OSHA 301 Requirements

Use the OSHA 301 Requirements checklist to document detailed information about workplace injuries and illnesses for compliance and reporting purposes.

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OSHA 301 Requirements

Employee Information

Health Care Professional Information

Case Information

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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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OSHA 301 Requirements

Use the OSHA 301 Requirements checklist to document detailed information about workplace injuries and illnesses for compliance and reporting purposes.

1. What is the full name of the employee?

2. What is the address of the employee?

3. What is the date of birth of the employee?

4. When was the employee hired?

1. What is the name of the physician?

2. If treatment was given away from the worksite, where was it given?

3. Was the employee treated in an emergency room?

4. Was the employee hospitalized overnight as an in-patient?

1. What is the case number?

2. What is the date of injury or illness?

3. What time did the employee begin work?

4. What time did the event occur?

5. What was the employee doing just before the incident occurred?

6. How did the injury occur?

7. What was the injury or illness?

8. What object or substance directly harmed the employee?

9. If the employee died, when is the date of death?