OSHA Challenge Program - Quarterly Reports

Challenge Pilot
Administrator's Quarterly Report
Administrator Name
[Fill in Administrator Name Here]

Report Period
Quarter
Year

Q1
2008

Section 1. Administrator Information Update
(If there were any changes)
Name
Site Address

Section 2. Administrator Contact Information Update
(If there were any changes)
Administrator Contact Name
Administrator Contact Title
Administrator Contact Phone Number
Administrator Contact Fax Number
Administrator Contact E-mail Address
Section 3. Coordinator Contact Information Update
(If there were any changes)
Coordinator Contact Name
Coordinator Contact Title
Coordinator Contact Phone Number
Coordinator Contact Fax Number
Coordinator Contact E-mail Address
Section 4. Candidate Information Update
Please list any Candidates who have dropped out or have been added since the last progress report. You
must submit a Candidate Information Package for all new Candidates.
Form Approved OMB# 1218 – 0239
Expired 4 -30- 2008
Public reporting burden for this collection of information is voluntary and is estimated to average 5 hours per
response, including the time for reviewing instruction, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection other aspect of this collection of
information, including suggestions for reducing this burden to the Division of Voluntary Programs, Department
of Labor, Room N-3700, 200 Constitution Avenue, N.W., Washington, DC 20210.

Challenge Pilot
Administrator's Quarterly Report