ComprehensiveReportFormat - FY 2010 Agency Name Annual...

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FY 2010 Agency Name Annual Occupational Safety and Health Report to the Secretary of Labor (Comprehensive Report Format) Your FY 2010 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: Self-Evaluation— Please submit a synopsis of the findings of your agency’s FY 2010 self-evaluation, required by § 1960.79 , and your agency’s plans to implement any changes to its OSH program. Fatality/Catastrophic Accident Summary Reports— Please provide copies of the summary reports for all fatality and catastrophic accident investigations, as required under 29 CFR Part 1960.70 (date, time, location, description of workplace operations, description of incident, analysis of incident cause, any resultant programmatic changes or corrective actions such as increased training). Establishment List— Please submit and/or update your agency’s establishment list and provide the North American Industry Classification System (NAICS) code for each establishment. (You can go to for an explanation of NAICS codes and a link to a current listing.) In addition, we have included the original guidance that OSHA provided to agencies concerning this issue. Following are the instructions for completing both the Executive Summary and the Detailed Report for all departments and independent agencies with more than 100 employees; and independent agencies that employ 100 or fewer employees that experienced at least one fatality or catatrophic incident in FY 2010, or had a FY 2010 total or lost time case rate above the FY 2010 government-wide (less the U.S. Postal Service) rates. OSHA will post the final FY 2010 rates on its website by November 15, 2010 at: ill-stats.html. Please note that the same information will be covered in both sections, with the Executive Summary being a condensed version of the information contained in the Detailed Report. The following sample report format is provided for your convenience and can be used as a template. Please delete the red text portions of the template before submitting your annual report. 1 of 12
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Name of Department/Agency: Address: Number of federal civilian employees this report covers: Name Official Title Telephone E-mail DASHO: OSH Manager*: * 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. Please provide contact information for all subagencies with 1,000 or more employees by going to Appendix I. Executive Summary The Executive Summary must not exceed three pages, and should summarize the report’s major points. Departments with subagencies must provide an overall assessment of the department's occupational safety and health programs – not a collation of the various subagencies' reports.
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ComprehensiveReportFormat - FY 2010 Agency Name Annual...

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