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Injury and Illness Incident Report. 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.
Together with Log of Work-Related Injuries and Illnesses and the accompanying Summary, these forms help the employer and Cal/OSHA develop a picture of the extent and severity of work-related incidents.
Easily create and download a free, fillable Cal/OSHA Form 301 Appendix C Injury and Illness Incident Report for California. Edit, sign, and save this document online or download it in PDF format.
Cal/OSHA Form 301 Appendix C Injury and Illness Incident Report This Injury and Illness Incident Report is one of the first forms you must fill out when a recordable work-related injury or illness has occurred. Together with accompanying Annual Summary, these forms help the employer and Cal/OSHA develop a picture of the
Cal/OSHA has many educational materials and resources available. Publications can be downloaded from our webpage or they may be picked up at a local Cal/OSHA office if available. Please check with the local Cal/OSHA office first by calling to ensure the publications are available.
This document contains an Injury and Illness Incident Report form used to record work-related injuries in accordance with Cal/OSHA regulations. The form collects information about the employee, such as name, contact details, and date of injury.
OSHA’s recordkeeping regulation (see 29 CFR Part 1904) provides more information about the definitions below. The Log of Work-Related Injuries and Illnesses (Form 300) is used to classify work-related injuries and illnesses and to note the extent and severity of each case.
