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

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

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

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

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

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

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

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

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

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

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

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

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

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

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

(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

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

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

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

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

(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

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

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

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

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

5. Hazard Reporting System for Employees - Required Actions

Participant Status

Administrator Status

No Outcomes Required

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

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

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

(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

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

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

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

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

(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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

b. OSHA Challenge

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

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

e. Specific responsibilities for each type of emergency

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

f. Emergency evacuation procedures

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

b. Methods for changing workplace safety and health attitudes and practices

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

c. Requirements for OSHA Challenge Stage I

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

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

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

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

preventive maintenance inspections.

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

e. Hazard elimination and control methods

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

g. How to develop a worker hazard-reporting system

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

i. How to develop emergency procedures

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

j. How to develop a hazard tracking system

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

b. OSHA Challenge

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

c. Hazards in the workplace

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

e. Specific responsibilities for each type of emergency

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

f. Emergency evacuation procedures

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

2. Accountability plan

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

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

• Insurance claim forms

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

• Accident reports

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

5. Baseline hazard analysis results, including IH reports

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

6. Written hazard control programs

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

7. Accident investigation forms and reports

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

8. Written contractor policies for this stage

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

necessary changes

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

10. Trend analysis results

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

11. Hazard correction action plan

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

12. Hazard correction tracking system

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

13. Preventative maintenance inventory

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

14. Written emergency procedures

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

N/A

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

Status

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

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

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

No action required.

N/A

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

Status

No action required.

N/A

5. Industrial Hygiene (IH) Program - Required Actions

Status

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

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

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

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

6. Routine Self-Inspections - Required Actions

Status

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

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

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

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

1. Continue investigating accidents, following the guidelines established in Stage I.

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

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

investigation records need not be provided).

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

9. Trend Analysis - Required Actions

Status

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

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

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

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

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

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

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

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

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

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

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

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

4. Tracking of Hazard Correction - Required Actions

Status

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

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

1. Review the equipment inventory developed in Stage I.

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

(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

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

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

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

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

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

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

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

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

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

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

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

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

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

d. How to conduct pre-use analyses

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

e. How to conduct IH sampling, if applicable

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

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

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

1. All documentation required in Stage I

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

2. Job Hazard Analysis forms and records

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

3. Routine self-inspection forms and records

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

4. Worker Hazard reporting forms

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

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

7. Trend analysis results

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

9. Documentation showing implementation of hazard controls and their effectiveness

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

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

11. Emergency Procedures – updated since Stage I

No Action Taken

Participant Goal:

Date Completed:

Participant Actions Taken:

Administrator Narrative:

12. Training matrix and records

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]
[Enter Participant Name]	[Enter Administrator Name]	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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.).			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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.			No Action Taken	No Action Taken
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 Type	application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified	0000-00-00
File Created	0000-00-00