OSHA 301 Requirements
Section 1 of 3 · 9 questionsCase Information
What is the case number?
What is the date of injury or illness?
What time did the employee begin work?
What time did the event occur?
What was the employee doing just before the incident occurred?
How did the injury occur?
What was the injury or illness?
What object or substance directly harmed the employee?
If the employee died, when is the date of death?
Section 2 of 3 · 4 questionsEmployee Information
What is the full name of the employee?
What is the address of the employee?
What is the date of birth of the employee?
When was the employee hired?
Section 3 of 3 · 4 questionsHealth Care Professional Information
What is the name of the physician?
If treatment was given away from the worksite, where was it given?
Was the employee treated in an emergency room?
Was the employee hospitalized overnight as an in-patient?
Checklist by GoAudits. This checklist is an example: we do not guarantee compliance with the laws applicable to your territory or industry. Seek professional advice to adapt it to your workplace or jurisdiction.
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