California Injury Report Form
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How to fill out Injury Report Form?
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FAQ
Occupational Safety and Health Administration (OSHA) Form 301, ?Injury and Illness Incident Report,? is used by employers to keep a record of a single injury, illness, or death in a workplace.
? Form 300-A is the Summary of Work-Related Injuries and Illnesses, which is. to be posted in the workplace annually. At the end of each calendar year, Form 300-A must be completed and certified by a company executive as correct and complete and posted in the workplace where notices to workers are usually posted.
The Cal/OSHA Form 300 is called the Log of Work-Related Injuries and Illnesses, the Cal/OSHA Form 300A is called the Summary of Work-Related Injuries and Illnesses, and the Cal/OSHA Form 301 is called the Injury and Illness Incident Report.
How does OSHA define a recordable injury or illness? Any work-related fatality. Any work-related injury or illness that results in loss of consciousness, days away from work, restricted work, or transfer to another job. Any work-related injury or illness requiring medical treatment beyond first aid.
You must complete an Injury and Illness Incident Report (Cal/OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable, call your local Cal/OSHA office for help.
Contact DIR to request an interpreter over the phone: Office NameTopicPhone NumbersCal/OSHAWorkplace Safety and Health833-579-0927Labor Commissioner's OfficeWages, breaks, retaliation and labor laws833-526-4636Division of Workers' CompensationBenefits for work-related injuries and illnesses1-800-736-74011 more row
The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid*.
All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.
