Osha Form 4 50 3 PDF Details

For businesses within the US, understanding and adequately completing all safety protocols and procedures is essential to a successful operation. One such critical form that must be filled out correctly is OSHA Form 4 50 3 - an OSHA log of work-related injuries and illnesses. This injury & illness recordkeeping document helps employers in multiple ways: it allows them to track employee welfare, identify patterns in workplace hazards, enforce safe practices, and understand their Workers' Compensation benefits if the need arises. Knowing how to fill out this form accurately can save your business time and money while promoting an overall greater level of safety at work – so let's explore what's involved!

QuestionAnswer
Form NameOsha Form 4 50 3
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesOutreach 101C_Outreach_T raining_Report_ Maritime teex osha outreach forms

Form Preview Example

Instructions for Submitting

OSHA Outreach Training Reports

Thank you for choosing the Texas A&M Engineering Extension Service for your training needs. Enclosed you will find a copy of the OSHA Outreach Training Report. As of August 2010, OSHA requires that you use the OSHA Outreach Training Report that corresponds to the type of training conducted (General Industry, Construction, or Maritime). Once you have downloaded the correct form, please fill in the required information.

TEEX encourages you to complete the enclosed OSHA Outreach Training Report electronically using Adobe Acrobat to request new student cards. If you prefer, you may print and complete the form manually. Keep in mind that only trainers who have received their trainer TEEX ID numbers are eligible to send requests by e-mail or fax. TEEX Trainer ID numbers are issued to trainers after their initial course is documented. If this is your first class, or if you have updated your trainer status, include a copy of your trainer card.

E-mail:

To submit your completed OSHA Outreach Training Report by e-mail completed the

 

enclosed form using Adobe Acrobat. Once completed, save a copy of the completed

 

form and e-mail it as an attachment to us at:

 

otisec@teex.tamu.edu

Fax:

To submit your completed OSHA Outreach Training Report by fax, please complete

 

the enclosed form and fax it to:

 

979-458-1426

Mail:

To submit your completed OSHA Outreach Training Report by mail, please complete

 

the enclosed form and mail it to:

 

TEEX-ITSI

 

Customer Care Center

 

PO Box 40006

 

College Station, TX 77842-4006

If you require assistance or have questions regarding your OSHA Outreach Training Report, please contact our Customer Care Center at 800-SAFE-811 (800-723-3811). You may also email at otisec@teex.tamu.edu.

Thank you again for choosing the Texas Engineering Extension Service for your training needs. We invite you to visit our website at www.teexsafety.org for a complete list of training opportunities.

CCC-Outreach-100

Page 1 of 1

Revised 4/18/13

U.S. DEPARTMENT OF LABOR

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

OUTREACH TRAINING PROGRAM REPORT

MARITIME

Read instructions before completing this form.

Submit completed forms to:

800-SAFE-811

Texas A&M Engineering Extension Service

 

 

800-723-3811

OSHA Training Institute Southwest Education Center

 

Fax: 979-458-1426

www.teexsafety.org

PO Box 40006 | College Station, TX 77842-4006

otisec@teex.tamu.edu

 

 

 

 

 

 

1. Trainer Name

 

2. ID No.

3. Recent Trainer Course

 

4. Expiration Date

 

 

 

 

 

/ /

5.Authorizing Training Organization

6. Trainer Address

 

Check if this is a new address

Company

 

 

 

Address

 

 

 

 

 

 

 

City

 

 

State

ZIP

 

 

Phone No.

(

)

Email

 

 

 

 

 

 

 

7.

Course Conducted

 

 

8. Course Information (check all that apply)

 

 

9. No. of

 

 

 

10-hour #7615-Shipyards

Spanish

 

 

 

Language other than English or Spanish (specify):

Students

 

 

 

10-hour #7617-Marine Terminals

 

 

 

 

 

 

 

 

 

 

 

10-hour #7618-Longshoring

Youth (age 18 or less)

 

 

 

OSHA Alliance or Partnership (specify):

 

 

 

 

 

 

 

 

 

 

 

30-hour #7635-Shipyards

 

 

 

 

 

 

 

 

 

 

 

30-hour #7637-Marine Terminals

 

 

 

 

 

 

 

 

 

 

 

30-hour #7638-Longshoring

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

Training Site Address

 

 

 

 

 

 

 

 

 

Street address

City

State

Country

11. Type of Training Site

Workplace

School Office Hotel Union Employer Association Other (specify):

12. Course Duration

Start Date

End Date

Start Time

End Time

13. Sponsoring Organization

 

 

 

 

Safety & Health

Employer

Labor/Union

Employer Association

Education

Community

N/A

Other (specify)

 

14.Statement of Certification

I certify that I have conducted this outreach training class in accordance with the OSHA Outreach Training Program guidelines. I have maintained the training records as required by these guidelines and I will provide these records to the OSHA Directorate of Training and Education (or their designee) upon request. I understand that I will be subject to immediate dismissal from the OSHA Outreach Training Program if information provided herein is not true and correct. I further understand that providing false information herein may subject me to civil and criminal penalties under Federal law, including 18 U.S.C. 1001 and section 17(g) of the Occupational Safety and Health Act, 29 U.S.C.666(g), which provides criminal penalties for making false statements or representations in any document filed pursuant to that Act. I hereby attest that all provided is true and correct.

Trainer Signature:

 

Date:

If submitting this form by electronic means, by checking the box to the left or affixing signature, I attest that all information provided in this submission is true and accurate.

OSHA FORM 4-50.3

MARCH 2011

U.S. DEPARTMENT OF LABOR

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

OUTREACH TRAINING PROGRAM REPORT

MARITIME

15. Topic Outline

*Indicate the amount of time spent on each of the topics in the class.

REQUIRED

Hours *

Introduction to OSHA (#7615, #7617, #7618) Walking & Working Surfaces (#7615, #7617, #7618) Personal Protective Equipment (#7615, #7617, #7618)

Fall Protection / Scaffolding (#7615) Electrical (#7615)

Confined and Enclosed Spaces (#7615) Fire Protection (#7615)

Managing Safety and Health (#7635, #7637, #7638)

ELECTIVE

Hours *

Hazard Communications / Hazardous Materials

Lockout / Tagout

Respiratory Protection

Fall Protection (#7617, #7618)

Electrical (#7617, #7618)

Confined and Enclosed Spaces (#7617, #7618)

Fire Protection (#7617, #7618)

OPTIONAL

Hours *

Hot Work – Welding, Burning & Cutting

Material Handling

Bloodborne Pathogens

Machine Guarding

Ergonomics and Proper Lifting Techniques

OTHER

Hours *

TOTAL

16. Student Names

(ensure that names are legible)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

PAGE 2

OSHA FORM 4-50.3

 

MARCH 2011

U.S. DEPARTMENT OF LABOR

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

OUTREACH TRAINING PROGRAM REPORT

INSTRUCTIONS FOR OUTREACH TRAINER

The Outreach Training Program is the Occupational Safety and Health Administration’s (OSHA) voluntary orientation training program aimed at workers. It provides workers with information about OSHA and provides an overview of job hazards. Trainers authorized through the OSHA Outreach Training Program must conduct outreach training classes in accordance with the current Outreach Training Program Guidelines issued by the Directorate of Training and Education (DTE). The Outreach Training Program Guidelines can be found online at the OSHA.gov website under Training, OSHA Outreach Training Program.

Item 1 Trainer Name

List your full name. When completing student course completion cards, print or type your name on each card to ensure it is legible.

Item 2

ID No.

 

This applies only to trainers who have already

 

received student cards. New trainers do not

 

have an ID number. ID numbers are issued to

 

trainers after their initial course is documented.

 

If this is your first class, or if you have updated

 

your trainer status, include a copy of your

 

trainer card.

Item 3

Recent Trainer Course

 

Indicate the most recent applicable course

 

number you have completed.

Item 4

Expiration Date

 

Enter your trainer expiration date as listed on the

 

bottom right of your Authorized Outreach

 

Trainer card.

Item 5

Authorizing Training Organization

 

List the name of the OSHA Training Institute

 

(OTI) Education Center responsible for your last

 

trainer or update course, or indicate if your

 

training was completed at the OSHA Training

 

Institute. See Attachment B of the Outreach

 

Training Program guidelines for this information

 

and options for where to send your card request.

Item 6

Trainer Address

 

Provide an address where to send the cards. The

 

address you provide should ensure that the

 

cards are sent directly. If you have an ID

 

number and there are no address changes, you

 

are not required to fill in this section.

Item 7

Course Conducted

 

Place an “x” in the appropriate box. A separate

 

report must be completed for each course

 

completed.

Item 8

Course Information (check all that apply)

 

Place an “x” next to all the information that

 

applies to the majority of this course.

Item 9 No. of Students

Indicate the number of students who completed the course. Note: If you held a class of more than 50 students, include a copy of the prior approval received from OSHA or the OTI Education Center.

Item 10 Training Site Address

Provide the address, city, state, and country where the course was conducted.

Item 11 Type of Training Site

Place an “x” next to the type of site where the training was held. If none of the choices apply, specify the type of training site.

Item 12 Course Duration

Enter the start date, end date, start time, and end time of the course.

Item 13 Sponsoring Organization

Place an “x” in the box to indicate the sponsor of the training, if applicable. If you had a sponsor, but that type of organization is not a choice, check “Other” and specify the type of sponsoring group or organization.

Item 14 Statement of Certification

The authorized trainer must sign the statement of certification to verify that the class was conducted in accordance with OSHA’s guidelines and attest to the accuracy of the documentation submitted. If requesting cards electronically, the trainer must place an “x” in the box or affix a signature.

Item 15 Topic Outline

Complete the applicable 10- or 30-hour topic outline. You must complete this part of the form.

Item 16 Student Names

List the first and last name of each student who completed the entire course. If mailing or faxing this form, ensure the names are legible. Your course records must include sign-in sheets for each day and indicate the card number dispensed to each student.

PAGE 3

OSHA FORM 4-50.3

 

MARCH 2011

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Pay attention when filling in this document. Make sure all mandatory blanks are filled out accurately.

1. It is crucial to complete the Osha Form 4 50 3 accurately, therefore be careful when filling out the sections comprising these specific fields:

Filling out part 1 of Osha Form 4 50 3

2. Once your current task is complete, take the next step – fill out all of these fields - Course Conducted Training Site, Workplace, School, Course Duration, Start Date Sponsoring Organization, Safety Health Education, Office, Hotel, Union, Employer Association, Other specify, End Date, Start Time, End Time, and Employer Community with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Osha Form 4 50 3 writing process clarified (part 2)

3. This 3rd step is usually relatively simple, Indicate the amount of time spent, REQUIRED, Hours, Introduction to OSHA, Walking Working Surfaces, Fall Protection Scaffolding, Hours, ELECTIVE, Hazard Communications Hazardous, Hours, OPTIONAL, Hot Work Welding Burning Cutting, and ensure that names are legible - all of these blanks has to be completed here.

Osha Form 4 50 3 conclusion process explained (step 3)

Concerning Hours and ELECTIVE, be sure you double-check them here. These two are the most important fields in the file.

4. Filling in Hot Work Welding Burning Cutting, OTHER, Hours, and TOTAL is key in this next part - always invest some time and fill out each and every blank area!

Part number 4 of submitting Osha Form 4 50 3

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