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DOE-HDBK-1101-2004
Exhibit 2.6.2
2.
Some firms are not required to complete OSHA 200 Log, because they have too
few employees.
(a)
If you haven't completed the OSHA Log, is it because your firm has too
few employees?
[ ] Yes [ ] No If you answer "NO," please explain.
___________________
(b)
If your company does not have to keep an OSHA 200 Log, provide a
yearly list for the past 3 years of injuries resulting in lost time and a list of
injuries not resulting lost time along with total man-hours worked for each
year.
3. Total employee hours worked last year at the GOCO facility? _______________
4. Your OSHA Recordable Incidence Rate1 for last 3 years?
Last Year
__________
1 Year Previous
__________
2 Years Previous
__________
5. Your Lost Workday Incidence Rate2 for last 3 years?
Last Year
___________
1 Year Previous
___________
2 Years Previous
___________
C. Industry Comparison Information
1. What North American Industry Classification System (NAICS) Code does your
company work under?
_______________
2. What is the OSHA Recordable Incidence Rate (most recent year) for your NAICS?
_______________
3. What is the Lost Workday Incidence Rate (most recent year) for your NAICS?
_______________
4. If your OSHA Recordable Incidence Rate and/or Lost Workday Incidence Rate is
greater than your NAICS code rate, attach a brief explanation and describe the action
plan that your company is using to improve your rates.
D.
Safety Policy and Organization
1. Do you have a written statement of your safety policy? (Please provide a copy.)
2. How is the safety policy communicated to employees?
1
OSHA Recordable Incidence Rate = #Recordable Injuries X 200,000 / Manhours
2
Lost Workday Incidence Rate = #Lost Workday Injuries X 2,000,000 / Manhours
55


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