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0 <br /> 0 <br /> c <br /> to <br /> M <br /> m <br /> 0 <br /> m <br /> OSHA's Farm 300A (Rsv.ov2oo l) Year 20 12 <br /> �.Department nt of Labor C)CD <br /> Summary oWork-Related tjuie a Illnesses <br /> C) <br /> xv'mvnaarmas+wamnxnns tnM mRem a�w•snum�marem a+m.:na.mmnu+vaawns^.imurm.m�mnvnrr wn..rava+ a a nrseaw�u+t rsuvaaonmoesu�u�wnoxe�+;ro ounvm axswuorwsers+aw.,>r�U wu¢,xeasia ee�emmI firs¢-n3 m <br /> W <br /> n <br /> All esisb5s17menfs covered by Part 1904 mast complete This Summary page,tratrr 9 n w0d.-m Wed injuries or illnmes occurred during the yea:Remember to reviewlfre Log rr <br /> li <br /> fo verity that the entries are complete and accurafe before completing this slrmmary. w <br /> Using the Log,count The indrvidLet enitlw you made for each calegwy.Then write iris rorats below,making surd you m added the entries from every ptga of the Lop.f1 you EslabHshment frdormatltrrr M <br /> had no cases.v4e•o., r«,..*1,.Wkrtm.d n_Racanelli Construction South m <br /> Employees,farmers W <br /> employees,2ndlhob r�resentativas have the Jet to taste-w the OS1dfi Farm 3fi0 in ils entirety.They assts have lfrnrTod access to the 0,49 Form 309 or <br /> its equivalenL See 29 CPR Part 1909,35,in OSHR's recordkeorig rule,for Irutimrdai is on ft access prow stirs for Giese forms. stma p <br /> sir; Apex st. NC zlp 27502 <br /> 00 <br /> CD <br /> tb <br /> W <br /> Total number of Total number of Total number of Total number of mducay dcYCren"0(c., o o rarro(,rraorrnrc4 w tin) w <br /> General Contractors Commercial Construction � <br /> deaths cases with days cuestvith job other recordable C71 <br /> away Eorn work tramfcr or restriction cases Stm hrdlndastr alCLnsiFcatiwr{SIL�,i(kn nvet(e4.,3715) m <br /> M <br /> 0 fl fl fl _t 5 4 2 ° <br /> OR <br /> fJorHt 336212) <br /> Am�icut ludtutriLLal Ctsssifiation!NAIL;.$},ifknown(e.B., <br /> Employment Information(IfpndviI haw dtafrn, <br /> Toctlnumberofda ya away Total number ofdaysofj pb rerrhr <br /> Wo kdrnr on the ba&,f this per to ttuwxff J <br /> from work transfer or restriction <br /> Annl21 avcagcnuinlxr ofrtnptoycrc 5 <br /> 0 p 6806 <br /> "Ibut hours wwked by all m7pioym rase year <br /> (K) {L) <br /> Sign heir <br /> Knowingly fshifying this document miry result in a fine. <br /> Total number Of... <br /> (ha) a fl <br /> (1)17tjurics (4)Poisonings I certify that I haslc f.'�ni d this document and that to ncu bcn of my <br /> (5)Hearing loss � knawtedgc rtrics2 true, rate,and comploc. r <br /> (2)Skin disorders fl (e)All other illnesses fl <br /> (3)Respiratory condi£rorm fl <br /> t 9197 363-360Q 1;4113 - <br /> pact this Summary page fraett February f to Aprif 00 of fhe jfear feRowlhg tbv year eovOmd by the form. <br /> P.W1,ropvmryr burden fu,Ihu wikttloo of information yesfimatad 1.ava.gn56 adsan•,per 7tspome,kuludtnl{tinMio rtnje.the 1mr,vrmn4 uvreb amly.4rtr+lx dw.needed.uns <br /> eur,pinR.ad 7nhew 7M w]teUfors of irJo'm.uon.i@rsoas>te w rN i,rd to respond w the uallttdon of Wfo7mWfoa unlar a dieplry.n aarudy eaDd OMB—..I'"I'M tr you h—'my <br /> eammenu shout share a�tim.tc.or.ray oJ+or..pacts ntrhN d.r.edleetion,.aofaco L>,DetwtnxN or,&or�OSHA f)fl1m of Staiukd MdyaG M'nrn N-3a44.70P Caneuluttan A­.W, <br /> Wudungfun.OC 217220.D.ra.ond tfu•wmpfn d forms w tbl..01— <br />