Company Name
City, State

Onsite Evaluation Date
Month - Start/End Dates, 20XX

VPP Evaluation Team
Name, Title
Name, Title
Name, Title
Name, Title
Name, Title

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EXECUTIVE SUMMARY

I. Purpose and Scope of Review

An onsite review was conducted from <Date>, at the <Organization> in <City, State>. The purpose of the evaluation was to determine the site's <eligibility or continued eligibility> for site-based participation in the Occupational Safety and Health Administration's (OSHA) Voluntary Protection Programs (VPP). NOTE If C-FOP add the following language "This onsite review was conducted using the Corporate Facility Onsite Process (C-FOP)". The VPP Evaluation Team consisted of:

• Name, Title/Special Government Employee (SGE), Office, City, State
• Name, Title/Special Government Employee (SGE), Office, City, State
• Name, Title/Special Government Employee (SGE), Office, City, State
• Name, Title/Special Government Employee (SGE), Office, City, State
• Name, Title/Special Government Employee (SGE), Office, City, State

II. Methods of Data Collection

The information for this report was obtained from the site's VPP application, documentation reviewed onsite, interviews with employees, annual evaluations, and site walk-throughs of the facility.

III. Employees at the Worksite

There are <XXX> employees working on site. In addition, there are <XXX> contractor employees onsite performing maintenance, capital projects, guard services, janitorial services, etc. Employees at the site are represented by the <insert union name(s) and local(s)> OR <Employees at the site are not represented by a collective bargaining agent.> Formal interviews were conducted with <XX> site employees and <XX> contract employees. Informal interviews were conducted with <XXX> site employees and <XXX> contract employees.

IV. The Worksite

The site is properly classified under North American Industrial Classification System (NAICS) code <XXXXXX>. Provide a description of the site, e.g., size, location, operation, buildings, etc. Describe the site's processes, productions, and applications. Housekeeping at the facility was considered by the VPP Evaluation Team to be <please select one: poor, fair, good or excellent>.

V. Worksite Hazards

The hazards at the site include, but are not limited to <state hazards>. The site <does or does not> use chemicals considered to be highly hazardous and in sufficient quantity to place the site under the Process Safety Management (PSM) Standard.

VI. Injury and Illness Rates

The three-year Total Case Incidence Rate (TCIR) and Days Away/Restricted/Transferred Case Incidence (DART) rate for the period <20XX-20XX> are <XX> and <XX>, respectively. The site TCIR is <XX%> <above/below>, and the DART rate is <XX%> <above/below> the 20XX Bureau of Labor Statistics (BLS) industry average for NAICS code <XXXXXX> for 20XX.

Team leader must verify that a comparison has been conducted against the site's injury and illness rates reviewed during the evaluation and the site's injury and illness rates reported in its annual self- evaluation.

VII. OSHA Activity

There has been no OSHA inspection activity or fatalities at this site within the past <XX> years. The site maintains an excellent relationship with its local OSHA Area and Regional offices.

VIII. Elements of the VPP Review/Program Changes

The VPP Evaluation Team has examined each of the required elements of the site's safety and health management programs. All VPP requirements have been met and all OSHA standards are appropriately covered.

Bullet summary information of VPP Elements.

• Management Leadership and Employee Involvement
• Worksite Analysis
• Hazard Prevention and Control
• Safety and Health Training

<For Reapproval evaluations>, discuss significant program or site changes since the last visit. A bulleted list is acceptable. [For Star reapproval evaluations recommending One-Year Conditional, add the following sentence: Refer to Section XI for discussion of safety and health management program corrections.]

<Incentive Programs> The site utilizes an incentive program which meets the requirements of revised Memorandum #5: Further Improvements to the Voluntary Protection Programs (VPP) dated 8/14/14. OR The site does not utilize an incentive program.

<Whistleblower Activity(ies)> Briefly document the site's policy on anti-retaliation/discrimination. Indicate whether the site has had or not had any whistleblower activity(ies) within the past <XX> years. If so, include brief description and findings/outcome.

IX. Areas of Excellence

All elements of the site's safety and health management programs met the high quality expected of VPP participants (or describe the program requirements that you considered an area of excellence). NOTE Do not characterize the safety and health management programs as meeting the high quality expected of VPP participants if the team is recommending One-Year Conditional reapproval.

X. Recommendation for Participation

The VPP Evaluation Team recommends <Site name, City, State> be approved for participation in the OSHA VPP <Star or Merit> Program (add if relevant but placed on One-Year Conditional status or but required to develop an agreed upon Two-Year Rate Reduction Plan).

XI. Goals (if applicable)

• Merit Goal(s) (if relevant)
• One-Year Conditional Goal(s) (if relevant)
• Two-Year Rate-Reduction Plan (if relevant)

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Corporate Facility Onsite Process (C-FOP)
or
Compressed Reapproval Process (CRP)
Site Worksheet

Company Name
City, State

Onsite Evaluation Date
Month - Start/End Dates, 20XX

 

Section I: Management Leadership and Employee Involvement

Merit Goals: (Include cross- reference to section, subsection, and question, e.g., I.B2)

1.  
2.  

90-Day Items: (Delete this section for final transmittal to National Office)

1.  
2.  

Best Practices:

1.  
2.  

Comments including Recommendations: (optional)

1.  
2.  

Documents Referenced, Programs Reviewed: (optional)

1.  
2.  

---

Section II: Worksite Analysis

Merit Goals: (Include cross- reference to section, subsection, and question, e.g., II.B2)

1.  
2.  

90-Day Items: (Delete this section for final transmittal to National Office)

1.  
2.  

Best Practices:

1.  
2.  

Comments including Recommendations: (optional)

1.  
2.  

Documents Referenced, Programs Reviewed: (optional)

1.  
2.  

---

Section III: Hazard Prevention and Control

Merit Goals: (Include cross reference to section, subsection, and question, e.g., I.B2)

1.  
2.  

90-Day Items: (Delete this section for final transmittal to National Office)

1.  
2.  

Best Practices:

1.  
2.  

Comments including Recommendations: (optional)

1.  
2.  

Documents Referenced, Programs Reviewed: (optional)

1.  
2.  

---

Section IV: Safety and Health Training

Merit Goals: (Include cross reference to section, subsection, and question, e.g., I.B2)

1.  
2.  

90-Day Items: (Delete this section for final transmittal to National Office)

1.  
2.  

Best Practices:

1.  
2.  

Comments including Recommendations: (optional)

1.  
2.  

Documents Referenced, Programs Reviewed: (optional)

1.  
2.  

 

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VPP Participant and Onsite Evaluation Team Data Sheet

PARTICIPANT AREAS OF EXCELLENCE/BEST PRACTICES CHECKLIST

• Ergo Program
• Confined Space Program
• LO/TO Program
• PSM
• Hazard Analysis
• Contractor Program
• Medical Program
• Self-Inspections
• Accountability
• Industrial Hygiene
• Employee Involvement
• Tracking of Hazards
• Pre-Job Analysis
• Other:

STRATEGIC PLAN
High Hazard Industries

• Landscaping - 078
• Oil/Gas - 138
• Fruits/Vegetables 203
• Concrete/Gypsum/Plaster - 327
• Blast Furnace/Steel Production - 331
• Ship/Boat Building/Repair - 373
• Wholesale Storage - 422

Hazards

• Ergo
• Lead
• Silica
• Amputations – Construction
• Amputations – General Industry

VPP CORPORATE TRACKING