OSHA Form 301 PDF Details

Employers must complete this form, or an equivalent, within 7 calendar days of learning about a recordable incident. This form is integral to workplace safety management, helping employers and OSHA track incidents to assess workplace safety and compliance with regulations.

The main information captured on the OSHA Form 301 includes:

- Details about the injured or ill employee (e.g., name, date of birth, employment date).

- A description of the incident, including what the employee was doing at the time, the exact nature of the injury or illness, and any equipment involved.

- Information about the medical treatment received and the healthcare provider involved.

This form documents the incident for compliance and monitoring and is used as a preventive measure to aid in identifying hazardous conditions. Adhering to the requirements of maintaining and updating these records and keeping them stored for 5 years after they are relevant helps develop strategies to improve workplace safety.

QuestionAnswer
Form Name OSHA Form 301
Form Length 1 pages
Fillable? Yes
Fillable fields 18
Avg. time to fill out 10 min
Other names OSHA form 301, form OSHA, OSHA accident report form, OSHA form 301 printable

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OSHA’S FORM 301 (Rev. 04/2004)

Injury and Illness Incident Report

Note: You can type input into this form and save it.

Because the forms in this recordkeeping package are “fillable/writable” PDF documents, you can type into the input form fields and

then save your inputs using the free Adobe PDF Reader. In addition, the forms are programmed to auto-calculate as appropriate.

Attention: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes.

U.S. Department of Labor

Occupational Safety and Health Administration

This Injury and Illness Incident Report is one of the first forms you must fill out when a recordable work-related injury or illness has occurred. Together with the Log of Work-Related Injuries and Illnesses and the accompanying Summary, these forms help the employer and OSHA develop a picture of the extent and severity of work-related incidents.

Within 7 calendar days after you receive information that a recordable work-related injury or illness has occurred, you must fill out this form or an equivalent. Some state workers’ compensation, insurance, or other reports may be acceptable substitutes. To be considered an equivalent form, any substitute must contain all the information asked for on this form.

According to Public Law 91-596 and 29 CFR 1904, OSHA’s recordkeeping rule, you must keep this form on file for 5 years following the year to which it pertains.

If you need additional copies of this form, you

may photocopy the printout or insert additional form pages in the PDF, and then use as many as you need.

Information about the employee

1)Full name

2)Street

City

 

State

 

ZIP

 

 

 

 

 

3) Date of birth

Month Day Year

4)Date hired

Month Day Year

5) Male Female

Information about the physician or other health care professional

6)Name of physician or other health care professional

7)If treatment was given away from the worksite, where was it given?

Facility

Street

Form approved OMB no. 1218-0176

Information about the case

10) Case number from the LOG

 

(Transfer the case number from the Log after you record the case.)

11)Date of injury or illness

 

 

Month

Day

Year

 

 

 

 

 

 

 

 

12)

Time employee began work (HH:MM)

 

 

 

 

 

 

 

 

AM

 

 

PM

 

 

 

 

 

 

 

 

 

 

13)

Time of event (HH:MM)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AM

 

 

PM

 

Check if time cannot be determined

*Re fields 14 to 17: Please do not include any personally identifiable information (PII) pertaining to worker(s) involved in the incident (e.g., no names, phone numbers, or Social Security numbers).

14)* What was the employee doing just before the incident occurred? Describe the activity, as well as the tools, equipment, or material the employee was using. Be specific. Examples: “climbing a ladder while carrying roofing materials”; “spraying chlorine from hand sprayer”; “daily computer key-entry.”

15)* What Happened? Tell us how the injury occurred. Examples: “When ladder slipped on wet floor, worker fell 20 feet”; “Worker was sprayed with chlorine when gasket broke during replacement”; “Worker developed soreness in wrist over time.”

16)* What was the injury or illness? Tell us the part of the body that was affected and how it was affected. Examples: “strained back”; “chemical burn, hand”; “carpal tunnel syndrome.”

Completed by

Title

PhoneDate

Month Day Year

City

 

State

 

ZIP

 

 

 

 

 

 

 

 

 

 

8)Was employee treated in an emergency room?

Yes

No

9)Was employee hospitalized overnight as an in-patient?

Yes

No

17)* What object or substance directly harmed the employee? Examples: “concrete floor”; “chlorine”; “radial arm saw.” If this question does not apply to the incident, leave it blank.

18) If the employee died, when did death occur? Date of death

 

 

Month Day

Year

 

 

 

 

 

 

 

 

Add a Form Page

 

 

Reset

 

 

 

 

 

 

 

 

 

 

 

 

 

Public reporting burden for this collection of information is estimated to average 22 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Persons are not required to respond to the collection of information unless it displays a current valid OMB control number. If you have any comments about this estimate or any other aspects of this data collection, including suggestions for reducing this burden, 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.

How to Edit OSHA Form 301 Online for Free

When a work-related injury or illness occurs, the OSHA Form 301, officially known as the Injury and Illness Incident Report, is a required document that helps track and analyze workplace incidents. Here is a step-by-step guide to help you complete the form.

1. Provide Employee Information

Write the full name, address, date of birth, and employment date of the employee who experienced the injury or illness.

2. Detail the Incident

Record the date and exact time of the incident, along with the specific activity the employee was engaged in just before the injury occurred. Describe the tools, equipment, or materials involved, and provide a detailed account of the incident, specifying how the injury or illness occurred.

Stage no. 1 for completing form osha

3. Describe the Injury or Illness

Specify the nature of the injury or illness, the part of the body affected, and the extent of the injury. Be precise in describing how the body part was affected to ensure appropriate record-keeping and facilitate any claims or medical follow-up needed.

form osha conclusion process shown (step 2)

4. Medical Treatment Information

Fill in details about the medical treatment received. Include the name and address of the healthcare professional or facility where treatment was provided. Indicate whether the employee was treated in an emergency room and if any hospitalization was required.

5. Additional Details and Compliance

If the incident resulted in a fatality, provide the date of death. Ensure all fields are filled out correctly and check for any sections requiring additional documentation or notes, such as the direct cause or object that led to the injury. Remember, some fields may not apply to every incident and can be left blank if irrelevant.

6. Verification and Submission

After completing the form, review all the information for accuracy. The form must be filed within 7 days after the reported incident and kept on record for five years.

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