Pensacola Chapter Application for Chapter Star

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Pensacola Chapter Application for Chapter Star Powered By Docstoc
					August 11, 2006

Mr. Ron Ross
ASSE Region 4 Vice President
C/O Chevron Refining, Inc
PO Box 1300
Pascagoula, MS 39568

Dear Ron,

The Pensacola Chapter is pleased to submit our application for the Chapter Stars
Recognition Program. We have had a very successful year as you will see
documented in the attached pages. This is our first application for this program,
and though we were not able to garner quite enough points for status as a
Chapter Star, we are nonetheless exceeding proud of our accomplishments and
we believe we have served ASSE and Region 4 well. If you have any questions
regarding our application, please don’t hesitate to call me at (850) 452-5670 Ext
217 or drop an e-mail at
                                      Table of contents

Section                                                               Page

1. Points Claimed for Activities in

       I. Administrative and Leadership Activities                       1

       II. Chapter Activities                                            2

       III. Professional Development                                     6

       IV. Communications                                                7

2. Supporting Documentation

       2005-2006 Monthly Technical Sessions                              8

       Executive Committee Meeting Agenda for August 8, 2005
             (2005-2006 Planning Meeting)                                9

       2006 Membership Survey                                           11

       Invitation to SPY Recipient’s Supervisor                         12

       Pensacola Chapter Scholarship Program Guidelines                 13

       Course Flier for Basic Electrical Safety with Application of
             NFPA 70E                                                   14

      CEU Approval Letter for Basic Electrical Safety with
           Application of NFPA 70E                                      15
I. Administrative/Leadership Activities.
Points are claimed for the following activities.

                                             Per               # of        Total       Your
POINT ALLOCATION                            activity         chapter      Possible   chapter's
I. Administrative/Leadership
Activities                                  Value            activities    Points     points
A. Officer Report Submitted by Due Date      200                 1          200        200
B. Financial Report Submitted by Due Date    200                 1          200        200
C. Leadership Conference Representative      300                1           300        300
D. House of Delegates Representation         300                1           300        300
                                                              total        1000       1000

A. Chapter submits Chapter Officer Delegate and Committee Chair Report to ASSE HQ
and RVP by May 31. Our Officer Report was submitted electronically by Chapter
President, Pam Perrich, on May 31, 2006.

B. Chapter submits Chapter financial Report to ASSE HQ and RVP by May 31. Our
Financial Report was submitted via the USPS by the Chapter Treasurer, Bill
Buterbaugh, on May 1, 2006.

C. Chapter sends at least one representative to the Annual Leadership Conference.
Chapter Secretary, Jeff Hughes, attended the October 2005 Leadership

D. Chapter sends appropriate representation to the Annual House of Delegates.
Chapter President, Pam Perrich, attended the June 2006 Professional
Development Conference and served as House of Delegates Representative.

II. Chapter Activities.
Points are claimed for the following activities.

                                            Per               # of        Total       Your
POINT ALLOCATION                           activity         chapter      Possible   chapter's
II. Chapter Activities                     Value            activities    Points     points
A. Chapter Programs (min. of 6 programs)    100                 1          100        100
B. Additional Programs                       20                 4          220         80
C. Awards & Honors                           15                 2          105         30
D. Membership Recruitment                    20                 1          100         20
E. Membership Retention                      20                 2           80         40
F. Membership Recognition                    20                 2          100         40
G. Ex.Committee Professional Development     15                 3           60         45
H. Miscellaneous Membership Services         10                 1           20         10
I. Revenue Generation & Disbursement         15                 6           90         90
J. Chapter Scholarships                      20                 2           60         40
K. Long Range Strategic Planning             15                 0           45          0
L. Technical Writing                         15                 0           75          0
M. Innovations                               20                 3           80         60
N. National/Regional/Area Activities       varies                           50          0
                                                             total        1185        555

A. Chapter Programs. Chapter holds a minimum of 6 technical programs (meetings)
each year. Topics must be relevant and timely. Attendance must be taken at each
meeting. Our Chapter holds 9 meetings each year; 8 with technical sessions and
1 Christmas Party. The programs presented this Chapter year are provided on
page 8.

B. Additional Programs.
       1. Two more technical meetings. See above.
        2. Average monthly attendance is 15% of the total membership or at least 40
members, whichever is smaller, over a one year period. Total attendance is 15% of
the total membership. Our average attendance was 25, and our rolls as of July 1
reflect a membership total of 95 (those in either an active status (93) and in grace
status (2), which equates to an average monthly attendance of 26% of our total
membership. Attendance is taken at each meeting.
       3. Average monthly attendance is 25% of the total membership or at least 40
members, whichever is smaller. See above.
       4. Chapter conducts a pre-planning meeting before the first meeting of the
Chapter year. Our Chapter conducts a pre-planning meeting before the first
meeting of the Chapter year. Our Chapter does not meet in June, July or August.
Each August the Executive Committee holds a planning meeting for the
upcoming year. This year the planning meeting was held on August 18, 2005,
before our first general meeting on Chapter year which was held on September 8,
2005 Chapter. A copy of the meeting agenda is provided as page 9.

C. Awards and Honors
       1. Chapter recognizes members for their outstanding service to the Society or
the Profession. This year our Chapter recognized all of our Chapter Officers with
gifts of appreciation at the May meeting. Committee Chairpersons were
recognized with Certificates of Appreciation signed by Society President, Mr.
Jack H. Dobson Jr.
       2. Chapter nominates and selects a Chapter SPY. This year, Chad Stewart,
was selected to receive our Chapter’s SPY award. The award was presented in a
special ceremony at the January 2006 meeting. The February 2006 newsletter has details.

D. Membership Recruitment.
     1. Chapter conducts a new member orientation annually. The Pensacola
Chapter conducted it first ever New Member Orientation on June 28, 2006.

E. Membership Retention.
       1. Chapter surveys members to determine member expectations. We typically
conduct our membership survey in May. This year the survey was distributed at
the May 5, 2006 meeting and sent electronically to those who were not in
attendance. A copy of the survey is provided on page 11 and the results of the
survey were published in the June 2006 newsletter.
       2. Chapter assigns a Hospitality Committee to welcome members at all Chapter
functions. This year our Hospitality Committee Chairperson was Ms. Gloretta
Lawrence. She and her Committee Members greeted each member and visitor,
gave each a name badge, collected their payment for dinner and directed them to
our meeting area.
F. Membership Recognition.
       1. Chapter recognizes members at Chapter functions. Each member and each
visitor introduces him/herself at each meeting.
       2. Chapter invites member’s supervisory team to a Chapter function to recognize
member achievements. For the SPY Award Ceremony in January 2006, the
recipient’s supervisor was invited to attend as our guest. A copy of the invitation
is provided as Tab 12.

G. Ex. Committee – Professional Development
       1. Chapter sends at least 1 person to the ASSE Leadership Conference. This
year, Mr. Jeff Hughes, Chapter Secretary, attended the Leadership Conference at
the Chapter’s expense.
       2. Chapter develops a duty checklist for all incoming officers that is reviewed
and update annually. This year, for the first time, we developed a duty checklist for
our officers. The checklist is provided as Tab X.
       3. Chapter conducts an annual new officer workshop. This year, for the first
time, we conducted training for our new officers and for our new committee

H. Miscellaneous Membership Services.
       1. A Chapter representative provides employment information at meetings, in
Chapter newsletters, and website. This year, jobs were announced at monthly
meetings by the Chapter President. In addition, the floor was opened to members
who had job openings. Information about job openings was also via our e-mail
distribution network.

I. Revenue Generation and Distribution.
       1. Chapter develops one or more revenue generating programs. Program 1 –
The Chapter invested in professional looking badges for our members and
visitors, but we needed a way to be sure we got them back after each meeting.
So at each meeting, members insert $1 into their badge, the badges are collected,
and the money collected is split between a member (whose name is drawn from
the collected badges) and the Chapter. Each meeting the Chapter collects
between 10 and 15 dollars from the 50/50 drawing, netting the Chapter about $100
per year. Program 2 – At several meetings, a vendor was invited to display their
goods or services for a fee ($100). After expenses (the fee includes dinner for the
vendor and a guest) this program netted about $500. Program 3 – This year the
Chapter sponsored an Electrical Safety Course which netted the Chapter about
$200 in revenue once expenses were paid. Our 3 revenue generating programs
netted us about $800.
       2. At least 50% of the net proceeds from revenue-generating programs is
returned to the Chapter membership in the form of member services. Approximately
$100 was distributed to members from our 50/50 drawing discussed in the section
above. At each meeting, one member is selected from those in attendance to
receive a free dinner at the next meeting (a $10 - $20 value for a total expenditure
of $110). Also, one member was selected to attend the Electrical Safety Course at
the Chapter’s expense (a $120 value). The restaurant where we hold our
meetings requires we provide a headcount 48 hours in advance of our meeting.
Members who RSVP for meetings, but who are unable to attend, are not charged
for the dinner reserved for them. As a member service, the Chapter assumes
those costs which were approximately $200 this year. Revenue generating
programs netted the about Chapter $800 and approximately $530 was returned to
the membership.

J. Chapter Scholarships.
       1. Chapter develops a written scholarship program with specific guidelines. This
year, the Chapter developed a scholarship program. The details are provided as
page 13.
       2. Chapter selects Scholarship recipient(s) within the Chapter year. Ms.
Maralee Prendergast was the recipient of our Chapter Scholarship this year and
attended our Electrical Safety Course at no cost.

M. Innovations.
       1. Chapter establishes a unique, extraordinary, or innovative program, activity or
service to enhance member services. Program 1 – For each professional

development course the Chapter sponsors, one member is selected to attend at
no charge. Program 2 – At each meeting, a member is selected from those in
attendance to receive a free dinner at the next month’s meeting. Program 3 – At
each meeting, a 50/50 drawing is held and proceeds are split between the Chapter
and a member selected from those in attendance.

III. Professional Development.
Points are claimed for the following activities:

                                        Per               # of        Total       Your
POINT ALLOCATION                       activity         chapter      Possible   chapter's
III. Professional Development           Value           activities    Points     points
A. Conference/Seminars/Workshops         20                 2          100         40
B. Career Enhancements                   15                 0           60          0
C. Volunteer Participation                1                 5           35          5
D. Common Interest Groups                10                 0           40          0
                                                          total        235         45

A. Conferences, Seminars, Workshops.
      1. Chapter provides a full day professional development activity. The Chapter
sponsored a full day Electrical Safety Course on May 22, 2006. The course flier is
provided as page 14.
      2. CEUs are offered for any of the above mentioned seminars. CEUs were
offered for the Electrical Safety Course.

C. Volunteer Participation.
       1. 1 point per member for members serving on a Chapter Committee who attend
at least 66% of all required meetings. The Governmental Affairs Chair (Tracy
Donahoo), the Programs Chair (Julie Wells), the Professional Development Chair
(Andy Richmond), the Hospitality Chair (Gloretta Lawrence), and the Newsletter
Chair (Maralee Prendergast) all attended at least 66% of our meetings this year.
       2. 1 point per member for members serving on a National Society Committee.
Shanaz Sharifipour serves as the Nominating Committing Chair for the Industrial
Hygiene Practice Specialty. Pam Perrich served on that committee as well.

IV. Communications
Points are claimed for the following activities.

                                        Per               # of        Total       Your
POINT ALLOCATION                       activity         chapter      Possible   chapter's
IV. Communication                       Value           activities    Points     points
A. Newsletters                           15               15          225         225
B. Marketing/Public Relations            15                0           90           0
C. Electronic Media/Chapter Web Site     20                4          100          80
                                                         total        415         305

A. Newsletters
        1. Chapter publishes a newsletter or notice for every Chapter meeting which
includes: meeting announcements, arrives at least 7 calendar days before the meeting,
accurate spelling, punctuation and grammar, and reasonable lack of typographical
errors, attractively printed or produced electronically or online. The Chapter publishes
a monthly newsletter which is distributed both electronically and via the USPS.
Our newsletter meets all the above criteria and examples can be seen on our
website at
        2. In addition to the above, plus lists the following: Chapter activities,
Membership campaigns, awards and honors, long range plans, governmental affairs
activities, external affairs, bylaws. See above.
        3. In addition to the above, plus the following: Graphics and pictures, Society
news such as Society awards and honors, PDC, educational seminars, etc. See

C. Electronic Media/Chapter Web Site
       1. Chapter creates a Chapter website which includes information on Chapter
meetings, Society information and Chapter officers’ information, including e-mail
addresses. This Chapter has a website which contains the above information.
Check us out at
       2. Chapter website includes electronic versions of Chapter newsletters. See
       3. Chapter website is hyperlinked to the Society website and ASSE’s Member
Only area and at least ten other safety, health or environmental sites. See above.
       4. Chapter website contains interactive presentations for member use and
orientation. See above.

                            Monthly Technical Sessions

September 8, 2005
     Mr. Allen Criner, Sacred Heart Health Systems, will present Occupational
Rehabilitation vs Traditional Therapy

October 6, 2005
      Ms. Linda Ford, Corvel, will present The Life of a Worker’s Compensation Claim

November 3, 2005
     Mr. Tracy Donahoo, KBR Construction, will present Observations of a Safety
Manager in a Combat Zone

December 8, 2005
     Christmas Party – no technical session

January 12, 2006
      Dr. Ramon Ryan, Baptist Occupational Health will present Wellness in the

February 2, 2006
      Mr. Bill Bice, Mobile Area OSHA Office, will present an OSHA Region IV Update.

March 2, 2006
      Randstad Risk Management will present Working Safely with a Temporary

April 6, 2006
        Ms. Shelia Schultz, Gulf Power Company, will present Work Zone Traffic Safety

May 4, 2006
       Mr. Garrett Walton, Rebuild Northwest Florida, will present lessons Learned from
Hurricane Seasons 2004 and 2005

June, July and August - Summer Break

                                      Executive Committee Meeting
                                               18 AUG 05

Call to Order

Treasurer’s Report

Approval of Minutes

Old Business

       September – Occupational Rehabilitation vs Traditional Therapy
              (Allen Criner – Sacred Heart Health Systems)
       October – Life Cycle of a Workers Comp Claim (Linda Ford –
       November – Safety Manager in a Combat Zone (Tracy Donahoo - KBR)
       December – Christmas Party

       Template chosen, most documents prepared, need to sign contract

New officer bios for newsletter – still need all but treasurer


        -Chapter schedules at least one (1) meeting with another safety, health or environmental

        -Chapter develops a duty checklist for all incoming officers that is reviewed and updated

        -Chapter submits a Chapter Stars Recognition Award petition.

        -Chapter surveys members or uses some other means to determine member expectations.

        -Chapter recognizes members within Chapter newsletter/web site who serve on committees,
        receive promotions / awards and/or who promote the Society through some type of media source
        (radio, TV, print, electronic, etc.)

        -Chapter invites member’s supervisory team to a Chapter function to recognize member
        achievements. (*Note: If the supervisor is invited but the invitation is not accepted, the Chapter
        still qualifies for points in this category.)

       -Chapter institutes or maintains a program to contact members whose membership has lapsed.

       -Chapter conducts an annual new officer workshop or sends its new officers to a Regional

       -Chapter forwards at least one SPY candidate for consideration at the Regional level.

       -Chapter creates a Chapter website which includes information on Chapter meetings, Society
       information and Chapter officers' information, including e-mail addresses. The website must be
       maintained on a regular basis so
       that material on the site is never outdated.

       -Chapter website includes electronic versions of Chapter

       -Chapter website is hyperlinked to the Society website and ASSE’s Member Only area and at
       least ten (10) other safety, health or environmental sites.

       -Chapter provides at least a 1/2 day seminar, conference, or workshop and CEUs are offered for
       any of the above mentioned seminars.

Awards and Honors
       SPY Award
       Longevity awards

Leadership conference

Golf Tourney


New Business

Special new member rates through Oct 31st

Professional Development course/workshop

Gracefest - Sept 16-17

Induction for VP and Secretary at Sept.8 meeting

Dinner receipts

Committee Chair Training

Vendors – Sept booked (Aerotech/P&K), no other meetings booked

Next meeting - 8 SEP 05 @ 4:30 PM @ NWL


                                                   - 10 -
                          2006 Membership Survey

1. Please rank the following meeting locations, with “1” being the
place you MOST want to meet and “4” being the place you LEAST want
to meet.

_____   New World Landing
_____   Sonny’s BBQ
_____   Hampton Inn with dinner catered
_____   Pensacola Civic Center
_____   No preference

2.   Does you employer pay your annual ASSE dues?   Yes   No

3. Does your employer pay for your meals at our monthly meetings?
Yes  No

4.   What topics interest you for guest presentations in 2006-2007?


5. What topics interest you for professional development courses in
the 2006-2007?

6. Do you have ideas or suggestions for improvements in our
meetings, newsletters, website, communications, or other aspects of
our Chapter?

7. Other comments.

Member    /   Visitor (please circle one)

Name (Optional):     ________________________

                                   - 11 -
- 12 -
                    Pensacola Chapter Scholarship Program

The Chapter hereby establishes a policy that for each professional
development event the Chapter brings to the local community one of our
members will be selected to attend at the Chapter’s expense.

The criteria for selection will be as follows:

      a. Each member wishing to be considered for the scholarship must
submit a written request indicating why they make a good candidate for the

      b. The member must be in an active status (dues current).

      c. Student members will have priority selection.

     d. Selection will be made by secret ballot and the winner will be
announced at least 2 weeks before the professional development event.

                                                     Pam Perrich
                                                     2005-2006 President
                                                     April 2006

                                       - 13 -
 The Pensacola Chapter of ASSE, in partnership with the University of West Florida’s Division
    of Life and Health Science, Occupational Safety and Health Program, proudly presents

               Basic Electrical Safety with Application of NFPA 70E
                **This course is approved for 1.0 CM Point (ABIH Approval #04-2731)/0.625 COC point

Course Date: Monday, May 22, 2006

Course Hours: 8 am to 5 pm

Course Location: Payne Building, Sacred Heart Hospital --5149 N. 9th Avenue, Suite 255, Pensacola, FL 32504

Course Fees:
       Advance Registration: Members $120 / Nonmember $160 - Requires receipt of payment 2 weeks prior to course date.
       Regular Registration: Members $140 / Nonmembers $180 - For payments received within 2 weeks of course date.
       Group Discount: Organizations sending 3 or more participants are eligible for a $10 discount per participant.

Learning Aids: Attendees will receive the latest edition of the NFPA 70E – Electrical Safety in Workplace Environment (a $40 value).
Attendees should bring an arithmetic / scientific calculator with square root function.

Objectives: This course introduces the health and safety professional to the engineering design principles for controlling electrical
hazards. Also covered are the management principles for an effective electrical safety program. The course is focuses on the
requirements of NFPA 70E.

Upon completion, the participant will be able to:

        Gain a fundamental understanding of engineering design principles and management principles of electrical safety, including
         the application of OSHA's newly adopted NFPA 70E electrical safety requirements
        Understand the basic principles of electricity, including current and electrical circuits
        Realize the hazards of electricity to the human body
        Implement engineering control principles of electrical hazards, including hazardous locations, wiring protection and design,
         grounding, workspace, electrical equipment, temporary wiring, and cord and plug equipment
        Explain the requirements when working on or near energized equipment when utilizing PPE, insulating equipment and
         barriers, approach boundaries, and energy control procedures
        Implement the training requirements for qualified persons
        Execute a company electrical safety program
        Demonstrate the skills learned in this course through hands-on laboratory sessions on basic principles, energy control and
         reverse polarity

Description: Worker injuries resulting from lacking or inadequate electrical safety controls can be debilitating and even fatal. It is the
responsibility of the health and safety professional to recognize electrical hazards and suggest methods of control. "Basic Electrical
Safety" is an introductory course for the safety professional. It provides the professional with how-to issues as well as a unique, direct
focus and explanation of principles and visual skills. The course's content covers the basic principles to comply with OSHA and NEC
standards. Objectives provide a chronological sequence for implementation of electrical hazard control and management.

Instructor: Paul Zoubek, CSP, CIH, Occupational Services Inc., San Diego, CA.

Paul A. Zoubek, CSP, CIH is Manager of Health and Safety Programs for Occupational Services, Inc. in San Diego, CA. He is primary
consultant for the firm’s electrical safety consultations for management and engineering control of electrical hazards in client facilities.
He advises companies in the areas of electrical hazard control, written program development, and qualified person training. He has a
Bachelor of Science Degree in environmental health and safety from Illinois State University and has worked in the field of occupational
health and safety for sixteen years.

                                                                   - 14 -
May 19, 2006

Pamela B. Perrich, CIH
ASSE Pensacola Florida Chapter, President
Pensacola Florida Chapter - ASSE
Naval Hospital Pensacola
450 Turner Street
Pensacola, FL 32508

Dear Ms. Perrich:

Your request for CEUs has been approved and I am pleased to award you .73 CEU for
each attendee of the ASSE Pensacola Florida Chapter’s seminar, titled “Basic Electrical
Safety with Application of NFPA 70E” on Monday, May 22, 2006.

After the event, please forward a summary report listing the date of the event, title of the
event, and name of your organization. In addition, please provide the following
information for each attendee on the enclosed sign-in sheet, which may be duplicated.

   Name
   Address
   Telephone and Fax Numbers
   ASSE member number

Please note that we do not issue an individual certificate to any attendee, but attendees
who are ASSE members may receive a free CEU transcript by requesting it from our
Customer Service Department at (847) 699-2929. Attendees who are not ASSE members
may request a transcript in writing to ASSE Customer Service, 33477 Treasury Center,
Chicago, IL 60694-3400. There is a $5.00 transcript fee that must be included when
mailing the written request. If you have any questions, please call me at (847) 768-3405.

Good luck with your conference.

Yours truly,

Trudy Goldman, ARM
Manager, Education and Program Development

                                            - 15 -

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