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

Semi-Annual Report is due by January 15, 2018
(For current period July 1 - December 31, 2017)

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

* Please enter your contact information.

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

* 1.) 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

* 2.) Average Number of Employees

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

* 3A.) Group Designation:  Please check the most appropriate group that best describes your company:

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

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

* 6.) 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.
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.

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