Partnership #505 - Renewal Agreement - July 25, 2013


Associated Builders and Contractors, Inc. Occupational Safety and Health Administration

OSHA Strategic Partnership Agreement
between
Associated Builders and Contractors, Inc
Keystone Chapter
and the
U.S. Department of Labor
Occupational Safety and Health Administration
Harrisburg Area Office


  1. PARTNERS

    The partners to the Agreement are:

    • The Keystone Chapter of the Associated Builders and Contractors, Inc. (here forth referred to as ABC Keystone). ABC Keystone is comprised of the following counties: Adams, Berks, a portion of Chester, Cumberland, Dauphin, Franklin, Perry, Lancaster, Lebanon, a portion of Schuylkill, and York.
    • The Harrisburg Area Office will be the lead office coordinating this Partnership with support from the Allentown, Philadelphia and Wilkes-Barre Area Offices of the U.S. Department of Labor, Occupational Safety and Health Administration (here forth referred to as OSHA). The Allentown Area Office has jurisdiction over the following counties: Bucks, Lehigh, Montgomery and Northampton. The Harrisburg Area Office has jurisdiction over the following counties: Adams, Berks, Centre, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry and York. The Philadelphia Area Office has jurisdiction over the following counties: Chester, Delaware, Philadelphia. The Wilkes-Barre Area Office has jurisdiction over the following counties: Bradford, Carbon, Clinton, Lackawanna, Luzerne, Columbia, Lycoming, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne and Wyoming.
    • Partnership Members are employers who recognize the importance of providing a safety and healthful work environment for their employees and wish to participate in the ABC Keystone and OSHA partnership agreement by participating in the Safety Training and Evaluation Process (STEP) program and by signing the Agreement of Participating Member form listed at Appendix B to this document.
  2. PURPOSE and SCOPE

    ABC Keystone and OSHA mutually recognize the importance of providing a safe and healthful work environment for those employees working in Pennsylvania. To advance our mutual goal, we strongly agree on the need to develop partnerships that foster mutual trust and respect for the respective roles of each organization in the construction safety process. We recognize and embrace the responsibilities inherent in those roles. We are committed to work as partners to achieve construction workplace safety and health through shared strategies and objectives.

    This agreement encourages contractors to voluntarily participate in the National ABC STEP program and implement effective safety and health programs. The STEP program is an objective tool that contractor members use to evaluate and strengthen their safety programs, policies and procedures. For the most recent version of the STEP application, go on the ABC National's website, http://www.abc.org/en-us/safety/step.aspx. ABC National and ABC Keystone recognize participants based on their development and enactment of safety programs, policies and procedures. The five recognition levels are Bronze, Silver, Gold, Platinum and Diamond. See Appendix A for a detailed description of the STEP program.

  3. PARTICIPATION GOALS/STRATEGIES/MEASURES

    ABC Keystone and OSHA will work in partnership to accomplish the following goals:

    • Promote and foster the dialogue regarding enhancing organization safety performance through the implementation of health and safety management systems. The audit team will review partnership member self-reported STEP scores and compare them to the STEP scores of members selected for non-enforcement verification audits.

      Strategy - Annually conduct 4 OSHA ABC Keystone Partnership sponsored seminars to educate and train Partner Members on what a management system is, the potential value and benefits of a management system, and strategies for implementation.

      Measure - Number of seminars have been conducted, topics to include information on safety management systems, including the STEP program or other safety related topics that will strengthen the company's overall safety program.

      • Demonstrate continuous improvement of the aggregate Partnership Members' Total Case Incident Rate (TCIR) and Days Away Restricted or Transfer Rate (DART). Partnership Member rates as a whole will be compared to the national average listed in the Bureau of Labor Statistics (BLS).

        Strategy - Attend and participate in ABC events where injury reduction strategies are discussed, best practices are shared and specific questions and issues can be addressed.

        Measure - TCIR and DART rate comparisons.

        • Increase Partnership Member participation at ABC Keystone Partnership sponsored safety events.

          Strategy - Require a minimum level of participation by all Partnership Members at ABC Keystone OSHA Partnership sponsored safety events in order to remain in the Partnership.

          Measure - Participants must attend at least three quarterly Safety Forums/Partnership Meetings and attend additional 3 safety events annually. Events include: attendance at the ABC Keystone Safety Committee meetings (which normally are held on the third Tuesday of each month) or any ABC Keystone sponsored safety class (any topic) during the STEP year. If another ABC Chapter sponsored class is utilized to fulfill this requirement, sufficient documentation must be provided to the ABC Keystone for tracking and reporting. An on-site non-enforcement verification inspection may be substituted for 1 of the 3 required partnership seminars.

          • Increase the number of ABC Keystone members who participate in STEP.

            Strategy - Demonstrate the value of STEP by showing better safety performance among STEP participants. Offer safety seminars and other safety activities that are of high quality and value to participants.

            Measure - Number of participants will be recorded in the annual STEP applications.

          • PARTNER ROLES AND RESPONSIBILITIES
            • ABC Keystone and OSHA agree to work in partnership to improve safety and health performance at participating companies.

            ABC Keystone agrees to:

            • Distribute the STEP application, information regarding this partnership and a written opportunity to participate in this partnership.
            • Inform OSHA of those companies participating in the partnership, along with their level of recognition (Bronze, Silver, Gold, Platinum or Diamond). Partnership Members will be required to complete an Appendix B, "Agreement of Participation" and Appendix C, "Focus Four Injury and Training Data Collection" and submit them through the ABC to the Harrisburg Area OSHA office to participate in the Partnership.
            • Provide OSHA with the worksite locations for Partnership Members to facilitate the onsite non-enforcement verification(s).
            • Share baseline and ongoing injury and illness measurement data with OSHA.
            • Meet with OSHA quarterly to discuss mutual partnership commitments, mentoring, issues and implementation and best practices in construction safety.
            • Share and post best practices in construction safety on ABC or ABC Keystone web sites, especially as they relate to correcting the four focused construction hazards and improving STEP award levels. The focused four construction hazards are electrocution, falls, struck-by and caught-in mishaps. Any Partnership Member that has been cited by OSHA within the past three (3) years for violations classified as "willful", "repeat" or "high gravity serious" will be excluded.

            OSHA agrees to:

            • Work cooperatively with ABC Keystone to provide safety and health information, technical assistance, and training to Partnership Members in order to facilitate improvements in safety and health management systems, as resources permit.
            • Work with ABC Keystone to recommend program improvements to individual Bronze, Silver, Gold, Platinum and Diamond STEP Applicants.
            • Ensure that the affected OSHA staff, including the Compliance Safety and Health Officers (CSHOs), are familiar with the requirements and objectives of this partnership.
            • Maintain and disseminate to OSHA field staff up-to-date information about participants and their STEP award levels.
            • Participate in conferences, committee meetings and/or other professional functions.
            • Recognize Partnership Member companies on OSHA's public web site.(updated April 2013)
            • Post best practices in construction safety on OSHA's public web site, especially as they relate to correcting the four focused construction hazards and improving STEP award levels.
            • OSHA reserves the right to exclude or withdraw recognition to any partnership companies who do not show good faith or follow the terms of the agreement.

            OSHA Partnership Member employers agree to:

            • Complete and submit the Safety Training and Evaluation Process (STEP) program application annually.
            • Complete, sign and submit to the ABC Keystone the "Agreement of Participation" (Appendix B).
            • Complete and submit the "Focus Four Injury and Training Data Collection Sheet" (Appendix C) annually.
            • Attend at least three quarterly Forums/Partnership meetings. The forums/partnership meetings may be held at different locations, to provide more opportunities to participate and greater flexibility with work schedules and geographical location.
            • Attend at least three other safety events, annually. These events can be attendance at the ABC Keystone Safety Committee meetings, which normally are held on the third Tuesday of each month or any ABC chapter or Keystone sponsored safety class during the STEP year. If another ABC Chapter sponsored class is utilized to fulfill this requirement, sufficient documentation must be provided to the ABC Keystone for tracking and reporting.
            • Withdraw from this agreement if the Partnership Member fails to meet these requirements. This action will occur after consultation with the Partnership Steering Committee.

            The OSHA Partnership Steering Committee will:

            • Be comprised of representatives from the ABC Keystone Chapter, Partnership Members (usually) and the OSHA Harrisburg Area Office.
            • Will meet quarterly and oversee the activities of this partnership
          • VERIFICATION

            Annually, an audit team will conduct onsite non-enforcement verification(s) of 10% of the OSHA ABC Keystone partnership member companies. The audit team will consist of an OSHA Compliance Assistance Specialist (CAS), an ABC Keystone Chapter Representative, and 1 partnership member who is not being audited. They will evaluate the company's implementation of its safety and health management system using National ABC's STEP criteria and observe the site to see if the partnership member is controlling hazards on the job-site. Emphasis will be placed on the top four causes of construction injuries: electrocution, falls, struck-by and caught-in mishaps. Sites will be selected by the OSHA. The partnership member shall make every effort to immediately correct identified hazards prior to OSHA exiting the site. If OSHA personnel identify hazards that site management refuses to correct, OSHA will make a referral for an enforcement inspection.

            Annually, all Partnership Members will be placed in a pool for random selection. If an employer had received an OSHA onsite non-enforcement verification audit in the preceding year, the employer's name will be withdrawn and a new employer will be selected. No Partnership Member employer will be selected for an OSHA verification audit in two consecutive years. The annual report will serve as a means of tracking which Partnership Members will be ineligible for a non-enforcement verification audit, because they received one the previous year.

          • PARTNERSHIP MANAGEMENT
            • ABC Keystone will forward the names of those companies who have elected to participate in this partnership, along with their STEP award level and North American Industrial Classification System (NAICS) code to OSHA's Harrisburg Area Office. The Area Office will forward partnership member names to the OSHA Regional Office to coordinate recognition of partnership members on OSHA's public web site.
            • ABC Keystone will provide OSHA with copies of each participating member's Agreement of Participation (Appendix B).
            • ABC Keystone will share with OSHA the necessary data to calculate the TCIR and DART rate for the baseline years and each subsequent year for the annual evaluation of this partnership.
            • The Partnership Steering Committee will meet quarterly to review partnership issues, mentoring activities, and TCIR and DART rates and the injury and illness reports of participating members. The Partnership Steering Committee will make recommendations and share best practices to improve participants' occupational safety and health programs.
          • EMPLOYEE AND EMPLOYER RIGHTS AND RESPONSIBILITIES

            This partnership does not preclude employees and/or employers from exercising any right provided under the OSH Act (or, for federal employees, 29 CFR 1960), nor does it abrogate any responsibility to comply with rules and regulations adopted pursuant to the Act.

          • TERMINATION OF PARTNERSHIP

            This agreement will terminate three years from the date the partnership is signed. If either OSHA or ABC Keystone wishes to withdraw 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.

            Participating members may withdraw from this agreement at any time upon submission and receipt of a written notice of intent to withdraw from this partnership agreement. Submission of withdrawal must be sent to the ABC-Keystone Chapter and the OSHA Harrisburg Area Office.

          • EVALUATION

            The Partnership Steering Committee (defined in section IV) will prepare an annual evaluation of the partnership using Appendix D. The evaluation will review the implementation of the agreement and will include a discussion of how the goals were met and any changes that need to be made to achieve its stated goals and objectives.

            ABC Keystone is responsible for gathering the necessary data. Participating members' aggregate TCIR and DART rate will be compared with National BLS published data for the industry and against the partnership's previous year's data.

          • Paperwork Reduction Act

            Paperwork Reduction Act Notice Form Approved MB# 1218-0244 expires 06-30-2015. Public reporting burden for the time needed to develop the Partnership requirements, craft agreement language, and conduct an internal review process is estimated to be an average of 11 burden hours per respondent.

          • SIGNATORIES

            All undersigned Parties mutually agree to the terms and conditions of this document and commencement of this Partnership Agreement.


          • John Zimmer
          • President & CEO
          • Associated Builders and Contractors, Inc.
          • Keystone Chapter

          Date

          • Kevin G. Kilp
          • Area Director
          • USDOL/OSHA
          • Harrisburg Area Office (Lead Office)

          Date

          • Barry Miller
          • Chairman of the Board
          • Associated Builders and Contractors, Inc.
          • Keystone Chapter

          Date

          • Domenic Salvatore
          • Area Director
          • USDOL/OSHA
          • Philadelphia Area Office

          Date

          • Jean Kulp
          • Area Director
          • USDOL/OSHA
          • Allentown Area Office

          Date

          • Mark Stelmack
          • Area Director
          • USDOL/OSHA
          • Wilkes-Barre Area Office

          Date
          APPENDIX A - The ABC STEP Program
          1. Program
            1. ABC has implemented a national program to assist its member construction companies to annually evaluate their safety and health program performance and their safety and health training programs. This program is known as the Safety Training and Evaluation Process, or "STEP" program. The ABC National Office processes all applications and, in turn, presents awards to qualified applicants.
            2. The STEP program was created by the ABC National Safety Committee in 1992. The National Safety Committee is composed of construction safety professionals drawn from ABC member companies throughout the United States. Along with this national committee, ABC National has over 60 safety committees formed in various chapters across the United States and Guam. Safety committee members at these local chapters identify and provide safety courses and seminars on safety compliance programs pertinent to their geographical area. These committees convey concerns, stance on issues and other items of construction safety interest to the National Safety Committee.
            3. The STEP program has five award levels. The Bronze, Silver, Gold, Platinum and Diamond awards are based on self-evaluation scores and are administered by ABC National. The fourth and fifth categories, Platinum and Diamond, will be open to those companies whose achievements in the area of worksite safety are, certifiably, the best of the best. OSHA will recognize contractors that participate in the STEP program in all levels.
            4. Once a partnership has been established, the ABC Keystone Staff and/or Partnership Steering Committee will inform their members who have successfully completed the application process and are thus eligible for participation in the partnership.
          2. Program Implementation

            The Partnership shall be implemented as follows:

            1. STEP Applications
              1. ABC National will distribute applications to its contractor members. The application consists of a two-part form. Part One of the form requests safety statistical data. This data is found on summary OSHA 300 logs. Part Two of the form is the self-evaluation section where contractors answer a series of questions related to their safety program; each response has a numerical rating. Responses from questions are totaled, providing a score.
              2. The next phase of the STEP program is the evaluation of applicants. Application evaluation is conducted at the ABC National office. Data from each application is keyed into ABC National's database. This includes information from the applicant's OSHA 300 Log, employee work-hours from the noted calendar year, as well as the self-evaluation score.
              3. Applicants seeking Platinum and Diamond incentive award level, must satisfy additional criteria. To review the criteria, see Section 1 of the "Instructions for completing the STEP Submittal Sheet" found in the annual STEP application.
            2. ABC National will forward the names of STEP companies, their appropriate STEP level, STEP score, and recordable rate to the ABC Keystone Chapter.
          3. Program Quality Controls
            1. The ABC Keystone Chapter will designate staff personnel to implement the following program monitoring activities:
              1. Periodically review participatory ABC chapter activities to ensure that program requirements are met.
              2. Termination of a participating contractor's status if findings indicate unacceptable performance or submission of falsified documentation;
              3. Provide recommendations to the Partnership Steering Committee for program improvements.
            2. Information submitted by contractors as part of the application or renewal process, as well as information 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. However, in event of an OSHA inspection, such information that is relevant to any element of the investigation and normally is available will be provided to OSHA upon request.
            3. OSHA reserves the right to exclude or withdraw recognition to any Partnership Member which does not show good faith or follow the terms of the agreement.
          4. Contractor Termination
            1. A contractor's participation will be terminated and OSHA will be informed if one or more of the following occurs:
              1. The contractor has falsified information on the application or supporting records;
              2. The contractor does not maintain an active membership with the ABC Keystone Chapter.
              3. The contractor takes other such actions that may be determined to be grounds for termination by the Partnership Steering Subcommittee;
            2. Prior to final termination of a contractor's status, the following will occur:
              1. The contractor will be notified in writing of the intent to terminate;
              2. The notice will include an explanation of the reasons for termination;
              3. The contractor will have an opportunity to reply to the written notice within a period of thirty (30) days; and
              4. The contractor will have the right to make an appearance before the Partnership Steering Subcommittee.
            3. The Partnership Steering Committee will have the authority to reinstate the Contractor if it is determined that the contractor's experience was unusual and not necessarily inconsistent with a sound safety and health program. In this event OSHA is free to conduct another non-enforcement verification inspection.
            4. Any contractor may terminate participation in the program at any time.
            5. OSHA reserves the right to exclude or withdraw recognition to any Partnership Member which does not show good faith or follow the terms of the agreement.

           

          APPENDIX B - AGREEMENT OF PARTICIPING MEMBER

          Of_______________
           (Member Name)
          IN THE PARTNERSHIP BETWEEN
          Associated Builders and Contractors, Inc., Keystone Chapter
          AND THE
          U.S. Department of Labor, OSHA, Harrisburg, Allentown,
          Philadelphia and Wilkes-Barre Area Offices

          The United States Department of Labor Occupational Safety and Health Administration (OSHA) and the Associated Builders and Contractors, Inc., Keystone Chapter (ABC Keystone) recognize the importance of providing a safe and healthful work environment for Pennsylvania's workforce. To advance our goal, we strongly agree on the need to develop a working relationship that fosters trust and respect for each organization's respective role in the safety process. We recognize and embrace the responsibilities inherent in those roles. We are committed to work as partners to achieve workplace safety.

          MEMBER NAME, (herein called Partnership Member) and ABC Keystone mutually recognize the importance of providing a safe and healthful work environment for their employees, and jobsites. To advance our goals, said member agrees with the criteria of the Partnership between OSHA's Harrisburg, Allentown, Philadelphia and Wilkes-Barre Area Offices and the ABC Keystone Chapter.

          Said member has read in its entirety the criteria of the partnership. In signing this agreement, said member company agrees to all the conditions and terms of the partnership. Said member also agrees to the following:

          1. Cooperate in the development and continuous improvement of safety training programs for their employees.
          2. Ensure that safety policies and practices are effective and consistent.
          3. Recognize and honor the Partnership on an annual basis.
          4. Review with the Partnership Steering Committee quarterly updates of said member's injury and illness experience including DART rates and the focused four construction hazards.
          5. Either party to the partnership may withdraw from the agreement at any time after submitting written notification of intent to the other partner.

          Agreed to this day, _____________________, 201__


          • Owner/Officer Name (Print)
          • Member Company
          • Member Address
          • Member City, State, Zip

          • Owner/Officer Signature
          • Title
          APPENDIX C - ABC-Keystone / OSHA Partnership - Focus Four Injury and Training Data Collection

          Employer: ______________________________________

          Please list the number of OSHA 300 recordable injuries for Calendar Year 201___ in each category (if none - please indicate 0):

          Falls: __________

           

          Struck-by: _________

           

          Other: _________

          Caught-in: _________

           

          Electrical: _________

           

          Other: _________

          Total hours worked by all employees: _____________

          Safety/Health Training (classroom, computer and/or toolbox topics) Information for Calendar Year 201___:

          Employee Hours: _____________

          Supervisor/Manager Hours: _____________

          Topics of Training:









          Person Reporting:


          Signature


          Print Name


          Position

          Please note: some of this information was previously reported on your STEP Application, but was removed in 2010. The ABC Keystone/OSHA Partnership is committed to tracking data in the Focus Four Hazards and safety/health training.

          Please send this information by email or fax to 717-653-6431, Attn: G. David Sload

           

          Appendix D - OSHA Strategic Partnership Program - Annual Partnership Evaluation Report

          Cover Sheet

          These tables are best viewed on tablets, notebooks, or desktop computer screens.

          Partnership Name

           

           

           

          Purpose of Partnership

           

           

           

          Goals of Partnership

          Goals Strategy Measure

           

           

           

           

           

           

           

           

           

           

           

           

          Anticipated Outcomes

           

           

           

          Strategic Management Plan Target Areas (check one)

          Construction   Manufacturing Amputations  
          Non-Construction      

          Strategic Management Plan Areas of Emphasis (check all applicable)

          Amputations in Construction   Oil and Gas Field Services  
          Blast Furnaces and Basic Steel Products   Preserve Fruits and Vegetables  
          Blood Lead Levels   Public Warehousing and Storage  
          Concrete, Gypsum and Plaster Products   Ship/Boat Building and Repair  
          Ergo/Musculoskeletal   Silica-Related Disease  
          Landscaping/Horticultural Services      

           

          Section 1 - General Partnership Information

          Date of Evaluation Report  
          Evaluation Period:
          Start Date   End Date  

          Evaluation OSHA Contact Person

           

          Originating Office

           

          Partnership Coverage

          # Active Employers   # Active Employees  

          Industry Coverage (note range or specific SIC and NAICS for each partner)

          Partner SIC NAICS
               
               
               
               
               
               
               
               

           

          Section 2 - Activities Performed

          Note whether an activity was required by the OSP and whether it was performed

           

          Required

          Performed

          a. Training    
          b. Consultation Visits    
          c. Safety and Health Management Systems Reviewed/Developed    
          d. Technical Assistance    
          e. VPP-Focused Activities    
          f. OSHA Enforcement Inspection    
          g. Offsite Verifications    
          h. Onsite Non-Enforcement Interactions    
          i. Participant Self-Inspections    
          j. Other Activities    

          2a. Training (if performed, provide the following totals)

          Training session conducted by OSHA staff  
          Training session conducted by non-OSHA staff  
          Employees trained  
          Training hours provided to employees  
          Supervisors/managers trained  
          Training hours provided to supervisors/managers  
          Comments/Explanations (briefly describe activities, or explain if activity provided for but not performed)

           

           

           

          2b. Consultation Visits (if performed, provide the following total)

          Consultation visits to partner sites  
          Comments/Explanations (briefly describe activities, or explain if activity provided for but not performed)

           

           

           

          2c. Safety and Health Management Systems (if performed, provide the following total)

          Number of systems implemented or improved using the 1989 Guidelines as a model  
          Comments/Explanations (briefly describe activities, or explain if activity provided for but not performed)

           

           

           

          2d. Technical Assistance (if performed, note type and by whom)

           

          Provided by OSHA Staff

          Provided by Partners

          Provided by Other Party

          Conference/Seminar Participation      
          Interpretation/Explanation of Standards or OSHA Policy      
          Abatement Assistance      
          Speeches      
          Other (specify)      
          Comments/Explanations (briefly describe activities, or explain if activity provided for but not performed)

           

           

           

          2e. VPP-Focused Activities (if performed, provide the following total)

          Partners/participants actively seeking VPP participation  
          Applications submitted  
          VPP participants  
          Comments/Explanations (briefly describe activities, or explain if activity provided for but not performed)

           

           

           

          2f. OSHA Enforcement Activity (if performed, provide the following totals for any programmed, unprogrammed, and verification-related inspections))

          OSHA enforcement inspections conducted  
          OSHA enforcement inspections in compliance  
          OSHA enforcement inspection with violations cited  
          Average number of citations classified as Serious, Repeat, and Willful  
          Comments/Explanations (briefly describe activities, or explain if activity provided for but not performed)

           

           

           

          2g. Offsite Verification (if performed, provide the following total)

          Offsite verifications performed  
          Comments/Explanations (briefly describe activities, or explain if activity provided for but not performed)

           

           

           

          2h. Onsite Non-Enforcement Verification (if performed, provide the following total)

          Onsite non-enforcement verifications performed  
          Comments/Explanations (briefly describe activities, or explain if activity provided for but not performed)

           

           

           

          2i. Participant Self-Inspections (if performed, provide the following total)

          Self-inspections performed  
          Hazards and/or violations identified and corrected/abated  
          Comments/Explanations (briefly describe activities, or explain if activity provided for but not performed)

           

           

           

          2j. Other Activities (briefly describe other activities performed)

           

           

           

           

          Section 3 Illness and Injury Information1

          Year

          Hours

          Total Cases

          TCIR

          # of Days Away from Work Restricted and Transferred Activity Cases

          DART

          2006          
          2007          
          2008          
          Total          
          Three Year Rate (2009-2011)      
          BLS National Average for 2007 - NAICS 23      
          Baseline          
          Comments

           

           

           

          *Sample Chart - not required format

           

          Section 4 - Partnership Plans, Benefits, and Recommendations

          Changes and Challenges (check all applicable)

           

          Changes

          Challenges

          Management Structure    
          Participants    
          Data Collection    
          Employee Involvement    
          OSHA Enforcement Inspection    
          Partnership Outreach    
          Training    
          Other (Specify)    
          Comments

           

           

           

          Plans to Improve (check all applicable)

           

          Improvements

          N/A

          Meet more often    
          Improve data collection    
          Conduct more training    
          Change goals    
          Comments

           

           

           

          Partnership Benefits (check all applicable)

          Increased safety and health awareness  
          Improved relationship with OSHA  
          Improved relationship with employers  
          Improved relationship with employees or unions  
          Increased number of participants  
          Other (specify)  
          Comments

           

           

           

          Status Recommendations

          Partnership Completed  
          Continue/Renew  
          Continue with the following provisions:  

           

           

           

          Terminate (provide explanation)  

           

           

           

           

          1 Sample Chart - Not required format

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