| Semi-Annual Report |
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JEFFERSON COUNTY SAFETY COUNCIL Co-sponsored by BWC’s Division of Safety and Hygiene Semi-Annual Report [ ] (for period January 1 – June 30, 2011) [ ] (for period July 1 – December 31, 2011) Safety Council Account Number ________________ / ___ ___ / ___ ___ / ___ ___ Company Name ____________________________________________ Phone __________________ Address __________________________________________________ Fax ____________________ City / State / Zip ____________________________________________________________________ Submitted By ______________________________________________ Date ___________________ Please check here if information provided above has been updated on this report. 1.) DATE OF MOST RECENT INJURY OR ILLNESS RESULTING IN DAY(S) AWAY FROM WORK ______ / ______ / ______ Month Day Year *********************************************************************************************************** Report All Information Below For CURRENT SIX MONTH PERIOD ONLY (corresponds with period identified above) 2.) Average Number of Employees...................................................................................... ___________ 3.) Total Hours Worked (entire six month period, all employees) ..................................................... ___________ *********************************************************************************************************** Items 4, 5 and 6 are based on the Recordkeeping Requirements under the Occupational Safety & Health Act of 1970 (rev. 1/1/02). The columns listed below correspond to the columns in the OSHA 300 Log. 4.) Number of Deaths . . (column G in OSHA 300 Log).......................................................................................... _______________ 5.) Number of occupational injuries and/or illnesses resulting in days away from work (column H in the OSHA 300 Log) .................................................................... ___________ 6.) Number of days away from work as a result of occupational injuries and/or illnesses (column K in the OSHA 300 Log)..................................................................... ___________ Note: If you report a death, injury or illness resulting in days away from work in the current six month period (item 4 or 5), the most recent date of death, injury or illness must correspond with item 1. Please return this form to: Jefferson County Safety Council Jefferson County Chamber of Commerce 630 Market Street Steubenville, OH 43952 (740) 282-6226 / (740) 282-6285 Fax |
