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Semi-Annual Reports
Address *
Address
City
State
Zip/Postal
If there has been no recordable injury/illness resulting in day(s) away from work, please date 00/00/0000
Report all information below for current six month period only
(corresponds with period identified above)
(entire six month period, all employees)
Items 4, 5 and 6 are based on the Recordkeeping Requirements under the Occupational Safety & Health Act of 1970 (rev. 1/1/02). The columns listed below correspond to the columns in the OSHA 300 log.
(column G in OSHA 300 Log)
(column H in OSHA 300 Log)
(column K in OSHA 300 Log)
Note: If you report a death, injury or illness resulting in days away from work in the current six month period (item 4 or 5), the most recent date of the death, injury or illness must correspond with item 1.