VPP Annual Evalutaion

VPP Corporate Annual Evaluation Template
(As of 12/20/07)
Form Approved
OMB# 1218 – 0239
Expires 04-30-08
Public reporting burden for this collection of information is voluntary and is estimated to average 40 hours per response, including
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate, or any other aspect of this collection of
information, including suggestions for reducing this burden to the Division of Voluntary Programs, Department of Labor, Room N3700, 200
Constitution Avenue, N.W., Washington, DC 20210

Corporation:
Contact Person:
Contact Phone:

Contact Email:

Quantitative Information
Number and list of applications submitted during CY 2007:
Number and list of projected applications for CY 2008:
Number and List of facilities approved through the Corporate Program during CY 2007:
Combined TCIR/DART Rates for all VPP facilities for CY 2007:
Combined TCIR/DART Rates for all non-VPP facilities for CY 2007:
TCIR/DART percentage above/below the BLS average for your dominant SIC/NAICS:
Number and percentage of US-based facilities in VPP:
Number and percentage of US-based employees covered by VPP:
Cost savings due to VPP participation (formula is as follows):
(C / 200,000) x H = n where:
H = total hours worked at VPP sites
C = Collective DART rate for non-VPP sites
n = Number of expected DART cases for VPP sites
Then:
(n – a) x $38,000 = x where:
n = Number of expected DART cases for VPP sites
a = Actual DART cases for VPP sites
x = Total $ saved in DART injuries at VPP sites

Qualitative Information
Please cite any Corporate-level S&H policy/procedural changes (including to VPP pre-screening):
Were there any major changes in Corporate Management/Structure? If “yes,” please describe:
Please list any/all SGE and/or mentoring activities performed during CY 2007:
Please list any Corporate-wide success stories or best practices:
Please describe how VPP Corporate participation is benefiting your organization (include any time/cost savings,
increased S&H awareness, etc.):
Please provide any feedback that you have regarding how OSHA could improve the VPP Corporate experience:
Other Issues/Concerns/Comments: