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BWC-Division of Safety & Hygiene
Report All Information Below For CURRENT SIX MONTH PERIOD ONLY (corresponds with period identified above)
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.
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 death, injury or illness must correspond with item 1.
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