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Get Cal/OSHA 300A 2007

Appendix B Cal/OSHA Form 300A Rev. 7/2007 Year 20 Annual Summary of Work-Related Injuries and Illnesses All establishments covered by CCR Title 8 Section 14300 must complete this Annual Summary even if no work-related injuries or illnesses occurred during the year. They also have limited access to the Cal/OSHA Form 301 or its equivalent. See CCR Title 8 Section 14300. If you had no cases write 0. Employees former employees and their representatives have the right to review the Cal/OSHA Form 300 in its entirety. Remember to review the Log 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 o f the Log. 35 in Cal/OSHA s recordkeeping rule for further details on the access provisions for these forms. Department of Indu trial Relations s Divisio of Occ tional Sa Health n upa fety Establishment information Your establishment name Street City State ZIP Number of Cases Total number of deaths cases with days away from work cases with job transfer or restriction G other recordable cases Industry description e*g* Manufacture of motor truck trailers H I J Standard Industrial Classification SIC if known e*g* SIC 3715 Employment information If you don t have these figures use the optional Worksheet to estimate. Number of Days Annual average number of employees K Total hours worked by all employees last year L Sign here Knowingly falsifying this document may result in a fine. Injury and Illness Types I certify that I have examined this document and that to the best of my knowledge the entries are true accurate and complete. M 2 Skin disorders 3 Respiratory conditions 4 Poisonings Company executive Title 5 Hearing loss 1 Injuries Phone Dat e 6 All other Illnesses t Post this Annual Summary from February 1 to April 30 of the year following the year covered by the form* ga. Remember to review the Log 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 o f the Log. 35 in Cal/OSHA s recordkeeping rule for further details on the access provisions for these forms. Department of Indu trial Relations s Divisio of Occ tional Sa Health n upa fety Establishment information Your establishment name Street City State ZIP Number of Cases Total number of deaths cases with days away from work cases with job transfer or restriction G other recordable cases Industry description e*g* Manufacture of motor truck trailers H I J Standard Industrial Classification SIC if known e*g* SIC 3715 Employment information If you don t have these figures use the optional Worksheet to estimate. Number of Days Annual average number of employees K Total hours worked by all employees last year L Sign here Knowingly falsifying this document may result in a fine. .

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