WineShip - OSHA's Form 300A
All establishments covered by Part 1904 must complete this Summary page, even if no injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this summary.
MaintainX
10/06/2022
WineShip - OSHA's Form 300A
All establishments covered by Part 1904 must complete this Summary page, even if no injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this summary.
Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you've added the entries from every page of the log. If you had no cases write "0."
Employees former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms.
Number of Cases
Total number of deaths
Total number of cases with days away from work
Total number of cases with job transfer or restriction
Total number of other recordable cases
Number of Days
Total number of days away from work
Total number of days of job transfer or restriction
Injury and Illness Types
(1) Injury
(2) Skin Disorder
(3) Respiratory Condition
(4) Poisoning
(5) Hearing Loss
(6) All Other Illnesses
Post this Summary page from February 1 to April 30 of the year following the year covered by the form
Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instruction, search and gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
If you have any comments about these estimates or any aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistics, Room N-3644, 200 Constitution Ave, NW, Washington, DC 20210. Do not send the completed forms to this office.
Establishment information
Your establishment name
Street
City
State
Zip
Industry description (e.g., Manufacture of motor truck trailers)
Standard Industrial Classification (SIC), if known (e.g., SIC 3715)
North American Industrial Classification (NAICS), if known (e.g., 336212)
Employment information
Annual average number of employees
Total hours worked by all employees last year
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Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and complete.
Company executive
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Phone
Title
Date
Source: MaintainX (Community Member)