Challenge Participant Tracking - General Industry

Challenge Participant Tracking-General Industry.xlsx

Voluntary Protection Program Information

Challenge Participant Tracking - General Industry

OMB: 1218-0239

Document [xlsx]
Download: xlsx | pdf

Overview

Overview
1 - Summary Page
2 - Stage I Status
3 - Stage II Status
4 - Stage III Status


Sheet 1: Overview

OSHA Challenge - General Industry Track



Site OCTPS Form Instructions















This form is to be completed by Challenge participants.

















Included in this spreadsheet are:




















Tab 1. Participant Status Summary












Tab 2. Stage I Status Report












Tab 3. Stage II Status Report











Tab 4. Stage III Status Report








































To access these worksheets, please click on the tabs at the bottom of this form.













Sheet 2: 1 - Summary Page

OSHA Challenge - General Industry Track
Summary Status Report














Participant Name
Administrator Name

Report Period







Time Period




Year















Stage I

















Mgt. Leadership
Hazard Safety and Documentation



and Worker Worksite Prevention and Health
Participant Summary
Involvement Analysis Control Training
Stage I Outcome Completion Status Status # % # % # % # % # %
No Action Taken 19 100% 7 100% 15 100% 30 100% 16 100%
In Progress 0 0% 0 0% 0 0% 0 0% 0 0%
Completed 0 0% 0 0% 0 0% 0 0% 0 0%
Total Outcomes 19 100% 7 100% 15 100% 30 100% 16 100%














Stage I Status Summary No Action Taken/In Progress



















Administrator Summary











Stage I Outcome Completion Status Status # % # % # % # % # %
No Action Taken 19 100% 7 100% 15 100% 30 100% 16 100%
In Progress 0 0% 0 0% 0 0% 0 0% 0 0%
Completed 0 0% 0 0% 0 0% 0 0% 0 0%
Total Outcomes 19 100% 7 100% 15 100% 30 100% 16 100%














Stage I Status Summary No Action Taken/In Progress




















Stage II

















Mgt. Leadership
Hazard Safety and Documentation



and Worker Worksite Prevention and Health
Participant Summary
Involvement Analysis Control Training
Stage II Outcome Completion Status Status # % # % # % # % # %
No Action Taken 21 100% 13 100% 16 100% 9 100% 12 100%
In Progress 0 0% 0 0% 0 0% 0 0% 0 0%
Completed 0 0% 0 0% 0 0% 0 0% 0 0%
Total Outcomes 21 100% 13 100% 16 100% 9 100% 12 100%














Stage II Status Summary No Action Taken/In Progress






















Administrator Summary











Stage II Outcome Completion Status Status # % # % # % # % # %
No Action Taken 21 100% 13 100% 16 100% 9 100% 12 100%
In Progress 0 0% 0 0% 0 0% 0 0% 0 0%
Completed 0 0% 0 0% 0 0% 0 0% 0 0%
Total Outcomes 21 100% 13 100% 16 100% 9 100% 12 100%














Stage II Status Summary No Action Taken/In Progress






















Stage III

















Mgt. Leadership
Hazard Safety and Documentation



and Worker Worksite Prevention and Health
Participant Summary
Involvement Analysis Control Training
Stage III Outcome Completion Status Status # % # % # % # % # %
No Action Taken 19 100% 13 100% 8 Err:509 3 100% 5 100%
In Progress 0 0% 0 0% Err:509 Err:509 0 0% 0 0%
Completed 0 0% 0 0% 0 Err:509 0 0% 0 0%
Total Outcomes 19 100% 13 100% Err:509 Err:509 3 100% 5 100%














Stage III Status Summary No Action Taken/In Progress






















Administrator Summary











Stage III Outcome Completion Status Status # % # % # % # % # %
No Action Taken 19 100% 13 100% 8 Err:509 3 100% 5 100%
In Progress 0 0% 0 0% Err:509 Err:509 0 0% 0 0%
Completed 0 0% 0 0% 0 Err:509 0 0% 0 0%
Total Outcomes 19 100% 13 100% Err:509 Err:509 3 100% 5 100%














Stage III Status Summary No Action Taken/In Progress




































Sheet 3: 2 - Stage I Status

OSHA Challenge - General Industry Track





Stage I Tracking Form































Participant Name
Administrator Name
Report Period






[Enter Participant Name]
[Enter Administrator Name]
Time Period [Enter Time Period]







Year [Enter Year]



















Stage I -- Management Leadership and Worker Involvement





1. Management Commitment - Actions Required



Participant Status Administrator Status





1. Safety and Health Mission Statement. Develop, issue, and communicate a Safety and Health Mission Statement (ie, defining where the site wants to be). This Vision statement should address the company’s desire to participate in OSHA Challenge. This process may include involving permanent workers in the development of these documents. No Action Taken No Action Taken











Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Safety and Health Policy Statement. Develop, issue, and communicate a Safety and Health No Action Taken No Action Taken





Policy Statement (i.e., what the site commits to doing).





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. Leadership. Company establishes a policy requiring managers to participate and demonstrate



No Action Taken No Action Taken





leadership in safety and health management system activities. Managers set an example and behaviors that









demonstrate a commitment to safety and health, such as attending training, participating in planning









meetings, wearing PPE, encouraging workers to report hazards, injuries





and illnesses, enforcing the “if it’s not safe, we’re not doing it” principle, and performing other safety









and health-related actions that are required of workers.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





4. Adequate resources and safety and health integration. Develop a safety and health budget for the No Action Taken No Action Taken





present and for the future, including a plan for covering typical safety and health expenditures,





as well as unusual or emergency expenditures such as requirements for prompt correction of





uncontrolled hazards Commit and ensure utilization of adequate resources to achieve this for OSHA





Challenge. Take management action to begin integrating safety and health into other aspects of





planning, such as planning for new equipment, processes, building materials, etc. Company





establishes a policy/requirement that safety and health will be integrated into the overall









planning and budgeting processes.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





5. Safety and health goals and objectives. Establish, document, and communicate to workers



No Action Taken No Action Taken





the annual safety and health goals and objectives that are clear, attainable, measurable, and relevant to









bringing about a safe and healthy work environment, as well as the policies and procedures that will help









achieve these goals and objectives. Goals should be based on outcome of baseline and trend analysis.









Establish a policy/requirement that subcontractors will develop their goals and objectives supportive









of the company goals in an equivalent manner.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





6. Clear lines of communication with workers and worker access. Take action to establish clear



No Action Taken No Action Taken





lines of communication with all workers and ensure that they have reasonable access to top









management with regard to safety and health issues Address issues of worker language barriers by









providing safety and health information in languages spoken and understood by workers.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





7. Clear responsibilities, authority, and accountability for safety and health. Clarify the safety












and health responsibilities of each company worker and contractor working on the site/project:








a. Identify who will be responsible for achieving safety and health goals and objectives.



No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





b. Identify specific persons to be accountable for meeting safety and health goals, including,



No Action Taken No Action Taken





at a minimum, managers, supervisors, and specific safety and health staff; assign adequate









authority, as appropriate to their level of responsibility; and explain their accountability and









authority to all workers.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





c. Develop a safety and health accountability plan to hold managers, supervisors, and non-supervisory



No Action Taken No Action Taken





workers accountable for meeting their responsibilities through a documented performance









standards and appraisal system.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Worker Involvement - Actions Required



Participant Status Administrator Status





1. Worker Safety and Health Perception Survey. Evaluate the current safety and health practices



No Action Taken No Action Taken





at the total site and establish a baseline in the following areas for each of the following categories of









personnel – managers, supervisors, and non-supervisory workers:





a. Levels of involvement in the safety and health management system








b. Values regarding the importance of worker safety and health








c. Perceptions of the effectiveness of the total company’s safety and health management system












d. Perceptions of how well the culture encourages and supports reporting








on hazards, accidents, and injuries








e. Levels of compliance with rules or unwritten safety and health standards








f. Perceptions regarding their roles, responsibilities, and accountability in ensuring safety












and health on the total project/site








Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Safety and Health Perception Survey Action Plan. Develop an action plan to address the



No Action Taken No Action Taken





findings from the survey and begin implementation of the plan.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. Worker notification. Notify company and subcontractor workers as follows:








a. Inform managers, supervisors, non-supervisory workers of their rights under the Occupational



No Action Taken No Action Taken





Safety and Health (OSH) Act. Take steps to encourage them to freely exercise their rights, especially that









of freely reporting hazards in the workplace.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





b. Inform all workers, including new hires, of the company’s participation in OSHA Challenge.



No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





4. Meaningful worker involvement. Develop a plan, including an implementation schedule, for



No Action Taken No Action Taken





how to bring about the meaningful involvement of all managers, supervisors, and





non-supervisory workers through participation in various safety and health related activities.









Specifically, for this OSHA Challenge:





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





a. Consistent with applicable labor laws, initiate the establishment of a few key teams



No Action Taken No Action Taken





(e.g., a safety and health planning team) representing different sectors of the site's staff, to bring about









meaningful change.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





b. Begin to involve some workers in safety and health activities such as accident investigations.



No Action Taken No Action Taken





Note: ensure that proper training is provided before workers conduct such activities.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. Contract Worker Coverage - Actions Required Participant Status Administrator Status





1. Contractor oversight and management system. Develop, document, and begin implementing the












following basic elements of an oversight and management system covering contractors:












a. Equal safety and health protection. Develop and begin implementing a plan for how to provide



No Action Taken No Action Taken





contractor workers with safety and health protection equal in quality to that provided to









company workers.








Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





b. Adherence to safety and health rules. Inform all contractors and their workers that they



No Action Taken No Action Taken





are required to adhere to all of the company’s safety and health rules, regardless of their status or the









length of time they perform work on the site.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





c. Hazards in contractor work areas. Establish a requirement that contractors provide



No Action Taken No Action Taken





timely identification, correction, and tracking of uncontrolled hazards in their work areas.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:



















Stage I -- Worksite Analysis






1. Baseline Safety and Industrial Hygiene Hazard Analysis - Required Actions



Participant Status Administrator Status





1. Conduct a baseline safety and industrial hygiene hazard analysis to establish initial levels of exposure



No Action Taken No Action Taken





(baselines) for comparison to future levels, so that changes can be recognized This study should









include a review of previous accidents, injuries, and illnesses; complaints of workplace hazards;









previous studies, etc









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Ensure that the baseline survey accomplishes the following:



No Action Taken No Action Taken





a. Identifies and documents common safety hazards in the site and how they are controlled.












b. Identifies and documents common health hazards in the site and determine if further sampling is needed.












c. Identifies and documents safety and health hazards that need further study.












d. Covers the entire work site and indicates who conducted the survey and when it was completed.












Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. Repeat the baseline survey only if warranted by significant changes (eg, changes in processes,



No Action Taken No Action Taken





equipment, hazard controls, etc).









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Hazard Analysis of Routine Jobs, Tasks, and Processes - Required Actions Participant Status Administrator Status





No Actions Required



N/A N/A





3. Industrial Hygiene (IH) Program - Actions Required



Participant Status Administrator Status





1. Complete a baseline study, including a chemical inventory, review of previously reported hazards, trends,



No Action Taken No Action Taken





or illnesses, to identify and quantify worker exposures to typical health hazards such as noise, chemicals, dust, etc.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





4. Routine Self-Inspections - Required Actions



Participant Status Administrator Status





No Outcomes Required



N/A N/A





5. Hazard Reporting System for Employees - Required Actions



Participant Status Administrator Status





No Outcomes Required



N/A N/A





6. Accident Investigations - Required Actions



Participant Status Administrator Status





1. Investigate accidents and maintain written reports of the investigations. Investigations should



No Action Taken No Action Taken





be conducted by trained personnel and:









a. Document the entire sequence of relevant events.












b. Identify all contributing factors.












c. Determine whether the safety and health management system was effective.












d. Recommend actions to prevent recurrence.












e. Assign timeframes and responsibility for implementing recommended controls.












g. The site should make the results available to workers on request (although actual












investigation records need not be provided).












Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





7. Trend Analysis - Required Actions



Participant Status Administrator Status





1. Conduct a trend analysis of previous three complete calendar years’ injury and illness history, based



No Action Taken No Action Taken





on a thorough review of OSHA 300 logs, workers' compensation claim forms, and accident reports.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Begin developing a plan for conducting an analysis of other safety and health-related information



No Action Taken No Action Taken





(e.g., hazards identified during inspections, worker reports of hazards, accidents, near-misses, etc.)









for the purpose of establishing or detecting trends, planning, and setting goals.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





Stage I -- Hazard Prevention and Control






1. Certified Professional Resources - Actions Required



Participant Status Administrator Status





1. Ensure that outside sources are available if needed to conduct baseline hazard analysis, and that they



No Action Taken No Action Taken





are certified, competent, and qualified to perform baselines pertinent to the work activity involved.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Hazard Elimination and Control Methods - Actions Required



Participant Status Administrator Status





1. Company establishes and implements a system that prioritizes hazards identified in this stage based on



No Action Taken No Action Taken





the potential seriousness of injury, illness, property loss, frequency of exposure, and long- term effects.









Establish an action plan for correction.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Identify options and select the most appropriate option or combination of options for hazard elimination



No Action Taken No Action Taken





and control methods, including engineering controls, administrative controls, work practices, and









personal protective equipment (PPE).









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. Take steps to ensure that the selected controls are appropriate to the site’s hazard(s); understood and



No Action Taken No Action Taken





followed by all affected parties; equitably enforced through the disciplinary system; written, implemented,









and updated as needed; used by workerss; and incorporated into training, positive reinforcement,









and correction programs.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. Hazard Control Programs - Actions Required



Participant Status Administrator Status





1. Conduct an inventory of existing hazard control programs required by OSHA standards



No Action Taken No Action Taken





(eg, PPE, Hazard Communication, Respiratory Protection, Lockout/Tagout, Confined Space









Entry, Process Safety Management, or Bloodborne Pathogens).









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Review existing programs to identify what is missing or unsatisfactory. No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. Develop missing programs and modify existing programs, as needed, to meet all OSHA guidelines,



No Action Taken No Action Taken





including training requirements.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





4. Occupational Health Care Program - Actions Required



Participant Status Administrator Status





1. Records Review. Conduct a thorough review of injury/illness records and ensure they are in order.



No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Licensed health care professionals. Provide workers access to licensed health care professionals



No Action Taken No Action Taken





who can provide onsite or offsite services and emergency services. Provide emergency services as required.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





5. Preventative Maintenance of Equipment - Actions Required



Participant Status Administrator Status





1. Conduct an inventory of equipment that requires preventive maintenance.



No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





6. Tracking of Hazard Correction - Actions Required



Participant Status Administrator Status





1. Develop and begin using a documented system to record hazards identified in this stage through the



No Action Taken No Action Taken





baseline study, trend analysis, and accident investigations. The system must document priority, assign









responsibility for correction, establish timeframes for correction, and follow up to ensure total abatement.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





7. Emergency Preparedness and Response - Required Actions



Participant Status Administrator Status





1. Establish and communicate written procedures for responding during all shifts to all types of



No Action Taken No Action Taken





emergencies (fire, chemical spill, accident, terrorist threat, natural disaster, etc), in compliance with









applicable requirements.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Conduct at least one evacuation drill and assess how well the procedures worked. No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. Make available and explain to all workers emergency procedures and services, including



No Action Taken No Action Taken





provisions for physician care and emergency medical care, ambulances, emergency





medical technicians, emergency clinics, or hospital emergency rooms, available for all shifts









within a reasonable time and distance.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





4. Conduct at least one training class on first aid and CPR so that there is at least one trained worker



No Action Taken No Action Taken





for each shift , or an alternative that is at least as effective.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





Stage I -- Safety and Health Training






1. Safety and Health Training - Required Actions Participant Status Administrator Status





1. Provide training to managers, supervisors, non-supervisory workers, and contract workers following












the general guidelines below:








a. Document training attendance. No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





b. Provide training at the following intervals: (1) For OSHA-required courses – as often as necessary to meet



No Action Taken No Action Taken





OSHA standards; (2) For non-OSHA required courses – at adequate intervals to meet specific needs;









(3) For training on new work processes, new equipment, and new procedures, as needed.









Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





c. Develop or acquire up-to-date and clearly understandable training for all required participants, with



No Action Taken No Action Taken





curricula and materials developed to meet specific site needs and modified to reflect changes and/or









new workplace procedures, trends, hazards, and controls identified by hazard analysis.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





d. Ensure that training is conducted by persons who have specific subject matter knowledge or expertise.



No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





E. Use findings of the various worksite analysis activities (e.g., baseline study, hazard analysis of



No Action Taken No Action Taken





routine jobs, tasks, and processes, etc.) to develop training that is relevant to the site (e.g., training









on safe job procedures; modifying workstations, equipment, or materials; incorporating findings in future









planning efforts, etc.).





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. At a minimum, provide the following types of training to current or new managers, supervisors, and











non-supervisory workers:






a. Their rights under the OSH Act No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





b. OSHA Challenge No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





c. Hazards in the workplace; how to recognize hazardous conditions; signs and symptoms of



No Action Taken No Action Taken





workplace-related illnesses; protective measures; safe work procedures





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





d. What is required PPE, why it is required, its limitations, how to use it, and how to maintain it No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





e. Specific responsibilities for each type of emergency No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





f. Emergency evacuation procedures No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. At a minimum, provide the following types of training to managers and supervisors:








a. Their specific safety and health responsibilities and how to carry them out effectively No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





b. Methods for changing workplace safety and health attitudes and practices No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





c. Requirements for OSHA Challenge Stage I No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





4. At a minimum, provide the following types of training to designated safety and health staff and others












with assigned safety and health responsibilities, to equip them with the knowledge and skills they need












to perform their assigned tasks or to identify appropriate vendors:








a. How to conduct an assessment of workplace safety and health practices No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





b. Methods for changing workplace safety and health attitudes and practices and how to develop a plan to



No Action Taken No Action Taken





address necessary changes





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





c. How to conduct the required baseline safety and industrial hygiene hazard analysis No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





d. How to conduct hazard analyses, accident/incident investigations, routine self-inspections, trend analyses, and



No Action Taken No Action Taken





preventive maintenance inspections.





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





e. Hazard elimination and control methods No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





f . How to develop a documented system for routinely scheduled self-inspections No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





g. How to develop a worker hazard-reporting system No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





h. How to develop a plan for a written IH Program No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





i. How to develop emergency procedures No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





j. How to develop a hazard tracking system No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





5. At a minimum, provide the following types of training to all contractors and contractors’ managers,











supervisors, and non-supervisory workers:







a. Their rights under the OSH Act No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





b. OSHA Challenge No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





c. Hazards in the workplace No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





d. What is required PPE, why it is required, its limitations, how to use it, and how to maintain it No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





e. Specific responsibilities for each type of emergency No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





f. Emergency evacuation procedures No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





Stage I -- Documentation






1. Minimum Required Documentation Participant Status Administrator Status





1. Vision and policy statements No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





2. Accountability plan No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





3. Budget documents showing allocated resources for Safety and Health No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





7. Accurate and up to date records of injury and illness for the previous three calendar years including:












• OSHA 300 logs No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





• Insurance claim forms No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





• Accident reports No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





5. Baseline hazard analysis results, including IH reports No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





6. Written hazard control programs No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





7. Accident investigation forms and reports No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





8. Written contractor policies for this stage No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





9. Results of baseline assessment of workplace safety and health practices and plan for addressing No Action Taken No Action Taken





necessary changes





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





10. Trend analysis results No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





11. Hazard correction action plan No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





12. Hazard correction tracking system No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





13. Preventative maintenance inventory No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:





14. Written emergency procedures No Action Taken No Action Taken





Participant Goal: Date Completed:







Participant Actions Taken:





Administrator Narrative:






Sheet 4: 3 - Stage II Status

OSHA Challenge - General Industry Track



















Stage II Tracking Form











































































Participant Name
Administrator Name
Report Period



















[Enter Participant Name]
[Enter Administrator Name]
Time Period [Enter Time Period]





















Year [Enter Year]















































Stage II -- Management Leadership and Worker Involvement




















1. Management Commitment - Required Actions Participant Status Administrator Status



















1. Safety and Health Mission and Policy Statements. Continue to communicate the site’s Safety and



No Action Taken No Action Taken



















Health Mission and Policy Statements for the entire site. Incorporate appropriate information about






















the Safety and Health Mission Statement and Policy Statement into the site’s orientation training for























new workers and contractors.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Leadership by example. Continue setting an example to the entire site through behaviors that demonstrate



No Action Taken No Action Taken



















total commitment to safety and health. Ensure increased participation by top executives and managers























in safety and health related activities, including examples of activities established in Stage I.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Adequate resources and safety and health integration. Continue committing and ensuring the utilization



No Action Taken No Action Taken



















of adequate resources to support safety and health activities and programs. Improve the integration of























safety and health into other planning processes.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















4. Safety and health goals and objectives. Review the site’s progress towards achievement of its safety



No Action Taken No Action Taken



















and health goals and objectives, as well as the policies and procedures to meet them; revise and























communicate new annual goals and objectives, as appropriate.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















5. Clear lines of communication with workers and worker access. Continue to take



No Action Taken No Action Taken



















necessary action to clarify lines of communication with Company and subcontractor workers and ensure























access to senior management regarding safety and health issues.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















6. Clear responsibilities, authority, and accountability for safety and health. Continue clarifying safety



No Action Taken No Action Taken



















and health expectations for each worker and contract worker on the site.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















a. Begin implementing the accountability plan for managers, supervisors, and safety and health staff



No Action Taken No Action Taken



















by incorporating into their performance plans their responsibilities and standards of performance























for safety and health and monitoring performance. Provide specific and timely feedback on performance;























require corrective action plans if needed; conduct performance appraisals; provide commensurate























rewards and recognition for good performance; and implement consequences for poor performance.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















b. Continue communicating management expectations regarding everyone’s safety and



No Action Taken No Action Taken



















health responsibilities.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















c. Continue supporting the authority of designated staff members who are accountable



No Action Taken No Action Taken



















for safety and health goals.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















d. Communicate who is responsible for achieving safety and health goals and objectives, with no unassigned



No Action Taken No Action Taken



















areas, so that each worker and contract worker can describe his/her responsibility for safety and health.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















7. Disciplinary plan. Develop and begin implementing a disciplinary plan (policy, procedures,



No Action Taken No Action Taken



















consequences), with an implementation schedule, for management and workers.



















Ensure equitable enforcement of the plan among all non-supervisory workers, as well as























across levels (e.g., management staff should not get better treatment than non-supervisory workers).























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















8. Annual self-evaluation of safety and health management program. No action required.


























2. Worker Involvement - Required Actions Status Status



















1. Worker Safety and Health Perception Survey. Continue reviewing and responding to the findings



No Action Taken No Action Taken



















and conclusions of the baseline worker safety and health perception survey conducted in Stage I.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Safety and Health Perception Survey Action Plan. Continue implementing the site’s Safety and Health



No Action Taken No Action Taken



















Perception Survey Action Plan developed in Stage I.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Worker notification. Notify new Company managers, supervisors, and non-supervisory



No Action Taken No Action Taken



















workers of their rights under the OSH Act, of the company’s participation in OSHA Challenge,























and any other pertinent information. Incorporate this information into the company's orientation for



















new workers and subcontractors.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















4. Meaningful worker involvement. Continue implementing the site’s worker involvement plan,


























developed in Stage I. Specifically, for Challenge Stage II:






















a. Encourage the formation of new and/or greater participation in safety and health teams



No Action Taken No Action Taken



















to meet the site’s needs at this Stage of OSHA Challenge.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















b. Increase worker participation as part of safety and health teams that conduct accident/



No Action Taken No Action Taken



















near-miss investigations, self-inspections, and job hazard analyses.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Contract Worker Coverage - Required Actions Status Status



















1. Contractor oversight and management system. Continue improving and fully implement the following


























basic elements of an oversight and management system covering contractors:






















a. Equal safety and health protection. Improve and continue implementing the contractor program



No Action Taken No Action Taken



















begun in Stage I.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















b. Adherence to safety and health rules. Improve process for requiring immediately and contractually that



No Action Taken No Action Taken



















contract workers who work on-site whether regular or temporary to adhere to all of the site's safety and























health rules, regardless of their status or the length of time they perform work on site.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















c. Contractor selection and oversight. Implement a policy and process for addressing safety and



No Action Taken No Action Taken



















health performance, including review of written safety and health plan and injury and illness rates, in






















selecting contractors and in overseeing their work while they are onsite.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















d. Hazards in contractor work areas. Improve and formalize the process for the timely identification,



No Action Taken No Action Taken



















correction, and tracking of uncontrolled hazards in the contractors’ work areas, as needed.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















e. Removal of contractor for violations. Develop and implement a penalty policy and process



No Action Taken No Action Taken



















for safety or health violations in contractor work areas including removal.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















Stage II -- Worksite Analysis




















1. Baseline Safety and Industrial Hygiene Hazard Analysis - Required Actions Status Status



















1. No action required (See IH Required Actions below).



N/A N/A



















2. Hazard Analysis of Routine Jobs, Tasks, and Processes - Required Actions Status Status



















1. Identify and document safety and health hazards of routine jobs, tasks, and processes and



No Action Taken No Action Taken


















recommend adequate hazard controls by conducting task-based or system/process hazard analyses























when the routine jobs, tasks, and processes have had injuries/illnesses associated with them or have:























experienced significant incidents or near-misses; are perceived as high-hazard tasks, i.e., they could























result in a catastrophic explosion, electrocution, or chemical overexposure; or are required by a regulation























or standard. Identify the steps of the task or procedure being analyzed, the hazard controls currently























in place, recommendations for needed additional hazard controls, dates conducted, and























the responsible parties.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Update the hazard analysis as appropriate, such as when the environment, procedures, or equipment



No Action Taken No Action Taken



















change or when errors are found that invalidate the most recent hazard analysis.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Hazard Analysis of Significant Changes - Required Actions Status Status



















No action required.



N/A N/A



















4. Pre-Use Analysis - Outcomes Achieved - Required Actions Status Status



















No action required.



N/A N/A



















5. Industrial Hygiene (IH) Program - Required Actions Status Status



















1. Develop a written IH Program to establish procedures and methods for identifying, analyzing,



No Action Taken No Action Taken



















and controlling health hazards to prevent occupational disease. The written program must address























sampling issues, including sampling methods, performed by whom, compared to what, required documentation,























and how communicated to workers.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Begin implementing the IH Program by doing the following:






















a. Conduct further analysis, such as full shift sampling, if necessary. No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















b. Establish and implement sampling frequencies – a schedule for sampling identified hazards



No Action Taken No Action Taken



















– and conduct additional sampling as needed, based on findings of the baseline hazard analysis,























review of chemicals, worker reports of hazards, previous exposures, and reports of illnesses.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















c. Begin implementing appropriate controls for hazards identified in Stages I and II. No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















6. Routine Self-Inspections - Required Actions Status Status



















1. Company develops a documented system for routinely scheduled self-inspections of the workplace,



No Action Taken No Action Taken



















including a tool or checklist, the inspection schedule, the members of the regular self-inspection teams to























be created, recording of findings, responsibility for abatement, and tracking of identified hazards for























timely correction.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















7. Hazard Reporting System for workers - Required Actions Status Status



















1. Develop and begin implementing a hazard-reporting system, which may be anonymous, that allows



No Action Taken No Action Taken



















workers to use specific tools to notify management staff in writing (or via alternate methods),























without fear of reprisal, about possibly hazardous conditions, accidents, and near-misses.























Determine and communicate to workers how they will receive feedback on actions taken regarding























the hazards they report.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















8. Investigation of Accidents and Near-Misses - Required Actions Status Status



















1. Continue investigating accidents, following the guidelines established in Stage I. No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Begin investigating near-misses, following the same guidelines established in Stage I for



No Action Taken No Action Taken



















investigating accidents.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Continue making findings and corrective actions available to workers on request (although actual



No Action Taken No Action Taken



















investigation records need not be provided).



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















9. Trend Analysis - Required Actions Status Status



















1. Conduct a trend analysis of the other safety and health-related information not yet studied



No Action Taken No Action Taken



















(e.g., hazards identified during inspections, worker reports of hazards, accidents, and























near-misses, etc.) for the purpose of establishing or detecting trends, planning, and setting goals.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Conduct another trend analysis of injury and illness history if a year has gone by since the



No Action Taken No Action Taken



















initial trend analysis.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















Stage II -- Hazard Prevention and Control



















1. Certified Professional Resources - Required Actions Status Status



















1. Provide access to certified safety and health professionals, licensed health care professionals, and others experts



No Action Taken No Action Taken



















as needed, who can provide onsite or offsite services.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Hazard Elimination and Control Methods - Required Actions Status Status



















1. Prioritize hazards identified in this stage based on seriousness and frequency of injury or illness or property



No Action Taken No Action Taken



















loss, frequency of exposure, and long- term effects. Establish an action plan for correction.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Identify options and select the most appropriate option or combination of options for hazard



No Action Taken No Action Taken



















elimination and control methods, including engineering controls (including protective safety devices),























administrative controls, work practices, and PPE.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Take steps to ensure that the selected controls are: appropriate to the site’s hazard(s);



No Action Taken No Action Taken



















understood and followed by all affected parties; equitably enforced through the disciplinary system; written,























implemented, and updated as needed; used by workers; and incorporated into training, positive























reinforcement, and correction programs.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Hazard Control Programs - Required Actions Status Status



















1. Continue implementing hazard control programs required by OSHA standards. Modify and



No Action Taken No Action Taken



















improve, as needed.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Continue training all workers on these programs, as needed. No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Establish necessary hazard control programs in compliance with new OSHA standards, if any.



No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















4. Tracking of Hazard Correction - Required Actions Status Status



















1. Continue implementing and improving the documented system, established in Stage I, to record



No Action Taken No Action Taken



















hazards identified in this Stage, through the means listed in Stage I, and now also through hazard























analysis of routine jobs, self-inspections, near-miss investigations, and worker reports of hazards.























Record priority, responsibility for correction, timeframes for correction, and follow up to ensure total abatement.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















5. Preventative Maintenance of Equipment - Required Actions Status Status



















1. Review the equipment inventory developed in Stage I. No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Establish and begin following a preventive maintenance schedule to monitor and maintain equipment



No Action Taken No Action Taken



















(including hazard controls, such as machine guards and exhaust ventilation) so it can be replaced or























repaired on a schedule according to manufacturers’ recommendations to prevent potential hazards.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















6. Occupational Health Care Program - Required Actions Status Status



















1. Licensed health care professionals. Provide workers access to licensed health care



No Action Taken No Action Taken



















professionals who can provide onsite or offsite services.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Health services, as needed. Company arranges for health services, such as pre-placement physicals,



No Action Taken No Action Taken



















audiograms, and lung function tests for workers, as needed, based on the outcomes of the baseline























safety and health analysis.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















7. Emergency Preparedness and Response - Required Actions Status Status



















1. Continue communicating the emergency procedures in compliance with applicable standards.



No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Improve and continue making available and explaining to all workers emergency procedures and



No Action Taken No Action Taken



















services, including provisions for emergency physician and medical care, ambulances, emergency























medical technicians, emergency clinics, or hospital emergency rooms available to all shifts within























a reasonable time and distance.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Establish an Emergency Response team including: persons trained in first aid and CPR available



No Action Taken No Action Taken



















on all shifts (or an alternative that is at least as effective). Increase the number of trained individuals from























from Stage I.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















4. Conduct at least one evacuation drill, assess how well the procedures worked, and improve the



No Action Taken No Action Taken



















emergency procedures, as needed.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















Stage II -- Safety and Health Training




















1. Safety and Health Training - Required Actions Status Status



















1. Continue to provide training to managers, supervisors, non-supervisory workers, and contract



No Action Taken No Action Taken



















workers following the general guidelines established in Stage I.



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. As needed, continue to provide current or new managers, supervisors, non-supervisory workers,



No Action Taken No Action Taken



















contract workers, and designated safety and health staff all the required training established in Stage I.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. In addition to required training established in Stage I, at a minimum, provide the following types of


























training to designated safety and health staff and others with assigned safety and health responsibilities


























to equip them with the knowledge and skills they need to perform their assigned tasks or to identify


























appropriate vendors:






















a. How to develop a disciplinary plan No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















b. How to develop a system and written procedures to annually evaluate the entire site’s safety



No Action Taken No Action Taken



















and health management system



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















c. How to conduct hazard analyses of significant changes No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















d. How to conduct pre-use analyses No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















e. How to conduct IH sampling, if applicable No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















f. How to conduct an annual evaluation of the site’s safety and health management system



No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















4. In addition to required training established in Stage I, at a minimum, provide contract workers



No Action Taken No Action Taken



















with training on how to recognize hazardous conditions, signs and symptoms of workplace-related























illnesses, protective measures, and safe work procedures.























Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















Stage II -- Documentation




















1. Minimum Required Documentation Status Status



















1. All documentation required in Stage I No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















2. Job Hazard Analysis forms and records No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















3. Routine self-inspection forms and records No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















4. Worker Hazard reporting forms No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















5. Minutes, charters, mission statements of safety and health teams No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















6. Contractor program documentation – updated to include additional policies established in this stage No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















7. Trend analysis results No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















8. Written IH Program- and any sampling results since the baseline No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















9. Documentation showing implementation of hazard controls and their effectiveness No Action Taken No Action Taken



















(i.e.- ventilation studies, PPE purchases, machine guarding purchases)



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















10. Written Preventive Maintenance schedule and system No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















11. Emergency Procedures – updated since Stage I No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:



















12. Training matrix and records No Action Taken No Action Taken



















Participant Goal: Date Completed:





















Participant Actions Taken:



















Administrator Narrative:




















Sheet 5: 4 - Stage III Status

OSHA Challenge - General Industry Track
Stage III Tracking Form
















Participant Name
Administrator Name
Report Period
[Enter Participant Name]
[Enter Administrator Name]
Time Period [Enter Time Period]


Year [Enter Year]







Stage III -- Management Leadership and worker Involvement
1. Management Commitment - Required Actions Participant Status Adminstrator Status
1. Safety and Health Mission and Policy Statements. Continue to communicate the site’s



No Action Taken No Action Taken
Safety and Health Mission and Policy Statements for the site and take necessary steps to



ensure all workers and contractors understand the statements. Ensure that appropriate information



about the site’s Safety and Health Mission and Policy Statements routinely becomes a part of the site’s



general communication and of specific training for new workers and contractors.



Participant Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
2. Leadership by example. Continue setting an example to the entire site through behaviors



No Action Taken No Action Taken
that demonstrate total commitment to safety and health (see examples in Stage I). Ensure



total involvement of all executives, managers, and supervisors in the site’s safety and health



related activities and programs.
Participant Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
3. Adequate resources and safety and health integration. Continue committing and ensuring the



No Action Taken No Action Taken
utilization of adequate resources to support safety and health activities and programs. Ensure



that safety and health is routinely integrated into all planning processes at the site.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
4. Safety and health goals and objectives. Review, revise, and continue communicating, as



No Action Taken No Action Taken
appropriate to this Stage, the previous year’s safety and health goals and objectives, as well as



the policies and procedures to meet them. Ensure that safety and health goals and objectives



are routinely considered in planning for and implementing the site’s various activities and programs.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
5. Clear lines of communication with workers and worker access. Continue



No Action Taken No Action Taken
to take necessary action to clarify lines of communication with all workers and ensure reasonable



access to top management with regard to safety and health issues. Take proactive steps to



encourage open dialogue between management staff and workers.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
6. Clear responsibilities, authority, and accountability for safety and health. Continue clarifying safety and



No Action Taken No Action Taken
health expectations for each worker and contract worker in the site. Ensure all workers understand and accept



their safety and health roles and responsibilities. Continue supporting the authority of designated staff



members who are accountable for achieving safety and health goals and objectives. In addition:



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
a. Ensure that safety and health performance elements have been incorporated into the written



No Action Taken No Action Taken
job descriptions and performance plans of all workers, including managers, supervisors,



and non-supervisory workers, as well as contractors.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
b. Incorporate safety and health responsibilities into the job descriptions and performance plans of all



No Action Taken No Action Taken
non-supervisory workers and ensure that every individual’s safety and health performance is



monitored and evaluated and that everyone receives feedback on their safety and health performance.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
c. Develop and implement a system of rewards and recognition for exemplary safety



No Action Taken No Action Taken
and health performance.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
7. Disciplinary plan. Improve and continue implementing the disciplinary plan developed in Stage II for



No Action Taken No Action Taken
non-supervisory workers, ensuring equitable enforcement as required. Enforce the plan to ensure



higher levels of compliance to achieve the desired outcomes for Stage III.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
8. Annual self-evaluation of safety and health management dystem. Develop a system and written



No Action Taken No Action Taken
procedures to annually evaluate the entire site’s safety and health management system. The evaluation may



be conducted by site workers with managers, qualified corporate staff, or trained outsiders. The evaluation



must: identify the strengths and weaknesses of the site’s safety and health management system; contain



specific recommendations, timelines, and assignment of responsibilities for improvements; and



document actions taken to satisfy the recommendations. The site must conduct at least one annual



self-evaluation of its safety and health management system in Stage III; the site must conduct additional



self-evaluations each year they remain in OSHA Challenge.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
2. Worker Involvement - Required Actions Status Status
1. Follow-up worker safety and health perception survey. Conduct a follow-up assessment of the baseline



No Action Taken No Action Taken
baseline worker safety and health perception survey to identify improvements.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
2. Safety and Health Perception Survey Action Plan. Continue implementing the site’s Safety and Health



No Action Taken No Action Taken
Perception Survey Action Plan developed in Stage I.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
3. Worker notification. Continue notifying new managers, supervisors, non-supervisory workers,



No Action Taken No Action Taken
and contractors of their rights under the OSH Act and of the site’s participation in OSHA Challenge. Assure that



appropriate information about workers' rights continue to be incorporated into the site's orientation



training for new workers and contractors. Take proactive steps to encourage all workers to freely exercise



their rights, especially that of freely reporting hazards in the workplace.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
4. Meaningful worker involvement. Take proactive steps to ensure full implementation of the site's worker






involvement plan developed in Stage I and refined in Stage II. Specifically, for Stage III:






a. Ensure that all the safety health teams needed to achieve the required outcomes for



No Action Taken No Action Taken
Stage III are established and that there is broad and active worker participation in these teams.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
b. Ensure that audits, accident/incident investigations, self-inspections, and job hazard analyses are



No Action Taken No Action Taken
routinely conducted by regular teams that have broad and active worker representation.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
c. Improve and continue implementing the site’s hazard-reporting program for workers. Take proactive steps



No Action Taken No Action Taken
to encourage more active and open worker participation.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
3. Contract Worker Coverage - Required Actions Status Status
1. Contractor oversight and management system. Continue improving and fully implementing the contractor



No Action Taken No Action Taken
oversight and management system. Take proactive steps to ensure that contractors receive safety and health



prtection equal to that received by workers; that they adhere to the site's safety and health rules and are removed



promptly for safety and health violations; that management considers contractors' safety and health



performance in selecting contractors and overseeing their work; and that the site identifies, corrects, and



tracks uncontrolled hazards in contractors' work areas.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
2. Safety and health management systems for contractors. Begin working with contractors to encourage and



No Action Taken No Action Taken
support them in developing and operating their own effective safety and health management systems.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
Stage III -- Worksite Analysis
Worksite Analysis - Required Actions Status Status
1. Baseline Survey. Repeat the baseline survey only if warranted by significant changes



No Action Taken No Action Taken
(e.g., changes in processes, equipment, hazard controls, etc.).
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
2. Hazard analyses of routine jobs, tasks, and processes: Continue conducting hazard anaylses,






following guidelines specified in Stages II, to identify, analyze, and control hazards at the site.






Specifically, for this Stage:






a. Identify hazards of routine jobs, tasks, and processes and recommend adequate hazard controls



No Action Taken No Action Taken
by conducting task-based or system/process hazard analyses when the routine jobs, tasks,



and processes: have written procedures; have been recommended by other studies and



analyses for more in-depth analysis; or are determined by the Challenge participant to warrant



hazard analysis. Follow the guidelines established in Stage II.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
3. Hazard analysis of non-routine tasks and significant changes. Identify and document safety and health



No Action Taken No Action Taken
hazards of significant changes, including but not limited to non-routine tasks (e.g., performed less than once a



year) and new processes, materials, equipment and facilities to identify uncontrolled hazards prior to the



activity or use and recommend adequate hazard controls.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
4. Pre-use analysis






a. If the site is considering new equipment, chemicals, facilities, or significantly different operations



No Action Taken No Action Taken
or procedures, conduct a pre-use analysis to review the potential safety and health impact



on the workers at a level of detail appropriate considering the perceived risk and the



number of people who may be affected.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
b. Develop and begin implementing a plan for how to integrate this practice into the procurement/



No Action Taken No Action Taken
design phase to maximize the opportunity for proactive hazard controls.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
c. Take proactive steps to ensure that pre-use analysis continues to be integrated into the



No Action Taken No Action Taken
procurement/design phase.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
5. Industrial hygiene program. Continue implementing the IH program to identify, analyze, and control



No Action Taken No Action Taken
health hazards to prevent occupational disease.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
6. Routine self-inspections.


a. Company and subcontractors continue implementing the documented system for routinely



No Action Taken No Action Taken
scheduled self-inspections of the workplace developed in Stage II.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
b. Continue conducting self-inspections by designated safety and health staff, with the



No Action Taken No Action Taken
participation of other non-supervisory workers.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
c. Take proactive steps to ensure that self-inspections are routinely conducted monthly and



No Action Taken No Action Taken
that the entire work site is covered at least quarterly.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
7. Hazard-reporting system. Continue implementing the hazard-reporting system and encourage active



No Action Taken No Action Taken
reporting. Implement program improvements as needed. Ensure regular feedback to all workers on the



status of hazards reported (e.g., through meetings, newsletters, e-mail messages, bulletin board postings,



intranet postings, etc.). Take proactive steps to encourage all workers to freely make suggestions and report



hazardous conditions without fear of retaliation.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
8. Investigation of accidents and near-misses. Continue investigating accidents and near-misses,



No Action Taken No Action Taken
as needed, following the guidelines specified in Stages I and II.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
9. Trend Analysis. Take proactive steps to establish a system for trend analysis to ensure that the process takes



No Action Taken No Action Taken
place regularly (at least annually) as scheduled, for all types of safety and health information and is used



in setting future goals to address identified trends of accidents, injuries, and illnesses.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
Stage III -- Hazard Prevention and Control
Hazard Prevention and Control - Required Actions Status Status
1. Certified professional resources. Continue to provide workers and contractors access to certified safety



No Action Taken No Action Taken
and health professionals and licensed health care professionals who can provide onsite and offsite services.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
2. Hazard elimination and control methods. Continue to proactively identify hazards through all means and



No Action Taken No Action Taken
selecting options or combinations of options to eliminate or control hazards using the most appropriate



methods or combination of methods, i.e., engineering controls (including protective safety devices),



administrative controls, work practices, and PPE. Correct all hazards identified in this and previous stages,



including long-term abatement projects, before graduating from Stage III.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
3. Hazard control programs. Continue to maintain all hazard control programs required by an



No Action Taken No Action Taken
OSHA standard, complying with all guidelines, including an annual review and training if required.



Take proactive steps to establish hazard control programs, if any, required by new OSHA standards



and to modify or update existing programs, as needed.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
4. Hazard Correction Tracking. Continue to implement and improve the site’s documented hazard



No Action Taken No Action Taken
tracking system. Take proactive steps to improve the tracking system, ensure that it is fully



implemented, and communicate with all workers throughout the process on the status of



specific hazards identified until they are totally abated.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
5. Preventive maintenance of equipment. Continue to implement the preventive maintenance



No Action Taken No Action Taken
on equipment to prevent any hazardous conditions. Take proactive steps to ensure that the site



schedule has an established, routinely-observed preventive maintenance schedule and that preventive



maintenance is automatically part of future systems.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
6. Occupational health care program. Take proactive steps to provide an excellent occupational






health care program, including:


a. Provisions for access to or availability of certified health care professionals, needed



No Action Taken No Action Taken
health services, and emergency physician and medical care; improve the program based



on all available safety and health information.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
b. Expand use of licensed health care providers to include site visits to help identify causes



No Action Taken No Action Taken
and symptoms of occupational injuries and illnesses. Ensure care provided is within the scope



schedule of licensure and standard operating procedures.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
7. Emergency preparedness and response. Continue to improve, communicate, and implement the site's



No Action Taken No Action Taken
written procedures for responding during all shifts to all types of emergencies. Review the results of



previous drills and conduct and evaluate, at a minimum, an annual drill. Ensure that there is at least one



fully operational emergency response team in every shift. Provide AEDs as appropriate and training on



their use. Take proactive steps to ensure full implementation and automatic tracking of the site's



emergency preparedness and response program and procedures. Establish a HAZMAT team if necessary and



consult with local fire department to ensure adequate coverage for fire, explosion, or chemical release.



Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
Stage III -- Safety and Health Training
Safety and Health Training - Required Actions Status Status
1. Continue to provide training to all workers, including contractors, following the general guidelines



No Action Taken No Action Taken
specified in Stage I.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
2. Take proactive steps to improve and continue providing training on specific topics, as needed.



No Action Taken No Action Taken
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
3. Provide training for contractors on how to recognize hazardous conditions and the signs and symptoms



No Action Taken No Action Taken
of workplace-related illnesses and injuries.
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
Stage III -- Documentation
Documentation Status Status
1. All documentation from Stages I and II completed and updated No Action Taken No Action Taken
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
2. Hazard analysis form showing analysis of non-routine tasks, or significant changes No Action Taken No Action Taken
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
3. Pre-use analysis forms and results No Action Taken No Action Taken
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
4. Annual self-evaluation of the site’s safety and health management system No Action Taken No Action Taken
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
5. Follow up Safety and Health Perception Survey and results No Action Taken No Action Taken
Participant Goal: Date Completed:

Participant Actions Taken:
Administrator Narrative:
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

© 2024 OMB.report | Privacy Policy