Osha 200 Form – Fill Out and Use This PDF

The OSHA Form 200, officially titled "Log and Summary of Occupational Injuries and Illnesses," is a critical document required by the U.S. Department of Labor. This form is essential for recording a wide array of work-related injuries and illnesses, detailing everything from the extent and outcome of these incidents to whether they resulted in fatalities, nonfatal injuries, or illnesses with or without lost workdays. Employers are mandated to accurately complete this form to ensure a safe working environment and to comply with federal regulations. For detailed guidance on how to fill out the OSHA Form 200, click the button below.

Get Form Now Download PDF

Osha 200 Form PDF Details

The OSHA Form 200, endorsed by the U.S. Department of Labor, operates as a crucial tool in the realm of occupational safety and health documentation for the calendar year it covers. At its core, the form serves as a comprehensive log and summary of occupational injuries and illnesses, which businesses are mandated to maintain and post within their establishments. This record-keeping not only aids in monitoring workplace safety incidents but also plays a vital role in the formulation of preventive measures against future occurrences. It meticulously categorizes incidents into injuries and illnesses, delineating between fatal and nonfatal outcomes, and further specifies cases involving lost workdays. Moreover, this form demands detailed entry of each incident, including the date, employee details, a description of the injury or illness alongside its extent, and the outcome. By requiring information about days away from work or days of restricted activity, it facilitates an in-depth analysis of the impact of workplace incidents. The obligation to complete and publicly post the summary of this form by a set deadline underscores the importance of transparency and accountability in upholding workplace safety. With penalties for noncompliance, the OSHA Form 200 exemplifies a rigorous approach towards ensuring that occupational health standards are not just met but continuously improved upon.

Question	Answer
Form Name	Osha 200 Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	osha log 200 form, osha form 200 log, osha form 200, osha 200 logs

Form Preview Example

OSHA Form 200

U.S. Department of Labor

For Calendar Year 19____

Page ___ of ___

Company Name

Form Approved

Establishment Name

O.M.B. No. 1220-0029

Establishment Address

Extent of and Outcome of INJURY

Type, Extent of, and Outcome of ILLNESS

Fatalities

Nonfatal Injuries

Type of Illness

Fatalities

Nonfatal Illness

Injury

Injuries With Lost Workdays

Injuries

CHECK Only One Column for Each Illness

Illness

Illnesses With Lost Workdays

Illnesses

Without

(See other side of form for terminations or

Without Lost

Lost

permanent transfers.)

Workdays

Enter

Enter a

Enter

Enter a

Enter DATE

Enter a

Enter

Enter a

DATE of

CHECK if

CHECK

number

number of

CHECK if

of death.

CHECK if

num-

number

CHECK if no

death.

injury

if injury

of DAYS

DAYS of

no entry

illness

ber of

entry was

involves

away

restricted

was made

involves

involved

DAYS

made in

days away

days

from

work

in columns

days away

days

away

of re-

columns 8 or

from work,

away

work.

activity.

1 or 2 but

from work,

away

from

stricted

Mo./day/

or days of

from

the injury

or days of

from

work.

work

yr.

restricted

work.

is re-

Mo./day/yr.

restricted

work.

activity.

work

cordable

work

activity, or

as defined

activity, or

both.

above.

both.

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(a) (b) (c) (d) (e) (f) (g)

(8)

(9)

(10)

(11) (12) (13)


Certification of Annual Summary Totals By ___________________________________________________		Title ______________________________________ Date __________________
OSHA No. 200	POST ONLY THIS PORTION OF THE LAST PAGE NO LATER THAN FEBRUARY 1.

Bureau of Labor Statistics

Log and Summary of Occupational

Injuries and Illnesses

NOTE: This form is required by Public Law 91-596 and				RECORDABLE CASES: You are required to record information about every
must be kept in the establishment for 5 years.				occupational death, every nonfatal occupational illness, and those nonfatal
Failure to maintain and post can result in the				occupational injuries which involve one or more of the following: loss of
issuance of citations and assessments of penalties.				consciousness, restriction of work or motion, transfer to another job, or medical
(See posting requirements on the other side of				treatment (other than first aid). (See definitions on the other side of form.)
form.)

Case or	Date of	Employee’s Name	Occupation		Department	Description of Injury or Illness
File	Injury or
Number	Onset of
	Illness
Enter a	Enter	Enter first name or	Enter regular job		Enter department in	Enter a brief description of the injury or illness and
nondupli-	Mo./day.	initial, middle initial,	title, not activity		which the employee	indicate the part or parts of body affected.
cating		last name.	employee was		is regularly
number			performing when		employed or a
which will			injured or at		description of normal
facilitate			onset of illness.		workplace to which
com-			In the absence of		employee is	Typical entries for this column might be: Amputation of
parisons			a formal title,		assigned, even	1st joint right forefinger; Strain of lower back; Contact
with			enter a brief		thought temporarily	dermatitis on both hands; Electrocution—body.
supple-			description of the		working in another
mentary			employee’s		department at the
records.			duties.		time of the injury or
					illness
(A)	(B)	(C)	(D)		(E)	(F)
						PREVIOUS PAGE TOTALS














						TOTALS (Instructions on other side of form)

Osha 200 Form – Fill Out and Use This PDF

Osha 200 Form PDF Details

Form Preview Example

Osha 200 Form isn’t the one you’re looking for?

Related Documents