Oshas Form 300 PDF Details

If you're responsible for workplace safety, you know that submission of the OSHA Form 300 is an essential compliance requirement. This form not only documents any injuries and illnesses that occur at your workplace but also acts as a way to remind employers just how important it is to ensure their workplaces are safe. On this blog post, we'll go over what exactly the OSHA Form 300 may entail so that employers can feel confident in meeting all federal regulations and in providing the safest environment possible for their employees.

QuestionAnswer
Form NameOshas Form 300
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesosha 300a, osha 300 logs, osha log form, osha form 300

Form Preview Example

OSHA’s Form 300 (Rev. 01/2004)

Log of Work-Related Injuries and Illnesses

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.

Year 20__ __

U.S. Department of Labor

Occupational Safety and Health Administration

You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR Part 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you’re not sure whether a case is recordable, call your local OSHA office for help.

Form approved OMB no. 1218-0176

Establishment name ___________________________________________

City ________________________________ State ___________________

Identify the person

 

 

Describe the case

 

 

 

 

 

 

 

 

 

 

(A)

(B)

(C)

 

(D)

(E)

(F)

 

 

 

 

 

Case

Employee’s name

Job title

 

Date of injury

Where the event occurred

Describe injury or illness, parts of body affected,

 

no.

 

(e.g., Welder)

 

or onset

(e.g., Loading dock north end)

and object/substance that directly injured

 

 

 

 

 

of illness

 

or made person ill (e.g., Second degree burns on

 

 

 

 

 

 

 

right forearm from acetylene torch)

 

_____

________________________

____________

/___

__________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

___________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

__________________

__________________________________________________

 

 

 

month/day

 

 

Classify the case

CHECK ONLY ONE box for each case based on the most serious outcome for that case:

Remained at Work

 

Days away Job transfer Other record-

Death

from work or restriction able cases

(G)

(H)

(I)

(J)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter the number of days the injured or ill worker was:

Away

On job

from

transfer or

work

restriction

(K)(L)

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

____ days

Check the “Injury” column or choose one type of illness:

(M)

Skindisorder

Respiratory condition

 

Hearingloss

 

INJURY

Poisoning

Allother illnesses

(1)

(2)

(3)

(4)

(5)

(6)

Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time to review the instructions, search and gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, 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.

Page totals

Be sure to transfer these totals to the Summary page (Form 300A) before you post it.

Page ____ of ____

INJURY

Skindisorder

Respiratory condition

Poisoning

Hearingloss

Allother illnesses

(1)

(2)

(3)

(4)

(5)

(6)

 

 

 

 

 

 

 

OSHA’s Form 300A (REV. 01/2004)

Year 20__ __

 

Summary of Work-Related Injuries and Illnesses

 

 

Occupational Safety and Health Administration

 

U.S. Department of Labor

 

 

 

 

 

 

 

Form approved OMB no. 1218-0176

All establishments covered by Part 1904 must complete this Summary page, 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 OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR Part 1904.35, in OSHA’s recordkeeping rule, for further details on the access provisions for these forms.

Number of Cases

Establishment information

Your establishment name __________________________________________

Street

_____________________________________________________

City

____________________________ State ______ ZIP _________

Total number of deaths

__________________

(G)

Total number of cases with days away from work

__________________

(H)

Total number of

Total number of

cases with job

other recordable

transfer or restriction

cases

__________________

__________________

(I)

(J)

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

_______________________________________________________

Standard Industrial Classification (SIC), if known (e.g., 3715)

____ ____ ____ ____

OR

North American Industrial Classification (NAICS), if known (e.g., 336212)

Number of Days

Total number of days away

Total number of days of job

from work

transfer or restriction

___________

___________

____ ____ ____ ____ ____ ____

Employment information (If you don’t have these figures, see the Worksheet on the back of this page to estimate.)

Annual average number of employees

______________

(K)

Injury and Illness Types

Total number of . . .

 

(M)

 

(1)

Injuries

______

(2)

Skin disorders

______

(3)

Respiratory conditions

______

(L)

(4)

Poisonings

______

(5)

Hearing loss

______

(6)

All other illnesses

______

Total hours worked by all employees last year ______________

Sign here

Knowingly falsifying this document may result in a fine.

I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and complete.

___________________________________________________________

Company executive

 

Title

(

)

-

/ /

Phone

 

 

Date

Post this Summary page from February 1 to April 30 of the year following the year covered by the form.

Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instructions, search and gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, 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.

OSHA’s Form 301

Injury and Illness Incident Report

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

Form approved OMB no. 1218-0176

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 and use as many as you need.

Completed by _______________________________________________________

Title _________________________________________________________________

Phone (________)_________--_____________

Date _____/ _____ / _____

Information about the employee

1)Full name _____________________________________________________________

2)Street ________________________________________________________________

City ______________________________________ State _________ ZIP ___________

3)Date of birth ______ / _____ / ______

4)Date hired ______ / _____ / ______

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 _______________________________________________________________

City ______________________________________ State _________ ZIP ___________

8)Was employee treated in an emergency room?

Yes

No

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

Yes

No

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

______ / _____ / ______

 

12)

Time employee began work ____________________

AM / PM

13)

Time of event

____________________

AM / PM Check if time cannot be determined

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; be more specific than “hurt,” “pain,” or sore.” Examples: “strained back”; “chemical burn, hand”; “carpal tunnel syndrome.”

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 ______ / _____ / ______

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.

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