Survey of Occupational Injuries and Illnesses - Private Sector

OMB No. 1220-0045

DISTRICT OF COLUMBIA DEPARTMENT OF LABOR

STATE SECONDARY NAME

STREET ADDRESS

MONTGOMERY, AL 36130-3500

U.S. Department of Labor

Bureau of Labor Statistics

For Help

Call: 334-242-3462 ext. 9999

334-242-3463 ext. 9999

334-242-3463 ext. 9999

334-242-3463 ext. 9999

Fax: 334-242-3333

User ID: 302203479880

Temporary Password: AnsU5155

NAICS: 512110 - Motion Picture and Video Production

12345 50

2019 Establishment ID: 01-203479880-1

Report for:

The Unit Description goes here

PRIMARY COMPANY NAME

{SECONDARY COMPANY NAME}

ADDRESS LINE 1

ADDRESS LINE 2

CITY, STATE ZIP-PLUS+4

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MANDATORY REPORT – DATED MATERIAL

U.S. GOVERNMENT DOCUMENTS ENCLOSED

Instructions for Completing the

2019 Survey of Occupational Injuries and Illnesses

YOUR RESPONSE IS REQUIRED BY LAW WITHIN 30 DAYS

^{How to Report Your Data}

• Report your data to the Bureau of Labor Statistics (BLS) online at: https://idcf.bls.gov

• Use the login credentials above when logging in for 2019; credentials are reset every year

• Check the User IDs and Establishment IDs if you receive multiple forms; you may have to report data for more than one establishment

• Report case circumstances and worker characteristics both for cases that resulted in days away from work (with or without days of job transfer or restriction) AND for cases that resulted in days of job transfer or restriction (without days away from work)

• Contact us using the telephone number(s) listed above for questions about this survey

• For alternate reporting methods, please contact your state office at the telephone number listed above.

We estimate it will take you an average of 24 minutes to complete this survey (ranging from 10 minutes to 5 hours per package), including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this information. If you have any comments regarding the estimates or any other aspect of this survey, including suggestions for reducing this burden, please send them to the Bureau of Labor Statistics, Occupational Safety and Health Statistics (1220-0045), 2 Massachusetts Avenue, N.E., Washington, DC 20212. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. DO NOT SEND THE COMPLETED FORM TO THIS ADDRESS.

The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act (44 U.S.C. 3572) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.

BLS-9300-IDCF

Under Public Law 91-596, all establishments that receive this survey must complete and return it within 30 days, even if they had no work-related injuries and illnesses during 2019.

In December 2018, you were notified to participate in the BLS 2019 Survey of Occupational Injuries and Illnesses (SOII) and asked to maintain records of workplace injuries and illnesses throughout 2019.

Forms to help you complete the survey

• OSHA’s Form 300 - Log of Work-Related Injuries and Illnesses; includes all injuries and illnesses for the year

• OSHA’s Form 300A - Summary of Work-Related Injuries and Illnesses; includes average employment and total hours worked

• OSHA’s Form 301 - Injury and Illness Incident Report; includes detailed injury and illness data

If the detailed case information requested is not recorded on your OSHA forms, please refer to other sources of information you may have (including your Workers’ Compensation records).  Please note, however, that OSHA’s rules (www.osha.gov/recordkeeping) concerning which injuries and illnesses to record differ from your state’s Workers’ Compensation reporting. 

How to Use the BLS Internet Data Collection Facility

Before reporting your data, you must register online with the BLS even if you have done so in previous years or for other BLS surveys. Please ensure that the individual registering this account will be the person entering data for the Survey of Occupational Injuries and Illnesses.

1. Type https://idcf.bls.gov directly into your Internet browser. The “s” in “https” is required.

2. Enter the 12-digit User ID in the field labeled “User ID” and the Temporary Password in the field labeled “Password”. Click I Accept.

U.S. Department of Labor

Bureau of Labor Statistics

Your NAICS

You will need your User ID and temporary password if you report using the Internet.

For Help

Call: 555-555-5555

555-555-5555

Fax: 555-555-5555

User ID:

302203479880

Temporary Password:

AnsU5155

NAICS: 512110 - Motion Picture and Video Production

3. Complete the “Check Email Address”, “Enter New User Information” and “Create a Permanent Password” pages.

4. Click Continue on the “Confirmation Notice” page.

5. Report your data and click Submit when you are finished. Print a copy of the completed survey for your records.

6. You may log onto the website using your User ID and permanent password at any time to make corrections to your data.

You can report for additional establishment IDs by logging into the survey again, clicking the Continue button on the “Dear Employer” page, and then clicking Add Establishment.

For alternate reporting methods, please contact your state office at the telephone number listed under “For Help” on the front page.

Need help?

• For step-by-step account creation instructions or website technical help, go to http://www.bls.gov/idcf/instructions.htm.

• For questions about this survey, contact us using the telephone number(s) listed on the front of this form.

• For information about SOII, including frequently asked questions and to download forms, go to http://www.bls.gov/respondents/iif/.

• For information about OSHA record keeping guidelines, go to https://www.osha.gov/recordkeeping/entryfaq.html.

To see how your data will be used, please visit our website at http://www.bls.gov/iif.