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									FY 2009 Agency Name Annual Occupational Safety and Health Report to the
                         Secretary of Labor
                     (Abbreviated Report Format)
Your FY 2009 Annual Occupational Safety and Health Report will not be considered
complete unless all documents are received. Please submit the following documents, in
addition to completing this report:
       Evaluation Protocol—Please submit an example of a self-evaluation protocol used in
       FY 2009 to conduct the self-evaluations required by 29 CFR §1960.79,.
       Evaluation Report—Please provide a copy of an evaluation report that resulted from
       that evaluation protocol.
       Agency OSH Poster— Please submit a copy of the agency’s 29 CFR §1960.12 (c)
       required poster. A template for federal agencies OSH poster can be found at:
       Contract Language—If your agency uses standard OSH language in your contracts,
       please provide a copy of that language.
       Pandemic Flu —If your agency has incorporated its pandemic flu response plan into its
       OSH program, please provide a copy of that part of your OSH program.
       Establishment List—If you did not submit a list of your agency’s establishments with
       your FY 2007 Annual Report, please do so now. Appendix I contains a list of agencies
       for which OSHA does not have an establishment list. In addition, we have included the
       original guidance that OSHA provided to agencies concerning this issue.

The following are the instructions for completing the Annual Report for independent agencies
with 50 or fewer employees, no fatalities or catastrophic incidents in FY 2009, and FY 2009
total and lost time case rates at or below the respective government-wide SHARE targets of
3.49 amd 1.61 (Goals 1 & 2) . The following sample report format is provided for your
convenience and can be used as a template.

Departments and independent agencies that do not satisfy these requirements are ineligible to
use this abbreviated report format, and must provide more detailed information as specified in
the comprehensive report template .


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Name of Department/Agency:
Number of federal civilian employees this report covers:

Please provide contact information for your Agency’s DASHO and OSH manager.

                   Name                   Official Title      Telephone              E-mail


* If your agency does not have a designated OSH manager, please provide the name and contact
information for the key person charged with occupational safety and health responsibilities.

I.       Statistics

         A. Injury and Illness Statistics
         Did any employees, supervised contract workers1 or volunteers2 experience any work-
         related injuries or illnesses in FY 2009?
                 NO—If you checked “NO” please proceed to Section II, B.

         a. Injury and illness rates
            Use agency injury and illness data to summarize your agency’s incident experience
            for total and lost time cases during FY 2009. When reporting your results include a
            discussion that compares your agency’s performance to that of the prior fiscal year.
            (You can find OSHA’s injury and illness statistics for all federal departments and
            many independent agencies at If statistics
            are not available on OSHA's website you may calculate injury and illness rates using
            the following formulas:
            Total Case Rate = (Total # of injury and illness cases in FY 2009 ÷ Total # of
            employees) x 100
            Lost Time Case Rate = (Total # of lost time injury and illness cases in FY 2009 ÷
            Total # of employees) x 100
            Please identify the source of the injury and illness and employment data used.

  29 CFR Part 1904.31(a)(3) requires employers to record any injuries or illnesses of contractor's employees if those
employees are under their day-to-day supervision.
  The definition of “employee” contained in 29 CFR Part 1960.2(g) includes “any person … employed or otherwise
suffered, permitted, or required to work by an agency …” OSHA intentionally devised this distinct phrasing, which
differs markedly from the definition of employee applicable in the private sector, to ensure more comprehensive
safety coverage of both paid and unpaid individuals who perform work for federal agencies.

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        b. Overseas Employees
           Please provide a summary of your overseas civilian employees. Include the number
           overseas employees, the percent who are covered by the State Department because
           they reside on State Department posts. Please describe how the agency ensures the
           occupational safety and health of those employees not located at these posts.

        b. Facilities with high injury and illness rates
           If applicable, explain how your agency identifies facilities with high injury and illness
           case rates, particularly those with high lost time case rates, and what was done to
           improve these facilities' OSH experience.

        B. Contract Workers and Volunteers
           Please provide the number of contract workers supervised by federal employees and
           the number of volunteer workers employed during FY 2009. List the number and
           type of injuries experienced by each group.

II.     OSH Initiatives—SHARE, Motor Vehicle and Seat Belt Safety, Recordkeeping,
        Workplace Violence, and Establishments
        A. SHARE—Safety, Health, and Return-to-Employment Initiative
           In 2004, the President established the Safety, Health and Return-to-Employment
           (SHARE) Initiative for all Executive Branch agencies, excluding the U.S. Postal
           Service. The initiative set four performance measures aimed at achieving measurable
           improvements in the safety, health, and injury case management outcomes at each
           federal agency.

             In FY 2009, did your agency file any injury and illness claims with the Department of
             Labor’s Office of Workers’ Compensation Programs (OWCP)?
                 NO—If you answered “NO”, please proceed to Section II, B.

        a. SHARE Analysis
           Provide a detailed analysis of your agency’s progress in achieving each of the four
           SHARE goals listed below.
           1. Reduce total injury and illness case rates by 3% per year;
           2. Reduce lost time injury and illness case rates by 3% per year;
           3. Increase the timely filing of injury and illness claims by 5% per year3; and
           4. Reduce the rate of lost production days due to injury and illness by 1% per year.4

  Under the SHARE extension, which began in FY 2007, all agencies are now required to achieve at least a 50%
timely filing rate under Goal 3. Agencies for which a 5% per year improvement from their FY 2003 baseline results
in a FY 2009 goal higher than 60% will have their performance tracked against that formula-driven target, except
that no agency’s goal is required to exceed 95%. Agencies must meet the minimum level or their formula-driven
goal, whichever is higher, up to a maximum of 95%.

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        b. SHARE Programs/Initiatives
           Describe programs established and initiatives your agency launched in support of
           SHARE. Discuss the successes and shortcomings of these programs or initiatives,
           and explain how they impacted the overall effectiveness of your agency’s OSH

        B. Motor Vehicle / Seat Belt Safety
           Describe any motor vehicle program your agency has in place.

            Executive Order 13043 requires seat belt use by federal employees on the job,
            including drivers and passengers. This requirement applies to all passengers, rather
            than front seat passengers only, as is the mandate in many states. Describe how your
            agency tracks seat belt usage, and the percentage or number of employees involved in
            motor vehicle accidents in FY 2009 who were wearing seat belts as compared to
            those who were not.

        C. Pandemic Flu Preparations
           OSHA would like to collect best practices for federal agencies on OSH planning for
           pandemic flu.
           Please provide the following:
              o Describe the focus of your agency’s pandemic flu planning, identifying
                  whether public safety and/or occupational safety and health has been
              o If occupational safety and health has been the focus of your planning, has
                  pandemic flu been incorporated into your OSH program?
              o If it has been incorporated into your OSH program, please provide a copy of
                  that part of your OSH program.

III.    Employee & Contractor Support

        A. OSH Training
           Describe your agency’s overall plan for ensuring that all staff receive appropriate
           OSH awareness and hazard recognition information and training. In addition,
           describe the overall impact of your agency’s training efforts on improving work-
           related safety and health. Please highlight training unique to emergency response and
           disaster recovery personnel, and note, which of these courses is also provided to
           contractors and volunteers, if any.

 Under the SHARE extension, Goal 4 targets have been slightly modified. Agencies with a FY 2003 baseline Lost
Production Day Rate (LPDR) at or below 15 days are charged with maintaining an LPDR of 15 or less. All other
agencies will have their progress measured against the formula-driven target of reducing LPDRs by 1% per year,
except that no such target is required to be fewer than 15 days.

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B. Agency OSH Poster
Please submit a copy of the agency’s 29 CFR §1960.12 (c) required poster. A template
for federal agencies OSH poster can be found at:

C. OSH Conferences/Seminars
OSHA is interested in learning about agencies’ plans for OSH conferences/seminars and
providing support when possible. Please provide the follwing information:.
   o List any safety seminars or conferences the agency is planning for FY 2010:

   o Explain if and how the sessions will address 29 CFR 1960 requirements.
   o Indicate if the agency would like assistance from OSHA—and if so, the kind of
     support you are seeking.

D. Field Federal Safety and Health Councils
   The Field Federal Safety and Health Councils (FFSHC) are cooperative interagency
   groups chartered by the Secretary of Labor to facilitate the exchange of OSH
   information throughout the federal government. According to 29 CFR Part
   1960.88(b), federal agency heads should encourage OSH personnel to participate in
   the activities of the councils. Generally these councils meet four to twelve times a
   year and may provide different types of OSH training. Currently there are
   approximately 45 active FFSHCs throughout the country.

   Has your agency participated on any FFSHCs?
      NO—If you answered “NO”, please proceed to III, C.

a. Involvement
   Describe the extent to which employees/managers from your agency were involved in
   these councils.

b. Field Council Support
   Describe if and how your agency encourages staff involvement and how your agency
   has provided support for these councils.

E. Contractor Safety
   OSHA would like to collect best practices with regard to contract language the
   agency may use to ensure contractor compliance with federal workplace safety and
   health requirements. Please provide the following information:
      o Describe whether any of your agency’s contracts include standard language
           addressing workplace safety requirements.
      o Explain if the agency has established a means for enforcing compliance with
           these contract provisions.
      o Submit the standard OSH language included in your agency’s contracts.

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              o Are contractors required to notify agency personnel if a contractor experiences
                a recordable injury? If so, how does the agency use this information?

       F. Other Support Activities
          Describe how your agency promotes staff involvement in other safety and health
          support activities, such as membership in professional safety and health
          organizations, attendance at safety and health conferences, and professional

IV.    Self Evaluations
       29 CFR Part 1960, Subpart J requires federal agencies to conduct self-evaluations of the
       effectiveness of their occupational safety and health programs. As required by 29 CFR
       Part 1960.78(b), please provide a summary of the most recent self-evaluations. The
       summary should include the year the evaluation was conducted and an explanation of
       how each of the major OSH program elements was evaluated.

       Please remember to submit an example of an evaluation protocol used in FY 2009 and
       the corresponding evaluation report.

V.     Accomplishments for FY 2009
       Accomplishments represent specific achievements above and beyond program
       requirements. Please discuss your agency’s OSH accomplishments describing the
       challenges the agency faced, the actions taken to overcome those challenges and the
       results of those actions. Please include a discussion of your agency's progress toward
       meeting the goals listed in its FY 2007 annual report.

VI.    Resources
       Explain any significant one-time or additional permanent resources allocated to the OSH
       program(s) in FY2009 for areas such as workplace hazard abatement, research and
       development, data systems, staffing, and training.

VII.   Goals
       Identify your annual OSH goals and significant OSH initiatives planned for FY 2009 and
       beyond. Please explain your agency's strategies for achieving those goals. In addition,
       please provide the timeframe for achieving each goal, and an explanation of how success
       will be measured.

VIII. Questions/Comments
      Submit any questions or comments you have concerning your agency’s OSH program
      and/or these reporting guidelines.

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Appendix I—Agencies for which OSHA Does Not Have Establishment Lists

  o   Advisory Council on Historic Preservation
  o   American Battle Monuments Commission
  o   Armed Forces Retirement Home
  o   Central Intelligence Agency
  o   Commission on Civil Rights
  o   Council on Environmental Quality
  o   Federal Labor Relations Authority
  o   Federal Mine Safety and Health Review Commission
  o   Federal Mediation and Conciliation Service
  o   Merit Systems Protection Board
  o   National Labor Relations Board
  o   National Mediation Board
  o   Nuclear Regulatory Commission
  o   Office of Government Ethics
  o   Office of Special Counsel
  o   Postal Rate Commission
  o   Selective Service System
  o   Small Business Administration
  o   Social Security Advisory Board
  o   U.S. African Development Foundation
  o   U.S. Commission of International Religious Freedom

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