Wednesday, August 27, 2008
Medina County Safety Council
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Sponsored by the Division of Safety and Hygiene in cooperation with the Greater Medina Chamber of Commerce.

145 North Court Street
Medina Ohio 44256


330.723.8773 - phone
330.722.6844 - fax

safety@medinaohchamber.com

Semi Annual Report Form

 

Medina County Safety Council
SEMI - ANNUAL REPORT

FIRST HALF 2008 - January 1 thru June 30, 2008
due by July 15, 2008

*First Name:
*Last Name:
*Company:
*Email:
Feedback / Message:

Date of MOST RECENT injury or illness resulting in day(s) away from work:
*Date of MOST RECENT injury or illness :

Report all information below for  CURRENT SIX MONTH PERIOD ONLY - January 1, 2008 thru June 30, 2008
*Average number of Employees :
*Total Hours worked - entire six month period :

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.

*Number of deaths (January 1 thru June 30, 2008):

The number of occupational injuries and or illnesses resulting in days away from work (column H in the OSHA 300 Log)

*Number of occupational injuries or illnesses:
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 January 1, 2008 thru June 30, 2008.
*Number of days away from work:
 
 

PLEASE SUBMIT THIS REPORT ON OR BEFORE 
JULY 15, 2008
THANK YOU

 

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