##### Recordkeeping and

# Reporting Guidelines

for Federal Agencies

**(MICROSOFT WORD VERSION)**

**Under the Williams-Steiger**

**Occupational Safety and Health Act of 1970**

**U.S. Department of Labor**

**William E. Brock, Secretary**

**Occupational Safety and Health Administration**

**John A. Pendergrass, Assistant Secretary**

**Revised 1986**

**OSHA 2O14**

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### TABLE OF CONTENTS

## PAGE

######### DEFINITIONS i

**INTRODUCTION 1**

**LOG OF OCCUPATIONAL INJURIES AND ILLNESSES 1**

######### SUPPLEMENTARY REC0RDS 2

######### AGENCY CODING OF FORMS CA-1, CA-2, AND CA-6 2

OCCUPATION CODE **2**

TYPE AND SOURCE CODES **2**

OWCP AGENCY CODE **3**

DUTY STATION ZIP CODE **3**

OSHA SITE CODE **3**

######### FATALITY AND CATASTROPHE NOTIFICATION 4

**ACCESS TO AND RETENTION OF RECORDS AND REPORTS 4**

######### AGENCY ANNUAL REPORT 4

######### APPENDICES: (Note: appendices A, B, E, G-J are hyperlinked to OSHA & DOL-OWCP web sites.) (Appendices C, D, and J are in Microsoft word).

> **A** - LOG OF FEDERAL OCCUPATIONAL INJURIES AND ILLNESSES (In
> [microsoft
> word](../Log%20of%20Federal%20Occ-%20Injuries-Illnesses.doc) version
> attached)
> [(http://www.osha-slc.gov/OshDoc/Directive_gif/fap13_1.gif)](http://www.osha-slc.gov/OshDoc/Directive_gif/fap13_1.gif)
>
> **B** - OSHA FORM No. 101
> (<http://www.osha-slc.gov/html/Forms/osha101.pdf>)
>
> **C** - SUMMARY OF OSHA ITEMS AGENCIES MUST CODE ON COMPENSATION FORMS
> **5**
>
> **D** - NONSTANDARD OCCUPATION CODES **6**
>
> **E** - TYPE AND SOURCE & INJURY/ILLNESS CODES
> (<http://www.osha-slc.gov/OshDoc/Directive_gif/fap13_3.gif>)
>
> **F** - AGENCY ANNUAL REPORT GUIDELINES **7&8**
>
> **G** - OWCP FORM CA-1 (REVISED 1986)
> <http://www.dol.gov/dol/esa/public/regs/compliance/owcp/ca-1.pdf>
>
> **H** - OWCP FORM CA-2 (REVISED 1986)
> <http://www.dol.gov/dol/esa/public/regs/compliance/owcp/ca-2.pdf>
>
> [**I**](http://www.dol.gov/dol/esa/public/regs/compliance/owcp/ca-2.pdf) -
> OWCP FORM CA-6 (REVISED 1976)
> <http://www.dol.gov/dol/esa/public/regs/compliance/owcp/ca-6.pdf>
>
> [**J**](http://www.dol.gov/dol/esa/public/regs/compliance/owcp/ca-6.pdf) -
> OSHA REGIONAL AND NATIONAL
>
> OFFICE ADDRESSES
> <http://www.osha-slc.gov/OshDoc/Directive_gif/fap13_9.gif>

**[definitions]{.underline}**

The followng definitions apply to terms used in this booklet:

-   Catastrophe -- An accident resulting in five or more agency and/or
    nonagency people being hospitalized for inpatient care.

```{=html}
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```
-   Compensation Claims -- Forms submitted to the Department of Labor's
    Office of workers' Compensation Programs to record and report
    injuries, illnesses, and fatalities arising out of or in the course
    of employment. Three forms contain items OSHA requires agencies to
    complete:

> [Form CA-1]{.underline} -- Federal Employe's Notice of Traumatic
> Injury and Claim for Continual of Pay/ Compensation (Appendix G);
>
> [Form CA-2]{.underline} -- Notice of Occupational Disease and Claim
> for Compensation (Appendix H) and,
>
> [Form CA-6]{.underline} -- Official Superior's Report of Employee's
> Death (Appendix I).

-   Establishment -- A singel physical location where business is
    conducted or where services for operations are ferformed. Typically,
    An "estalbhment" refers to a field activity, regional office, area
    office, installation or facility.

```{=html}
<!-- -->
```
-   Illness/Disease -- A nontraumatic physiological harm or loss of
    capacity produced by systemic infection; continued or repeated
    stress or strain; expeosure to toxins, poisons, fumes, etc.; or
    other continued and repeated exposures to conditions of the work
    environment over a long period of time. For practical purposes, an
    occupational illness/disease is any reported condition which does
    not meet the defition of injury.

```{=html}
<!-- -->
```
-   Incident -- Used to refer to an injury or illenss/disease.

```{=html}
<!-- -->
```
-   Injury -- A traumatic wound or other condition of the body caused by
    external force, including stress or strain. The injury is
    identifiable as to time and place of occurrence and member or
    function of the body affected, and is caused by a specific event or
    incident or series of events or incidents within a single day or
    work shift.

```{=html}
<!-- -->
```
-   Lost Time Case -- A nonfatal traumatic injury that causes any loss
    of time for work beyond the day or shift on which it occurred; or a
    nonfatal nontraumatic illness that causes loss of time from work or
    disability at any time.

```{=html}
<!-- -->
```
-   No Lost Time Case -- A nonfatal incident that does not meet the
    definiton of a lost time case. (Usually created by a compensation
    claim for medical expense.)

**-i-**

**[INTRODUCTION]{.underline}**

THIS BOOKLET SUMMARIZES FEDERAL ACCIDENT REPORTING AND RECORDKEEPING
REQUIRE-MENTS OF THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION
(OSHA). IT ADDRESSES PROVISIONS OF THE OCCUPATIONAL SAFETY AND HEALTH
ACT OF 1970 (PL 91-596), EXECUTIVE ORDER 12196, OCCUPATIONAL SAFETY AND
HEALTH PROGRAMS FOR FEDERAL EMPLOYEES, AND 29 CFR PART 1960, BASIC
PROGRAM ELEMENTS FOR FEDERAL EMPLOYEE OCCUPATIONAL SAFETY AND HEALTH
PROGRAMS.

FEDERAL AGENCIES ARE REQUIRED TO COLLECT OCCUPATIONAL INJURY AND ILLNESS
DATA, TO ANALYZE THIS DATA TO IDENTIFY UNSAFE AND UNHEALTHFUL WORKING
CONDITIONS, AND TO ESTABLISH PROGRAM PRIORITIES BASED ON THEIR ANALYSES.
OSHA IS TO HAVE ACCESS TO AGENCY RECORDS OF OCCUPATIONAL INJURIES AND
ILLNESSES UNLESS THEY ARE SPECIFICALLY REQUIRED BY EXECuTIVE ORDER TO BE
KEPT SECRET IN THE INTEREST OF NATIONAL DEFENSE OR FOREIGN POLICY.

OSHA USES INJURY/ILLNESS DATA FROM COMPENSATION CLAIM FORMS SUBMITTED
UNDER THE FEDERAL EMPLOYEES\' COMPENSATION ACT AND PROVIDED BY THE U.S.
DEPARTMENT OF LABOR, EMPLOYMENT STANDARDS ADMINISTRATION, OFFICE OF
WORKERS\' COMPENSATION PROGRAMS. OSHA USES THE DATA TO SET PROGRAM
PRIORITIES, IDENTIFY FEDERAL WORKSITES FOR OSHA INSPECTIONS, MONITOR
AGENCIES\' PROGRESS IN REDUCING OCCUPATIONAL INJURIES, ILLNESSES, AND
FATALITIES, AND TO REPORT ON THE STATUS OF FEDERAL CIVILIAN EMPLOYEES\'
SAFETY AND HEALTH.

AGENCIES ARE REQUIRED TO COMPLETE OSHA-RELATED ITEMS ON OWCP
COMPENSATION CLAIM FORMS. IN 1986 OWCP REVISED FORMS CA-1 AND CA-2 TO
ACCOMODATE AGENCIES\' CODING AND OWCP\'s ENTRY OF DATA. THE REVISED
FORMS INCLUDE LABELED BLOCKS FOR THE CODES; CODES ARE TO BE PLACED IN
EXISTING BLOCKS ON PREVIOUS FORMS.

THE RECORDKEEPING AND REPORTING PROVISIONS DESCRIBED IN THIS BOOKLET
COVER THE BASIC REQUIREMENTS FOR ALL OCCUPATIONAL SAFETY AND HEALTH
PROGRAMS. AGENCIES SHOULD AUGMENT THESE REQUIREMENTS TO DESIGN ACCIDENT
PREVENTION PROGRAMS TAILORED TO THEIR MISSIONS, ORGANIZATIONS, AND
OPERATIONS.

**[LOG OF OCCUPATIONAL INJURIES AND ILLNESSES (1960.67, .69, AND
.71)]{.underline}**

EACH ESTABLISHMENT MUST MAINTAIN A LOG OF OCCUPATIONAL INJURIES AND
ILLNESSES TO PROVIDE A QUICK AND CURRENT VIEW OF WORKPLACE SAFETY AND
HEALTH THROUGHOUT THE ESTABLISHMENT. THE FORMAT SHOWN IN APPENDIX A, OR
ONE WITH THE SAME DATA ITEMS, IS TO BE USED FOR THE LOG. THE LOG IS TO
BE COMPLETED WITHIN SIX WORKING DAYS AFTER RECEIVING INFORMATION ON AN
INCIDENT, ALL INJURIES, ILLNESSES, AND FATALITIES FOR WHICH A CA-1, 2 OR
6 IS FILED [WITH OWCP]{.underline} SHALL BE LOGGED. CA-1s SUBMITTED TO
doCUMENT AN INJURY OR EXPOSURE ARE TO BE PLACED IN THE EMPLOYEE\'S
OFFICIAL PERSONNEL OR MEDICAL FOLDER, NOT SENT TO OWCP, IF THERE IS NO
LOST TIME OR MEDICAL REIMBURSEMENT REQUIRED.

CLAIMS CONTROVERTED OR OTHERWISE CHALLENGED SHALL BE LOGGED BUT MAY BE
DELETED IF OWCP DENIES THE LEGITIMACY OF THE CLAIMS. CLAIMS RESULTING IN
PERMANENT TRANSFER, TERMINATION OF EMPLOYMENT OR SUBSEQUENT GRANTING OF
CONTINUATION OF PAY (COP) SHALL BE RECORDED AS LOST TIME CASES.
MAINTENANCE OF LOGS AT AREA OR REGIONAL LEVELS IS PERMITTED IF THERE IS
QUARTERLY FEEDBACK OF DATA TO EACH ESTABLISHMENT FOR ACCESS BY
MANAGEMENT, EMPLOYEE REPRESENTATIVES, EMPLOYEES AND OSHA.

**-1-**

YEARLY TOTALS OF ALL INJURIES/ILLNESSES/FATALITIES\'SHALL BE POSTED IN
EACH ESTABLISHMENT WITHIN 45 DAYS OF THE CLOSE OF THE FISCAL YEAR AND
SHALL REMAIN POSTED FOR 30 CONSECUTIVE DAYS. THE LOG FORMAT (APPENDIX A)
WI.TH THE RIGHT LOWER PART COMPLETED MAY BE USED FOR THIS POSTING
REQUIREMENT.

**[SUPPLEMENTARY RECORDS (1960.68)]{.underline}**

AN INCIDENT RESULTING IN A FATALITY, A LOST TIME CASE, OR MEDICAL
EXPENSE, INCLUDING TERMINATION AND PERMANENT TRANSFER, WARRANTS
INVESTIGATION, ANALYSIS AND DOCUMENTATION oN A SUPPLEMENTARY RECORD. THE
SUPPLEMENTARY RECORD SHOULD IDENTIFY THE PERSONNEL, EQUIPMENT, AND
ACTIVITIES INVOLVED, As WELL AS THE CAUSES AND CONTRIBUTING FACTORS.
OSHA FORM 101 (APPENDIX B), OWCP FORMS CA-1, 2 AND 6, OR EQUIVALENT
AGENCY FORMS, MAY BE USED FOR SUPPLEMENTARY RECORDS.

SUPPLEMENTARY RECORDS SHALL BE COMPLETED WITHIN SIX WORKING DAYS AFTER
RECEIPT OF INFORMATION THAT AN ACCIDENT HAS OCCURRED. IF OWCP FORMS ARE
USED TO MEET OSHA'[s]{.smallcaps} REQUIREMENT FOR SUPPLEMENTARY RECORDS,
COPIES SHALL BE MAINTAINED IN THE OCCUPATIONAL SAFETY AND/OR HEALTH
OFFICE.

REGARDLESS OF THE FORM USED AS A SUPPLEMENTARY RECORD, AGENCIES SHALL
COMPLETE OWCP FORMS CA-1, CA-2, AND CA-6 AS DESCRIBED IN THIS
PUBLICATION. PRIVACY ACT RESTRICTIONS, APPLICABLE TO OWCP RECORDS SHALL
BE MAINTAINED FOR OWCP FORMS AND DATA WHEN THEY ARE USED IN RELATION TO
ACCIDENT PREVENTION.

**[AGENCY CODING OF FORMS CA-1, CA-2, AND CA-6 (1960.68)]{.underline}**

OSHA REQUIRES AGENCIES TO CODE ITEMS ON\'THE\' CA-I, CA-2 ANd CA-6 PRIOR
TO THEIR SUBMISSION TO OWCP. APPENDIX C SUMMARIZES WHERE THE CODES ARE
TO BE PLACED ON THE NEW (CA-1 AND CA-2, REVISED 1986) AND OLD VERSIONS
OF THE FORMS. NEW FORMS HAVE CODING BLOCKS FOR THE OSHA-RELATED ITEMS.
ON OLD FORMS, THE CODES ARE TO BE [ADDED TO]{.underline} INFORMATiON
REQUIRED BY THE TITLE OF THE BLOCK.

#### OCCUPATION CODE

INDENTIFY THE OCCUPATION BY WRITING THE Two LETTERS OF THE EMPLOYEE\'S
PAY PLAN AS LiSTED ON THE EMPLOYEE\'S MOST RECENT, NOTIFICATION OF
PERSONNEL ACTION (i.e., "GS," "GM," "WG," [ETC]{.smallcaps}.) AND THE
FOUR NUMBERS OF THE OCCUPATIONAL\"SERIES, (OPM STANDARD FORM 50).
OCCUPATIONAL SERIES ARE LISTED IN THE FEDERAL PERSONNEL MANUAL,
SUPPLEMENT 292-1, \"PERSONNEL DATA STANDARDs." FOR U.S. POSTAL SERVICE
EMPLOYEES, WRITE \"PS\", FOLLOWED By THE FIRST Four NUMBErS OF THE
OCCUPATIONAL CODE. FOR EMPLOYEES WHO PERFORM SERVICES FOR THE FEDERAL
GOVERNMENT, BUT Do NOT HAVE JOB TITLES THAT FALL UNDER THE USUAL JOB
CLASSIFICATION SYSTEM, SEE APPENDIX D, NONSTANDARD OCCUPATION CODES.

#### TYPE AND SOURCE CODES 

TYPE AND SOURCE CODES ARE USED TO DESCRIBE WHAT CAUSED THE INCIDENT. THE
TYPE CODE STANDS FOR AN [ACTION]{.underline} AND SOURCE CODE FOR AN
[OBJECT OR]{.underline} [SUBSTANCE]{.underline}. TOGETHER, THEY FORM A
BRIEF DESCRIPTION OF HOW THE INCIDENT OCCURRED. Where there ARE TWO
DIFFERENT SOURCESI CODE THE INITIATING

**-2-**

SOURCE OF THE INCIDENT (SEE EXAMPLE 1, BELOW). TYPE AND SOURCE CODES ARE
GIVEN IN APPENDIX E. EXAMPLES ARE:

1\. An Employee tripped on carpet and struct TYPE: 210 (fell on same
level)

> his head on a desk. SOURCE: 0110 (walking/working
>
> surface)

**NOTE: THIS EXAMPLE WOULD NOT BE CODED 120 (STRUCK AGAINST) AND 0140**

**(FURNITURE).**

2\. A LETTER CARRIER WAS BITTEN BY A DOG. TYPE: 440 (BITTEN BY)

SOURCE: 0911 (DOG)

3\. A FOREST RANGER CONTRACTED DERMATITIS TYPE: 510 (CONTACT)

FROM POISON ivy SOURCE: 0920 (PLANT)

4\. A NURSE CONTRACTED HEPATITIS AFTER BEING TYPE: 410 (PUNCTURED BY)

PUNCTURED BY A CONTAMINATED NEEDLE. SOURCE: 0831 (NEEDLE)

5\. AN EMPLOYEE WAS DRIVING A GOVERNMENT TYPE: 800 (TRAVELING IN)

VEHICLE WHEN IT WAS STRUCK BY ANOTHER SOURCE: 0421 (GOVERNMENT-OWNED

Vehicle. vehicle, as driver)

> **NOTE: THE TYPE CODE 800, \'TRAVELING IN\" IS DIFFERENT FROM\'THE
> OTHER TYPE CODES IN THAT ITS FUNCTION IS NOT TO.IDENTIFY FACTORS
> CONTRIBUTING TO THE INJURY OR FATALITYI BUT RATHER TO COLLECT DATA ON
> THE TYPE OF VEHICLE THE EMPLOYEE WAS OPERATING OR TRAVELING IN AT THE
> TIME OF THE INCIDENT.**

AGENCIES DESIRING ADDITIONAL CODES TO COVER HAZARDS OF THEIR OPERATIONS
SHOULD CONTACT THE OFFICE OF FEDERAL AGENCY PROGRAMS, TELEPHONE
FTS/202-523-9329.

#### OWCP AGENCY CODE

THE OWCP AGENCY CODE (\"CHARGEBACK CODE\") IS A FOUR-DIGIT (OR
FOUR-DIGIT PLUS TWO-LETTER) CODE USED TO IDENTIFY THE EMPLOYEE\'S
AGENCY. AGENCIES WISHING TO EXPAND FROM A FOUR-DIGIT TO A SIX-DIGIT CODE
MUST CONTACT THE OFFICE OF WORKERS\' COMPENSATION PROGRAMS, TELEPHONE
FTS/202-523-8463.

#### DUTY STATION ZIP CODE

DUTY STATION ZIP CODES SHOULD BE ENTERED IN THE BLOCKS INDICATED IN
APPENDIX C. FOR AN EMPLOYEE OFFICIALLY DETAILED TO ANOTHER DUTY STATION,
USE THE ZIP CODE FOR THE TEMPORARY DUTY STATION. **[DO
NOT]{.underline}** ENER THE ZIP CODE OF A CENTRAL OFFICE PROCESSING
COMPENSATION FORMS IN THESE BLOCKS.

#### OSHA Site Code

If OSHA finds that THE OWCP CODE AND.THE DUTY STATION ZIP CODE DO NOT
EFFECTIVELY IDENTIFY AN AGENCY\'S ESTABLISHMENTS, OSHA WILL REQUIRE THE
AGENCY To DEVELOP OSHA SITE CODES. IN MOST CASES THE AGENCY WILL BE ABLE
TO USE EXISTING CODES\--FINANCIAL MANAGEMENT CODES OR UNIT
IDENTIFICATION CODES, FOR EXAMPLE. AGENCIES WISHING TO ESTABLISH OSHA
SITE CODES MAY CONTACT THE OFFICE OF FEDERAL AGENCY PROGRAMS, TELEPHONE:
FTS/202-523-9329.

**-3-**

**[FATALITY AND CATASTROPHE NOTIFICATION (1960.70)]{.underline}**

AGENCIES MUST NOTIFY OSHA WITHIN 48 HOURS OF EACH OCCUPATIONAL FATALITY
OR INPATIENT HOSPITALIZATION OF FIVE OR MORE PEOPLE, AGENCY AND
NONAGENCY PEOPLE INCLUDED. DEATHS OCCURRING WITHIN SIX MONTHS OF AN
OCCUPATIONAL INCIDENT SHALL ALSO BE REPORTED TO OSHA WITHIN 48 HOURS.

NOTIFICATION CAN BE BY TELEPHONE OR.TELEGRAPH TO NATIONAL; REGIONAL OR
AREA OFFICES OF OSHA. THE NATIONAL OFFICE oF FEDERAL AGENCY PROGRAMS
TELEPHONE NUMBER IS: FTS/202-523-9329. NOTIFICATION TO OSHA SHALL
INCLUDE:

-   NAMES OF INDIVIDUALS INVOLVED

-   NUMBER OF FATALITIES AND/OR INJURIES AND ILLNESSES AND THEIR EXTENT

-   ESTABLISHMENT NAME, TIME, DATES LOCATIONS TYPE OF ACCIDENT, AND KIND
    OF OPERATION CONDUCTED AT THE ACCIDENT SITE

-   ACTIONS TAKEN BY THE AGENCY TO INVESTIGATE THE ACCIDENT AND WHETHER
    OSHA ASSISTANCE IS DESIRED.

AGENCIES SHALL PROVIDE THE OFFICE OF FEDERAL AGENCY PROGRAMS WITH A
SUMMARY REPORT OF EACH FATAL AND CATASTROPHIC ACCIDENT INVESTIGATION.
THE SUMMARY SHOULD INCLUDE THE INFORMATION LISTED ABOVE, CAUSAL FACTORS,
THE EFFECTIVENESS OF APPLICABLE STANDARDS, AND.PROPOSED
CORRECTIVE/PREVENTIVE ACTIONS.

**[ACCESS TO AND RETENTION OF RECORDS AND REPORTS]{.underline} (1960.71,
.72 AND .73) \"**

AGENCIES SHALL PUBLICIZE THE AVAILABILITY OF AND PROVIDE ACCESS TO
ESTABLISH-MENT LOGS AND ANNUAL INJURY/ILLNESS SUMMARIES. ACCESS To THESE
DOCUMENTS SHALL BE PROVIDED TO ESTABLISHMENT/AGENCY SAFETY AND HEALTH
PERSONNEL, ESTABLISHMENT OCCUPATIONAL SAFETY AND HEALTH COMMITTEES,
EMPLOYEES, EMPLOYEE REPRESENTATIVES AND FORMER EMPLOYEES WITH A NEED TO
KNOW, AND TO THE secretary OF LABOR, SECRETARY OF HEALTH AND HUMAN
SERVICES AND THEIR AUTHORIZED REPRESENTATIVES. RECORDS AND REPORTS SHALL
BE MAINTAINED BY THE AGENCY for FIVE YEARS FOLLOWING THE END OF THE
FISCAL YEAR TO WHICH THEY RELATE.

**[AGENCY ANNUAL REPORT]{.underline} (1960.74)**

BY JANUARY 1[st]{.smallcaps} OF EACH YEAR, AGENCIES SHALL SUBMIT A
REPORT TO.THE SECRETARY OF LABOR DESCRIBING THE PREVIOUS FISCAL YEAR\'S
OCCUPATIONAL SAFETY AND HEALTH PROGRAM. GUIDELINES FOR THE REPORT ARE
PROVIDED IN APPENDIX F.

**-4-**

**Appendix C**

**[Summary of OSHA Items Agencies Must]{.smallcaps}**

**[Code on Compensation Forms]{.smallcaps}**

+-----------+--------+-----------+----------+-----------+-----------+
|           | **FORM |           | ###### F |           | **FORM    |
|           | CA-1** |           | ORM CA-2 |           | CA-6**    |
+-----------+--------+-----------+----------+-----------+-----------+
| **[\      | **Old\ | **NEW\    | **Old\   | **New\    | **Old\    |
| I         | (R     | (Revised  | (Revised | (Revised  | (Revised  |
| TEM]{.sma | evised | 1986**    | 1985)**  | 1986)**   | 1976)**   |
| llcaps}** | 1      |           |          |           |           |
|           | 983)** |           |          |           |           |
+-----------+--------+-----------+----------+-----------+-----------+
| *         | [Block | [Shaded   | [BLOCK   | [Shaded   | [BLOCK    |
| *[Occupat | 12.]   | Box       | 7.]{.sm  | Box       | 13.]{.s   |
| ion]{.sma | {.smal | "]{       | allcaps} | "]{       | mallcaps} |
| llcaps}** | lcaps} | .smallcap |          | .smallcap |           |
|           |        | s}a["]{.s | [Occupat | s}a["]{.s | [Was      |
| **[C      | [Emplo | mallcaps} | ion]{.sm | mallcaps} | employee  |
| ode]{.sma | yee's] |           | allcaps} |           | in        |
| llcaps}** | {.smal | [O        |          | [O        | pe        |
|           | lcaps} | ccupation |          | ccupation | rformance |
|           |        | Code]{.s  |          | Code]{.s  | of duty   |
|           | [Occup | mallcaps} |          | mallcaps} | when      |
|           | ation] |           |          |           | injury    |
|           | {.smal |           |          |           | occu      |
|           | lcaps} |           |          |           | rred?]{.s |
|           |        |           |          |           | mallcaps} |
+-----------+--------+-----------+----------+-----------+-----------+
| **[Type   | [Block | [Shaded   | [BLOCK   | [Shaded   | [BLOCK    |
| of        | 13.]   | Box       | 15.]{.sm | Box       | 12.]{.s   |
| Inj       | {.smal | "]{       | allcaps} | "]{       | mallcaps} |
| ury]{.sma | lcaps} | .smallcap |          | .smallcap |           |
| llcaps}** |        | s}b["]{.s | [Nature  | s}b["]{.s | [Describe |
|           | [Cause | mallcaps} | of the   | mallcaps} | how       |
| *         | of     |           | Dise     |           | injury    |
| *[Illness | I      | [Type     | ase]{.sm | [Type     | occ       |
| C         | njury] | Code]{.s  | allcaps} | Code]{.s  | urred]{.s |
| ode]{.sma | {.smal | mallcaps} |          | mallcaps} | mallcaps} |
| llcaps}** | lcaps} |           |          |           |           |
+-----------+--------+-----------+----------+-----------+-----------+
| **[Source | [Block | [Shaded   | [BLOCK   | [Shaded   | [BLOCK    |
| of Injury | 13.]   | Box       | 15.]{.sm | Box       | 12.]{.s   |
| Illness   | {.smal | "]{       | allcaps} | "]{       | mallcaps} |
| C         | lcaps} | .smallcap |          | .smallcap |           |
| ode]{.sma |        | s}c["]{.s | [Nature  | s}c["]{.s | [Describe |
| llcaps}** | [Cause | mallcaps} | of the   | mallcaps} | how       |
|           | of     |           | Dise     |           | injury    |
|           | I      | [Source   | ase]{.sm | [Source   | occ       |
|           | njury] | Code]{.s  | allcaps} | Code]{.s  | urred]{.s |
|           | {.smal | mallcaps} |          | mallcaps} | mallcaps} |
|           | lcaps} |           |          |           |           |
+-----------+--------+-----------+----------+-----------+-----------+
| **[OWCP   | [Block | [Block    | [Block   | [Block    | [BLOCK    |
| Age       | 22.]   | 17.]{.s   | 23.]{.sm | 19.]{.s   | 6.]{.s    |
| ncy]{.sma | {.smal | mallcaps} | allcaps} | mallcaps} | mallcaps} |
| llcaps}** | lcaps} |           |          |           |           |
|           |        | [OWCP     | [Bureau  | [OWCP     | [Bureau   |
| **[C      | [      | A         | or       | Agency    | or        |
| ode]{.sma | Bureau | gency]{.s | Off      | Code]{.s  | O         |
| llcaps}** | or     | mallcaps} | ice]{.sm | mallcaps} | ffice]{.s |
|           | O      |           | allcaps} |           | mallcaps} |
|           | ffice] | [Code]{.s |          |           |           |
|           | {.smal | mallcaps} |          |           |           |
|           | lcaps} |           |          |           |           |
+-----------+--------+-----------+----------+-----------+-----------+
| **[OSHA   | [      | [Block    | [\-\-    | [Block    | [         |
| Site      | \-\-\- | 17.]{.s   | \-\-\-\- | 19.]{.s   | \-\-\-\-\ |
| C         | \-\-\- | mallcaps} | \-\-\-\- | mallcaps} | -\-\-\-\- |
| ode]{.sma | \-\-\- |           | \--]{.sm |           | \-\--]{.s |
| llcaps}** | \-\--] | [OSHA     | allcaps} | [OSHA     | mallcaps} |
|           | {.smal | Site      |          | Site      |           |
|           | lcaps} | Code]{.s  |          | Code]{.s  |           |
|           |        | mallcaps} |          | mallcaps} |           |
|           |        |           |          |           |           |
|           |        | [(As      |          | [(As      |           |
|           |        | neces     |          | neces     |           |
|           |        | sary)]{.s |          | sary)]{.s |           |
|           |        | mallcaps} |          | mallcaps} |           |
+-----------+--------+-----------+----------+-----------+-----------+
| **[Duty   | [Block | [Block    | [Block   | [Block    | [Block    |
| Station   | 7.]    | 18.]{.s   | 8.]{.sm  | 20.]{.s   | 5.]{.s    |
| Zip       | {.smal | mallcaps} | allcaps} | mallcaps} | mallcaps} |
| C         | lcaps} |           |          |           |           |
| ode]{.sma |        | [Duty     | [Name    | [Duty     | [D        |
| llcaps}** | [Name  | St        | and      | St        | epartment |
|           | and    | ation]{.s | Address  | ation]{.s | or        |
|           | A      | mallcaps} | of       | mallcaps} | A         |
|           | ddress |           | E        |           | gency]{.s |
|           | of     |           | mploying |           | mallcaps} |
|           | Emp    |           | Age      |           |           |
|           | loying |           | ncy]{.sm |           |           |
|           | A      |           | allcaps} |           |           |
|           | gency] |           |          |           |           |
|           | {.smal |           |          |           |           |
|           | lcaps} |           |          |           |           |
+-----------+--------+-----------+----------+-----------+-----------+

**-5-**

**Appendix D**

Nonstandard Occupation Code

**[\"Nonemployees\" covered by OWCP:]{.smallcaps}**

+---------+-------------------------+-------+-------------------------+
| *       | ####### TITLE           | **C   | ####### TITLE           |
| *CODE** |                         | ODE** |                         |
+---------+-------------------------+-------+-------------------------+
| [?013   | [Peace Corps            | [?00  | [Chaplain]{.smallcaps}  |
| 6]{.sma | Volunteer]{.smallcaps}  | 60]{. |                         |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?008   | [Non-Fed. Law Enf.      | [?18  | [State/Local Agri       |
| 3]{.sma | Off.]{.smallcaps}       | 63]{. | Insp.]{.smallcaps}      |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?002   | [Vista                  | [?00  | [Sports Clinic          |
| 1]{.sma | Volunteer]{.smallcaps}  | 30]{. | Perform.]{.smallcaps}   |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?024   | [Neighborhood YC        | [?01  | [Entertainer/Armed      |
| 3]{.sma | Enroll]{.smallcaps}     | 88]{. | Forces]{.smallcaps}     |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?024   | [Job Corps              | [?02  | [Vocational             |
| 3]{.sma | Enrollee]{.smallcaps}   | 43]{. | Trainee]{.smallcaps}    |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?030   | [Mail                   | [?04  | [Forest Service         |
| 2]{.sma | Messenger]{.smallcaps}  | 60]{. | Cooperator]{.smallcaps} |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?350   | [Contract Job           | [?13  | [Gage Reader, Corps     |
| 1]{.sma | Cleaner]{.smallcaps}    | 16]{. | Engrs]{.smallcaps}      |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?062   | [Student                | [?47  | [Maintenance Workers,   |
| 1]{.sma | Nurse]{.smallcaps}      | 01]{. | HUD]{.smallcaps}        |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?046   | [Forest Srvc            | [?00  | [Nat'l Park Srvc        |
| 2]{.sma | Volunteer]{.smallcaps}  | 26]{. | Voluntr]{.smallcaps}    |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?134   | [Vol. Weather           | [?02  | [Nat'l Defens Exec      |
| 1]{.sma | Observer]{.smallcaps}   | 04]{. | Reserv]{.smallcaps}     |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?009   | [State Martme Acad      | [?17  | [Nat'l Teachrs Corps    |
| 9]{.sma | Cadt]{.smallcaps}       | 40]{. | Mbr]{.smallcaps}        |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?009   | [ROTC                   | [?06  | [Contact                |
| 9]{.sma | Cadet]{.smallcaps}      | 10]{. | Nurse]{.smallcaps}      |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?093   | [Federal                | [?06  | [Contract               |
| 0]{.sma | Juror]{.smallcaps}      | 02]{. | Physician]{.smallcaps}  |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?218   | [Civil Air Patrol       | [?06  | [Nutritional Aide,      |
| 1]{.sma | Vol.]{.smallcaps}       | 30]{. | USDA]{.smallcaps}       |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?068   | [Vol. Hospital          | [?17  | [Reader for the         |
| 5]{.sma | worker]{.smallcaps}     | 40]{. | Blind]{.smallcaps}      |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?024   | [Youth Cons. Corps      | [?10  | [Trust Empl             |
| 3]{.sma | Vol.]{.smallcaps}       | 16]{. | S                       |
| llcaps} |                         | small | mithsonian]{.smallcaps} |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?047   | [Cnty Agnt, Dept.       | [?04  | [Soil/Water Cons Dist   |
| 5]{.sma | Agri.]{.smallcaps}      | 57]{. | Empl]{.smallcaps}       |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?350   | [Student                | [?02  | [Yth/Adlt Cons Corps    |
| 6]{.sma | Aide]{.smallcaps}       | 43]{. | Enrll]{.smallcaps}      |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?982   | [Seaman]{.smallcaps}    | [?00  | [Military Acad          |
| 5]{.sma |                         | 99]{. | Cadet]{.smallcaps}      |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?020   | [Coast Guard Res        | [?00  | [Vol Trainee Probation  |
| 4]{.sma | Membr]{.smallcaps}      | 06]{. | Off]{.smallcaps}        |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?020   | [Coast Guard Aux        | [?00  | [Urban Crime Prev Prog  |
| 4]{.sma | Membr]{.smallcaps}      | 06]{. | Vol]{.smallcaps}        |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?002   | [National Park Srvc.    | [?03  | [Congressional Staff    |
| 3]{.sma | Collab]{.smallcaps}     | 45]{. | Mbr]{.smallcaps}        |
| llcaps} |                         | small |                         |
|         |                         | caps} |                         |
+---------+-------------------------+-------+-------------------------+
| [?009   | [College Wk/Stdy        |       |                         |
| 9]{.sma | Partic.]{.smallcaps}    |       |                         |
| llcaps} |                         |       |                         |
+---------+-------------------------+-------+-------------------------+
|         |                         |       |                         |
+---------+-------------------------+-------+-------------------------+

**-6-**

######## Appendix F

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Guidelines for Agency's Annual Occupational Safety**

**and Health Report to the Secretary of Labor**

Fiscal Year: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Agency (Department):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Component:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Number of employees coveted by this report:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of individual responsible for the occupational safety and health
program of

the agency or component covered by this report:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Telephone
number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Each agency shall:

1\. a. Use agency injury/illness data to display the annual statistics
for fatalities and lost time disabilities for the report year and, if
possible, compare these fatalities and disabilities with similar
statistics for the previous three-year period. Data based on agency
claims submitted to OWCP is preferred, but internal accident or incident
reporting data (FARS) is acceptable, if OWCP data is not available to
the agency. The data should be displayed in charts or tables so that
changes can be easily seen or demonstrated.

b.  Use agency data to display the most recent OWCP chargeback and COP
    costs and, if possible, compare these costs with similar statistics
    for the previous three-year period. The data should be displayed in
    charts or tables so that changes can be easily seen or demonstrated.

> c\. Use agency accident or incident reporting system or supplemental
> reports to the OSHA logs or the OWCP reports for details which will
> help explain any significant trends and major causes or sources of
> fatalities and lost time disabilities which occurred last year(s).

2.  Describe safety and occupational health program accomplishments and
    initiatives implemented last fiscal year to control the trends and
    major causes or sources of fatalities and lost time disabilities in
    your agency and to improve your agency's overall safety and
    occupational health programs. Discuss your successes and/or failures
    as a result of your agency's implementation of these initiatives.
    Explain any significant onetime or additional permanent resources
    allocated to the safety and occupational health program last year
    for areas such as: workplace hazard abatement, research and
    development, data systems, staffing, training, etc. Attach a copy of
    any significant safety and occupational health policy or
    proclamation related to those initiatives.

**-7-**

**Appendix F (Continued)**

**Guidelines for Agency's Annual Occupational Safety**

**and Health Report to the Secretary of Labor**

In describing your accomplishments and initiatives, please try to
explain your agency's efforts in the following areas:

-   Accomplishments for assuring that workers, supervisors and committee
    members received appropriate job health and safety awareness and
    hazard recognition information and training.

-   Accomplishments for assessing the effectiveness of your safety and
    occupational health programs.

-   Accomplishments in the identification, assessment and resolution of
    safety and health problems, including your agency's system of (a)
    providing recognition to outstanding achievers and (b) establishing
    accountability and performance standards for managers, supervision
    and employees.

-   Unique or significant accomplishments that your agency made last
    year to enhance employee participation, involvement and consultation
    in the safety and occupational health program.

3\. Identify your annual OSH plans, goals and objectives, and
significant OSH initiatives planned and programmed for the coming
year(s).

4\. Provide comments, requests and recommendations for consideration by
OSHA's Office of Federal Agency Programs (OFAP) in Government-wide
occupational safety and health programs or report any items of special
interest concerning occupational safety and health activities or
programs. (Optional)

It is suggested that the report be in executive summary format and be
limited to ten pages exclusive of attachments.

**-8-**