Optional Information
Name of school: 
Date of inspection:
Career-Technical program/course/room:
Signature of inspector: 

 
Occupational Injury and
Illness Reporting
Self Inspection Checklist

Guidelines: This checklist covers regulations issued by the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA) under 29 CFR 1904. These regulations apply only to private employers and their employees, unless adopted by a state agency and applied to other groups such as public employees. Definitions of terms in bold type are provided at the end of the checklist to help you understand some of the questions.
  Please Circle
  1. Does the school (employer) maintain a log and summary of

    2. recordable occupational injuries and illnesses (OSHA
    Form No. 300 or equivalent) that reflects separately the
    illness and injury experience of each establishment? (in
    most cases this would mean your school building, see
    definition) [29 CFR 1904.2(a)]

    Note: The OSHA No. 300 is a log and summary form
    available from OSHA for recording occupational injuries
    and illnesses. OSHA accepts equivalent forms as long as
    the forms include all the required information and are
    readable and comprehensible.
 Y   N   N/A   ?? 
  1. Are all recordable injuries or illnesses reported on the log

    2. and summary within 6 working days after the employer
    finds out about the case, or are the requirements for
    alternative site recording met, as described Question 3?
    [29 CFR 1904.2(a)]
 Y   N   N/A   ?? 
  1. If the employer keeps the log and summary at an alternative

    2. site or in a computer, is a hard copy of the information
    available at the establishment that is current to within 45
    days and which can, at anytime, be updated to within 6 days
    after a reportable case has occurred? [29 CFR 1904.2(b)]
 Y   N   N/A   ?? 
  1. Is a supplementary record on OSHA Form No. 301 or

    2. equivalent available for each recordable occupational
    injury or illness? [29 CFR 1904.4]

    Note: The OSHA Form No. 301 is a form available from
    OSHA for recording supplementary information about an
    occupational injury or illness. Workmen's compensation,
    insurance, or other reports are acceptable alternative records
    if they contain the information required by OSHA Form
    No. 301.
 Y   N   N/A   ?? 
  1. Is the summary of the previous calendar year showing the

    2. totals from the OSHA Form No. 300 completed by
    February 1 and posted from February 1 to March 1?
    [29 CFR 1904.5]
 Y   N   N/A   ?? 
  1. Does the posted summary include totals from the OSHA

    2. Form No. 300, calendar year covered, establishment name
    and address, signature of certifier (employer representative),
    title, and date? [29 CFR 1904.5]
 Y   N   N/A   ?? 
  1. Is the summary posted in places where information for

    2. employees is normally posted (such as employee or union
    bulletin boards)? [29 CFR 1904.5]
 Y   N   N/A   ?? 
  1. Do employees who do not regularly report to their

    2. establishment receive a copy of the summary with their
    paycheck or in the mail? [29 CFR 1904.5]
 Y   N   N/A   ?? 
  1. Are all of the injury and illness records described above

    2. kept for 5 years? [29 CFR 1904.6]
 Y   N   N/A   ?? 
  1. Are employees, former employees, and their representatives

    2. granted access to the summary and the log (OSHA Form
    No. 300) for examination and copying? [29 CFR 1904.7]
 Y   N   N/A   ?? 
  1. Is every fatality or the in-patient hospitalization of three or

    2. more employees resulting from a work-related incident
    reported within 8 hours to the nearest OSHA Area Office in
    person or by using the OSHA toll-free central telephone
    number? [29 CFR 1904.8]
 Y   N   N/A   ?? 
  1. Are work-related needlestick injuries and cuts from sharp objects that are contaminated with another person's blood or potentially infected material recorded in the OSHA 300 log?
    [29 CFR 1904.8]
 Y   N   N/A   ?? 
  1. Does your establishment complete OSHA's annual survey

    2. form, if requested? [29 CFR 1904.17]
 Y   N   N/A   ?? 

 
Definitions:
 
Establishment: If an employer has more than one establishment, a separate set of records must be maintained for each one. The recordkeeping regulations define an establishment as a single physical or administrative location where governmental business is conducted or where services or other activities are performed (for example: a garage, prison, central administrative office, warehouse, fire station, police precinct, school, institution, etc.). If distinctly separate activities are performed at a single physical location, each activity must be considered as a separate establishment and a separate OSHA No. 200 must be prepared for each such establishment.
Recordable occupational injuries or illnessare any occupational injuries or illnesses that result in:
  1. Fatalities, regardless of the time between the injury and death, or the length of the illness; or
  2. Lost workday cases, other than fatalities, that result in lost workdays; or
  3. Nonfatal cases without lost workdays that
    • result in transfer to another job or termination of employment,
    • require medical treatment (other than first aid), or
    • involve loss of consciousness or restriction of work or motion. This category also includes any diagnosed occupational illnesses that are reported to the employer but are not classified as fatalities or lost workday cases.
Comments/Corrective action:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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National Institute for Occupational Safety and Health