Get Miosha Form

The Miosha Form is essential for reporting work-related injuries and illnesses within your establishment. Completing this form accurately ensures compliance with Michigan regulations and helps maintain a safe workplace for all employees.

Follow the steps to fill out the Miosha Form online.

1. Click the ‘Get Form’ button to access the Miosha Form and open it in your editor.
2. Begin by entering your establishment information. Provide the name of your establishment, street address, city, state, and zip code. This information helps identify your business and should match official records.
3. Next, count the number of work-related injuries and illnesses recorded throughout the year. Use the previous log entries to tally each category accurately. Even if no injuries occurred, you must enter '0' for each category.
4. Fill in the totals for various case types: total number of deaths, total number of cases with days away from work, total number of cases with job transfer or restriction, and total number of other recordable cases. Ensure that each number corresponds with your log counts.
5. Indicate the total number of days away from work and the total number of days of job transfer or restriction. This information provides insight into the severity of reported cases.
6. Report the total number of injuries and illnesses, segregated into types (e.g., injuries, skin disorders, respiratory conditions, poisonings, hearing loss, and other illnesses). Ensure totals are derived from your records.
7. Review the document to ensure all entries are accurate and complete. Signature is required from a company executive to certify the information provided is true to the best of their knowledge.
8. Once all sections are complete, save your changes. You may then download, print, or share the completed form as necessary.

Take action now and complete the Miosha Form online to ensure compliance and promote workplace safety.