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["Challenge Pilot"]
["Candidate Information Package Instructions"]
[]
[]
[]
["Included in this spreadsheet are:"]
[]
["Tab 1.  Candidate Statement of Commitment "]
["Tab 2.  Candidate Information Form "]
["Tab 3.  OSHA 300 Baseline Information Form [Must provide at least 1 year of data]"]
["Tab 4.  Optional Data (e.g., productivity rate, turnover rate, absenteeism rate)"]
[]
["To access these documents, please click on the tabs at the bottom of this form."]
[]
[]
[]
["Please complete and return each of these documents to your Challenge Pilot "]
["Administrator."]
[]
["You may submit this package electronically or via hard copy.  However, you "]
["must still fax a signed, original of the Statement of Commitment Letter to your"]
["Challenge Pilot Administrator."]
[]
[]
["Once your Administrator receives your Candidate Information Package, it will be "]
["reviewed by OSHA.  You will be contacted by your Administrator if any missing "]
["information needs to be provided.  Confirmation of your acceptance as an OSHA "]
["Challenge Participant will be provided by mail.  Please allow 30 days for the "]
["review process. "]
[]
[]
["OMB# 1218 – 0239                                                                                                                          Expires xx-xx-xxxx \nPublic reporting burden for this collection of information is voluntary and is estimated to average 10 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate, or any other aspect of this collection of information, including suggestions for reducing this burden to the Office of Partnerships and Recognition,  Department of Labor, Room N-3700, 200 Constitution Avenue, N.W., Washington, DC 20210\n\"        \n        \n        \n        \n        \n        \n        \n"]

{"sheet":"1 - Statement of Commitment","index":1,"n_rows":14,"n_cols":1,"rows_kept":14,"cut":false,"hidden":false,"merged":[[0,0,0,8],[7,0,7,8],[1,0,1,8],[3,0,3,8],[4,0,4,8]],"flags":["formulas_cached_only"]}
["Challenge Pilot"]
["Candidate Statement of Commitment"]
[]
["Sample Letter Only "]
["(The Administrator must receive a signed Statement of Commitment from each candidate)"]
[]
[]
["In our quest to produce high quality products and services, we, [insert Candidate facility’s name, city and state], value our employees as our greatest assets.  Therefore, management is committed to providing a safe and healthful workplace for our employees.  Safety and health are paramount to our corporate vision and mission.  Management hereby states that we will [strive to] successfully complete the three stages of the Challenge Pilot Program, provide the necessary data and documentation to our Administrator, [Insert Administrator name], and keep our Administrator informed of our progress.  We also will involve our employees in the Challenge Pilot process.  We are excited to be involved in voluntary efforts with OSHA and look forward to reaching our goals. "]
[]
["Sincerely,"]
[]
[]
[]
["Site Manager"]

{"sheet":"2 - Candidate Information","index":2,"n_rows":38,"n_cols":5,"rows_kept":38,"cut":false,"hidden":false,"merged":[[8,1,8,2],[18,1,18,2],[0,0,0,2],[1,0,1,2],[9,0,9,1],[12,0,12,1],[3,0,3,2],[4,1,4,2],[5,1,6,2],[7,1,7,2],[10,1,10,2],[16,0,16,2],[11,1,11,2],[17,1,17,2],[13,1,13,2],[33,1,33,2],[19,1,19,2],[20,1,20,2],[21,1,21,2],[29,1,29,2],[32,1,32,2],[38,0,44,0],[36,0,36,2],[31,0,31,2],[23,0,23,2],[24,1,24,2],[25,1,25,2],[26,1,26,2],[27,1,27,2],[35,0,35,2],[28,1,28,2]],"flags":["formulas_cached_only"]}
["Challenge Pilot"]
["Candidate Information Form"]
[]
["Section 1.  Candidate Information"]
["Candidate Name"," "]
["Site Address"," "]
[]
["Site Manager Name"," "]
["Site Manager Title"," "]
[{"$nulls":4}," "]
["Company/Corporate Name                                                          (If different from above)"," "]
["Company/Corporate Address"," "]
[]
["Administrator Name"]
[]
[]
["Section 2.  Challenge Candidate Contact Information"]
["Candidate Contact Name"," "]
["Candidate Contact Title"," "]
["Candidate Contact Phone Number"," "]
["Candidate Contact Fax Number"," "]
["Candidate Contact E-mail Address"," "]
[]
["Section 3.  Collective Bargaining Representative"]
["Union Name and Local #"," "]
["Agent's Name"," "]
["Agent's Address"," "]
["Agent's Phone Number"," "]
["Agent's Fax Number"," "]
["Agent's E-mail Address"," "]
[]
["Section 4.  Employees"]
["Number of Employees"," "]
["Number of Contract Employees"," "]
[]
["Section 5.  Type of Work and Products/Services"]
["Please provide a comprehensive description of the work performed at your site, the type of product produced, and/or servicesprovided, and the typical hazards associated with your industry.  Also provide your SIC and NAICS."]
["Description","SIC","NAICS"]

{"sheet":"3 - OSHA 300 Baseline Info","index":3,"n_rows":52,"n_cols":15,"rows_kept":52,"cut":false,"hidden":false,"merged":[[23,3,23,4],[12,0,12,2],[12,3,12,4],[7,0,7,3],[7,4,7,5],[18,4,18,5],[18,0,18,3],[1,0,1,10],[0,0,0,10],[5,0,5,1],[3,2,3,4],[35,9,35,10],[35,5,35,6],[35,0,35,2],[3,0,3,1],[31,0,31,2],[31,3,31,4],[16,0,16,1],[23,0,23,2],[26,4,26,5],[26,0,26,3]],"flags":["formulas_cached_only"]}
["Challenge Pilot Program"]
["OSHA 300 Baseline Information*"]
[]
["Candidate Name",{"$nulls":12},"Candidate 1",2001]
[{"$nulls":13},"Candidate 2",2002]
["REQUIRED DATA",{"$nulls":5}," ",{"$nulls":6},"Candidate 3",2003]
[{"$nulls":13},"Candidate 4",2004]
["Most Recent Complete Calendar Year of Data",null,null,null,"[Enter Year of Data Here]",{"$nulls":8},"Candidate 5",2005]
[{"$nulls":13},"Candidate 6",2006]
["G","H","I","J","K","L","M:1","M:2","M:3","M:4","M:5"]
[" "," "," "," "," "," "," "," "," "," "," "]
[]
["Total Hours Worked",null,null," ",null,null,"TCIR",{"$error":"#VALUE!"},null,"DART",{"$error":"#VALUE!"}]
[]
[]
[]
["OPTIONAL DATA"]
[]
["Previous Year's Data",null,null,null,"[Enter Year of Data Here]",{"$nulls":8},"Candidate 5",2005]
[{"$nulls":13},"Candidate 6",2006]
["G","H","I","J","K","L","M:1","M:2","M:3","M:4","M:5"]
[" "," "," "," "," "," "," "," "," "," "," "]
[]
["Total Hours Worked",null,null," ",null,null,"TCIR",{"$error":"#VALUE!"},null,"DART",{"$error":"#VALUE!"}]
[]
[]
["Data from Two (2) Years Previous",null,null,null,"[Enter Year of Data Here]",{"$nulls":8},"Candidate 5",2005]
[{"$nulls":13},"Candidate 6",2006]
["G","H","I","J","K","L","M:1","M:2","M:3","M:4","M:5"]
[" "," "," "," "," "," "," "," "," "," "," "]
[]
["Total Hours Worked",null,null," ",null,null,"TCIR",{"$error":"#VALUE!"},null,"DART",{"$error":"#VALUE!"}]
[]
[]
[]
["3-Year Average",null,null,null,"TCIR",{"$error":"#VALUE!"},null,null,"DART",{"$error":"#VALUE!"}]
[]
["* - OSHA will use this information to track the progress of OSHA Challenge Candidates.  It will NOT be used for enforcement purposes."]
[]
[]
[]
[]
[null,null,null," "]
{"$rows_empty":7}
["* - OSHA will use this information to track the progress of OSHA Challenge Candidates.  "]
["    It will NOT be used for enforcement purposes."]

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["Challenge Pilot Program"]
["Optional Data"]
[]
["Please provide data for your most recent calendar year, where possible."]
[]
["Candidate Name"]
[]
[]
[{"$nulls":4},"Year of"]
[{"$nulls":4},"Data"]
[{"$nulls":4},"Provided"]
["Absenteeism Rate"]
[]
[]
[]
["Turnover Rate",null,null,null," "]
[{"$nulls":6}," "]
[]
[]
["Productivity Rate",null,null,null," "]
[]
[]
[]
["Other Data*"]
[]
[]
[]
["Other Data*",{"$nulls":5}," "]
[]
[]
[]
["Worker's Compensation Data"]
["Fees"]
["Direct Costs"]
["EMR"]
["Loss Run Data"]
[]
[]
[]
[]
[]
[" "]
[]
[]
[]
["* - Other data provided by Challenge Participant that may be useful for tracking purposes."]