Western States
Roofing Contractors
Association
Tool Box
Safety Talks
O-1
SAFETY ITEMS REQUIRED ON SITE:
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Personal Protective Equipment (PPE)
First Aid Kit
Material Safety Data Sheets (MSDS)
Fall Protection Equipment
Fire Extinguisher
DESCRIPTION: OSHA 300 Log Sheet - Accident Reporting
This sheet discusses accident reporting procedures.
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Report hazardous conditions and/or equipment deficiencies to supervisor immediately.
Do not perform any work or use tools or equipment while under the influence of drugs or
other substances that impair or affect your judgment or ability.
1.
2.
OSHA 300 pertains to employers with 10 or more employees.
Work-related injury or illness is presumed for injuries and illness resulting from events or
exposures occuring in the workplace, unless an exception specifically applies.
Injuries or illnesses that should be recorded as a result of: death, loss of consciouness,
days away from work, restricted work activity or job transfer and medical treatment
beyond first aid.
Additional criteria: Any needleprick injury or cut from a sharp object that is contaminated
with another persons blood or other potentially infectious material
3.
(B)
Employee’s name
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(A)
Case
no.
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month/day
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month/day
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(D)
(E)
Date of injury Where the event occurred
(e.g., Loading dock north end)
or onset
of illness
(e.g. month/day)
Describe the case
(H)
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Days away
from work
(G)
Death
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(I)
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(J)
Job transfer Other recordor restriction able cases
Using these four categories, check ONLY
the most serious result for each case:
Classify the case
(L)
Away
from
work
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(K)
On job
transfer
or restriction
(1)
(2)
(3)
(4)
(5)
(6)
(6)
(5)
(4)
(3)
(2)
(1)
(M)
Enter the number of
Check the “Injury” column or
days the injured or
ill worker was:
choose one type of illness:
Be sure to transfer these totals to the Summary page (Form 300A) before you post it.
Page totals
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(F)
Describe injury or illness, parts of body affected,
and object/substance that directly injured
or made person ill
(e.g., Second degree burns on right forearm from acetylene torch)
Injury
(C)
Job title
(e.g., Welder)
Injury
Identify the person
City ________________________________ State ___________________
Establishment name ___________________________________________
Skin disorder
Skin disorder
You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer,
days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health
care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in CCR Title 8 Section 14300.8 through 14300.12. Feel free to
use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (Cal/OSHA Form 301) or equivalent form for each injury or illness recorded on this
form. If you’re not sure whether a case is recordable, call your local Cal/OSHA office for help.
Department of Industrial Relations
Division of Occupational Safety and Health
Respiratory
condition
Respiratory
condition
Log of Work-Related Injuries and Illnesses
Year 20__ __
Poisoning
Poisoning
Attention: This form contains information relating to employee health
and must be used in a manner that protects the confidentiality of
employees to the extent possible while the information is being used
for occupational safety and health purposes.
See CCR Title 8 14300.29(b)(6)-(10)
Hearing losss
Appendix A
All other
Hearing loss
Cal/OSHA Form 300 (Rev. 4/2004)
Illnesses
Illnesses
All other