Form OSHA 171 OSHA 171 Grantee Quarterly Progress Report

Grantee Quarterly Progress Report
1. GRANTEE NAME

U.S. DEPARTMENT OF LABOR
Occupational Safety and Health Administration
2. GRANT NUMBER

3. REPORTING PERIOD
From:
To:

TRAINING SESSIONS
4. DATE

5. LOCATION

6. LENGTH
(Hours)

NUMBER IN ATTENDANCE
7. EMPLOYEES 8. EMPLOYERS

9. TOTAL

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10. TOTAL FROM REPORTING PERIOD
11. PLAN FOR QUARTER
12. PERCENTAGE OF PLAN ACCOMPLISHED
13. GRANTEE SIGNATURE

%
14. DATE

%

%

INSTRUCTIONS
Instructions for the Grantee Quarterly Progress Report (OSHA 171 and Narrative Report) are contained on the reverse of this form.
RETURN THE COMPLETED FORM TO THE OSHA REGIONAL OFFICE ADMINISTERING YOUR GRANT.

PAPERWORK REDUCTION ACT NOTICE
Form Approved. OMB No. 1218-0100. Expires TBD.
Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
This information is being collected so that OSHA can monitor grantee progress in meeting grant workplans, to evaluate the
overall effectiveness of the grant program, and, when applicable, to be used as one factor in determining continued funding of
the grant. The grant program provides training for employers and employees in the recognition, avoidance, and prevention of
unsafe and unhealthful working conditions in accordance with Section 21(c) of the Occupational Safety and Health Act. This
collection of information is required to obtain or retain a benefit (29 CFR 95.51 (b) and (d)). This collection of information is
not confidential. We estimate it will take an average of 12 hours to complete this information collection, 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 Directorate of Training and Education, 2020 S. Arlington
Heights Road, Arlington Heights, IL 60005.
Previous editions may not be used

OSHA 171 Revised TBD