<p> PRE-SHARP Review</p><p>This form is designed to help you and your consultant prepare for the SHARP process. It contains a list of information and documents that will help start the process. Please review this form. A consultant will contact you soon to discuss how to proceed with your goal of becoming a SHARP participant. </p><p>A. Company/Contact Information:</p><p>Company Name </p><p>Contact person/title </p><p>Email address </p><p>Mailing Address </p><p>Phone Number </p><p>Union local if applicable </p><p>B. Facility Information</p><p>• Facility floor space in square feet (include multiple floors in calculations) </p><p>• Facility layout/floor plan of building(s)</p><p>▪ Organizational chart</p><p>C. Types of Activity/Processes at facility</p><p>Activity/process No of Employees</p><p>▪ Process Descriptions:</p><p>- Sample Process Flow Charts D. Safety and Health Information</p><p>If you have any of these documents or information mentioned below, please have them available for our first visit. </p><p>• Safety & health related policies, procedures, manuals, goals and objectives. May include: -Hazard Communications Program -Respirator Program - Confined Space Program - Exposure Control Program - Hearing Conservation Program - Electrical Safety Plan - Preventive Maintenance Plan - Management of Change Program - Ergonomics program -Sling/Crane Program - Control of Hazardous Energy (Lockout/tagout) - Emergency procedures (medical plan, emergency action plan, fire prevention plan) - Personal Protective Equipment Assessment and Training documentation -Job Safety/health Analyses (JSA)</p><p>▪ Employee Handbook</p><p>▪ Safety committee operations, minutes, members, inspection records, accountability, training</p><p>▪ Accident/incident reports</p><p>▪ Industrial hygiene program, sampling records, list of hazardous chemicals used at the facility</p><p>▪ Safety and health training program and records</p><p>▪ Internal audits or evaluations of safety and health program</p><p>▪ Standard Industrial Classification (SIC/NAICS) Codes & Classifications under which the facility operates</p><p>▪ OSHA 300 and Logs for the last five years (801s if OSHA 300 log not required)</p><p>▪ Days Away, Restricted or Transferred (DART) rate for the last five years (Fill in attached table)</p><p>2 Claims Data</p><p>Remained at work</p><p>NUMBER OF CASES WITH ..... e y t a l a a w R n</p><p> a</p><p> t o r</p><p> i s n e r t y y f e e a a s a d</p><p> h i N t n s D w c r a S r a O r n u</p><p> t o s I C</p><p> s o</p><p>I e b d d y e s H h A e s e a o</p><p> a t t J a k e c a N c D r</p><p> n e i C e k e T o r</p><p> o y l r t l i D R t o s b o a W l t c e a A i p w - o</p><p> r R t d D T m d r s m e e e E o o r r c g r r</p><p> f e a r e r r f o e s v n a A r T Year (G) (H) (I) (J) DART TCIR</p><p>Formulas for calculating DART and TCIR can be found here: http://www.orosha.org/consult/sharp/sharp_appendix-e.pdf </p><p>3</p>