Challenge Administrator Application

CHALLENGE ADMINISTRATOR APPLICATION AND INSTRUCTIONS

1. Complete the Challenge Administrator Application.

2. Write and sign a Challenge Administrator letter of commitment. A sample letter of commitment is at the end of this application.

3. To submit electronically, attach the completed Challenge Administrator Application and a scanned copy of the signed Challenge Administrator letter of commitment to an email and send it to: harris.richard@dol.gov

To submit via hard copy, send the completed Challenge Administrator Application and the signed Challenge Administrator letter of commitment to:

Rick Harris

OSHA Challenge Coordinator

Directorate of Cooperative and State Programs

Occupational Safety and Health Administration

200 Constitution Avenue, NW, Room N3700

Washington, DC 20210

If you have questions about OSHA Challenge or the Challenge Administrator application Process, please contact Office of Partnerships and Recognition at 202-693-2213.

Challenge Administrator Application
Contact Information
Organization Name:
Organization Type (e.g., private company, federal agency, association, etc.):
Administrator Name within Organization:
Administrator Title within Organization:
Administrator Work Address:
Administrator Phone Number:
Administrator Fax Number:
Administrator Email Address:
Knowledge and Experience
In 400 words or less, please describe your organization’s knowledge and experience with developing, implementing, and evaluating safety and health management programs. Experience may include involvement in other OSHA cooperative programs such as the Voluntary Protection Programs, the OSHA Strategic Partnership Program, and/or experience in administering and evaluating corporate-wide safety and health programs.
Resources
In 100 words or less, please confirm the availability of resources (e.g., time and personnel) to administer OSHA Challenge and guide the Challenge participants through the Challenge stages.
Data Collection
In 250 words or less, please provide a description of what your process will be for collecting progress reports and baseline and quarterly/annual data from each of your Challenge participants and ensuring that the data obtained is accurate.

Challenge Administrator Application

Sample Letter of Commitment

Mr. Sherman Williamson

Director, Office of Partnerships and Recognition

Directorate of Cooperative and State Programs

Occupational Safety and Health Administration

200 Constitution Avenue, NW, Room N3700

Washington, DC 20210

Dear Mr. Williamson:

I am writing to inform you of the intent of <organization name> to participate in OSHA Challenge and serve as a Challenge Administrator. We have reviewed the OSHA Challenge requirements and believe <organization name> meets the necessary criteria. We assure you that <organization name> is committed to assisting Challenge participants progress through the Challenge stages and achieve an effective safety and health management program and to fulfilling the responsibilities inherent in being a Challenge Administrator.

Attached please find our Challenge Administrator Application. Should you have any questions or need additional information, please contact me at <organization representative telephone number> or <organization representative email address>.

Sincerely,

<Organization representative name>

<Organization representative title>

<Organization name>

OSHA Challenge Administrator Application – revised 051012