspections must apply for deferral annually.
Signed on this 7th day of March, 2008
This program was designed in conjunction with management, trade labor and OSHA representation all working together to create a program which will mutually benefit the membership of the UTCANJ, all corresponding trades which work with the UTCANJ, and the Occupational Safety and Health Administration.
The goals of this program are:
In addition to the above, OSHA will remove BLUE Level contractors from the programmed inspection list for one year. All participants must re-apply annually to maintain status in the program.
An annual awards program will also be conducted, sponsored by the UTCANJ and OSHA, to acknowledge publicly those who participate in this program. Awards will be judged by the UTCANJ-OSHA Partnership Advisory Committee and given to members in the following categories:
1) Excellent Safety Performance 2) Most Improved Contractor 3) Safety Mentor of the Year
This is an exciting new venture for New Jersey=s construction industry. It promises to be an effective new communication tool between the membership of the UTCANJ, LABOR and OSHA in which all participants will benefit.
If you have any questions, please call the UTCANJ office at 732-292-4300.
The UTCANJ, LABOR and OSHA sincerely appreciate your interest and participation in this program.
All applicants must complete the following application to considered for participation in the partnership.
____Complete the UTCANJ-OSHA Construction Industry Safety Partnership Application Packet:
____Part I - Company Information
____Part II - Statistical Data
____Part III - Self – Evaluation
____Part IV – Labor Support / Involvement Documentation
____Attach a copy of your 300 for the previous three calendar years
____Attach a list of your current active job sites in New Jersey (BLUE Level Applicants only)
____Make sure all forms are signed
____Mail completed package to the Utility and Transportation Contractors' Association of New Jersey
NOTE: All application packets must be complete upon submission. Incomplete packets will be returned by UTCANJ unapproved.
Part I - Company Information
All companies wishing to participate in the UTCANJ-OSHA Construction Industry Safety Partnership must submit a completed application.
New Application OR Re-application (required annually to sustain participation)
State:_______ Zip Code:_______________
Phone Number: ( )____________ Fax: ( )____________ E-mail:__________________
Please supply the following information:
Number of employees:________ (Include all field and office personnel)
Number of Safety, Health and Environmental Personnel within company: Full-Time:_____ Part-Time:_____
Do you subcontract safety responsibilities to an outside firm? Yes No
(If yes, please supply the following information)
Name of Consultant:______________________________________________________
State:_______ Zip Code:_______________
Phone Number: ( )____________ Fax: ( )____________ E-mail:__________________
Do you have a substance abuse program? (If yes, please provide copy with application.) Yes No
Number of Recordable Injuries/Illnesses in current and past two calendar years:___________
Have you, or any of your sub contractors had any fatalities in the past 3 years? Yes No
Number of Fatalities:
If so, did you receive OSHA citations? Yes No
What were the citations you received?
I have supplied the above information to the best of my ability and have not knowingly made any false representation of the above stated company applying for enrollment Into the UTCANJ-OSHA Construction Industry Safety Partnership.
Part II - Statistical Data
1. _______ Average Number of Employees - (an average number of persons on your payroll for each of the previous calendar years)
2. _______ Total Hours Worked - (the total of all hours worked for each of the previous three calendar years by all employees in the company, including office personnel, not including hours for vacation or sick leave).
Number of Work-Related Injury or Illness Cases*
a._______ Total number of work-related deaths (report all deaths which were the result of any injury or occupational illness). See OSHA Log Form 300, Column G (OSHA Log Form 200 Columns 1+8).
b._______ Total number of recordable cases with days away from work, days of restricted work activity, or job transfer (DART). See OSHA Log Form 300, Sum of Columns H+I (OSHA Log Form 200 Sum of Columns 2+9).
c._______ Total number of non-fatal cases without lost workdays, restricted work activity, or job transfer. See OSHA Log Form 300, Column J (OSHA Log Form 200 Columns 6+13).
d._______ Total number of recordable cases with days away from work. See OSHA Log Form 300 Column H.
3. _______ Total Number of recordable Cases (a+b+c).
Number of Lost Workdays Due to Work Related Injuries or Illnesses*
a._______ Total number of workdays lost (Days away from work, do not include day of injury). See OSHA Log Form 300, Column L (OSHA Log Form 200 Sum of Columns 4+11)
b._______ Total number of, days of restricted work activity, or job transfer. See OSHA Log Form 300, Column K (OSHA Log Form 200 Sum of Columns 5+12).
4. Total Number of Workdays Lost (a+b).
*NOTE: If you are not required to maintain OSHA Log Form 300 (or OSHA Log Form 200 prior to calendar year 2001), refer to your insurance records to obtain the information requested above.
Contractor Experience Modification Rate:______________
Completed by (print name):__________________________________________________________
Part III - Self Evaluation
Directions: Place a check next to all items which apply to your program. Each checked item represents one point unless otherwise specified. Please write the number of points for each section into subtotal column. Once complete, add subtotals to get your total score. Your total score will help you determine what level your company should apply for in the UTCANJ-OSHA Construction Industry Safety Partnership Program.
Company Name: _______________________________________________________
A. SAFETY & HEALTH PROGRAM (15 points possible)
B. MANAGEMENT COMMITMENT (6 points possible)
C. SUPERVISOR MEETINGS (5.5 points possible)
D. Contractor RESPONSIBILITY (5.5 points possible)
E. EMPLOYEE PARTICIPATION (7 points possible)
F. PROJECT PRE-PLANNING (7 points possible)
G. ANNUAL SAFETY BUDGET (4 points possible)
H. GOALS OF SAFETY PROGRAM (7 points possible)
I. SAFETY ORIENTATION (11 points possible)
J. SAFETY TRAINING AND EDUCATION (15 points possible)
K. RULES and REGULATIONS (6 points possible)
L. SUPERVISOR/PROJECT MANAGER TRAINING (13 points possible)
M. TOOL BOX TALKS (9.5 points possible)
N. PERSONAL PROTECTIVE EQUIPMENT AND ITS USE (9 points possible)
O. JOBSITE INSPECTIONS/AUDITS (11.5 points possible)
P. ACCIDENT INVESTIGATION (7 points possible)
Q. RECORDKEEPING REQUIREMENTS (11 points possible)
I have read, understand and answered the above questions to the best of my ability. I have not knowingly made any false representation of this company applying for the UTCANJ-OSHA Construction Industry Safety Partnership.
City:_______________________________ State: ______________ Zip:__________________________
Phone Number:_____________________ Fax Number:______________ E-mail:__________________
Name of person completing Self Evaluation:
Part IV-A – Written Documentation of Organized Labor Support.
Directions: To participate in the Partnership, written documentation of organized labor support is required for all applicants that have agreements with organized labor. All applicants who do not have agreements with organized labor must complete Part IV-B of this part of the application only. Documentation of labor support must be signed by a union official who is at least at the BA level. Applicants may either obtain separate letters of support from each Union from which it employs labor in New Jersey, or it may have each union complete a copy of this form. Written support is required from all organized labor groups applicants utilize in New Jersey for this application to be considered complete.
The undersigned labor group fully supports, or at a minimum, is not opposed to, the participation of ________________________________________ (name of company) in the UTCANJ-OSHA Construction Industry Safety Partnership and we agree that this applicant includes employee involvement as part of its overall safety and health management system. We fully understand support of the above-mentioned employer's participation in this partnership, in no way, diminishes any employees' rights under the Occupational Safety and Health Act (e.g., employees' right to file complaints).
Name of Organized Labor Group__________________________________________________________________
Name of Authorized representative________________________________________________________________
Signature of Authorized representative_____________________________________________________________
Title of Authorized Representative_________________________________________________________________
Part IV-B – Written Documentation of Employee Involvement for applicants who do not have agreements with organized labor groups.
Directions: To participate in the Partnership, written certification of employee involvement in the applicant's safety and health management system is required. All applicants do have agreements with organized labor must complete Part IV-A of this part of the application only. The following certification must be executed by an officer representing the applicant contractor for the application to be considered complete.
Written certification of employee participation in the applicant's safety and health management system.
The undersigned applicant contractor representative certifies that employee involvement is an integral part of the applicant's safety and health management system. Furthermore, the aforementioned employee involvement meets or exceeds the employee involvement requirements outlined in Section 7 of this partnership for the level of participation the applicant is applying for.
Name of applicant contractor__________________________________________________________________
Name of Authorized Representative____________________________________________________________
Signature of authorized representative__________________________________________________________
Title of authorized representative_______________________________________________________________