STARK COUNTY SAFETY COUNCIL
Co-sponsored by BWC’s Division of Safety and Hygiene

Semi-Annual Report is due by July 15, 2017
(For current period January 1 - June 30, 2017)

* Safety Council Account Number (optional - enter if available)

* Please enter your contact information.

* Has the information provided above been updated on this report?

* DATE OF MOST RECENT INJURY OR ILLNESS RESULTING IN DAY(S) AWAY FROM WORK

Date:
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Report All Information Below For CURRENT SIX MONTH PERIOD ONLY

* Average Number of Employees

* Total Hours Worked (entire six month period, all employees)

Items 4, 5 and 6 are based on the Recordkeeping Requirements under the Occupational Safety & Health Act of 1970 (rev. 1/1/02). The columns listed below correspond to the columns in the OHSA 300 Log.

* Number of Deaths...(column G in OHSA 300 Log/PERRP Form 300P)

* Number of occupational injuries and/or illnesses resulting in days away from work...(column H in the OSHA 300 Log/PERRP Form 300P)

* Number of days away from work as a result of occupational injuries and/or illnesses (column K in the OHSA 300 Log/PERRP Form 300P)

Note: If you report a death, injury or illness resulting in days away from work in the current six month period (item 4 or 5), the most recent date of death, injury or illness must correspond with item 1.

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