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Date of MOST RECENT injury or illness resulting in day(s) away from work:
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*Date of MOST RECENT injury or illness :
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Report all information below for CURRENT SIX MONTH PERIOD ONLY - JULY 2011 thru DECEMBER 31, 2011
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*Average number of Employees :
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*Total Hours worked - entire six month period :
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Data for the following questions is based on the Recordkeeping Requirements under the Occupational Safety & Health Act of 1970 (rev. 1/1/2002). The columns listed below correspond to the columns in the OSHA 300 Log. If you report a death, injury or illness resulting in days away from work in the current six month period, the most recent date of death, injury or illness must correspond with item 1.
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*Number of deaths (July 1 thru December 31, 2011):
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The number of occupational injuries and or illnesses resulting in days away from work (column H in the OSHA 300 Log) (July 1 thru December 31, 2011)
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*Number of occupational injuries or illnesses :
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Number of days away from work as a result of occupational injuries and/or illnesses (Column K in the OSHA 300 Log) Total of all days missed from all occupational injuries or illnesses during July 1 thru December 31, 2011
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*Number of days away from work:
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