Safety Intervention Grant Case Study

One Year Case Study

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1. Company Information

Company Name

Policy Number

Application Number

Employer Contact Name

Total Number of Employees

Number of Employees Affected by Intervention(s)

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2. Please provide picture(s) in a word document of the intervention(s) being used.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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3. What intervention(s) were implemented?

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4. How did the intervention(s) improve safety?

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5. What feedback have affected employees of the intervention(s) given in regards to using the equipment?

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6. Provide productivity data for the intervention(s).
(i.e. parts produced per hour, service time or task time improvements, etc.)
The data should compare productivity before and after the intervention(s).

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7. Please provide quality data for the intervention(s).
(i.e. missed deadlines, reduced work, etc.)
The data should compare quality before and after the intervention(s).

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8. Fill-in the cost/benefit analysis below. Some cells may contain “0”. However if in the grant application productivity or other savings were anticipated, they would likely be expected below.

A. Intervention Cost

B. Training Costs

C. Maintenance and Other Costs

D. Cost of claims related to the intervention for the two year baseline reporting period.

E. Cost of claims related to the intervention for the one year follow-up reporting period.

F. Number of hours saved in production time this year because of the
intervention.

G. Number of hours saved in less re-work this year because of the intervention.

H. Number of hours saved in absenteeism this year because of the intervention.

I. Average hourly wage of affected employees.

J. Other cost savings because of the intervention

Safety Intervention Grant Case Study

One Year Case Study

Question Title

1. Company Information

Question Title

2. Please provide picture(s) in a word document of the intervention(s) being used.

Question Title

3. What intervention(s) were implemented?

Question Title

4. How did the intervention(s) improve safety?

Question Title

5. What feedback have affected employees of the intervention(s) given in regards to using the equipment?

Question Title

6. Provide productivity data for the intervention(s).
(i.e. parts produced per hour, service time or task time improvements, etc.)
The data should compare productivity before and after the intervention(s).

Question Title

7. Please provide quality data for the intervention(s).
(i.e. missed deadlines, reduced work, etc.)
The data should compare quality before and after the intervention(s).

Question Title

8. Fill-in the cost/benefit analysis below. Some cells may contain “0”. However if in the grant application productivity or other savings were anticipated, they would likely be expected below.

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9. If you had other cost savings as a result of the intervention(s) please descibe them below.

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10. Is there any other information you would like us to know regarding the intervention(s)?

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1. Company Information

Question Title

2. Please provide picture(s) in a word document of the intervention(s) being used.

Question Title

3. What intervention(s) were implemented?

Question Title

4. How did the intervention(s) improve safety?

Question Title

5. What feedback have affected employees of the intervention(s) given in regards to using the equipment?

Question Title

6. Provide productivity data for the intervention(s).(i.e. parts produced per hour, service time or task time improvements, etc.)The data should compare productivity before and after the intervention(s).

Question Title

7. Please provide quality data for the intervention(s).(i.e. missed deadlines, reduced work, etc.)The data should compare quality before and after the intervention(s).

Question Title

8. Fill-in the cost/benefit analysis below. Some cells may contain “0”. However if in the grant application productivity or other savings were anticipated, they would likely be expected below.

Question Title

9. If you had other cost savings as a result of the intervention(s) please descibe them below.

Question Title

10. Is there any other information you would like us to know regarding the intervention(s)?

6. Provide productivity data for the intervention(s).
(i.e. parts produced per hour, service time or task time improvements, etc.)
The data should compare productivity before and after the intervention(s).

7. Please provide quality data for the intervention(s).
(i.e. missed deadlines, reduced work, etc.)
The data should compare quality before and after the intervention(s).