OSHA 300 Log

• Case No.

• Employee Name (Optional)

• Establishment name

• Conducted on

  Date

• Prepared by

Log of Work-Related Injuries and Illnesses

• Job title

• Date of injury or onset of illness

  Date

• Where the event occurred

• Type of incident

  Select Injury Skin disorder Respiratory condition Poisoning Hearing loss Other illnesses

  • Injury
  • Skin disorder
  • Respiratory condition
  • Poisoning
  • Hearing loss
  • Other illnesses

• Describe injury or illness, parts of body affected, and object/substance that directly injured or made person ill.

• Upload photos of incident

  Media

• Classify the case. Check only one box for each case based on the most serious outcome for that case:

  Death

  Days away from work

  Job transfer or restriction

  Other recordable cases

• Please specify

• No. of days the injured or ill worker was away from work

• No. of days the injured or ill worker was on a job transfer or restriction

Completion

• Observations and comments

• Full Name and Signature of Record Keeper

  Sign