OSHA Form 301 for Reporting Incident

Attention: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes.

This is one of the first forms you must fill out when a recordable work-related injury or illness has occurred. Together with the Log of Work-Related Injuries and Illnesses and the accompanying Summary, these forms help the employer and OSHA develop a picture of the extent and severity of work-related incidents.

Within 7 calendar days after you receive information that a recordable work-related injury or illness has occurred, you must fill out this form or an equivalent. Some state workers’ compensation, insurance, or other reports may be acceptable substitutes. To be considered an equivalent form, any substitute must contain all the information asked for on this form.

According to Public Law 91-596 and 29 CFR 1904, OSHA’s recordkeeping rule, you must keep this form on file for 5 years following the year to which it pertains.

No information you provide on this form is stored by this or any other website. When submitted, form responses are sent to the email addresses provided and then deleted.
IF YOU WISH TO RETAIN THE INFORMATION YOU HAVE ENTERED, ADD AN EMAIL ADDRESS AND SUBMIT.

OSHA Form 301
Injury and Illness Incident Report





SITE SUPERVISOR - Complete when a reportable incident has occurred.
PROJECT MANAGER - Copy to Project Binder, Copy to Accounting/Risk Management.
ACCOUNTING/RISK MANAGEMENT - File in Safety Compliance folder for minimum 5 years.








Information about the employee

Information about the physician or other health care professional

Information about the case

Case number from the log
What was the employee doing just before the incident occured?
What happened?
What was the injury or illness?
What object or substance directly harmed the employee?
Public reporting burden for this collection of information is estimated to average 22 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Persons are not required to respond to the collection of information unless it displays a current valid OMB control number. If you have any comments about this estimate or any other aspects of this data collection, including suggestions for reducing this burden, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.

When the “Send Inspection Report” button is selected, an email with all the information in this Inspection Report will be sent to the “Builder email” address of the Company Representative completing this report and to the “Subcontractor email” address and “Copy to” addresses if provided.

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