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In this package, you’ll find everything you need to complete
OSHA’s
and the
for the next several years. On the following pages, you’ll find:
General instructions for filling out the forms in this package
and definitions of terms you should use when you classify
your cases as injuries or illnesses.
An e xample to guide you in filling
out the
properly.
Several pages of the
(but you may make as many copies of
the
as you need.) Notice that the
is separate from the
Removable
pages
for easy posting at the end of the year.
Note that you post the
only,
not the
Aworksheet for
figuring the average number of employees who worked for
your establishment and the total number of hours worked.
Acopy of the OSHA 301 to
provide details about the incident. You
may make as many copies as you need or
use an equivalent form.
Take a few minutes to review this package. If you have any
questions,
We’ll be happy to help you.
Log
Summary of Work-Related Injuries and Illnesses
Log
Log
Log
Log
Summary.
Summary
Summary
Log.
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Dear Employer:
This booklet includes the forms needed for maintaining
occupational injury and illness records for 2004. These new forms have
changed in several important ways from the 2003 recordkeeping forms.
In the
,
OSHA announced its decision to add an occupational hearing loss
column to OSHA’s Form 300, Log of Work-Related Injuries and
Illnesses. This forms package contains modified Forms 300 and
300A which incorporate the additional column M(5) Hearing Loss.
Employers required to complete the injury and illness forms must begin
to use these forms on January 1, 2004.
In response to public suggestions, OSHA also has made several
changes to the forms package to make the recordkeeping materials
clearer and easier to use:
• On Form 300, we’ve switched the positions of the day count
columns. The days “away from work” column now comes before
the days “on job transfer or restriction.”
• We’ve clarified the formulas for calculating incidence rates.
• We’ve added new recording criteria for occupational hearing loss
to the “Overview” section.
• On Form 300, we’ve made the column heading “Classify the
Case” more prominent to make it clear that employers should
mark only one selection among the four columns offered.
The Occupational Safety and Health Administration shares with you
the goal of preventing injuries and illnesses in our nation’s workplaces.
Accurate injury and illness records will help us achieve that goal.
December 17, 2002 Federal Register (67 FR 77165-77170)
Occupational Safety and Health Administration
U.S. Department of Labor
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The
(Form 300) is used to classify work-related
injuries and illnesses and to note the extent
and severity of each case. When an incident
occurs, use the
to record specific details
about what happened and how it happened.
The
—a separate form (Form 300A)
—shows the totals for the year in each
category. At the end of the year, post the
in a visible location so that your
employees are aware of the injuries and
illnesses occurring in their workplace.
Employers must keep a
for each
establishment or site. If you have more than
one establishment, you must keep a separate
and
for each physical location that
is expected to be in operation for one year or
longer.
Note that your employees have the right to
review your injury and illness records. For
more information, see 29 Code of Federal
Regulations Part 1904.35,
Cases listed on the
are not necessarily eligible
for workers’ compensation or other insurance
benefits. Listing a case on the
does not
mean that the employer or worker was at fault
or that an OSHA standard was violated.
Record those work-related injuries and
illnesses that result in:
death,
loss of consciousness,
days away from work,
restricted work activity or job transfer, or
medical treatment beyond first aid.
You must also record work-related injuries
and illnesses that are significant (as defined
below) or meet any of the additional criteria
listed below.
Log of Work-Related Injuries and Illnesses
Log
Summary
Summary
Log
Log
Summary
Employee Involvement.
Log of Work-Related
Injuries and Illnesses
Log
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