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' <br /> - -_-� - <br /> �� <br /> -- -_'� - <br /> � <br /> (D <br /> Attention"This;form contains information relatIng to <br /> OSHA"S Form 300 (R.0112-OG4) employee health and must be used in a manner that- (0 <br /> protects the conMenfiality of employees to the extent Year 20 12 0 <br /> pd�sible while the information is being used for ——0 n <br /> Log of Work-Related Injuries and Illnesses U.S.Department of Labor 0 <br /> occupational safety and health purposes. 00 <br /> Yourmust record Information about evoiywork-relateddeath and aboutemwy work-relatedinjug,crijiness that involves loss ofCQnsCbuShoSS,resUioted vvcdcSCUWY�wjOb transfer 321&0116 <br /> days avray hnm wczk ormedloaf treatment beland irstad-You must also fecoxfstgairicant wotk-refafed injudes and Nnessess that we dia_Onosed by aph�dan or licensed health -n <br /> cars Proressionar.Yo Lt must also tc=d work4ebted 4urias and Illnesses that me ot any of the sPOOSC lecord1n.9 Cdefia listed in 29 CFR Part 7 9 04,8 through 1904.!?-FWJ tree to Etab& 0 <br /> use&wo lines for a single case ifyou need to.Yo u must complete an 4uiy and Iffness Incident Repoit(OSHA Form,3oi)or equIvatent form fOr each 4MY OF iffnCSS�ecolced on this M <br /> form,If yo uli e n ot sure whath er a c is re cordable,call yo ur local 0 SHA o frice for help. <br /> C41 M <br /> piuryl"I <br /> wUder) Onset (e-g-L—fiTd.&—,f),end) —d-hjcct�substance that&recOy injuted <br /> akl <br /> Ai <br /> ME <br /> wit <br /> ' <br /> � <br /> � <br /> � <br /> � <br />