OSHA

Forms for RecordingWork-Related Injuries and Illnesse

U.S. Department of Labor

Occupational Safety and Health Administration

Dear Employer:

This booklet includes the forms needed for maintaining

occupational injury and illness records for 2004. These new forms havechanged in several important ways from the 2003 recordkeeping forms.

In the ,

OSHA announced its decision to add an occupational hearing losscolumn to OSHA’s Form 300, Log of Work-Related Injuries andIllnesses. This forms package contains modified Forms 300 and300A which incorporate the additional column M(5) Hearing Loss.Employers required to complete the injury and illness forms must beginto use these forms on January 1, 2004.

In response to public suggestions, OSHA also has made several

changes to the forms package to make the recordkeeping materialsclearer and easier to use:

• On Form 300, we’ve switched the positions of the day count

columns. The days “away from work” column now comes beforethe days “on job transfer or restriction.”

• We’ve clarified the formulas for calculating incidence rates.• We’ve added new recording criteria for occupational hearing loss

to the “Overview” section.

• On Form 300, we’ve made the column heading “Classify the

Case” more prominent to make it clear that employers shouldmark only one selection among the four columns offered.

The Occupational Safety and Health Administration shares with you

the goal of preventing injuries and illnesses in our nation’s workplaces.Accurate injury and illness records will help us achieve that goal.

December 17, 2002 Federal Register (67 FR 77165-77170)

Occupational Safety and Health AdministrationU.S. Department of Labor
The

(Form 300) is used to classify work-relatedinjuries and illnesses and to note the extentand severity of each case. When an incidentoccurs, use the to record specific detailsabout what happened and how it happened.The — a separate form (Form 300A)— shows the totals for the year in eachcategory. At the end of the year, post the

in a visible location so that your

employees are aware of the injuries andillnesses occurring in their workplace.

Employers must keep a for each

establishment or site. If you have more thanone establishment, you must keep a separate

and for each physical location that

is expected to be in operation for one year orlonger.

Note that your employees have the right to

review your injury and illness records. Formore information, see 29 Code of FederalRegulations Part 1904.35,

Cases listed on the

are not necessarily eligible

for workers’ compensation or other insurancebenefits. Listing a case on the does notmean that the employer or worker was at faultor that an OSHA standard was violated.

Record those work-related injuries andillnesses that result in:

death,loss of consciousness,days away from work,restricted work activity or job transfer, ormedical treatment beyond first aid.

You must also record work-related injuries

and illnesses that are significant (as definedbelow) or meet any of the additional criterialisted below.

Log of Work-Related Injuries and Illnesses

Log

Summary

Summary

Log

Log Summary

Employee Involvement.

Log of Work-Related

Injuries and Illnesses

Log

When is an injury or illness considered

work-related?

Which work-related injuries andillnesses should you record?

An injury or illness is consideredwork-related if an event or exposure in thework environment caused or contributed to thecondition or significantly aggravated apreexisting condition. Work-relatedness is

presumed for injuries and illnesses resultingfrom events or exposures occurring in theworkplace, unless an exception specificallyapplies. See 29 CFR Part 1904.5(b)(2) for theexceptions. The work environment includesthe establishment and other locations whereone or more employees are working or arepresent as a condition of their employment.See 29 CFR Part 1904.5(b)(1).

You must record any significant workrelated injury or illness that is diagnosed by a

physician or other licensed health careprofessional. You must record any work-relatedcase involving cancer, chronic irreversibledisease, a fractured or cracked bone, or apunctured eardrum. See 29 CFR 1904.7.

You must rethey are wor

any needobject thperson’s infectiouany case medically of an OStuberculopositive sor other after exptuberculoan emploreveals 1experien(STS) in (average2) the emdecibels zero ( alsHz) in th

Medical treacaring for a combating dare not consNOT record

visits to a solely for 

What are 

What is 



An Overview:

Recording Work-Related Injuries and Ill

The Occupational Safety and Health (OSH) Act of 1970 requires certain employers to prepare and maintain records of work-related injuries and illnessesdefinitions when you classify cases on the Log. OSHA’s recordkeeping regulation (see 29 CFR Part 1904) provides more information about the definition

U.S. Department of Labor

Occupational Safety and Health Administration






diagnostic procedures, includingadministering prescription medications thatare used solely for diagnostic purposes; andany procedure that can be labeled first aid.( )

You must coninjuries or illn

an injury oor to the ran injury oassault,a mental ia case of Htuberculosa needlestobject that other pote29 CFR Paother illneindependehis or her 

You must not OSHA 300 “privacy case” the employeeconfidential liemployee namconcern cases and provide iasked to do so

If you ha

that informatcase may be pthe employeeuse discretion on both the Omust enter encause of the in

See below for more information about first aid.

Lo

Under wha

NOT enter 

OSHA Form 

What is first aid?If the incident required only the following typesof treatment, consider it first aid. Do NOTrecord the case if it involves only:

using non-prescription medications at nonprescription strength;administering tetanus immunizations;cleaning, flushing, or soaking wounds on theskin surface;using wound coverings, such as bandages,BandAidsTM, gauze pads, etc., or usingSteriStripsTM or butterfly bandages.using hot or cold therapy;using any totally non-rigid means of support,such as elastic bandages, wraps, non-rigidback belts, etc.;using temporary immobilization deviceswhile transporting an accident victim(splints, slings, neck collars, or back boards).drilling a fingernail or toenail to relievepressure, or draining fluids from blisters;using eye patches;using simple irrigation or a cotton swab toremove foreign bodies not embedded in oradhered to the eye;using irrigation, tweezers, cotton swab orother simple means to remove splinters orforeign material from areas other than theeye;

using finger guards;using massages;drinking fluids to relieve heat stress

Restricted work activity occurs when, as theresult of a work-related injury or illness, anemployer or health care professional keeps, orrecommends keeping, an employee from doingthe routine functions of his or her job or fromworking the full workday that the employeewould have been scheduled to work before theinjury or illness occurred.





How do you decide if the case involved

restricted work?

How do you count the number of days

of restricted work activity or the

number of days away from work?

Count the number of calendar days theemployee was on restricted work activity or wasaway from work as a result of the recordableinjury or illness. Do not count the day on whichthe injury or illness occurred in this number.Begin counting days from the day theincident occurs. If a single injury or illnessinvolved both days away from work and days ofrestricted work activity, enter the total numberof days for each. You may stop counting days ofrestricted work activity or days away from workonce the total of either or the combination ofboth reaches 180 days.

after

U.S. Department of Labor

Occupational Safety and Health Administration
Classifying illnesses

Skin diseases or disorders

Respiratory conditions

Hearing Loss

All other illnesses

Skin diseases or disorders are illnesses involvingthe worker’s skin that are caused by workexposure to chemicals, plants, or othersubstances.

Contact dermatitis, eczema, or

rash caused by primary irritants and sensitizersor poisonous plants; oil acne; friction blisters,chrome ulcers; inflammation of the skin.Respiratory conditions are illnesses associatedwith breathing hazardous biological agents,chemicals, dust, gases, vapors, or fumes at work.

Silicosis, asbestosis, pneumonitis,

pharyngitis, rhinitis or acute congestion;farmer’s lung, beryllium disease, tuberculosis,occupational asthma, reactive airwaysdysfunction syndrome (RADS), chronicobstructive pulmonary disease (COPD),hypersensitivity pneumonitis, toxic inhalationinjury, such as metal fume fever, chronicobstructive bronchitis, and otherpneumoconioses.

Noise-induced hearing loss is defined forrecordkeeping purposes as a change in hearingthreshold relative to the baseline audiogram ofan average of 10 dB or more in either ear at2000, 3000 and 4000 hertzAll other occupational illnesses.

Heatstroke, sunstroke, heat

exhaustion, heat stress and other effects ofenvironmental heat; freezing, frostbite, andother effects of exposure to low temperatures;decompression sickness; effects of ionizingradiation (isotopes, x-rays, radium); effects ofnonionizing radiation (welding flash, ultra-violetrays, lasers); anthrax; bloodborne pathogenicdiseases, such as AIDS, HIV, hepatitis B orhepatitis C; brucellosis; malignant or

Examples:

Examples:

Examples:

PoisoningPoisoning includes disorders evidenced byabnormal concentrations of toxic substances inblood, other tissues, other bodily fluids, or thebreath that are caused by the ingestion orabsorption of toxic substances into the body.

Poisoning by lead, mercury,

cadmium, arsenic, or other metals; poisoning bycarbon monoxide, hydrogen sulfide, or othergases; poisoning by benzene, benzol, carbontetrachloride, or other organic solvents;poisoning by insecticide sprays, such asparathion or lead arsenate; poisoning by otherchemicals, such as formaldehyde.

Examples:

benign

tumors; histoplasmosis; coccidioidomycosis.

, and the employee’s

total hearing level is 25 decibels (dB) or moreabove audiometric zero (also averaged at 2000,3000, and 4000 hertz) in the same ear(s).

When mus

How long 

and Summ

Do you ha

OSHA at t

You must po

by Feb

year covered until April 30 You must kee5 years followpertain.No. You do nforms to OSHdo so.

Log —

U.S. Department of Labor

Occupational Safety and Health Administration
What is an incidence rate?

How do you calculate an incidence

rate?

What can I compare my incidence

rate to?

An incidence rate is the number of recordableinjuries and illnesses occurring among a givennumber of full-time workers (usually 100 fulltime workers) over a given period of time(usually one year). To evaluate your firm’sinjury and illness experience over time or tocompare your firm’s experience with that ofyour industry as a whole, you need to computeyour incidence rate. Because a specific numberof workers and a specific period of time areinvolved, these rates can help you identifyproblems in your workplace and/or progressyou may have made in preventing workrelated injuries and illnesses.You can compute an occupational injury andillness incidence rate for all recordable cases orfor cases that involved days away from work foryour firm quickly and easily. The formularequires that you follow instructions inparagraph (a) below for the total recordablecases or those in paragraph (b) for cases thatinvolved days away from work, for bothrates the instructions in paragraph (c).

(a)

count the number of line entries on yourOSHA Form 300, or refer to the OSHA Form300A and sum the entries for columns (G), (H),(I), and (J).

(b)

count

the number of line entries on your OSHAForm 300 that received a check mark incolumn (H), or refer to the entry for column

(H) on the OSHA Form 300A.

(c)

. Refer to OSHA Form

300A and optional worksheet to calculate thisnumber.

You can compute the incidence rate for all

recordable cases of injuries and illnesses usingthe following formula:(The 200,000 figure in the formula representsthe number of hours 100 employees working40 hours per week, 50 weeks per year wouldwork, and provides the standard base forcalculating incidence rates.)

You can compute the incidence rate for

recordable cases involving days away fromwork, days of restricted work activity or jobtransfer (DART) using the following formula:You can use the same formula to calculateincidence rates for other variables such as casesinvolving restricted work activity (column (I)on Form 300A), cases involving skin disorders(column (M-2) on Form 300A), etc. Justsubstitute the appropriate total for these cases,from Form 300A, into the formula in place ofthe total number of injuries and illnesses.The Bureau of Labor Statistics (BLS) conductsa survey of occupational injuries and illnesseseach year and publishes incidence rate data by

various clasemployer sipublished dBLS Region

and

To find out the total number of recordable

injuries and illnesses that occurred during the year,

To find out the number of injuries and

illnesses that involved days away from work,

The number of hours all employees actually

worked during the yearTotal number of injuries and illnesses 200,000 ÷Number of hours worked by all employees = Totalrecordable case rate(Number of entries in column H + Number ofentries in column I) 200,000 ÷ Number of hoursworked by all employees = DART incidence rate

X

X

Optional

Calculating Injury and Illness Incidence 

Worksh

U.S. Department of Labor

Occupational Safety and Health Administration Number 

Column H 

Total numinjuries a
The is

used to classify work-related injuries andillnesses and to note the extent and severityof each case. When an incident occurs, usethe to record specific details about whathappened and how it happened.

We have given you several copies of the

in this package. If you need more than

we provided, you may photocopy and use asmany as you need.

The — a separate form —

shows the work-related injury and illnesstotals for the year in each category. At theend of the year, count the number ofincidents in each category and transfer thetotals from the to the Thenpost the in a visible location so thatyour employees are aware of injuries andillnesses occurring in their workplace.

Log of Work-Related Injuries and Illnesses

Log

Log

Summary

Log Summary.

Summary

If your company has more than one

establishment or site, you must keepseparate records for each physical locationthat is expected to remain in operation forone year or longer.

You don’t post the Log. You post only

the Summary at the end of the year.

How to Fill Out the Log

U.S. Department of Labor

Occupational Safety and Health Administration Revise the lo

progresses a

serious than 

the case. Cr

the original 

Be as specific as possible. You can use two lines if you need more room. 

R

Desand or m

(A) (B) (C) (D) (E) 

You must record information about every work-related death and about every work-related injury or illness that indays away from work, or medical treatment beyond first aid. You must also record significant work-related injuriecare professional. You must also record work-related injuries and illnesses that meet any of the specific recordinuse two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (OSHA Foform. If you’re not sure whether a case is recordable, call your local OSHA office for help.

(Rev. 01/2004)
OSHA’s Form 300 (Rev. 01/2004) 

Log of Work-Related Injuries and Illnesses

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 transdays 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 licensed hecare 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 through 1904.12. Feel free use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on form. If you’re not sure whether a case is recordable, call your local OSHA office for help.

Be sure to transfer these 

Page totals

month/day

month/day

month/day

month/day

month/day

month/day

month/day

month/day

month/day

month/day

month/day

month/day

month/day

Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time to reviewthe instructions, search and gather the data needed, and complete and review the collection of information. Persons are not requiredto respond to the collection of information unless it displays a currently valid OMB control number. If you have any commentsabout these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of StatisticalAnalysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.

(A) (B) (C) (D) (E) (F)

D

Attentionemployee heprotects the possible whoccupationa

C

b

t

Identify the person Describe the case CCase Employee’s name Job title Date of injury Where the event occurred Describe injury or illness, parts of body affected,

of illness or made person ill (

no. or onset and object/substance that directly injured

e.g., Second degree burns on

e.g., Welder e.g., Loading dock north end

right forearm from acetylene torch

( ) ( )

)

_____ ________________________ ____________ ______/___ _______ __________________ ___________________ ________________________________ _____ ________________________ ____________ ______/___ _______ __________________ ________________________________ ___________________ 

_____ ________________________ ____________ ______/___ _______ __________________ ______________________ _____________________________ _____ ________________________ ____________ ______/___ _______ __________________ ______________________ _____________________________ _____ ________________________ ____________ ______/___ _______ __________________ ___________________ ________________________________ _____ ________________________ ____________ ______/___ _______ __________________ ______________________________ ______________________ _____ ________________________ ____________ ______/___ _______ __________________ ______________________________ ______________________ _____ ________________________ ____________ ______/___ _______ __________________ ______________________________ ______________________ _____ ________________________ ____________ ______/___ _______ __________________ ______________________________ ______________________ _____ ________________________ ____________ ______/___ _______ __________________ ___________________ _________________________________ _____ ________________________ ____________ ______/___ _______ __________________ ______________________________ ______________________ _____ ________________________ ____________ ______/___ _______ __________________ ______________________________ ______________________ _____ ________________________ ____________ ______/___ _______ __________________ ___________________ _________________________________ 
OSHA’s Form 300A (Rev. 01/2004) 

Summary of Work-Related Injuries and Illne

Total number ofdeaths__________________

Total number ofcases with daysaway from work__________________

Number of Cases

Total number of days awayfrom work___________

Total number of days of jobtransfer or restriction___________

Number of Days

Post this Summary page from February 1 to April 30 of the year following the year covered by the form.

All establishments covered by Part 1904 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the to verify that the entries are complete and accurate before completing this summary.

Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you’ve added the entries from every page of the Log. If y

had no cases, write “0.”

Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 

its equivalent. See 29 CFR Part 1904.35, in OSHA’s recordkeeping rule, for further details on the access provisions for these forms.

Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instructions, search and gather the data needed, andcomplete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have anycomments about these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW,Washington, DC 20210. Do not send the completed forms to this office.

Total number of...Skin disorders ______Respiratory conditions ______Injuries ______

Injury and Illness Types

Poisonings ______Hearing lossAll other illnesses ______

______

(G) (H) (I) (J)

(K) (L)

(M)

(1)(2)(3)

(4)(5)(6)

Total number ofcases with jobtransfer or restriction__________________

Total number ofother recordablecases__________________
At the end of the year, OSHA requires you to enter the average number of employees and the total hours worked by your employees on the summary. If y

information on this page to estimate the numbers you will need to enter on the Summary page at the end of the year.

For example, Acme Construction figured its average employment this way:For pay period... Acme paid this number of employees...1 102 03 154 305 4024 2025 1526 +

830

▼ ▼

10

How to figure the average number of employees

who worked for your establishment during the

year:



Add

Count

Divide

Round the answer

the total number of employees your

establishment paid in all pay periods during theyear. Include all employees: full-time, part-time,temporary, seasonal, salaried, and hourly.

the number of pay periods your

establishment had during the year. Be sure toinclude any pay periods when you had noemployees.

the number of employees by the number of

pay periods.

to the next highest whole

number. Write the rounded number in the blankmarked Annual average number of employees.

The number of employeespaid in all pay periods =

The number of payperiods during the year =

=

The number rounded =



How to figure Include hours wwell as hours woyour establishme

Do not includ

even if employeethe hours paid oestimate the hou

If this numbe

estimate it.

OptionalWorksheet to Help You Fill Out the Summ

U.S. Department of Labor

Occupational Safety and Health Administration 

x

+

Optional Wor

Number of employees paid = 830Number of pay periods = 26

= 31.92

2631.92 rounds to 3232 is the annual average number of employees830
Information about the employee

Information about the physician or other health care

professional

Full nameStreetCity State ZIPDate of birthDate hired

MaleFemale

Name of physician or other health care professionalIf treatment was given away from the worksite, where was it given?FacilityStreetCity State ZIPWas employee treated in an emergency room?

YesNo

Was employee hospitalized overnight as an in-patient?

YesNo

_____________________________________________________________

________________________________________________________________

______________________________________ _________ ___________

______ / _____ / ______

______ / _____ / ______

__________________________

________________________________________________________________________

_________________________________________________________________

_______________________________________________________________

______________________________________ _________ ___________



OSHA’s Form 301

Injury and Illness Incident Report

This is one of thefirst forms you must fill out when a recordable workrelated injury or illness has occurred. Together withthe and theaccompanying these forms help theemployer and OSHA develop a picture of the extentand severity of work-related incidents.

Within 7 calendar days after you receive

information that a recordable work-related injury orillness has occurred, you must fill out this form or anequivalent. Some state workers’ compensation,insurance, or other reports may be acceptablesubstitutes. To be considered an equivalent form,any substitute must contain all the informationasked for on this form.

According to Public Law 91-596 and 29 CFR

1904, OSHA’s recordkeeping rule, you must keepthis form on file for 5 years following the year towhich it pertains.

If you need additional copies of this form, you

may photocopy and use as many as you need.

Injury and Illness Incident Report

Log of Work-Related Injuries and Illnesses

Summary,

InCDTTW

W

W

W

If 

tocafedmtu“

Completed byTitlePhone Date

_______________________________________________________

_________________________________________________________________

(________)_________--_____________ _____/ ______ / _____

Public reporting burden for this collection of information is estimated to average 22 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaini

collection of information unless it displays a current valid OMB control number. If you have any comments about this estimate or any other aspects of this data collection, including suggestions for reducing 

Washington, DC 20210. Do not send the completed forms to this office.

10)11)12)13)14)15)

16)

17)

18)

1)2)3)5)6)7)8)9)4)

Attentionemployee heprotects the possible whoccupationa
If you need help deciding whether a case is recordable, or if you have questions about the information in this package, f

contact us. We’ll gladly answer any questions you have.

If You Need Help...



Visit us online at www.osha.govCall your OSHA Regional officeand ask for the recordkeepingcoordinatororCall your State Plan office

Federal Jurisdiction Region 1 - 617 / 565-9860Region 2 - 212 / 337-2378Region 3 - 215 / 861-4900Region 4 - 404 / 562-2300Region 5 - 312 / 353-2220Region 6 - 214 / 767-4731Region 7 - 816 / 426-5861Region 8 - 303 / 844-1600Region 9 - 415 / 975-4310Region 10 - 206 / 553-5930Connecticut; Massachusetts; Maine; Ne

Hampshire; Rhode Island

New York; New Jersey

DC; Delaware; Pennsylvania; West Virgin

Alabama; Florida; Georgia; Mississippi

Illinois; Ohio; Wisconsin

Arkansas; Louisiana; Oklahoma; Texas

Kansas; Missouri; Nebraska

Colorado; Montana; North Dakota; South

Dakota

Idaho

U.S. Department of Labor

Occupational Safety and Health Administration
U.S. Department of Labor

Occupational Safety and Health Administration