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StrongWare ® for Managing OSHA & EPA Data


1. MSDSs
2. HazMat Inventorying
3. HazMat/Waste Labels
4. Threshold Quantity
5. EPA 317
6. OSHA 101 Form
7. OSHEPLog
8. Process Safety
9. Program Evaluation
10. Job Safety Analysis
11. Workers Comp
12. Experience Modifier
13. *Training & PPE
*System Safety
*Modeling

You can use your OSHA and EPA Strongware® for:
  • 1. Recording Material Safety Data Sheet, MSDS, data;
  • 2. Summarizing the MSDS data with your HazInLog report;
  • 3. Creating labels for containers in use or waste, HazWaLbl & HazInLbl;
  • 4. Inventorying HazMats with Threshold Planning Quantity spreadsheet StrongForms;
  • 5. EPA Form 0317, Emergency and Hazardous Chemical Inventory spreadsheetsEPA317 ;
  • 6. Recording incidents with your OSHA 101 Form ;
  • 7. Summarizing incidents with your OSHEPLog and OSHA 200 spreadsheet;
  • 8. Creating Process Safety block diagrams with spreadsheets;
  • 9. Performing self-audits with Program Evaluation Profile, OSHAPEP spreadsheet;;
  • 10. Documenting Job Safety Analyses JSA and Hazard Analyses;
  • 11. Documenting and Summarizing Workers Compensation Claim data WC ; and
  • 12. Calculating OSHA Incident Experience Modifiers, EXPERMOD .
  • 13. You can record training and PPE issuing with *Training
    You can also view the *System Safety and *Modeling pages.
    Note: The example templates shown on this webpage are the word processing text templates that you can download at *Download Demos for text. Many of the database forms and spreadsheets are also available there.
    To view examples of screens, click on the hotlinks for *__ Screen.


    You can download a copy of the safety logo at swlogo
    If you like integrated safety and quality, you can download an MS Word 6 journal article, *COSMIC (246k)
    You can access many resources at *Hotlinks

    1. Material Safety Data Sheets


    You can record Material Safety Data with either of OSHEP or MSDSANSI StrongForms.

    You can cross-check compliance at *OSHA 174
    To view an example of a screen, click on *MSDS ANSI Screen. Use your browser's BACK function to return to this page.

    You can enter your MSDS data and customize and distribute copies of it for workers, trainers, handlers, responders, etc.

    /SW\   O S H A   M S D S   AND   E P A , O S H E P,  R e c o r d    RECNO: 1
    
    Date,TimeZ: 09/17/1994,12:12E  Due:     /  /    About: Enter same as for LaPS.
    DB File:HAZBEN  HRecord Nbr:  10.00  Previous: n/a    SS File: MINISS   Column-Row: B3
    Prepared by: Dick Strong  Position: Proprietor   Telephone: 800-COSMIC-0  FAX-EMAIL: 800-COSMIC-0        
    
    Section 1 - Material Identification and Hazardous Component %: 33  MSDS #: 9999
    Identification: HAZMAT A                  NIIN : 999999       CAS#: 99-999     
    Manufacturer: ABC MFG.                Telephone: 999-999-9999  Part Number: 999-9999      
    Org'n. Address: HAZMAT DIV.           Dept: SALES       Receiving Manifest#: 9999      
    St.# Address: 999 MAIN  ST      City: ANYTOWN             State: AA  ZIP: 99999-9999  
    ACGIH TLV: 99    OSHA PEL:   99  Carcinogen Reference: NTP   Physical Form: LIQUID 
    
    Section 2 - Physical / Chemical Characteristics:
    Boiling Point : 555   Vapor Pressure: 5     Vapor Density: 5.5   Water Solubility:  5.0
    Specific Gravity: 1   Water Reactive?: 0
    
    Section 3 - Fire and Explosion Hazard Data:
    Flash Point: 666  Method:    Evaporation:   0 Method:     AutoIgnitionTemperature: 777  
    Flammability Limits in Air:  LowerExpLimit:  4  UpperExpLim:  9  ExtinguishingMedia: A
    ExplosiveClass: na Type:    Life Expires: 1996/04/11  Weight: 1000.00 Gage/Caliber:  0.000 
    Firefighting Procedures: Hydrocarbon Fire Procedure      Velocity:    0
    Firefighting Hazards: Flashover in confined spaces.     FF PPE: SCBA
    
    Section 4 - Stability: Stable?:y  pH: 5.5  Incompatibilities: Avoid oxidizers
    Decompos. Products: Soot, CO, CO2                   Polymers: n/a
    
    Section 5 - Health Hazard Data:  Health Hazard: SEPSIS    Route of Entry: EATING   
    Target Organ: STOMACH   Required Training: Demo      Required Examination: ANNUAL    
    Exposure - Amount;  .1E-8  Frequency;   9  Duration; 3.00
    Symptoms: chestpan  Medical Conditions Aggravated: pleurosy  First Aid: wash,CPR
    
    Section 6 - Control Measures: P.P.E.: RESP,faceshd  Ventilation: local  Hygiene: soap/wat
    
    Section 7 - Precautions: NFPA Class: 4  Disposal Process: Incinerator           
    Handling and Storage: Store cool  ventilated          Other: n/a
    
    
    C. ENVIRONMENTAL PROTECTION 40 CFR 621/624 AND SARA DATA AND DOT DATA
    
    Facility ID: XYZ Bldg 13         Temp.Storage Start Date: 09/09/1995
    Quantity~Gals: 123  Lbs/Gal: 8.0  Nbr.Items:  55  Qty~Lbs: 984  ReEnter: 98456  
    
    Disposal Location/Point Source: HazWaste Site 4     Geo. Coords: N-S:   45.40 E-W;   78.90
    Disposal Orgn: EDC       EPA Code:       EPA Permit#: 999    EPA Waste#: abc123
    Requisition Document: abc              Disposal Manifest: 123abc    
    
    DoT Name(s): hydrocarbon fuel      DoT Class: tbd   Date Shipped: 02/03/1996
    
    Gen.Name: Dick         Strong        Tel: 800-COSMIC0      Org: Safety Analysis 
    Address: 7514 Belle Plaine Dr  City: Huber Heights         St: OH  ZIP: 45424-3229
    
    Emergency Telephone: 513-236-0361          
    
    You can view and report and printout the data in a way that is more easily readable for workers with MSDSGW:
    
    

    Note: If you want to include additional data that is larger than the fields provided in the database, then you can copy and paste the data to the OSHEP textfile form provided with your StrongWare.
    If you are using Microsoft Access, then you can use the transfer to Microsoft Word function to transfer your record to a Word file and then enter in the additional data. Note: Strongware® also provides forms and reports in ANSI Z400.1 style, MSDSANSI.
    /SW\        Material Safety Data Sheet ( ANSI Z400.1-1993 )        RECNO:  3 
    
    Date: 09/01/1996 Time: 1212 E Due: 97/02/23  About: J0000002; TxtFil HK000002   
    DB: HAZBEN  RecId: HI00001a Prev: n/a      LaPSRecId: L0000001  SS: MINISS01 CR: B3
    Prepared by: Rich      Strong    Tel#: 800-COSMIC-0  E-Mail : 800-COSMIC-0
    
    Section 1.  Chemical Product and Company Identification:   MSDS#:  9999  
    Identification: HAZMAT A              NIIN: 999999     CAS #: 99-999
    Manufacturer:  ABC MFG.      Part Nbr.: 999-9999   Mfr Tel.#: 999-999-9999
    Org'n Address:  HAZMAT DIV.      Dept:       Receiving Manifest #: tbd    
    # & St. Address:  999 MAIN ST  City: ANYTOWN  State:  AA    ZIP: 99999  
    
    Section 2. Composition, Information on Ingredients: Comp.%: 100  [Remarks]         
    
    Section 3. Hazards Identification:  
    Hazard: Casting    Entry: EATING  Organ : Foot     Carcinogen Reference: NTP
    
    Section 4. First Aid Measures:   wash,CPR
    
    Section 5. Firefighting Measures:   NFPA Class: 4  Autoignition Temp:  777 
    Flash Point: 666  Method: tbd  Evaporation Rate:   Method: tbd
    Flammability Limits: LEL:  9  UEL: 4   Fire Extinguisher: A    FF PPE: SCBA 
    Explosive Class: n/a  Type: n/a Life Exp: 96/04  ExplosWt.: 0000 Ga/Cal: 100 
    FF Procedure: Hydrocarbon Fire Procedure                         Vel: 0000
    FF Hazards: Flashover in confined spaces.
    
    Section 6. Accidental Release Measures:  Absorb.
    
    Section 7. Handling & Storage;   Store cool / ventilate   Hygiene:   soap/water
    
    Section 8. Exposure Controls, Personal Protection:  
    PPE:  RESP,facesh   Ventilation Required: local  
    OSHA PEL: tbd  ACGIH TLV: tbd  Exposure: Amount;  0.1  Frequency; 10  Duration;  4
    
    Section 9. Physical and Chemical Characteristics:  Physical Form:  LIQUID  
    Boiling Point: 555  Vapor Density:  5.  Vapor Pressure:   Water Solubility: 5 
    Specific Gravity:  0    pH: 5.                Water Reactive?:    1 1
    Accel: 1 Noise: 77 Environs: dusty  Press:  Temp: 212 Volts: 12 Amps:  999
    Freq.Min: 5.50e+05 Freq.Max: 1.08e+09 Rads: 0.00e+0  Rad.Type: Radio  E.R.P.:  2000
    
    Section 10. Stability and Reactivity: Stable?: y   
    Incompatibilities: Avoid oxidizers  Decomposition Products: Soot, CO, CO2      
    Hazardous Polymers:  n/a    
    
    Section 11.  Toxicological Information:  Training: Demo        Exam:  ANNUAL
    Symptoms: chestp         Medical Condition Aggravated: pleurosy       
    
    Section 12.  Ecological Information:
    Disposal Location: HazWaste Site   Geo.Coordinates : N-S 39.80; E-W :68.00
    
    Section 13.  Disposal Considerations:  Disposal Process :  Incinerator
    Disposal Organization: EDC      Requisition Doc.#: tbd   Disposal Manifest #: 123abc
    
    Section 14. Transport  Information:  Date Shipped:  02/03/1996
    DOT Names : hydrocarbon fuel   DOT Class :tbd      
    
    Section 15.  Regulatory Information: ( EPA Form 0317 data)
    USEPA Code : tbd     EPA Permit #: tbd   EPA Waste #: tbd    
    Facility ID#: XYZ Bldg 13  Temp. Stor. Start Date:09/09/1995  
    Nbr.Items: 123   Quantity~Gals:  55   Lbs/Gal:  5.4  Qty~Lbs: 0.4  ReEnter Qty:    
    
    Section 16. Other Information:  Emergency Telephone:   800-COSMIC-0
    Generator Name :  Rich     Strong  Tel: 513-236-036  Orgn. Adrs :  Safety Analysis 
    # & St: 7514 Belle Plaine Dr  City: Huber Heights   ST: OH ZIP: 45424-3229 
    

    2. HazMat Inventory Log


    You can summarize with your HazInLog report.
      /SW\           H A Z M A T / H A Z R A D   I N V E N T O R Y     12/28/94      
                                                                                        
      1.OWNER NAME             2.OWNER PHONE #   3.RECORD NBR.V   4.STORAGE DATE        
      5.MANUFACTURER           6.MFR PHONE #     7.MFR PART NBR   8.REQUISITION DOC #   
      9.MATERIAL/ DEVICE NAME 10.QUANTITY       11.NBR. OF ITEMS 12.LOCATION            
     13.DoT NAME              14.DoT CLASS      15.PERMIT #      16.USAGE               
     17.NIIN                  18.EPA CODE #     19.MSDS #        20.CAS #               
     21.CONTROLLED SUBS.CLASS 22.pH             23.NFPA CLASS    24.EXPLOSIVE CLASS     
     25.RADIATION TYPE        26.RADIOACTIVITY  27.EXPIRATION    28.POWER               
                                                                                        
      1. Strong                2. 999-999-9999   3. 10.00        4. 01/01/1995          
      5. ABC Oil Co.           6. 123-456-7890   7. 99999999     8. 999999999           
      9. Gasoline and ethanol 10. 84            11. 1            12. Garage             
     13. TBDL                 14. TBDL          15. TBDL         16. 4200               
     17. TBDL                 18. TBDL          19. TBDL         20. TBDL               
     21. N/A                  22. 5.5           23. TBDL         24. TBDL               
     25. N/A                  26. N/A           27. 04/11/1996   28. 7.20e+03           
    

    3. Hazardous Material Labels

    You can print 1"*3.5" labels for affixing to HazMats:

      H A Z A R D O U S   M A T E R I A L 
      MATERIAL: Gasoline; ethanol; CO     
      OWNER: Strong   TEL: 937-236-0361   
      RECId: 10.20   PPE Reqd: Faceshield 
      Hazard: Asphyx. Target Organ: Lungs 
    

    You can also print 3" x 5" HazWaLbl labels to affix to HazWaste containers and/ or use them for a rotary cardfile.

     /SW\       H A Z A R D O U S   W A S T E             
        Federal Law Prohibits Improper Disposal            
     DATE: 1993.10.12     TEMP. STORAGE DATE: 10/30/1993
     DATABASE FILENAME: HazBen   RECORD NUMBER:  10.20     
     GENERATOR: Rich_______ Strong______ TEL: 937-236-0361 
     GEN.ORGN:_________________ ADRS: 7514 Belle Plaine Dr.
     CITY: _______________________ ST: __ ZIP: __________  
                        
     MAT'L NAME: Gasoline; ethanol; oil PPE REQ:Glove,visor
     NBR. ITEMS:___1 QTY EACH: ___42 LOCN: _______________ 
     MFR: Local service station    MFR.TEL: ______________ 
     MFR.PART #: Unknown   MSDS#: TBD ______ NIIN: 12345678
     DISPOSAL ORGN: __________  DISP.LOCN: ________________
     EPA CODE: _____ EPA WASTE: _____ EPA PERMIT: N/A_____ 
     DOT NAME(S): TBD_________________ DOT CLASS: tbd      
     NFPA CLASS: TBD pH: 5.5 DISPOSAL MANIFEST: __________ 
     EMERGENCY TEL: ___-___-____X___ SHIP DATE: ___/___/__ 
    

    4. Threshold Planning Quantities

    You can summarize HazMats for Threshold Planning Quantities. Weights, and totals are automatically calculated in your TPQ for EPA Form 0317, Emergency and Hazardous Chemical Inventory, EPA0317, spreadsheet. TPQ provides for 10 columns of materials, only two are shown here for clarity.

    
    Component CAS#=>                                  ||64742-47-8|108-88-3
    Component Name=>                                  ||  Naptha  | Toluene
                                                      ||          |   |      
    Record Id=>                                       ||   |      |   |      
    ========================================================================
    Record ID:  Material Name:       | Gals|#/Gal  #  || % |  #   | % |  #   
    ========================================================================
    O000006a    Alkyd Enamel         |  800|8.00| 6400|| 45|  2880| 12|   768
    O000007a    Alkyd Vehicle        | 1200|8.00| 9600|| 16|  1536|  9|   864
                AAA Safety Solvent   |     |    |11000||   |     0|   |     0
                Calcium Hydroxide HP | 1000|7.00| 7000||   |     0|   |     0
                Kwik Dry Adhesive    | 1000|7.00| 7000||   |     0| 18|  1260
                Zip Etch 50          |     |    | 1100||   |     0|   |     0
                Unleaded Gasoline    | 3600|8.00|28800||   |     0| 25|  7200
    =========================================================================
         Totals =>                   |     |    |     ||   |  4416|   | 10092
    =========================================================================
         Threshold Quantity=>                                 na          500
    =========================================================================
         Excess over TQ=>                                     na         9592
    
    

    5. EPA 317

    You can record your Emergency Planning and Hazardous Chemical with a spreadsheet StrongForm that is a facsimilae of Ohio EPA Form 0317.
    To view an example of an EPA 317 screen, click on
    *EPA 0317 Screen


    6. OSHA Form 101

    Strongware® provides a form to comply with the OSHA 101 for recording incidents, OSHARep.
    To view an example of a Form 101 screen, click on
    *OSHARep Screen
    To view a report done with Access 7, click on *OSHARep


    /SW\ Supplemental Record of Occupational Injuries and Illnesses (OSHA101)
    
    Case#: K000001   RECNO:  1          
    
    Employer                                                                   
    1. Name:  Safety Analysis Systems                                          
    2. Mail Address: 7514 Belle Plaine Dr  Dayton OH 45424-3229          
    3. Location: n/a                                                     
    
    Injured or Ill Employee                                                    
    4. Name:  Dick      Allen       Strong          SSAN: 123-45-6789    
    5. Home Address: 123 Main   City: Anytown    ST: AA  ZIP:12345-6789         
    6. Age: 67    7. Sex  Male: 1  Female:  0                                  
    8. Occupation:                                                       
    9. Department:  Facility 1                                           
    
    The Accident or Exposure to Occupational Illness                            
    10. Place of Accident or Exposure:                                   
    11. Was place of accident or exposure on employer's premises? Yes 1 No 0
    12. What was the employee doing when injured?                             
        Servicing vehicle.                                                         
    13. How did the accident occur?                                      
        Failed to secure fuel shut-off valve.                            
        Gasoline container fuel shut-off leaked.                         
    
    Occupational Injury or Occupational Illness                        
    14. Describe the injury or illness and part of body affected. Part:       
        Spilled HazMat.                                               lung          
    15. Name the object or substance which directly injured the employee.      
        Gasoline.                                             HAZMAT A.  
    16. Date of injury or diagnosis of occupational illness: 95/12/04 asphyx 
    17. Did employee die?  Yes  0   No  1            Fatal?  0           
    
    Other                                                                
    18. Name and address of physician  n/a                               
    19. If hospitalized, name and address of hospital:                   
    n/a                                                              
    Date of Report: 1995/12/05  Prepared by:  D. Strong  Position:Safety Mgr    
    TEXTFile: K0000001       LAPSRECId: LK000001                         
    Lost Time Days:  80    Ending:  02/23/1996                         
    Restricted Days:  150   Ending:  07/19/1996                        
    

    You can also record Workers Comp cases with a similar form that provides fields for WC data.

    Strongware® provides a StrongForm to report and record hazards, *OSHazRep

      Hazard Report Nbr:  O00000  Date:
    
    Potential Accident or Exposure:
    Department:                        
    Occupation:
    What would an employee be doing when injured?:
    How could an accident occur?:
    Describe the potential injury or illness in detail:  
    Body Part Affected:
    Name the object or substance that could directly injure an employee:
    Substance:
    What kind of occupational illness could result from the exposure?:
    
    You can also use the Job Safety Analysis Report format:
    
    SW          JOB SAFETY ANALYSIS      04/07/1998    Page:  1
    
    RECNBR:   Sequence of Steps    Potential Hazard     Recommended Action
    ============================================================================
    HM000001  Vehicle stored OR    Sparks AND HAZMAT    Seal HAZMATs. Ground/ 
              maintained OR        cause fire OR        vent/ drain/ detect 
              operated.            pollution.           fumes/ fire.
    
    


    7. OSHEPLog Summaries


    Incident results are summarized with OSHEPLog.

    
    /SW\         OSHA INCIDENT REPORT LOG                       10/13/1996
    
    EVENT DATE:  INCIDENT:                                         REST:  LOST:
    ----------------------------------------------------------------------------
    ----------------------------------------------------------------------------
    DEPARTMENT: SALES
    ----------------------------------------------------------------------------
        /  /    Vehicle stored OR maintained OR operated            150     80
    ----------------------------------------------------------------------------
    DEPARTMENT SUMMARY FOR SALES                                    150     80
    ----------------------------------------------------------------------------
    DEPARTMENT:
    ----------------------------------------------------------------------------
       /  /                                                           0     0
    ----------------------------------------------------------------------------
    DEPARTMENT SUMMARY FOR                                            0      0
    ----------------------------------------------------------------------------
    
    GRAND SUMMARY:                                                  150     80
    
    


    Your Strongware® also includes OSHA Form 200 in spreadsheet form StrongForm, OSHA200.
    To view an example of an OSHA 200 screen, click on
    *OSHA 200 Screen (Partial)

    8. Process Safety Block Diagrams

    You can create Process Safety Block Diagrams with spreadsheets by using the Strongware® techniques (Check hot-link to *Modeling ). The example shown is based on the example shown in the OSHA directive on Process Safety. Note that, as a spreadsheet, you can insert fault paths, formulae, and transmit the sheet by Email.
    To view an example of a PSA screen, click on *FloBlok Screen (Partial)

    
    Raw          
    Material      Primary       
    Feed     >>>  Reactor   >\   Product Gas  >>> 
                             \                     
    Steam    >X>>>>>>>>>>>> >\>  Distillation >>> 
              \                     V V V          
              \                  1.Direct Cont.    
              \              />    Cooling         
              \              /      V V V          
              \              \< 
              X >>>>>>>>>>>> >>> 3. Stripping >X> 2.Pump/Tank  >>> Waste Water 
              \                                \                     ( P22 )
              \                                \> Compressor       
              \                                      V V V         
              \                                   Heat Exchanger   
              \                                      V V V         
              \                                   Condenser    >\  
              \                                   Primary       \                                    
              \                                   Liquifier     \                                   /> Railroad Car >>> To Customers
              \                                    V V V        \                                   /
              \                                   7.Condenser   \> 6.Liquid Prod >>> 9.35 PSIG     >X> 8.100 PSIG   >X> Evaporator
              \                                   Secondary     X>   Accum. Tank     Storage Tank      Storage Tank  /    V V V
              \                                   Liquifier     \                                                    /  Product for
              \                                                 \                                                    /  Plant Use
              \> >>>>>>>>>>> >>> >>>>>>>>>>>> >>> >>>>>>>>>>>> >>> >>>>>>>>>>>>> >>> >>>>>>>>>>>>> >>> >>>>>>>>>>>>>>/
                                                                \
                                                                \> 4. Gas        >X> 11. Neutraliz->X< 12. Neutraliz->> Waste Water
                                                                   Absorber       \  ation Disposal /  ation Scrubber
                                                                                  \                 /  
                                                                                  \> Caustic       >/  
    

    9. OSHA Program Evaluation Profile

    Strongware® also includes a spreadsheet layout for your self-evaluation, based on OSHA's Program Evaluation Profile, OSHAPeP.

    
    Area:   Factor:                                      Factor  Average
                                 Sub-Factor:             Score:  Score:
                                  1    2    3    4   5
    Management Leadership & Employee Participation
      Management Leadership       1    2    3   4    5      3
      Employee Participation      2                         2
      Implementation              1                         1
      Contractor Safety           1                         1
      Minimum of Mgmt&Ldrshp, 
      Emp.Part., or Average.                                           2
    Workplace Analysis
      Survey and Hazard Analysis  1                         1
      Inspection                  1                         1
      Hazard Reporting            1                         1
      Average                                                          1
    Accident & Record Analysis
      Accident Investigation      1                         1
      Data Analysis               1                         1
      Average                                                          1
    Hazard Prevention & Control
      Hazard Control              1                         1
      Maintenance                 1                         1
      Medical Program             1                         1
      Average                                                          1
    Emergency Response
      Emergency Preparedness      1                         1
      First Aid                   1                         1
      Average                                                          1
    Safety & Health Training
      Safety & Health Training    1                         1          1
    Total Average                                                      1
    

    10. Job Safety Analysis, JSA

    StrongWare provides both database JSAR log reports and spreadsheet StrongForms for documenting JSA. You can use either your database or your spreadsheet for analyzing tasks, such as those you described in your WorkPlan database records. You can use your [Wrkplnss] translator to input from your WorkPlan to your JSA spreadsheet, analyze for hazards and recommended actions, then revise your WorkPlan to include your actions.
    Note that the timing may be critical, such as situations where there are management pressures to reduce the timing allowed.
    To view an example of a spreadsheet JSA screen, click on
    *JSA Screen

    
             JOB SAFETY ANALYSIS        JOB TITLE:         DATE:
    Co/ Org:                                               NEW    PAGE
    
    Title of Person who does job:                Analysis By:
    
    Plant/ Location:                   Department:            Reviewed By:
    
    REQUIRED AND/ OR RECOMMENDED PERSONAL PROTECTIVE EQUIPMENT:
    
    
    TimeReq'd: SEQUENCE OF JOB STEPS:      POTENTIAL HAZARDS:          RECOMMENDED ACTIONS:
    
    1.2        1                           1                           1
    
    2.3        2                           2                           2
    
               3                           3                           3
    ...
    3.5
    
    

    11. Recording Workers Compensation Claim Data with OSHAWC and ClaimLog

    You can record the data on your OSHAWC form, that is similar to your OSHARep form, but with added fields for the WC data.

    Workers Compensation Claim Data- Claim Id: XYZ              Date:  02/23/1997
    Amount for Temporary:   44           Annual Amount for Permanent:      55
    Company:  tbdl           Agent/Attorney: tbd              Telephone:  1-800-888-8888
    
    OSHA Workers Compensation Log
    Claim       Last Name:  Company:
    Date        First       Agent/Attorney:   Annual:  Temporary:
    =============================================================
    XYZ Co.     Strong      tbdl                  55           44
    02/23/1997  Rich        tbd                                  
    =============================================================
    Summaries:                                    55           44
    


    12. Experience Modifier Calculation Spreadsheet

    You can calculate and summarize Workers Compensation data for various jobs ,SICs, or Job Codes with your EXPERMOD spreadsheet.
    To view an example of a screen, click on
    *ExperMod Screen

    
    ExMod.		Experience Modifier		200000.00
     BLS Data 
    Exper.Rate=(Incidents/Hours)*200000
    
    Date:      File: SIC: JobCode: BLS Rate: Premium: Incidents:  Hours:  Exper.Rate: Exp./BLS:  Mod.Premium:
    =========================================================================================================
    04/05/2000       8888    na      5.00    $200.00         2    100000     4.00       0.80         $160.00 
    Enter additional line items
    =========================================================================================================
    Summary (Enter Nbr of Items):            $200.00         2    100000     4.00                    $160.00 
    Gain: Base Premium less Modified Premium:  $40.00 
    "Gain Ratio, Base Premium / Modified:   1.25					
    

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