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<br /> OSHA's Form 300 (Rev.0112004)
<br /> Note:You can type input into this form and save it. Attention:This form contains information relating to
<br /> Because the forms in this recordkeeping package are"fillablefwntable" employee health and must be used in a manner that O
<br /> Log of Work-Related PDF documents,you can type into the input form fields and protects the confidentiality of employees to the extent Year 20 1 2
<br /> then save your inputs using the free Adobe PDF Reader.In addition, possible while the information is being used for co
<br /> Injuries and Illnesses the forms are programmed to auto-calculate as appropriate occu ational 5afet and health u oses. U.S.Department of tabor to
<br /> p Y purposes. or:cupauoraar Safaty and Hearth Administration O
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<br /> You must record information about every work-related death and about every work related injury or illness that involves loss of consciousness,restricted work activity or job Foau approved OMB no.1218-0176 N
<br /> transfer,days away from work,or medical treatment beyond first aid.You must also record significant work-related injuries and illnesses that are diagnosed by a physician or Harris Bros E!ecffi e&Controls D
<br /> licensed health care professional.You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR Part 1904,8 Estatxtshmem name (�
<br /> through 1904.12,Feel free to use two lines for a single case if yeu need to.You must complete an Injury and illness Incident Report(OSHA Form 301)or equivalent form for
<br /> each injury or illness recorded on this form.If you're not sure whether a case is recordable,call yourlocal OSHA office forhelp. ci,Durham state NC
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<br /> Public reponing burden fa this collection or infermabon is estimated m average 14 minutes per response•inclodiag time to miew the g$ 2 Q
<br /> insrudions,aeard and gather the dma needed,and complete and review the mlketien of ief—hoe.Perseas*rem required to A
<br /> respond b the cullcuian of information unlos it displays a em:mtly valid OMB control number.if ynubave any cdmmaxs about[heat g t '� -> �`�"{ v x'°te✓v h� 1 o '8 8 a
<br /> estimates or any odrr arcw of&%din w1leetim scone:US Department of Labor,OSHA ice of Sutistinl Analysis-Room
<br /> H-3644.200 constitution Avanut,Nor,washiwtan,DC 202 to.Do not send the aamplaed forms to hbis ofrm (1) (2) (3) (4) (5) (6)
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