Osha Work-Related Injury And Illness Data Collection Form, 2011 (Page 3 of 4) in pdf

Establishment Information

Using your completed calendar year 2011 Summary of Work-Related Injuries and Illnesses (OSHA Form 300A), copy the establishment

information into the boxes below. If these numbers are not available on your OSHA Form 300A, or if your establishment does not keep

records needed to answer (1) and (2) below, you can estimate using the steps that follow.

1. For the reporting site identified on the cover: Enter

2. For the reporting site identified on the cover:

the annual average employment for 2011. (You can

Enter the total hours worked for 2011. (You can

copy this from your OSHA Form 300A.)

Annual average number

Total hours worked

of employees for 2011

by all employees in 2011

Note: Total Hours Worked should exclude vacation, sick leave,

If needed: Steps to estimate employment

holidays, and other non-work time.

STEP 1: Add the number of employees your establish-

If needed: Steps to estimate total hours worked

ment paid in every pay period during 2011. Include all

employees: full-time, part-time, temporary, seasonal,

STEP 1: Find the number of full-time employees in your

salaried, and hourly.

establishment for 2011.

Acme Construction pays its employees 26 times each year.

ABC Company had 15 full-time employees during 2011.

During 2011,

STEP 2: Multiply this number by the number of hours

In this pay period

Acme paid this many

worked for a full-time employee in a year. This is equal

employees

to the number of full-time hours worked:

1 ..................................... 30

2 ..................................... 0

ABC Company’s 15 full-time employees worked an average of about

3 ..................................... 35

1,760 hours each per year after excluding vacation, sick leave, holi-



days, and other non-work time. (The hours worked for a full-time

25 ................................... 36

employee in a year may be different at your reporting site)

26 ................................... 32

830 (sum)

15 (full-time employees) times 1,760 (hours worked by a full-time

employee in a year) equals 26,400 full-time hours.

STEP 2: Divide the sum by the number of pay periods

your establishment had in 2011. Include any pay peri-

STEP 3: Add the number of any overtime hours and the

number of hours worked by other employees (part-time,

ods when you had no employees.

temporary, seasonal) to the amount in Step 2:

Because Acme has 26 pay periods, it would divide its sum by 26.

ABC Company’s full time employees worked a total of 1,500 hours

830 divided by 26 = 31.92

of overtime. In addition, 3 part time employees worked a total of

2,715 hours during 2011. Adding these hours to those from Step 2:

STEP 3: Round the answer to the next highest whole

number. Write the rounded number in the box marked

Full-time hours from Step 2

26,400

Annual average number of employees.

Overtime hours

1,500

Part-time hours

2,715

Acme would round 31.92 to 32 and write that number in

Total hours worked by all employees in 2011

30,615

the box marked Annual average number of employees.

3. Check any conditions that might have affected your annual average number of employees or total hours

worked during 2011:

 Strike or lockout

 Shorter work schedules or fewer pay periods than usual

 Shutdown or layoff

 Longer work schedules or more pay periods than usual

 Seasonal work

 Other reason: _____________________________________

 Natural disaster or adverse weather conditions

 Nothing unusual happened to affect our employment or

hours figures

Osha Work-Related Injury And Illness Data Collection Form, 2011 Page 3

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