OSHA Form 301 — Injury and Illness Incident Report

Complete one incident report for each case on your 300 Log and download it as a PDF 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.

Information about the employee

1) Full name

2) Street

City

State

ZIP

3) Date of birth

4) Date hired

5) Sex

Information about the physician or other health care professional

6) Name of physician or other health care professional

7) Facility (if treatment was given away from the worksite)

Street

City

State

ZIP

8) Treated in an emergency room?

9) Hospitalized overnight as an in-patient?

Information about the case

Fields 14–17: do not include personally identifiable information (names, phone numbers, Social Security numbers).

10) Case number from the Log

11) Date of injury or illness

12) Time employee began work

13) Time of event

Time of event cannot be determinedCheck if the time cannot be determined

14) What was the employee doing just before the incident occurred?

15) What happened? Tell us how the injury occurred.

16) What was the injury or illness?

17) What object or substance directly harmed the employee?

18) If the employee died, date of death

Completed by

Title

Phone

Date

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About the 301

Fill out a 301 (or an equivalent form such as a workers’ compensation report with the same information) for every recordable case, within 7 calendar days (29 CFR 1904.29(b)(2)–(4)).
Keep it on file for 5 years following the year it covers (1904.33).
The report contains health information; share it only as 1904.35 and 1904.40 allow, and remove names before any other disclosure (1904.29(b)(10)).