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| Exhibit 2.6.2
DOE-HDBK-1101-96
(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 Standard Industry Classification (SIC) Code does your company work under?
_______________
2. What is the OSHA Recordable Incidence Rate (most recent year) for your SIC?
_______________
3. What is the Lost Workday Incidence Rate (most recent year) for your SIC?
_______________
4. If your OSHA Recordable Incidence Rate and/or Lost Workday Incidence Rate is
greater than your SIC 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?
3. Do you have a safety organization? (Please provide an organization chart and descrip-
tion of responsibilities.)
4. Who is the most senior person for coordinating safety matters, and what is his/her
experience?
5. Is management accountable for safety performance? If so, state how this is practiced.
1
OSHA Recordable Incidence Rate = #Recordable Injuries X 200,000 / Manhours
2
Lost Workday Incidence Rate = #Lost Workday Injuries X 2,000,000 / Manhours
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