- DATE OF MOST RECENT INJURY OR ILLNESS RESULTING IN DAY(S) AWAY FROM WORK
/ / This date must be prior to July 01, 2008
Report All Information Below For CURRENT SIX MONTH PERIOD ONLY (January 1 – June 30, 2008)
- Average Number of Employees
( Full & Part Time)
Total Hours Worked (entire six month period, all employees)
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Items 4, 5 and 6 are based on the Recordkeeping Requirements under the Occupational Safety & Health Act of 1970 (rev. 1/1/02). The columns listed below correspond to the columns in the OSHA 300 Log.
Number of Deaths (You may use your OSHA 300 Log)
Number of occupational injuries and/or illnesses resulting in days away from work
(You may use your OSHA 300 Log)
If you entered a date in the current 6 month period for Line 1 you must enter a number on line 5
Number of days away from work as a result of occupational injuries and/or illnesses
(You may use your OSHA 300 Log)
Must be equal to or greater than line 5 and can include any days taken from 1/1/08 – 6/30/08 even if
injury or illness occurred outside of this six month period.
Note: If you report a death, injury or illness resulting in days away from work in the current
six month period (item 4 or 5), the most recent date of death, injury or illness must correspond with item 1.
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