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U.S. Department of Labor

## Occupational Safety and Health Administration

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**Form No. OSHA 6-40.1.**

### Serious Event Reporting Online Form

----

Validation Check - Enter State of Event to determine reporting requirements.
***State   **

**NOTE: For employers covered by Federal OSHA that are located in State Plan States, to make a report                  - Call the nearest  OSHA office .
- Call the OSHA 24-hour hotline at 1-800-321-6742 (OSHA).**

----

**OMB Control Number: 1218-0176**

**Expiration Date: April 30, 2025**

OSHAPRA@dol.gov

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U.S. Department of Labor

Occupational Safety and Health Administration200 Constitution Ave NW                                                                                    Washington, DC 20210                                          **1-800-321-OSHA1-800-321-6742www.osha.gov

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