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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, OSHAs National Office. To see examples of VPP success stories and best practices on OSHAs 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)
Industry Description and NAICS Code   # employees   # of employer/s  
Date Participant Entered VPP  

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 workplaces 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 persons 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.


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 VPP!