• Report All Information Below For CURRENT SIX MONTH PERIOD ONLY (corresponds with period identified above).

  • 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. The columns listed below correspond to the columns in the OSHA 300 Log and PERRP Form 300P.

  • (column G in OSHA 300 Log/PERRP Form 300P)
  • (column H in the OSHA 300 Log/PERRP Form 300P)
  • (column K in the OSHA 300 Log/PERRP Form 300P)
  • 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.