Orange County NC Website
Browse       Search
0 <br /> 0 <br /> c <br /> to <br /> tom' <br /> M <br /> m <br /> 0 <br /> m <br /> OSHA's Form 300A (Reu 0112004) Year 20_14_ <br /> co <br /> Summary of ork- elate Injuries and Illnesses U.S.Department of Labor <br /> accapalronal Saroty and Hoafth Administration 0 <br /> race oppmved OMB—12111006 <br /> All establishments covered byPart 1904 must complete this Summarypage,even ifno work-related injuries orfllnesses occurred during the year Remember w review the Log n <br /> to verify that the enVJes are complete and accurate before completing Ws summary C)T Using the Log,counr the Individual entries you made for each category.Than write the totals below making sure you've added the entries from every page of the Log.Ifyou Establishment information A <br /> had no cases,write"0_' Ill <br /> Yarn natabttshmaat anmo <br /> Employees,former employees,and their representatives have the right to review the OSHA Form 300 in its entirety.They also have p Lomax Construction, Inc. o miled access to the OSHA 301 or o C f�' ,J �I <br /> its equlvalenL See 29 CFR Pad 1904.3$in OSHA's recordkeepinng rule,for further details on the access provisions forthese forms. 851 7-A Norcross Road W <br /> su0ct 00 <br /> cry Colfax S--Nczlp 27235 <br /> Number of Cases <br /> Total number of Total number of Total number of Total number of Ind descr tion D <br /> unity p (eq.,Mrtnu/nr[nrc ofwa(ar trsrrk lrailea) v <br /> deaths cases with days cases withjob other recordable Ge P.rcal(nntr2ctnr I Cnnstruc:tion 00 <br /> away from work transfer or restriction cases Standard lodusrrial Classification(SIC),if known(eg.,3715) 0 <br /> 0 0 0 0 15- 9 D <br /> w <br /> {G) (H) (Q (J) OR D <br /> Number of NorcbtLnerictn Industrial Classification(NAILS),Kknown(eg..336212) <br /> Days <br /> Total number ofdays away Total number ofdays ofjob Employment information(I you dau'thavctht fgn¢y:ede <br /> from work transfer or restriction N/arkdted on thr bad:ofrhir page m atu,rala) <br /> 0 0 Maud w=gcnumberofemployees 20 <br /> (K) (L) Toellhoursworkcdhyalletnployees lost yctr 41,600 <br /> Injury and Illnes�s Types M <br /> Sign here <br /> Total number of... Knowingly falsifying this document may result in a free. <br /> (M) <br /> (1)Injuries 0 (4)Poisonings 0 <br /> (5)Heating loss ---0— I certify that I have wamined this document apd that to the best of my <br /> (2)Skin disorders 0 knowledge the entries are true,accurate,and complete. <br /> (6)All other illnesses <br /> (3)Respiratoryconditions Q J Aravis Langley , Corp. Secretary_ <br /> r335 992 _ 7000 12/31/14 <br /> Post this summary page fram February 1 to April 30 of the year following the year covered by the form. <br /> Puhac rnpmdaghurden for ddr oouecdan of rmatwnEac i--d w average 58 minutes prrza.pomc Including lime m review 1he;n.nr_w morchaad gather the dotaneedcd.and <br /> comprew and review lhceoBecuon orivfaraudan.Person arenas requiccd w rcopond w lhecolre as oriotouo u..aolrm itdtsplayaae dyvalid OMB eoatrd nambcultyou have any <br /> nuoeatsshoaltheca od="-aranyotbcc arpecn arlhis dots mllecdnn,co .L ilS nopotmuntorl.oboti OSHA.0al—rStodadm1 Aaalpk,R.—N-3644,2200 C—dt tloaAvenne,MAr <br /> Wuhi tg oa.DC 211210.Do notsmd the completed Tams b the oM= <br />