US Dept of Labor

Occupational Safety & Health AdministrationWe Can Help

OSHA Challenge Success Story and Best Practice Submission

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 at OSHA Challenge Administrators and Current Participants by Region

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)  

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.)

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!

OSHA Challenge Success Story and Best Practice Submission

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 at OSHA Challenge Administrators and Current Participants by Region

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)  

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.)

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!


*Accessibility Assistance: Contact OSHA's Directorate of Cooperative and State Programs at (202) 693-2200 for assistance accessing PDF materials.

All other documents, that are not PDF materials or formatted for the web, are available as Microsoft Office® formats and videos and are noted accordingly. If additional assistance is needed with reading, reviewing or accessing these documents or any figures and illustrations, please also contact OSHA's Directorate of Cooperative and State Programs at (202) 693-2200.

**eBooks - EPUB is the most common format for e-Books. If you use a Sony Reader, a Nook, or an iPad you can download the EPUB file format. If you use a Kindle, you can download the MOBI file format.

Back to Top

Thank You for Visiting Our Website

You are exiting the Department of Labor’s Web server.

The Department of Labor does not endorse, takes no responsibility for, and exercises no control over the linked organization or its views, or contents, nor does it vouch for the accuracy or accessibility of the information contained on the destination server. The Department of Labor also cannot authorize the use of copyrighted materials contained in linked Web sites. Users must request such authorization from the sponsor of the linked Web site. Thank you for visiting our site. Please click the button below to continue.

Close