Florida Hospital Association WHYB Essential Data Request

OSHA Recordable Worker Injury Data - OSHA Form 300A Summary Data

Your hospital has pledged to participate in the We Have Your Back (WHYB) Worker Safety Collaborative, which will focus on preventing physical injuries, needlestick and blood exposure accidents and workplace violence. As with all safety and quality initiatives, data is vital to our ability to establish a benchmark and measure progress in our goal to reduce injuries in our workforce. FHA will periodically survey our WHYB Worker Safety Collaborative hospitals to collect data that is included in your Occupational Safety and Health Administration (OSHA) Recordable Worker Injury Data – OSHA Form 300A Summary Data. As with all FHA surveys, all data will remain strictly confidential. No hospital specific data will be published. Thank you for your participation in this important initiative.

About this survey:

The purpose of this survey is to establish the baseline data for the We Have Your Back Worker Safety Collaborative.
There are two data reporting periods requested:
- 2015, January through December
- 2016, January through June
Questions one through six are OSHA recordable on the OSHA Form 300A.
Questions seven through ten request “type of injury” data and are requested if available. Some of this data may be recorded on OSHA Form 301s.
All data will remain strictly confidential – no hospital specific data will be published

Please submit your information by October 28, 2016.

Questions?
Katie Woodward, FHA, 850-222-9800 or katie@fha.org

Question Title

* 1. Please complete the following

Hospital/Health System (Please spell out):

Contact Name:

Title:

City:

Email:

Question Title

* 2. If you are a health system or part of a health system, do these answers represent the entire health system?

Yes

If no, please specify which hospital:

Questions 3 through 6: Data requested is OSHA recordable on the OSHA Form 300A

Question Title

* 3. Total # of Cases with Days Away from Work

a. Number of Cases
(2015, Jan.-Dec.)

b. Number of Cases
(2016, Jan.-June)

c. Number of Days
(2015, Jan.-Dec.)

d. Number of Days
(2016, Jan.-June)

Question Title

* 4. Total # of Cases with Days Requiring Job Transfer or Restriction

a. Number of Cases
(2015, Jan.-Dec.)

b. Number of Cases
(2016, Jan.-June)

c. Number of Days
(2015, Jan.-Dec.)

d. Number of Days
(2016, Jan-June)

Question Title

* 5. Total # of Other Recordable Cases

a. Number of Cases
(2015, Jan.-Dec.)

b. Number of Cases
(2016, Jan.-June)

Question Title

* 6. Total # of Hours Worked by All Employees

a. Number of Hours
(2015, Jan.-Dec.)

b. Number of Hours
(2016, Jan.-June)

Questions 7 through 11 request type of injury data and are requested if available.

Question Title

* 7. Total # Cases Related to Lifting, Moving and Handling of Patients.

a. Number of Cases
(2015, Jan.-Dec.)

b. Number of Cases
(2016, Jan.-June)

Question Title

* 8. Total # Cases on Sharps Injury Log

a. Number of Cases
(2015, Jan.-Dec.)

b. Number of Cases
(2016, Jan.-June)

Question Title

* 9. Total # Cases Mucous Membrane Blood/Body Fluid Exposure (includes cases that are recordable and non-recordable)

a. Number of Cases
(2015, Jan.-Dec.)

b. Number of Cases
(2016, Jan.-June)

Question Title

* 10. Total # Cases of Physical Assault

a. Number of Cases
(2015, Jan.-Dec.)

b. Number of Cases
(2016, Jan.-June)

Question Title

* 11. Total # Cases of Physical Assault with injury

a. Number of Cases
(2015, Jan.-Dec.)

b. Number of Cases
(2016, Jan.-June)

Question Title

* 12. Comments:

Questions? Please contact Katie Woodward at (850) 222-9800.

Thank you for your participation!