Osha Form 300A PDF Details

When it comes to managing a workplace, ensuring the safety of your employees is always top priority. Osha Form 300A is an annual summary and record-keeping report that’s intended to track employee injuries and illnesses in the workplace. By doing so, employers can effectively ensure their workers are safe while also adhering to OSHA's annual guidelines. Whether you’re researching or just getting started with OSHA Form 300A reporting, we have all the information you need to get up and running in no time!

QuestionAnswer
Form NameOsha Form 300A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names300a form, osha 300a form, osha form 300a, osha 300a form pdf

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CAL/OSHA FORM 300A (REV. 7/2007)

Appendix B

Annual Summary of Work-Related Injuries and Illnesses

Year 20 _ _

Department of Industrial Relations

Division ofOccupational Safety& Health

All establishments covered by CCRTitle 8 Section 14300 must complete this Annual Summary, 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 Cal/OSHA Form 300 in its entirety. They also have limited access to the Cal/OSHA Form 301 or its equivalent. See CCR Title 8 Section 14300.35, in Cal/OSHA’s recordkeeping rule, for further details on the access provisions for these forms.

 

N u m b e r o f Ca s e s

 

 

 

 

 

 

 

Total num ber of

Total num ber of

Total num ber of

Total num ber of

deaths

cases with days

cases with job

other recordable

 

 

away from work

 

 

transfer or restriction

cases

 

 

 

__________________

__________________

__________________

__________________

 

 

 

 

(G)

(H)

(I)

(J)

 

 

 

 

 

N u m b e r o f Da ys

 

 

 

 

 

 

 

Total number of days

Total number of days of job

 

 

away from work

 

transfer or restriction

 

___________

 

___________

 

 

(K)

 

(L)

 

I n j u r y a n d I l l n e s s Typ e s

T otal num ber of . . .

 

(M)

 

 

 

(1)

Injuries

______

(4)Poisonings

______

 

 

 

(5)Hearing loss

______

(2)

Skin disorders

______

(6)All other Illnesses

_____

 

 

 

(3)

Respiratory conditions

______

 

 

Es t a b l i s h m e n t i n f o r m a t i o n

Yo u r e s t a b l i s h m e n t n a m e _____________________________________________

Street ___ __ __ ___ ___ ____ __ ___ __ ______ ___ ___ __________________________

C ity __ ___ ___ __ ______________________________State ______ Z IP _________

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

_______________________________________________________

Standard Industrial C lassification (SIC ), if known (e.g., S IC 3715)

____ ____ ____ ____

 

Em p l o ym e n t i n f o r m a t i o n

(If you don’t have these figures, use the optional

 

Worksheet to estimate.)

Annual average num ber of em ployees

______________

Total hours worked by all em ployees last year ______________

Si g n h e r e

Knowingly falsifying this document may result in a fine.

I certify that I have exam ined this docum ent and that to the best of m y knowledge the entries are true, accurate, and com plete.

____________________________________________________________

C om pany executive

Title

 

 

Phone

Dat e

t

Post this Annual Summary from February1 to April 30 of the yearfollowing the year covered by the form.

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