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How to Fill Out the Log

The

Log of Work-Related Injuries and Illnesses

used to classify work-related injuries and

Attention: This form contains information relating to

illnesses and to note the extent and severity

employee health and must be used in a manner that

(Rev. 01/2004)

of each case. When an incident occurs, use

protects the confidentiality of employees to the extent

possible while the information is being used for

the

Log

to record specific details about what

occupational safety and health purposes.

happened and how it happened.

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 transfer,

Form approved OMB no. 1218-0176

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 licensed health

XYZ Company

If your company has more than one

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 through 1904.12. Feel free to

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 this

Anywhere

establishment or site, you must keep

form. If you’re not sure whether a case is recordable, call your local OSHA office for help.

separate records for each physical location

CHECK ONLY ONE box for each case

Enter the number of

(A)

(B)

(C)

(D)

(E)

(F)

based on the most serious outcome for

days the injured or

Check the “Injury” column or

that is expected to remain in operation for

that case:

Describe injury or illness, parts of body affected,

ill worker was:

choose one type of illness:

and object/substance that directly injured

Remained at Work

one year or longer.

(M)

or made person ill

Away

On job

from

transfer or

Days away

Job transfer

Other record-

work

restriction

Death

from work

or restriction

able cases

We have given you several copies of the

(G)

(H)

(I)

(J)

(K)

(L)

Log

in this package. If you need more than

(1)

(2)

(3)

(4)

(5)

(6)

we provided, you may photocopy and use as

many as you need.

The

Summary

— a separate form —

shows the work-related injury and illness

totals for the year in each category. At the

end of the year, count the number of

incidents in each category and transfer the

totals from the

Log

to the

Summary.

Then

post the

Summary

in a visible location so that

your employees are aware of injuries and

illnesses occurring in their workplace.

You don’t post the Log. You post only

the Summary at the end of the year.

Be as specific as possible. You

can use two lines if you need

more room.

Choose ONLY ONE of these

Note whether the

categories. Classify the case

case involves an

by recording the most

injury or an illness.

serious outcome of the case,

Revise the log if the injury or illness

with column G (Death) being

progresses and the outcome is more

the most serious and column

serious than you originally recorded for

J (Other recordable cases)

the case. Cross out, erase, or white-out

being the least serious.

the original entry.

Osha'S Form 300 (Rev. 01/2004) - Log Of Work-Related Injuries And Illnesses With Instructions

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