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<br /> Attention:This form contains information relating to p
<br /> OSHA's Form 300 (Rem otf2oo4) employee health and must be used in a manner that
<br /> protects the confidentiality of employees to the extent Year 2025 00
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<br /> Log of Work-Related /i9�uries an Illnesses Possible while the information is being used for U.S.Departmenf of Labor n
<br /> / [ occupational safety and health purposes. oro�,�.o,rsa/oh,ne xnana as nr t�:R H,n
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<br /> You must record information about every work-related death andabout every work-related injury oriflness that involves loss of consciousness,restricted work activiryorjob transfer, r nn approved ohtb no.121 a-one 00
<br /> l days away from work,or medical treatment beyond first aid.You must also recordsigniBcant work-re/aced injuries and illnesses that are diagnosed by a physician orlicensed health
<br /> care professional.You must also record work{elated injuries and Binesses that meet any of the specific recording criteria listed In 29 CFR Part 7904.8 through 1904-72 Feel free to Estabrai..fnarm GtO,'ryj lZ.Y GO}7� �7
<br /> use two lines fora single case if you need to.You must complete an Injury and fitness Incident Report(OSHA Form 307)or equivalent form for each injury orilfness mcarded on this /^ �•n_ C')
<br /> form.If you're not sure whether a case is recordable,call your focal OSHA office for help. ctn, C� Stain 44/r T
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<br /> Case Employee's Warne Job title Dateofbn Wheretheeventoceurred Des¢ibe•'u .rillness, o£hod aff-w ill worker wax -
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<br /> Public repontng burden for 11.collsxtion orinlormation is a C--d m av—gr LL minuw perrcpoo-ie,including time w miew 3e sure to transfer These loiats to the Sur--ypgge(F.-300F)before youpost d.
<br /> the isutcvecions,smrcb atu!gather the dam needed,and mmpkm and revirn•the can«don oCinlormadom Yawns are riot fegnired ,g d
<br /> respondmthecnllcaion.fintornuaon unit�s icd:splaysacurrend7•valid[h�iu mnual numbee try..have nnpmmmenu ' _
<br /> about d�ese esdmaies ur any.d—nap—.!this duo cnllcaion,—mm US Depanmwcc olLabor.OSHA air—ursutirumi
<br /> daalys�,Room NSfi14,211U Consrio.don Avenue,Nw,tvashingmn,DC 2U2Ie.D.not wrd du romplacd r��mmdtis Brim Pooa,._ar_ (1) (2) (3) (4) (5) (6)
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