Monday, December 17, 2018


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Sponsored by the Division of Safety and Hygiene in cooperation with the Greater Medina Chamber of Commerce.

211 South Court Street
Medina, OH 44256


330.723.8773 - phone

Safety@MedinaOhChamber.com

Semi Annual Report Form

Medina County Safety Council
SEMI - ANNUAL REPORT

FIRST HALF 2018
January 1, 2018-  June 30, 2018
due by July 15, 2018

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

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

  • Report all information below for  CURRENT SIX MONTH PERIOD ONLY - JANUARY 1, 2018 THRU JUNE 30, 2018 (corresponds with period identified above)
  • *2) Average number of Employees :
  • 3) Total Hours WORKED - entire six month period :


  • Items 4, 5 and 6 are based on the Recordkeeping Requirements under the Occupational Safety & Health Act of 1970.

    The fields listed below correspond to the columns in the OSHA 300 Log and PERRP Form 300P.


    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.

  • *4) Number of deaths :
  • The number of occupational injuries and or illnesses resulting in days away from work (column H in the OSHA 300 Log/PERRP Form 300P) 
  • *5) 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/PERRP Form 300P)  
  • *6) Number of days away from work:
  • PLEASE SUBMIT July15, 2018
    THANK YOU
    Please Note: Submissions before July 1, 2018 will not be accepted.
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