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Outline

The OSHA 300 form serves as an essential tool for tracking work-related injuries and illnesses within a workplace. Employers must use this form to document every work-related death, as well as any injury or illness that leads to loss of consciousness, restricted work activity, job transfer, or days away from work. It also requires reporting of significant injuries diagnosed by a physician or licensed health care professional. Each case must be classified based on the most serious outcome, and employers are encouraged to provide detailed descriptions of the incidents, including the nature of the injury and the affected body parts. If an injury or illness meets specific criteria outlined in federal regulations, it must be recorded. For each incident logged, an Injury and Illness Incident Report (OSHA Form 301) or an equivalent form is necessary. Employers unsure about what constitutes a recordable case can reach out to their local OSHA office for guidance. Confidentiality is crucial, as the form contains sensitive employee health information. Accurate completion of the OSHA 300 form not only aids in compliance with federal regulations but also helps improve workplace safety by identifying trends and areas for improvement.

Sample - Osha 300 Form

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

 

 

Classify the case

 

 

 

 

 

 

 

 

 

 

 

 

CHECK ONLY ONE box for each case

 

 

 

 

(A)

(B)

(C)

 

(D)

(E)

(F)

 

 

Enter the number of

 

Check the “Injury” column or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

based on the most serious outcome for

 

days the injured or

 

Case

Employee’s name

Job title

 

Date of injury

Where the event occurred

Describe injury or illness, parts of body affected,

 

that case:

 

ill worker was:

 

choose one type of illness:

no.

(e.g., Welder)

or onset

(e.g., Loading dock north end) and object/substance that directly injured

 

Remained at Work

 

 

 

 

 

 

 

of illness

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

 

Away

On job

 

 

 

 

 

 

 

 

 

right forearm from acetylene torch)

 

 

 

 

 

 

 

Job transfer

Other record-

from

transfer or

 

 

 

Days away

 

 

 

Death from work

or restriction

able cases

work

restriction

(M)

Injury

Skindisorder

Respiratory condition

Poisoning

Hearingloss

Allother illnesses

_____

________________________

____________

/___

__________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

__________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

__________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

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/___

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month/day

 

 

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/___

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

_____

________________________

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/___

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__________________________________________________

 

 

 

month/day

 

 

(G)

(H)

(I)

(J)

(K)

(L)

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

____ days

____ days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____ days

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____ days

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____ days

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____ days

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____ days

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____ days

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____ days

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____ days

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____ days

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____ days

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____ days

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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

(1)

Skindisorder

Respiratory condition

Poisoning

Hearingloss

Allother illnesses

(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.

Form Information

Fact Name Details
Purpose The OSHA 300 form logs work-related injuries and illnesses.
Recordable Events It must include all work-related deaths, injuries, and illnesses that meet specific criteria.
Confidentiality Employee health information must be handled confidentially.
Incident Report Requirement An Injury and Illness Incident Report (OSHA Form 301) is needed for each case recorded.
Legal Reference The form follows the guidelines set in 29 CFR Part 1904.8 through 1904.12.
Completion Timeline Employers are required to complete the form within a specified time frame after an incident.
Public Reporting Burden It takes approximately 14 minutes to complete the form, including data gathering.
Transfer to Summary Totals from the OSHA 300 form must be transferred to the Summary page (Form 300A).

Detailed Guide for Filling Out Osha 300

Filling out the OSHA 300 form is an important task for employers to ensure workplace safety and compliance. This form tracks work-related injuries and illnesses, helping organizations monitor and improve their safety practices. After completing the form, the totals need to be transferred to the Summary page (Form 300A) before posting it.

  1. Begin by entering the establishment name, city, and state at the top of the form.
  2. Identify the person involved in the incident by writing their name and job title.
  3. Record the date of injury or illness.
  4. Specify where the event occurred (e.g., loading dock, office).
  5. Describe the injury or illness, including parts of the body affected and the object or substance that caused the injury or illness.
  6. Classify the case by checking one box based on the most serious outcome:
    • Remained at Work
    • Days Away from Work
    • Job Transfer
    • Other Recordable Cases
    • Death
  7. Enter the number of days the injured worker was away from work, transferred, or had work restrictions.
  8. Fill in the month and day for each incident, as necessary.
  9. If there are multiple cases, feel free to use two lines for a single case if needed.
  10. At the end of the form, calculate and enter the page totals.

Obtain Answers on Osha 300

  1. What is the OSHA 300 Form?

    The OSHA 300 Form, officially known as the Log of Work-Related Injuries and Illnesses, is a record-keeping tool used by employers to document work-related injuries and illnesses. It is a requirement for certain employers under OSHA regulations. This form helps track incidents that result in employee fatalities, loss of consciousness, restricted work activity, job transfers, or medical treatment beyond first aid.

  2. Who is required to complete the OSHA 300 Form?

    Employers in specific industries with 10 or more employees are generally required to maintain this log. However, some low-risk industries are exempt. It's important to check if your business falls under the requirement. If unsure, consult with your local OSHA office.

  3. What types of incidents must be recorded on the OSHA 300 Form?

    Record any work-related death, injury, or illness that meets the following criteria:

    • Loss of consciousness
    • Restricted work activity or job transfer
    • Days away from work
    • Medical treatment beyond first aid
    • Significant injuries or illnesses diagnosed by a physician or licensed health care professional
  4. How do I determine if an incident is recordable?

    If you are uncertain whether an incident should be recorded, consider the nature of the injury or illness and whether it meets any of the specific criteria outlined in OSHA regulations. For further clarification, you can contact your local OSHA office for guidance.

  5. What additional forms are required when completing the OSHA 300 Form?

    For each incident recorded on the OSHA 300 Form, you must also complete an Injury and Illness Incident Report (OSHA Form 301) or an equivalent form. This report provides detailed information about the incident and supports the data recorded on the 300 Form.

  6. How long must I keep the OSHA 300 Form records?

    Employers must maintain the OSHA 300 Form for a minimum of five years following the end of the calendar year in which the incidents occurred. This retention period ensures that records are available for review and analysis.

  7. What should I do with the totals from the OSHA 300 Form?

    After completing the OSHA 300 Form, you must transfer the totals to the Summary page, known as Form 300A. This summary must be posted in a visible location within the workplace from February 1 to April 30 of the following year, allowing employees to review the safety record of the workplace.

Common mistakes

Filling out the OSHA 300 form can be straightforward, but mistakes can lead to inaccuracies. One common mistake is failing to record all required incidents. Every work-related death, injury, or illness that involves loss of consciousness, restricted work activity, or medical treatment beyond first aid must be documented. Not including these can result in incomplete records.

Another frequent error is misclassifying the case. Each incident should be categorized based on the most serious outcome. For instance, if an employee is transferred to another job due to an injury, this should be marked appropriately. Misclassification can skew data and affect safety measures.

People often overlook the need to complete an Injury and Illness Incident Report (OSHA Form 301) for each case recorded. This report is essential for detailed tracking and analysis of incidents. Skipping this step can lead to confusion and incomplete records.

Inaccurate descriptions of the injury or illness are also a problem. The form requires a clear account of the injury, including the parts of the body affected and the object or substance involved. Vague descriptions can hinder proper assessment and response to workplace safety issues.

Another mistake is neglecting to update the form with the number of days away from work or days of job transfer. This information is crucial for understanding the impact of incidents on employees. Leaving these fields blank can misrepresent the severity of the situation.

Some individuals do not consult with their local OSHA office when unsure about recordability. If there is doubt about whether an incident should be recorded, it is important to seek guidance. Ignoring this step can lead to further complications.

Additionally, failing to protect employee confidentiality can be a significant oversight. The information on the form must be handled carefully to maintain privacy. Not doing so can result in legal issues and loss of trust among employees.

People sometimes forget to transfer totals to the Summary page (Form 300A) after completing the form. This step is essential for accurate reporting and compliance. Neglecting to do this can lead to discrepancies in safety records.

Using incorrect dates or formats when entering information is another common mistake. The form requires specific date formats for consistency. Errors in this area can complicate data analysis and reporting.

Lastly, some individuals fail to review the completed form for errors before submission. A thorough review can catch mistakes that might otherwise go unnoticed. Taking this extra step can help ensure that the form is accurate and complete.

Documents used along the form

The OSHA 300 form is a critical document for tracking work-related injuries and illnesses within an organization. However, it is often accompanied by several other forms that help ensure comprehensive reporting and compliance with safety regulations. Understanding these documents is essential for maintaining workplace safety and fulfilling legal obligations.

  • OSHA Form 301: This is the Injury and Illness Incident Report. It provides detailed information about each individual case recorded on the OSHA 300 form. Employers must complete this form for every injury or illness that occurs in the workplace, documenting specifics such as the nature of the injury and the circumstances surrounding it.
  • OSHA Form 300A: This form serves as a summary of the injuries and illnesses recorded on the OSHA 300 form. It must be posted in the workplace from February 1 to April 30 each year. The summary includes total counts of injuries and illnesses, making it easier for employees and regulators to understand the safety record of the organization.
  • First Aid Records: These documents track minor injuries treated on-site. While they may not need to be reported on the OSHA 300 form, maintaining accurate first aid records can help identify trends and prevent future incidents.
  • Safety Data Sheets (SDS): These sheets provide information about hazardous materials used in the workplace. They are crucial for understanding the risks associated with certain substances and ensuring that employees are trained on safe handling procedures.
  • Incident Reports: These are internal documents that detail any workplace accidents or near misses. They help organizations analyze incidents, improve safety protocols, and prevent future occurrences.
  • Employee Training Records: These records document safety training sessions attended by employees. Keeping these records up to date demonstrates compliance with safety regulations and helps ensure that employees are knowledgeable about workplace hazards.
  • Return-to-Work Agreements: These agreements outline the terms under which an employee can return to work after an injury or illness. They often include modified duties or accommodations to support the employee's recovery while ensuring workplace safety.

In summary, while the OSHA 300 form is essential for documenting work-related injuries and illnesses, it is just one part of a broader safety management system. Familiarity with these accompanying forms and documents can significantly enhance an organization’s ability to maintain a safe work environment and comply with legal requirements.

Similar forms

The OSHA 300 form is an important document for tracking work-related injuries and illnesses. It shares similarities with several other forms used in workplace safety and health documentation. Here are four documents that are comparable to the OSHA 300 form:

  • OSHA Form 301 (Injury and Illness Incident Report): This form is used to provide detailed information about each specific work-related injury or illness. Like the OSHA 300, it records incidents that require medical treatment beyond first aid, but it focuses on the specifics of each case, including the nature of the injury and the circumstances surrounding it.
  • OSHA Form 300A (Summary of Work-Related Injuries and Illnesses): This summary form is derived from the data recorded on the OSHA 300. It provides an annual overview of work-related injuries and illnesses. Employers post this form in a visible location, making it accessible to employees, similar to how the OSHA 300 logs incidents throughout the year.
  • Workers' Compensation Claims Forms: These forms are used to file claims for benefits when an employee is injured on the job. Like the OSHA 300, they document work-related injuries, but they are specifically aimed at ensuring employees receive compensation for lost wages and medical expenses resulting from their injuries.
  • First Report of Injury (FROI): This document is typically submitted to insurance companies when an employee is injured at work. Similar to the OSHA 300, it captures essential information about the injury, including the date, location, and nature of the injury. However, the FROI is primarily focused on initiating the claims process rather than tracking overall workplace safety statistics.

Dos and Don'ts

When filling out the OSHA 300 form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are five things to do and not do:

  • Do record every work-related death and any injury or illness that results in loss of consciousness, restricted work activity, job transfer, or days away from work.
  • Do complete an Injury and Illness Incident Report (OSHA Form 301) for each case recorded on the OSHA 300 form.
  • Do ensure that the information is accurate and reflects the most serious outcome of the case.
  • Do maintain the confidentiality of employee information while using the form for safety and health purposes.
  • Do consult your local OSHA office if you are unsure whether a case is recordable.
  • Don't omit any significant work-related injuries or illnesses diagnosed by a physician or licensed health care professional.
  • Don't use vague descriptions; be specific about the injury or illness and the parts of the body affected.
  • Don't forget to transfer totals from the OSHA 300 form to the Summary page (Form 300A) before posting.
  • Don't send completed forms to the OSHA office; they are not to be submitted there.
  • Don't hesitate to take two lines for a single case if necessary for clarity.

Misconceptions

Understanding the OSHA 300 form is crucial for workplace safety and compliance. However, several misconceptions can lead to confusion. Here are ten common misunderstandings about the OSHA 300 form:

  1. Only serious injuries need to be recorded. Many people believe that only severe injuries should be documented. In reality, any work-related injury or illness that meets specific criteria must be recorded.
  2. All injuries must be reported immediately. Some think that every injury needs to be reported right away. While prompt reporting is important, you have time to gather information before completing the form.
  3. First aid cases do not need to be recorded. It is a common belief that injuries treated with first aid do not require documentation. However, if an injury leads to more serious medical treatment later, it must be recorded.
  4. Only injuries that result in time off work need to be documented. This misconception overlooks the fact that any work-related injury or illness that restricts work or requires medical treatment should be recorded, regardless of time lost.
  5. The form is only for physical injuries. Some individuals think the form only tracks physical injuries. In truth, it also includes illnesses that are work-related, such as respiratory issues from exposure to harmful substances.
  6. You can skip cases if you're unsure about their recordability. It is a mistake to assume that uncertainty means you can leave a case off the form. If in doubt, it is better to consult with OSHA or document the case.
  7. Only the employer is responsible for completing the form. While the employer typically fills out the form, employees also play a role in reporting injuries and illnesses accurately.
  8. Once the form is submitted, it cannot be changed. Many believe that submitted forms are final. However, corrections can be made if new information comes to light.
  9. The OSHA 300 form is only for large companies. This is not true. All employers with more than ten employees are required to maintain the form, regardless of the size of the company.
  10. Confidentiality is not a concern. Some think that confidentiality is not important when filling out the form. In fact, protecting employee privacy is essential, and information should be handled with care.

By understanding these misconceptions, employers and employees can better navigate workplace safety requirements and ensure compliance with OSHA regulations.

Key takeaways

Filling out and using the OSHA 300 form is essential for maintaining workplace safety and compliance. Here are key takeaways to consider:

  • Recordable Cases: Document every work-related death, injury, or illness that results in loss of consciousness, restricted work activity, job transfer, days away from work, or medical treatment beyond first aid.
  • Confidentiality: Protect employee confidentiality while using the form for occupational safety and health purposes.
  • Incident Reporting: Complete an Injury and Illness Incident Report (OSHA Form 301) for each case recorded on the OSHA 300 form.
  • Consultation: If uncertain about whether a case is recordable, contact your local OSHA office for guidance.

Ensure that totals from the OSHA 300 form are transferred to the Summary page (Form 300A) before posting it. This process is crucial for accurate reporting and compliance with regulations.