Information You'll Need for the VPP Application

A. General Information

1. Applicant

• Site Name
• Site Address
• Site Manager
• Title
• Site VPP Contact for OSHA correspondence
• Title
• Phone Number
• Email Address

2. Company/Corporate Name

• Name (if different from above)
• Address
• VPP Contact (if applicable)
• Title
• Phone Number
• Email Address

3. Collective Bargaining Agent(s) (list information on each separately)

• Union Name and Local #
• Agent’s Name
• Address
• Phone Number
• Email Address
• *For Additional Collective Bargaining Agents, attach a file to this application with the same information as listed here for each.

4. Number of Employees and Contractor Employees

• Number of Employees working at Applicant’s site
• Number of Temporary Employees supervised by Applicant
• Number of Applicable Contractor* Employees
  *An Applicable Contractor has employees working 1,000 or more hours in at least one calendar quarter at the Applicant’s site.

5. Type of Work Performed and Products Produced

• Provide a comprehensive description of the work performed at your site
• Provide a comprehensive description of the type of products produced
• Provide a comprehensive description of the type of hazards typically associated with your industry.

6. Applicant’s North American Industrial Classification System (NAICS) Code (3-6 digit number)

• Provide your site’s NAICS code.

7. Recordable Non-fatal Injury and Illness Case Incidence Rates

TCIR is the total case incidence rate for recordable non-fatal injuries and illnesses.

DART rate is the incidence rate for recordable non-fatal injury and illness cases involving days away from work, restricted work activity, and/or job transfer.

If you are a small business, you may be eligible for the alternative rate calculation. Contact the Oregon OSHA VPP Program Coordinator, Mark Hurliman, 541-539-8385, mark.e.hurliman@dcbs.oregon.gov

• Attach a copy of your completed Excel file, or your own document with the injury, illness, and hours for each of the last 3 years used to calculate your TCIR and DART rates.

Enter this site's 3-year TCIR and DART rate.

• Combined 3-year TCIR
• Combined 3-year DART

B. Management Leadership and Employee Involvement

Management Leadership

1. Commitment

• Attach a copy of your top level safety policy specific to your facility.

Note: Management must clearly demonstrate commitment to meeting and maintaining the requirements of the VPP.

2. Organization

• Attach a copy of your organization chart.
• Describe how your company’s safety and health function fits into your overall management organization.

3. Responsibility

• Describe how your line and staff are assigned safety and health responsibilities. Include examples of specific responsibilities.

4. Accountability

• Describe your accountability system used to hold managers, line supervisors, and employees responsible for safety and health. Examples are job performance evaluations, warning notices, and contract language.
• Describe system documentation.

5. Resources

• Identify the available safety and health resources.
• Describe the safety and health professional staff available, including appropriate use of certified safety professionals (CSP), certified industrial hygienists (CIH), other licensed health care professionals, and other experts as needed, based on the risks at your site.
• Identify any external resources (including corporate office and private consultants) used to help with your safety and health management system.

6. Goals and Planning

• Identify your annual plans that set specific safety and health goals and objectives.
• Describe how planning for safety and health fits into your overall management planning process.

7. Self-Evaluation

• Provide a copy of the most recent annual self-evaluation of your safety and health management system.
• Include assessments of the effectiveness of the VPP elements listed in these application guidelines, recommendations for improvement, assignment of responsibility, and documentation of action items completed.
• Describe how you prepare and use the self-evaluation.

Employee Involvement

8. Three Ways

• Provide specific information about decision processes that employees impact, such as hazard assessment, inspections, safety and health training, and/or evaluation of the safety and health management system.
• List at least three meaningful ways employees are involved in your safety and health management system, including the safety committee.

9. Employee Notification

• Describe how you notify employees about site participation in the VPP
• Describe how you notify employees about their right to register a complaint with Oregon OSHA
• Describe how you notify employees about their right to obtain reports of inspections and accident investigations upon request.

10. Contract Workers’ Safety

• Describe the process used for selecting contractors to perform jobs at your site.
• Describe your system for ensuring that all contract workers who do work at your site are provided the same healthful working conditions and the same quality protection as your regular employees.

11. Site Map

• Attach a site map or general layout.

C. Worksite Analysis

1. Baseline Hazard Analysis

• Describe the methods used for baseline hazard analysis to identify hazards associated with your specific work environment, for example, air contaminants, noise, or lead.
• Identify the safety and health professsionals involved in the baseline assessment and subsequent needed surveys.
• Explain any sampling rationale and strategies for industrial hygiene surveys if required.

2. Hazard Analysis of Routine Jobs,Tasks, and Processes

You should base priorities for hazard analysis on historical evidence, perceived risks, complexity, and the frequency of jobs/tasks completed at your worksite. In construction, the emphasis must be on special safety and health hazards of each craft and phase of work.

• Describe the system used for examination and analysis of safety and health hazards associated with routine tasks, jobs, processes, and/or phases.
• Provide some sample analyses and any forms used.

3. Hazard Analysis of Significant Changes

Significant changes may include non-routine tasks and new processes, materials, equipment, and facilities.

• Explain how, prior to activity or use, you analyze significant changes to identify uncontrolled hazards and the actions needed to eliminate or control these hazards.

4. Self-Inspections

• Describe your worksite safety and health routine general inspection procedures.
• Indicate who performs inspections, their training, and how you track any hazards through to elimination or control.
• For routine health inspections, summarize the testing and analysis procedures used and qualifications of personnel who conduct them.
• Attach forms used for self-inspections.

5. Employee Reports of Hazards

• Describe how employees notify management of uncontrolled safety or health hazards.

An opportunity to use a written form to notify management about safety and health hazards must be part of your reporting system.

• Explain procedures for follow-up and tracking corrections.

6. Industrial Hygiene (IH) Program

• Describe your written IH program. Include information regarding IH surveys, your IH sampling strategy, the use of sampling results, and the IH expertise available to your site.

7. Accident and Incident Investigations

Incidents should include first aid and near-miss cases.

• Describe your written procedures for investigation of accidents, near-misses, first aid cases, and other incidents.
• What training do investigators receive?
• How do you determine which accidents or incidents warrant investigation?
• Describe how results are used.

8. Pattern Analysis

• Describe the system you use for safety and health data analysis.
• Indicate how you collect and analyze data from all sources, including injuries, illnesses, near-misses, first aid cases, work order forms, incident investigations, inspections, and self-audits.
• Describe how results are used.

D. Hazard Prevention and Control

1. Engineering Controls

Engineering controls include, for example, reduction in pressure or amount of hazardous material, substitution of less hazardous material, reduction of noise produced, fail-safe design, leak before burst, fault tolerance/ redundancy, and ergonomic design changes. Although not as reliable as true engineering controls, this category also includes protective safety devices such as guards, barriers, interlocks, grounding and bonding systems, and pressure relief valves to keep pressure within a safe limit.

• Describe and provide examples of engineering controls you have implemented that either eliminated or limited hazards by reducing their severity, their likelihood of occurrence, or both.

2. Administrative Controls

• Describe ways you limit daily exposure to hazards by adjusting work schedules or work tasks.

3. Work Practice Controls

Work practice controls include, for example, workplace rules, safe and healthful work practices, specific programs to address Oregon OSHA standards, and procedures for specific operations.

• Describe and provide examples of your work practice controls.
• Identify major technical programs and regulations that pertain to your site, such as lockout/tagout, process safety management, hazard communication, machine guarding, and fall protection.

4. Personal Protective Equipment

• Describe and provide examples of required personal protective equipment your employees use.

5. Safety and Health Rules

• Describe your general safety and health rules.
• Demonstrate that there is a disciplinary system for equitably enforcing these rules for managers, supervisors, and employees.

6. Preventive/Predictive Maintenance

• Describe your written system for monitoring and maintaining workplace equipment to predict and prevent equipment breakdowns that may cause hazards.
• Provide a brief summary of the type of equipment covered.

7. Occupational Health Care Program

• Describe your on-site and off-site medical service and physician availability.
• Explain how you utilize the services of licensed occupational health care professionals.
• Indicate the coverage provided by employees trained in first aid, CPR, and other paramedical skills, their training, and available equipment.

8. Emergency Preparedness

• Describe your emergency planning and preparedness system.
• Provide informationon emergency drills and training, including evacuations.

9. Process Safety Management

If applicable, complete and attach the VPP Application Supplement for sites subject to the Process Safety Management (PSM) standard.

VPP Application Supplement A (opens in a new tab)

E. Safety and Health Training

• Describe the formal and informal safety and health training provided for managers, supervisors, and employees.
• Identify training protocols, schedules, and information provided to supervisors and employees on programs such as hazard communication, personal protective equipment, and handling of emergency situations.
• Describe how you verify the effectiveness of the training given.

F. Assurances

VPP applications must include a signed statement. Attach your signed statement that affirms:

1. Compliance

You will comply with the Occupational Safety and Health Act (OSH Act) and correct in a timely manner all hazards discovered through self-inspections, employee notification, accident investigations, Oregon OSHA onsite reviews, process hazard reviews, annual evaluations, or any other means. You will provide effective interim protection, as necessary.

2. Correction of Deficiencies

Within 90 days, you will correct safety and health deficiencies related to compliance with Oregon OSHA requirements and identified during any Oregon OSHA onsite review.

3. Employee Support

Your employees support the VPP application. At sites with employees organized into one or more collective bargaining units, the authorized representative for each collective bargaining unit must either sign the application or submit a signed statement indicating that the collective bargaining agent(s) support VPP participation. Oregon OSHA must receive concurrence from all such authorized agents to accept the application. At non-union sites, management’s assurance of employee support will be verified by the Oregon OSHA onsite review team during employee interviews.

4. VPP Elements

VPP elements are in place, and management commits to meeting and maintaining the requirements of the elements and the overall VPP.

5. Orientation

Employees, including newly hired employees and contract employees, will receive orientation on the VPP, including employee rights under VPP and under Chapter 654 or the OSE Act or 29 CFR 1960.

6. Non-Discrimination

You will protect employees given safety and health duties as part of your safety and health management system from discriminatory actions resulting from their carrying out such duties, just as 654.062 of the OSE Act, Section11(c) of the OSH Act, and 29 CFR 1960.46(a) protect employees who exercise their rights.

7. Employee Access

Employees will have access to the results of self-inspections, accident investigations, and other safety and health data upon request. At unionized construction sites, this requirement may be met through employee representative access to these results.

8. Documentation

You will maintain your safety and health management system information and make it available for Oregon OSHA review to determine initial and continued approval to the VPP. This information will include:

Any agreements between management and the collective bargaining agent(s) concerning safety and health.

All documentation enumerated under Section III.J.4. of the July 24, 2000 Federal RegisterNotice.*

*Reprinted on Page I-24 of this document. Any data necessary to evaluate the achievement of individual Merit or 1-Year Conditional Star goals.

9. Annual Submission

Each year by February 15, you will submit the following information to the Oregon OSHA VPP/SHARP Program Coordinator:

Participant Rates

a. For the previous calendar year, the TCIR for injuries and illnesses, and the DART rate.

b. The total number of cases for each of the abovetwo rates.

c. Hours worked and estimated averageemployment for the past full calendar year.

Contractor Rates

If you are a general industry or state agency site, you will submit data on each applicable contractor. Applicable contractors are those employers who have contracted with you to perform certain jobs and whose employees worked a total of 1,000 or more hours in at least one calendar quarter at your worksite. The data will consist of:

a. The site’s TCIR and DART rate for eachapplicable contractor’s employees.

b. The total number of cases from which thesetwo rates were derived.

c. Hours worked and estimated averageemployment for the past full calendar year.

d. The appropriate NAICS code for eachapplicable contractor’s work at the site.

Annual Evaluation

A copy of the most recent safety and health annual evaluation. Include a description of any success stories, such as reductions in workers’ compensation rates, increases in employee involvement, and improvements in employeemorale.

10. Organizational Changes

Whenever significant organizational or ownership changes occur, you will provide Oregon OSHA (within 60 days) a new Statement of Commitment signed by both management and any authorized collective bargaining agents.

11. Collective Bargaining Changes

Whenever a change occurs in the authorized collective bargaining agent, you will provide Oregon OSHA (within 60 days) a new signed statement indicating that the new representative supports VPP participation.