Appendix B Year 20 Annual Summary of Work-Related Injuries ...

Department of Indus rial RelationstDivision of Occupational Safety & HealthCal/ osha form 300a (Rev. 7/2007) Appendix B Year 20 _ _Annual Summary of Work-Related Injuries and IllnessesTotal number ofdeaths_____Total number ofcases with daysaway from work_____Number of CasesTotal number of daysaway from work _____Total number of days of jobtransfer or restriction_____Number of DaysPost this Annual Summary from February 1 t o April 30 of the year following the year covered by the establishments covered by CCR Title 8 Section 14300 must complete this Annual Summary , even if no Work-Related Injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this the Log, count the individual entries you made for each category.

Cal/OSHA Form 300A (Rev. 7/2007) Appendix B. Year 20 __ Annual Summary of Work-Related Injuries and Illnesses. Total number of deaths _____ otal number of cases with days away from work. Number of Cases. Total number of days away from work _____ Total number of days of job transfer or restriction _____ Number of Days

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  Form, Osha, 300a, Osha form 300a

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