Success Story Narrative

Office of Small Business Assistance
On-site Consultation Program

Instructions and Guidelines


OSHA's Office of Small Business Assistance (OSBA) is seeking small business and Safety and Health Achievement Recognition Program (SHARP) success story narratives that highlight the positive impact that the On-site Consultation Program has on workplace safety and health. Please note that any information provided may be posted on OSHA's Web site, or used in other Agency public relations or outreach activities. You may be contacted for additional information.

To participate, please complete and submit this form to Ann Grevenkamp or phone (608) 215-4003.

Success Story Template

This table is best viewed on tablets, notebooks, or desktop computer screens.

General Information

*Number of employees includes all full-time, part-time, temporary, seasonal, salaried, and hourly workers.
Establishment Name  
Mailing Address  
City, State  
Contact Person  
Contact Phone Number  
Contact Email Address  
Company Web site  
Industry Type   NAICS Code  
High Hazard Industry Yes No Ownership Public Private Other
Number or Employees* Onsite:
Date of Initial Consultation Visit  
Date of Participant's Initial SHARP Approval   Date Participant's SHARP Renewal  

Please describe the nature of the business and the type of customers that the company serves.

How did the company learn of the OSHA On-site Consultation Program?

What prompted the company to contact the On-site Consultation Program?

What hazards did the consultant identify during the walkthrough of the work site?

What hazard correction methods did the company implement during the hazard correction process?

Give a brief description of how business practices changed after the first consultation visit. (E.g. the implementation of new programs, training, employee involvement, accident investigation, and/or abatement procedures).

Please highlight successes resulting from participating in the On-site Consultation Program. (E.g. a reduction in Days Away, Restricted, and Transferred (DART) rate; cost savings; improved workplace safety and health culture; an increase in employee involvement and management commitment)

What challenges did the company identify while improving/implementing its safety and health management system?

If applicable, please highlight successes resulting from participating in the SHARP program.

What impact has working with the On-site Consultation Program had on the company?

This table is best viewed on tablets, notebooks, or desktop computer screens.

Injury and Illness Data

Please complete the data cells below and provide any additional information regarding factors and/or benchmarks used to characterize the safety and health success of this company.
  Year Prior to First Consultation Visit Year of First Consultation Visit Year Entered SHARP (If Applicable) 20XX 20XX 20XX 20XX 20XX, most recent available
Number of Injuries and Illnesses                
Total Recordable Case Rate (TRC)                
Days Away, Restricted, and/ or Transfer Rate (DART)                
Experience Modifier Rate                
Dollar Value of Workers' Compensation Claims                
Dollar Value of Workers' Compensation Premium                
Additional Information (Include contact information for OSHA On-site Consultation Project Manager and/or Consultant and other information that will be useful in the story but not included elsewhere in the template.)
Company Photo

Please include a company photo(s) in at least 300 dpi resolution as well as captions identifying the individuals in the photo(s). A DOL Photo or Video Release form, signed by a company representative, is required.










Photo 1










Photo 2

Photo Caption 1: NOTE: Include the names of the people in the photo if there are 10 or fewer people. Add their titles if the people are from multiple organizations.


Photo Caption 2:


Publications Standards (OOC)

When using photography, it is important to show photographs that are engaging and relevant to your content and audience. They should also accurately reflect diversity. When sending a project to designers, art directors and printing companies, use high-resolution photographs that are at least 300 dpi (dots per inch). Images at 72 dpi are acceptable for web use and PowerPoint presentations, not print publications.

Download a Department of Labor Photo Release Form [PDF]


Style -- A single image is more powerful than photos displayed in a collage; however a row of images can be used when needing to convey multiple subjects.

Release Forms -- Proper photo release forms must be signed and on-file for all photos commissioned for use in a publication. Parental consent must be secured for photos of minors (under age 18) before photographs can be used.

Photo Captions -- Photos are not required to be captioned. If a photo is captioned, the caption should consist of a short, descriptive phrase in sentence form, beginning with a capital letter and ending with a period.

Photo Credits -- For professionally shot or rights-managed photography, a credit should be placed on the inside front cover or at the end of the table of contents. They should not be credited under that actual photograph.

Endorsements -- Photos should not prominently display corporate logos or other identifiers that might imply endorsements of a particular product or company

Avoid mixing graphics or illustrations with photography. Most often the styles do not mix well.

Do not use photographs downloaded from web sites, unless they are identified as high-resolution.

Use only photographs for which you have or know copyright ownership.


Download a Department of Labor Video Release Form [PDF]

Video Release Form for minors [PDF]