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<br /> Attention.This form contains information relating to — o
<br /> r S �OC employee health and must be used in a manner that
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<br /> QSForm 300 (Rev.o�t2o( ) ^'
<br /> protects the confidentiatity of employees to the extent Year 2012
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<br /> Log of Work-Related Injuries an-a' Illnesses occu ple ride safely information is being used U.S.Department of Labor C)
<br /> occupat)orrat safe and heath purposes. natuDatianat Safety:n t Hearttrarlminlsir fine m
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<br /> You must recordmrormation about every waArerairo ddeetltanc r about every worrt•retefadinpxyorr7lnesslfnt kholies lass ofcwxlm nM,MSMOW wOfk 00a*Cti0b fpnslax, IvrmwpprnedC)vuo¢1'1K•ut7G W
<br /> days awry from work,or medical iraafmant bayand grsf aid.You must also record sign kart wDer-er.ed inNnies aria imasses(hat are clagrlosadhy a physlrlan GY lfoerimalicAtr (I
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<br /> care proreswlonal.You must also record work-related in1udes and&msas thAf awpi"of the spatgc fecord ag crkeria:istad fn 29 CFR Part 1904.8 11rougta 1904,T2_Feel free to fatso-�,,r.RscaneM Constructfon South (JI
<br /> use two Jrhe3 fora single case iryaf need ta.You must comptate an lnjuyand Ulnas&Ixident r)eporf r SHAFarm 301)oraquiaaltnr form ror each v•ury or,i cress fecorded on this
<br /> Iamr.iryoui e not sure wnel lwacasaI sfeeortiabte,catfyourbW OSHA oll�e for help. �� E NC
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<br /> Case Employees name johtitle Datcofinjury t4lurrthelocalnceurned Describe injuryuritlnesaapansofIwdyttfftcicd, of War= Ft' v
<br /> uo. (e.g..Welder) or onset (rat••Lead dig dash narfh rwd) and objeat/substwtce tint directly ir4ared (�' t + r t� t W
<br /> of illncas or made pers46 iti{ag,Seeaaddig,rr bteaa ax Away t.rnb ".�tV _ c. W
<br /> right fares rl f tvl areffdew!MCA) ll #� ! front tranaTp or '.3, _ ),E. W
<br /> work re►triotton { �I
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<br /> No reported work related injuries or i] nes' es for 2012 +' D d Q m
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