OSHA 300 Log of Work-Related Injuries and Illnesses

OSHA’s Form 300 (Rev. 01/2011. Previous versions are not to be used.)

Log of Work-Related Injuries and Illnesses

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.

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Paperwork Reduction Act Statement
Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time
to review the instructions, search and gather the data needed, and complete and review the collection of information.
Response to this data collection is mandatory pursuant to 29 CFR Part 1904. Persons are not required to respond to the
collection of information unless it displays a currently valid OMB control number. If you have any comments about these
estimates or any other aspects of this data collection, 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.

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(1)

(2) (3)

All other
illnesses

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(L)

Hearing loss

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(K)

Musculoskeletal
disorders

(J)

Poisoning

(I)

(4) (5) (6) (7)

____ days ____ days
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Page totals
Be sure to transfer these totals to the Summary page (Form 300A) before you post it.

Page ____ of ____

(1)

(2) (3)

All other
illnesses

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(H)

Hearing loss

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(G)

On job
transfer or
restriction

Musculoskeletal
disorders

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Other recordable cases

Away
from
work

Poisoning

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Days away Job transfer
from work or restriction

Check the “Injury” column or
choose one type of illness:

(M)

Remained at Work
Death

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Enter the number of
days the injured or
ill worker was:

Skin disorder

(F)
Describe injury or illness, parts of body affected,
and object/substance that directly injured
or made person ill (e.g., Second degree burns on
right forearm from acetylene torch)

Respiratory
condition

(E)
Where the event occurred
(e.g., Loading dock north end)

Respiratory
condition

(D)
Date of injury
or onset
of illness

Classify the case
CHECK ONLY ONE box for each case
based on the most serious outcome for
that case:

Skin disorder

(C)
Job title
(e.g., Welder)

City ________________________________ State ___________________

Injury

(B)
Employee’s name

Establishment name ___________________________________________

Injury

(A)
Case
no.

Describe the case

U.S. Department of Labor
Occupational Safety and Health Administration

Form approved OMB no. 1218-0176

You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer,
days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health
care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR Part 1904.8 through 1904.12. Feel free to
use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this
form. If you’re not sure whether a case is recordable, call your local OSHA office for help.

Identify the person

Year 20__ __

(4) (5) (6) (7)