Years Reported* 2015 2016 2017 Total Hours Worked (in thousands) 1 Number of incidents: (per OSHA definitions) Fatalities 2 Lost Workday Cases 3 Total Recordable Cases 4 OSHA Incidence Rates 5 Fatalities Plus Lost Workday OSHA Rate Recordable OSHA Rate Report for the period of project or program duration; if the project is less than 12 months report for the * year in which the project occurred. 1: Site Assigned Personnel Only (Omit head and regional offices). 2: If are any mitigating circumstances, please feel free to present details surrounding the case if you so desire. 3: OSHA Classification Workday Case-Away From Work.” “Lost 4: OSHA Recordable Injuries/Illness. 5: OSHA Incident Cases per 200,000 hours worked. – PART 3: Owner Project Information (NOTE: This part must be limited to 8 printed pages. Charts, graphs, or other illustrations may be embedded only in Part 3 and must be included in the page count.) OWNER NAME: List below three contractors on the project who can verify your safety practices and performance. Years when work was performed, and approximate size (Effort-hours Company and or $ value) Contact Person City State Zip Telephone A. B. C. Description of projects/work. Include any special situations/conditions that impacted on project safety achievement.
Years Reported* 2015 2016 2017 Total Hours Worked (in thousands) 1 Number of incidents: (per OSHA definitions) Fatalities 2 Lost Workday Cases 3 Total Recordable Cases 4 OSHA Incidence Rates 5 Fatalities Plus Lost Workday OSHA Rate Recordable OSHA Rate * Report for the period of project or program duration; if the project is less than 12 months report for the year in which the project occurred. 1: Site Assigned Personnel Only (Omit head and regional offices). 2: If are any mitigating circumstances, please feel free to present details surrounding the case if you so desire. 3: OSHA Classification “Lost Workday Case-Away From Work.” 4: OSHA Recordable Injuries/Illness. 5: OSHA Incident – Cases per 200,000 hours worked. PART 3: Owner Project Information (NOTE: This part must be limited to 8 printed pages. Charts, graphs, or other illustrations may be embedded only in Part 3 and must be included in the page count.) OWNER NAME: List below three contractors on the project who can verify your safety practices and performance. Years when work was performed, and approximate size (Effort-hours or $ value) Company and Contact Person City State Zip Telephone A. B. C. Description of projects/work. Include any special situations/conditions that impacted on project safety achievement.