Form Mechanical Power P Mechanical Power P Mechanical Power Presses Injury Form

Mechanical Power Presses Injury Form | Occupational Safety and Health Administration
UNITED STATES
DEPARTMENT OF LABOR

OSHA

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Mechanical Power Presses Injury Form
In accordance with 29 CFR 1910.217(g) employers must report within 30 days all point of operations injuries to operators or other employees. Employers may
either mail the following information to the following address: Directorate of Standards and Guidance (insert footnote stating formerly Director of Safety
Standards) OSHA, U.S. Department of Labor, Washington D.C. 20210, or the State agency administering a plan approved by the Assistant Secretary of Labor for
Occupational Safety and health; or, employers may email the information by completing the following items.

OMB Control Number: 1218-0070

Expiration Date: October 31, 2018

Public reporting for this collection of information is estimated to average 20 minutes per response, including the 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 currently valid Office of Management and Budget Control Number. If you have any comments regarding this estimate
or any other aspect of this information collection, including suggestions for reducing this burden, please send them to OSHA's Office of Engineering Safety, Room
N-3609, 200 Constitution Avenue, NW, Washington, DC 20210.

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UNITED STATES
DEPARTMENT OF LABOR

Occupational Safety and Health Administration
200 Constitution Ave NW
Washington, DC 20210
¨ 800-321-6742 (OSHA)
TTY
www.OSHA.gov
FEDERAL GOVERNMENT

OCCUPATIONAL SAFETY AND HEALTH

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Accessibility Statement

Office of Inspector General

https://www.osha.gov/pls/oshaweb/mechanical.html

10/15/2018

Mechanical Power Presses Injury Form | Occupational Safety and Health Administration
UNITED STATES
DEPARTMENT OF LABOR

OSHA

Page 1 of 2

­¬ŧ±

English | Spanish

Find it in OSHA

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ABOUT OSHA

WORKERS

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DATA

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Mechanical Power Presses Injury Form
1. Employer's Name

2. Address of establishment
City
State



Select a State

Zip Code

3. Employee's Name

4. Describe the type of Injury sustained

5. Type of clutch used on the press

Select a clutch used



6. Type of safeguard(s) being used

Select a safeguard



7. Cause of the accident

8. Type of feeding



Select a accident cause

Select a feeding type

9. Means used to actuate press stroke



Select a means

10. Number of operators required for the operation



Select a task

Type of task being performed when injury was sustained

0





https://www.osha.gov/pls/oshaweb/!Mechanical.PowerPress_form?session_id=591583598

10/15/2018

Mechanical Power Presses Injury Form | Occupational Safety and Health Administration
11. Number of operators provided with controls and safeguards

0

Page 2 of 2



** Response to Item 12 is voluntary **
12. What corrective action has been taken, if any

Submit Form

Clear Form

UNITED STATES
DEPARTMENT OF LABOR

Occupational Safety and Health Administration
200 Constitution Ave NW
Washington, DC 20210
¨ 800-321-6742 (OSHA)
TTY
www.OSHA.gov
FEDERAL GOVERNMENT

OCCUPATIONAL SAFETY AND HEALTH

ABOUT THE SITE

White House

Frequently Asked Questions

Freedom of Information Act

Disaster Recovery Assistance

A - Z Index

Privacy & Security Statement

USA.gov

Freedom of Information Act

Disclaimers

No Fear Act Data

Read the OSHA Newsletter

Important Website Notices

U.S. Office of Special Counsel

Subscribe to the OSHA Newsletter

Plug-Ins Used by DOL

OSHA Publications

Accessibility Statement

Office of Inspector General

https://www.osha.gov/pls/oshaweb/!Mechanical.PowerPress_form?session_id=591583598

10/15/2018