Workers’ Compensation Services is pleased to provide a revised, streamlined reporting template for your FY 2009 EO 94 (05) Workplace Safety and Employee Health annual loss control report. We would like to acknowledge and thank the many state agency representatives who participated in our focus groups this summer and the attached template incorporates many of the suggestions and ideas generated from those discussions.
This report should be completed by all Executive Branch agencies. Please complete the cover sheet, checking the appropriate box under each key element of the Executive Order and have your agency head sign the sheet, attesting to the accuracy of the information. If you are in complete compliance with each element, please submit ONLY the signed cover sheet with compliance checked for each item. If you are not in complete compliance with any element(s), please complete and return the signed cover sheet and ONLY the section(s) requested for the element(s) which need improvement. You may delete any unneeded pages.
This report is due to Workers’ Compensation Services by October 1. Please submit your signed, scanned reports by email to eo94@dhrm.virginia.gov. If you do not have scanning capability, please email the body of the report and fax a copy of the signed cover sheet to 804-786-8840.