OSHA Form 300A — Summary of Work-Related Injuries and Illnesses

Enter your establishment information, the column totals from your 300 Log, and the certification details, then download the Summary on the official form.

Not legal advice. Not affiliated with or endorsed by OSHA, the U.S. Department of Labor, or Cal/OSHA. OSHA Paperwork explains the rules and cites them; it does not decide them for you. Official free forms: https://www.osha.gov/recordkeeping/forms and https://www.dir.ca.gov/dosh/etools/recordkeeping/

Prefer the official fillable package? It is free at osha.gov/recordkeeping/forms. California employers: Cal/OSHA versions at dir.ca.gov. This tool fills the federal Rev. 04/2004 forms.

Establishment information

Year covered

Your establishment name

Street

City

State

ZIP

Industry description

NAICS code (6 digits)

Employment information

If you don't have these figures, OSHA's worksheet in the forms package explains how to estimate them.

Annual average number of employees

Total hours worked by all employees last year

Number of cases (from the Log)

If you had no cases, leave zeros; the Summary must still be completed and posted.

(G) Total number of deaths

(H) Cases with days away from work

(I) Cases with job transfer or restriction

(J) Other recordable cases

Number of days

(K) Total days away from work

(L) Total days of job transfer or restriction

Injury and illness types (M)

M(1)–M(6) must add up to G+H+I+J.

(1) Injuries

(2) Skin disorders

(3) Respiratory conditions

(4) Poisonings

(5) Hearing loss

(6) All other illnesses

Certification

A company executive certifies the Summary (29 CFR 1904.32(b)(3)–(4)); sign the printed copy.

Company executive

Title

Phone

Date

Autosaved in this browser only. Nothing you type is stored on our servers.

About the 300A

Every establishment required to keep records must complete the Summary, even with zero cases (29 CFR 1904.32).
A company executive must certify it (1904.32(b)(3)–(4)). Sign the printed copy.
Post it from February 1 to April 30 of the year after the one it covers (1904.32(b)(6)).
Establishments covered by 1904.41 must also submit the same data electronically through OSHA’s Injury Tracking Application by March 2. Not sure? Use the checker.