OSHA Form 301 for Reporting Incident

The filing of the report is at the discretion of the Job Supervisor. However, it is recommended that an injury report be filed for each reported injury incident, no matter the severity. It is better to file a report and not need it than to need a report and not have filed it.

IMPORTANT:

This form contains information relating to worker health and must be used in a manner that protects the confidentiality of workers 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 to 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.

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.
RISK MANAGER
File in Safety Compliance
folder for minimum 5 years.




We are issuing an Injury or Illness Incident Report

Information relating to the affected person

Information about treatment

Information about the case

What was the nature of the injury or illness?
What was the employee doing just before the incident occured?
What happened?
What object or substance directly harmed the employee?

Follow-Up

Send to

When the “Send Report” button is selected, an email with all the information in this Report will be sent to the email addresses provided.