Osha form 301 checklist
This osha form 301 injuries and illnesses incident report has been converted into an iauditor digital template. this report is one of the first forms you must fill out when a recordable work-related injury or illness has occurred.
What does this form include?
This form contains 20 sections:
Full name
Address
Date of birth Date
Date hired Date
Information about the employee
Name of physician or other health care professional
Information about the physician or other health care professional
- Was treatment given away from the worksite?
- Was employee treated in an emergency room?
- Was employee hospitalized overnight as an in-patient?
Case number from the log
Date of injury or illness Date
Time employee began work Date
Estimated time of event (leave blank if time cannot be determined) Date
What was the employee doing before the incident occurred? Describe the activity, as well as the tools, equipment or material the employee was using.
What happened? Tell us how the the injury occurred.
Type of incident
Describe the injury or illness? Tell us the part of the body that was affected and how it was affected
What object or substance directly harmed the employee?
Upload photos of the incident
Information about the case
Observations and comments
Full Name and Signature of Record Keeper
Use this template