300A Osha Form PDF Details

Osha Form 300A is a form used to report work-related injuries and illnesses. This form must be filled out by the employer, and is due by February 1 of every year. The purpose of this form is to track and analyze injury and illness data in order to improve safety in the workplace. The information collected on this form can be used to identify hazards in the workplace, and help employers put into place strategies to prevent injuries and illnesses. It's important for employers to fill out this form accurately and submit it on time, so that they can ensure the safety of their employees.

QuestionAnswer
Form Name300A Osha Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesosha 300a forms, osha's form 300a, osha forms, osha 300a

Form Preview Example

OSHA’s Form 300A (REV. 01/2004)

Year 20__ __

 

Summary of Work-Related Injuries and Illnesses

 

 

Occupational Safety and Health Administration

 

U.S. Department of Labor

 

 

 

 

 

 

 

Form approved OMB no. 1218-0176

All establishments covered by Part 1904 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this summary.

Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you’ve added the entries from every page of the Log. If you had no cases, write “0.”

Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR Part 1904.35, in OSHA’s recordkeeping rule, for further details on the access provisions for these forms.

Number of Cases

Establishment information

Your establishment name __________________________________________

Street

_____________________________________________________

City

____________________________ State ______ ZIP _________

Total number of deaths

__________________

(G)

Total number of cases with days away from work

__________________

(H)

Total number of

Total number of

cases with job

other recordable

transfer or restriction

cases

__________________

__________________

(I)

(J)

Industry description (e.g., Manufacture of motor truck trailers)

_______________________________________________________

Standard Industrial Classification (SIC), if known (e.g., 3715)

____ ____ ____ ____

OR

North American Industrial Classification (NAICS), if known (e.g., 336212)

Number of Days

Total number of days away

Total number of days of job

from work

transfer or restriction

___________

___________

____ ____ ____ ____ ____ ____

Employment information (If you don’t have these figures, see the Worksheet on the back of this page to estimate.)

Annual average number of employees

______________

(K)

Injury and Illness Types

Total number of . . .

 

(M)

 

(1)

Injuries

______

(2)

Skin disorders

______

(3)

Respiratory conditions

______

(L)

(4)

Poisonings

______

(5)

Hearing loss

______

(6)

All other illnesses

______

Total hours worked by all employees last year ______________

Sign here

Knowingly falsifying this document may result in a fine.

I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and complete.

___________________________________________________________

Company executive

 

Title

(

)

-

/ /

Phone

 

 

Date

Post this Summary page from February 1 to April 30 of the year following the year covered by the form.

Public reporting burden for this collection of information is estimated to average 50 minutes per response, including time to review the instructions, search and gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.

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For you to complete this form, be sure you enter the necessary details in each and every field:

1. Whenever submitting the osha's form 300a, make sure to complete all important blank fields within its corresponding form section. It will help facilitate the process, which allows your details to be handled efficiently and correctly.

Writing section 1 of osha form 300a printable

2. Right after this section is done, proceed to type in the relevant details in all these - K L, Injury and Illness Types, Total number of , M Injuries, Skin disorders, Respiratory conditions, Poisonings, Hearing loss, All other illnesses, Post this Summary page from, Public reporting burden for this, Annual average number of employees, Total hours worked by all, Sign here, and Knowingly falsifying this document.

All other illnesses, Public reporting burden for this, and Hearing loss of osha form 300a printable

Regarding All other illnesses and Public reporting burden for this, make sure you get them right in this section. Both of these could be the most significant ones in the form.

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