Osha form 300 excel

OSHA Form 300

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.

OSHA's Form 300 (Rev. 01/2004) Year

Log of Work-Related Injuries and Illnesses U.S. Department of Labor

Occupational Safety and Health Administration

You must record information 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 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 Classify the case

CHECK ONLY ONE box for each case based on the most serious outcome for that case: Enter the number of days the injured or ill worker was: Check the "injury" column or choose one type of illness:

(A) (B) (C) (D) (E) (F)

Case No. Employee's Name Job Title (e.g., Welder) Date of injury or onset of illness Where the event occurred (e.g. Loading dock north end) Describe injury or illness, parts of body affected, and object/substance that directly injured or made person ill (e.g. Second degree burns on right forearm from acetylene torch)

(M) Skin Disorder Respiratory Condition Poisoning Hearing Loss All other illnesses

Death Days away from work Remained at work Away From Work (days) On job transfer or restriction (days) Injury

(mo./day)

Job transfer or restriction Other record- able cases

(G) (H) (I) (J) (K) (L) (1) (2) (3) (4) (5) (6)

Page totals 0 0 0 0 0 0 0 0 0 0 0 0

Be sure to transfer these totals to the Summary page (Form 300A) before you post it. Injury Skin Disorder Respiratory Condition Poisoning Hearing Loss All other illnesses

Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time to review the instruction, 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 aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistics, Room N-3644, 200 Constitution Ave, NW, Washington, DC 20210. Do not send the completed forms to this office.

Page 1 of 1 (1) (2) (3) (4) (5) (6)

OSHA Form 300A

OSHA's Form 300A (Rev. 01/2004) Year

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 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." Establishment information

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 1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms. Your establishment name

Street

Number of Cases City State Zip

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

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

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

0 0 0 0

(G) (H) (I) (J) OR North American Industrial Classification (NAICS), if known (e.g., 336212)

Number of Days Employment information

Total number of days away from work Total number of days of job transfer or restriction

Annual average number of employees

0 0 Total hours worked by all employees last year

(K) (L)

Injury and Illness Types

Sign here

Total number of… Knowingly falsifying this document may result in a fine.

(M)

(1) Injury 0 (4) Poisoning 0

(2) Skin Disorder 0 (5) Hearing Loss 0 I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and complete.

(3) Respiratory Condition 0 (6) All Other Illnesses 0

Company executive Title

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

Public reporting burden for this collection of information is estimated to average 50 minutes per response, including time to review the instruction, 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 aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistics, Room N-3644, 200 Constitution Ave, NW, Washington, DC 20210. Do not send the completed forms to this office.