Transcription of SUMMARY OF WORK-RELATED INJURIES AND ILLNESSES
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SUMMARY OF WORK-RELATED INJURIES AND ILLNESSES
Divison of Safety and HealthSTATE OF NEW YORKP ublic Employee Safety and HealthDEPARTMENT OF LABORS tate Office CampusBuilding 12, Room 158 Albany, NY 12240 SUMMARY OF work -RELATEDC alendar YearINJURIES AND ILLNESSESFORM establishments covered by PART 801 must complete this SUMMARY annually, even if no occupational INJURIES or ILLNESSES occurred during the , former employees, and their representatives have the right to review this form. They also have limited access to the Log ( sh 900 ) or its and instructions for further details on access provisions for these ESTABLISHMENT INFORMATION2. EMPLOYMENT INFORMATIONESTABLISHMENT NAMEIf you don't have accurate figures, see theinstructions on the back of this ADDRESSAVERAGE NUMBER OF EMPLOYEESCITY, STATE, ZIP CODEINDUSTRY DESCRIPTION ( ,village fire department)TOTAL HOURS WORKED BY ALL EMPLOYEES LAST YEARNORTH AMERICAN INDUSTRIAL CLASSIFICATION SYSTEM (NAICS).
SUMMARY OF WORK-RELATED INJURIES AND ILLNESSES Calendar Year FORM SH-900.1 All establishments covered by PART 801 must complete this summary annually, even if no occupational injuries or illnesses occurred during the year. Employees, former employees, and their representatives have the right to review this form.
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