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.

QuestionAnswer
Form NameOsha 200 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesosha 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

Related

 

 

 

 

Without

(See other side of form for terminations or

Related

 

 

 

 

 

 

Without Lost

 

 

 

 

 

Lost

permanent transfers.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Workdays

 

 

 

 

 

Workdays

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter

Enter a

Enter a

Enter

Enter

Enter a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter DATE

Enter a

 

Enter a

Enter

Enter

Enter a

DATE of

CHECK if

CHECK

number

number of

CHECK if

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of death.

CHECK if

 

CHECK if

num-

number

CHECK if no

death.

injury

if injury

of DAYS

DAYS of

no entry

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

illness

 

illness

ber of

of

entry was

 

involves

involves

away

restricted

was made

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

involves

 

involved

DAYS

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

9.

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)