Instructions for Completing OSHA 300/300A Forms

As you learn of work-related incidents (injuries or onsets of illness), work with the site manager to record information within seven (7) calendar days in Columns A-F and M of the form. 

As you learn more information, work with the site manager to record information in Columns G, H, I or J, whichever is the most serious and in Columns K and L if applicable.

Column A:  Enter the next case number in the series. Example: 10080, 10081, 10082, 10083.

Column B: If the case is not a privacy concern case, write the employee’s full name (first name and then last name). If this case is a privacy concern case, write “privacy concern case” and email the name of the employee and the case number to hr@nkyhealth.org.

Column C:  Write the position classification title of the employee.

Column D:  Write the date (month, dd) that the injury, exposure or onset of illness occurred.

Column E:  Write the specific geographic location of where the injury, exposure or onset of illness occurred. Be specific enough so that a third party could find the exact geographic location.

Column F:  Describe the injury, exposure or illness in as much detail as possible. Use multiple lines if needed.

Columns G – J:  Check the most serious of the results of the injury, exposure or illness. Check only one of these blocks.

Column K:  Write the total number of calendar days the employee was transferred to another job as a result of the illness, exposure or injury, excluding the day of injury or exposure, even if this total spans over weekends or holidays. Use whole days. If they employee missed a partial day, round it up.

Column L:  Write the total number of calendar days the employee was unavailable to work, excluding the day of injury or exposure, even if this total spans over weekends or holidays. Use whole days. If they employee missed a partial day, round it up.

Column M:  If you are recording an injury, check the #1 block. If you are recording an illness, check the block that corresponds to the classification of illnesses as follows:

• Skin diseases/disorders are illnesses to the employee’s skin caused by exposure to chemicals, plants or other substances

• Respiratory conditions are illnesses associated with breathing hazardous biological agents, chemicals, dust, gases, vapors or fumes.

• Poisoning includes disorders evidenced by abnormal concentrations of toxic substances in blood, other tissues, other bodily fluids or the breath that are caused by the ingestion or absorption of toxic substances into the body.

Page Totals: Tally the totals for the page as soon as possible after January 1 for the previous calendar year.  Round up to whole numbers. Write "0" when there are none.

Record as soon as possible after January 1 for the previous calendar year.

Number of Cases:  Enter the total number of each case by type recorded in columns G, H, I and J of the 300 form.

Number of Days:  Enter the total number of days by type recorded in columns K and L of the 300 form.

Injury and Illness Types:  Enter the total number of injuries and illnesses by type recorded in column M 1 through 6 of the 300 form.

Leave the rest blank.

OSHA requires that the 300A form for the previous year be posted in a conspicuous location at each site available to all employees at that site between February 1 and April 30 annually.

The head of Human Resources will send site managers the completed form to post.

At the end of the calendar year, site managers:

1. Double-check the form to make sure all entries are accurately recorded.

2. Summarize the page totals for each column.  Round up to whole numbers.

3. Turn the form over and copy the totals onto Form 300A in the corresponding columns. Do not write in the Establishment Information box.

4. Scan each form as a separate .PDF, and email it from your fname.lname@nkyhealth.org account to hr@nkyhealth.org by the end of the first week in January.

5. Human Resources will complete the remainder of the information and return it to the site manager for mandatory posting. 

If you make an error, strike through the error and initial the strikethrough.  Do not use white-out or correction tape.

NKY Health must retain the OSHA 300 form, the privacy case list, the Annual Summary (OSHA 300-A), and the OSHA 301 Incident Report for five (5) years following the end of the calendar year.  

The OSHA 300 forms must be updated over the five (5) year period to include any newly discovered recordable injuries or illnesses and to show any changes that have occurred in the classification of previously recorded injuries and illnesses.  If the description or outcome of a case changes, NKY Health must remove or line out the original entry and enter the new information.  

Updating the OSHA 300-A (Annual Summary) and the OSHA 301 Incident Report is voluntary (there is no requirement to update these two documents).