OSHA’s Form 300A Year 20 (Rev. 01/2004) Summary of Work-Related Injuries and Illnesses U.S. Department of Labor Occupational Safety and Health Administration 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. cases with Total number of Total number days away cases with job Total number of deaths from work transfer or of other restriction recordable Total number of cases (G) (H) (I) (J) number of days Total number of days of away from work job transfer or restriction (K) (L) Total number of... (M) Injuries Poisonings Hearing loss Skin disorders All other illnesses Respiratory conditions 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 300A (Rev. 01/2004) Year 20 Summary of Work-Related Injuries and Illnesses U.S. Department of Labor Occupational Safety and Health Administration 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. Total number of deaths Total number of cases with days away from work Total number of cases with job transfer or restriction Total number of other recordable cases (G) (H) (I) (J) number of days away from work Total number of days of job transfer or restriction (K) (L) Total number of... (M) Injuries Skin disorders Respiratory conditions Poisonings Hearing loss All other illnesses 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%20300%20Form.docx