BOEM-New Performance Measures Data

Appendix A

U.S. Department of the Interior

OMB Control Number 1010-0176
OMB Approval Expires xx/xx/xxxx

Bureau of Ocean Energy Management (BOEM)

PERFORMANCE MEASURES DATA – Renewable Energy
Provide Data on an Annual Basis for the Previous Calendar Year by March 31 of Each Year

Company Name(s)

BSEE Region

Operator Code(s)*

Calendar Year

Contact Name

Email Address

Telephone

Date

INJURIES / ILLNESSES

Site Assessment Construction
Activities
Operations
A. Number of Company
Employee Recordable
Non-DART**
Injuries/Illnesses

1st Qtr
2nd Qtr
3rd Qtr
4th Qtr

B. Number of Contractor
Employee Recordable
Non-DART**
Injuries/Illnesses

1st Qtr
2nd Qtr
3rd Qtr
4th Qtr

C. Number of Company
Employee DART***
Injuries/Illnesses

1st Qtr
2nd Qtr
3rd Qtr
4th Qtr

Energy Production
and Maintenance
Operations

Decommissioning
and Removal
Operations

D. Number of Contractor 1st Qtr
2nd Qtr
Employee DART***
Injuries/Illnesses
3rd Qtr
4th Qtr
* Please list all operator codes that these data represent
** A non-DART injury and illness for purposes of this report is a significant injury or illness that requires medical treatment
beyond first aid, involves a loss of consciousness, or results in a diagnosis by a physician or other licensed health care
professional, but does not meet the definition of a DART injury or illness.
*** A DART injury and illness for purposes of this report is an injury or illness that results in a recommendation by a physician or
other licensed health care professional for days away from work, restricted duty, or job transfer. Fatalities are to be reported
to BOEM separately under 30 CFR 535.831(a).
Form BOEM-xxxx (date)

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Appendix A
WORK HOURS

Site Assessment
Activities
A. Number of Company
Employee Hours
Worked

Construction
Operations

Energy Production
and Maintenance
Operations

Decommissioning
and Removal
Operations

1st Qtr
2nd Qtr
3rd Qtr
4th Qtr

B. Number of Contractor 1st Qtr
Employee Hours
2nd Qtr
Worked
3rd Qtr
4th Qtr

Electric Energy Generation
A. Number of MW-Hrs
Generated

1st Qtr
2nd Qtr
3rd Qtr
4th Qtr

B. Capacity Factor (%)
[Average generation
÷ Installed Capacity]

1st Qtr
2nd Qtr
3rd Qtr
4th Qtr

Paperwork Reduction Act of 1995 (PRA): The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that BOEM collects this information
to carry out its responsibilities under the OCS Lands Act, as amended. BOEM will use the information to evaluate the effectiveness of
industry’s continued improvement of safety and environmental management in the OCS. Responses are mandatory (43 U.S.C. 1334). No
proprietary data are collected. We estimate the public reporting burden, including the time for reviewing instructions, gathering and maintaining
data, completing and reviewing, and retaining the information to average 82 hours per response. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget (OMB)
control number. The OMB has approved this collection of information and assigned OMB Control Number 1010-0176. You may direct
comments regarding the burden estimate or any other aspect of this collection of information to the Information Collection Clearance Officer,
Bureau of Ocean Energy Management, 45600 Woodland Road, Sterling, VA 20166.
COMPANY-SPECIFIC DATA COLLECTED UNDER THIS REQUEST IS INTENDED FOR GOVERNMENT USE ONLY

Form BOEM-xxxx (date)

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