# Work-Related Injury and Illness Log: [Establishment name], [Year]

> A log of recordable work-related injuries and illnesses for one
> establishment, an incident detail record per case and an annual
> summary with incidence rates. The fields follow the US OSHA
> recordkeeping rule, 29 CFR Part 1904 (Forms 300, 300A and 301), used
> here as the dated example (October 2026); employers elsewhere can
> adapt the structure to their national reporting rules. Replace every
> `[bracketed]` value and every row marked *Example*. This is a
> documentation format, not legal advice: use the official OSHA forms
> or an equivalent, and check the current regulation and a qualified
> professional.

<!--
Guidance: How to use this template
- Keep one log per establishment per calendar year. Section 29 CFR
  1904.29 allows equivalent forms if they hold the same information,
  are as readable and follow the same instructions as the OSHA forms.
  Check yours against the official forms package before relying on it.
- Decide recordability with section 2 for every work-related case,
  and enter recordable cases within 7 calendar days of learning about
  them.
- This file holds health information. Store it with restricted access,
  and handle privacy concern cases as section 4 describes.
- The examples describe the fictional US assembly plant of Quillfen
  Devices Inc. People and cases are invented.
- Related templates: OH&S Hazard and Risk Register
  (`compliance/iso-45001-hazard-register`), Corrective Action
  (`compliance/capa-nonconformity`), Psychosocial Risk Assessment
  (`hr/psychosocial-risk-assessment`).
-->

## Contents

1. Who must keep records (check first)
2. Recording decision
3. Log of recordable cases (Form 300 fields)
4. Privacy concern cases
5. Incident detail record (Form 301 fields)
6. Severe events reported to OSHA
7. Annual summary (Form 300A fields)
8. Retention, access and electronic submission
9. Other jurisdictions
10. Standard and licence note

## Document control

<!-- Guidance: Name the person who keeps the log and the executive who certifies the annual summary. -->

| Field | Value |
|---|---|
| Log ID | [OSH-LOG-2026-01] |
| Establishment | [Name, street address, city, state] |
| Industry code (NAICS) | [Code] |
| Calendar year | [YYYY] |
| Record keeper | [@ehs-coordinator] |
| Certifying executive | [Name, title] |
| Classification | Confidential: contains health information |
| Last updated | YYYY-MM-DD |

### Revision history

| Version | Date | Author | Change |
|---|---|---|---|
| 1.0 *(Example)* | 2026-01-02 | [@ehs-coordinator] | Log opened for 2026 |
| 1.4 *(Example)* | 2026-09-22 | [@ehs-coordinator] | Case 2026-004 added |

## 1. Who must keep records (check first)

<!-- Guidance: Answer these questions each January. Record the answer and the source you checked. -->

- [ ] Did the company have more than 10 employees at any time during
      the last calendar year? If not, it is partially exempt (29 CFR
      1904.1), but must still report severe events (section 6).
- [ ] Is the establishment in an industry listed as partially exempt
      under 29 CFR 1904.2? Check the current list.
- [ ] Has OSHA or the Bureau of Labor Statistics asked in writing for
      records? That request applies even to exempt employers.
- [ ] Does a State Plan apply, with its own rules?

## 2. Recording decision

<!-- Guidance: A case is recorded only if it is work-related, a new case and meets at least one general recording criterion (29 CFR 1904.7). Write down the reason for every decision, including cases you decide not to record. -->

A work-related new case is recordable if it results in any of:

1. death,
2. days away from work,
3. restricted work or transfer to another job,
4. medical treatment beyond first aid,
5. loss of consciousness, or
6. a significant injury or illness diagnosed by a physician or other
   licensed health care professional (for example, a fracture,
   cancer or a punctured eardrum).

Count days away and restricted days in calendar days, starting the day
after the injury, and stop counting at 180.

```mermaid
flowchart TD
  A["Injury or illness reported"] --> B{"Work-related?"}
  B -->|"No"| X["Not recorded, reason noted"]
  B -->|"Yes"| C{"New case?"}
  C -->|"No"| U["Update the existing case"]
  C -->|"Yes"| D{"Meets a general recording criterion?"}
  D -->|"No"| X
  D -->|"Yes"| E["Enter on the log and incident record within 7 calendar days"]
  E --> F{"Severe event to report?"}
  F -->|"Yes"| G["Report to OSHA within 8 or 24 hours"]
  F -->|"No"| H["Continue to track days"]
  G --> H
```

| Screening ID | Date | Event | Work-related | Criterion met | Decision |
|---|---|---|---|---|---|
| SCR-2026-011 *(Example)* | 2026-06-03 | Small cut on finger, cleaned and plaster applied | Yes | None (first aid only) | Not recordable |
| [SCR-ID] | YYYY-MM-DD | [Event] | [Yes / No] | [Criterion] | [Decision] |

## 3. Log of recordable cases (Form 300 fields)

<!-- Guidance: One line per recordable case. Column letters follow the OSHA 300 form: (G) to (J) classify the most serious outcome, (K) and (L) count days, (M) gives the case type. Check one outcome box only. -->

| (A) Case | (B) Employee | (C) Job title | (D) Date | (E) Where | (F) Description | Outcome (G to J) | (K) Days away | (L) Restricted or transfer days | (M) Type |
|---|---|---|---|---|---|---|---|---|---|
| 2026-001 *(Example)* | [Name] | Assembler | 2026-03-09 | Line 2 | Laceration to left hand from sheet metal edge, sutures | (J) Other recordable | 0 | 0 | Injury |
| 2026-002 *(Example)* | [Name] | Material handler | 2026-05-18 | Warehouse | Lower back strain lifting a parts carton | (H) Days away | 12 | 0 | Injury |
| 2026-003 *(Example)* | [Name] | Forklift operator | 2026-08-04 | Loading dock | Bruised right foot when a pallet slipped, fracture ruled out | (I) Job transfer or restriction | 0 | 9 | Injury |
| 2026-004 *(Example)* | [Name] | Solder technician | 2026-09-15 | Line 1 | Contact dermatitis on both hands from flux, prescription cream | (J) Other recordable | 0 | 0 | Skin disorder |
| [Case] | [Name or "privacy case"] | [Title] | YYYY-MM-DD | [Location] | [Body part, injury, object or substance] | [(G) / (H) / (I) / (J)] | [N] | [N] | [Injury / Skin disorder / Respiratory condition / Poisoning / Hearing loss / All other illnesses] |

## 4. Privacy concern cases

<!-- Guidance: 29 CFR 1904.29(b)(7) gives a closed list. Do not extend it. -->

Write "privacy case" instead of the name, and keep a separate,
confidential list linking case numbers to names, for:

- an injury or illness to an intimate body part or the reproductive
  system,
- an injury or illness resulting from sexual assault,
- mental illness,
- HIV infection, hepatitis or tuberculosis,
- a needlestick or cut from a sharp object contaminated with another
  person's blood or other potentially infectious material,
- other illnesses, if the employee voluntarily asks for their name to
  be left off.

## 5. Incident detail record (Form 301 fields)

<!-- Guidance: Complete one record per log entry within 7 calendar days. An insurance or workers' compensation form can serve if it holds the same information. -->

| Field | Case 2026-002 *(Example)* |
|---|---|
| Employee details | [Name, address, date of birth, date hired, sex as on the form] |
| Health care professional and facility | [Name, facility, whether treated in an emergency room, whether hospitalized overnight as an in-patient] |
| Case number from the log | 2026-002 |
| Date and time of event, time work began | 2026-05-18, [time] |
| What the employee was doing just before | Lifting a carton of parts from a floor pallet to a shelf |
| What happened | Felt sudden pain in the lower back while twisting with the load |
| Injury or illness and body part | Strain, lower back |
| Object or substance that harmed the employee | Carton of parts, [weight] |
| Date of death, if any | Not applicable |
| Completed by, title, date | [@ehs-coordinator], YYYY-MM-DD |

Link each case to its investigation and corrective action
(`compliance/capa-nonconformity`), and update the hazard register.

## 6. Severe events reported to OSHA

<!-- Guidance: 29 CFR 1904.39. These deadlines apply even to employers exempt from keeping the log. -->

| Event | Report within | Condition |
|---|---|---|
| Work-related fatality | 8 hours of learning of it | Death within 30 days of the incident |
| In-patient hospitalization, amputation or loss of an eye | 24 hours of learning of it | Event within 24 hours of the incident |

Report by phone to the nearest Area Office, to 1-800-321-OSHA
(1-800-321-6742) or through the online reporting application.

| Report ID | Case | Event | Reported on | Method | OSHA reference |
|---|---|---|---|---|---|
| [REP-ID] | [Case] | [Event] | YYYY-MM-DD hh:mm | [Phone / online] | [Reference] |

## 7. Annual summary (Form 300A fields)

<!-- Guidance: Total the log, certify it, and post it from 1 February to 30 April of the next year where notices to employees are usually posted (29 CFR 1904.32). Enter zeros when there were no cases. -->

| Field | Year 2026 *(Example)* |
|---|---|
| Total deaths (G) | 0 |
| Cases with days away from work (H) | 1 |
| Cases with job transfer or restriction (I) | 1 |
| Other recordable cases (J) | 2 |
| Total recordable cases | 4 |
| Total days away from work (K) | 12 |
| Total days of job transfer or restriction (L) | 9 |
| Injuries / skin disorders / respiratory / poisoning / hearing loss / all other illnesses (M) | 3 / 1 / 0 / 0 / 0 / 0 |
| Annual average number of employees | 85 |
| Total hours worked by all employees | 172,000 |
| Certified by, title, date | [Name, plant manager], YYYY-MM-DD |
| Posted from and to | 2027-02-01 to 2027-04-30 |

Incidence rates use the BLS formula: number of cases multiplied by
200,000 (100 full-time workers for a year), divided by hours worked.

| Rate | Calculation | Result *(Example)* |
|---|---|---|
| Total recordable case rate | 4 x 200,000 / 172,000 | 4.65 |
| Days away, restricted or transferred (DART) rate | (1 + 1) x 200,000 / 172,000 | 2.33 |

## 8. Retention, access and electronic submission

<!-- Guidance: Check these each year against the current regulation. As of October 2026. -->

- **Retention:** keep the log, the privacy case list, the summary and
  the incident records for 5 years after the end of the year they
  cover, and update the log for newly found or reclassified cases
  (29 CFR 1904.33).
- **Employee access:** give employees, former employees and their
  representatives a copy of the log by the end of the next business
  day when asked (29 CFR 1904.35).
- **Reporting procedure:** tell employees how to report injuries and
  that they will not face retaliation for reporting (29 CFR 1904.35).
- **Electronic submission (29 CFR 1904.41):** by 2 March of the next
  year, establishments with 20 to 249 employees in industries listed
  in Appendix A, and those with 250 or more employees, submit the 300A
  data; establishments with 100 or more employees in industries listed
  in Appendix B also submit 300 and 301 data, without employee names
  and addresses. *Example:* the 85-employee Quillfen plant submits its
  300A only if its industry is listed in Appendix A.

## 9. Other jurisdictions

<!-- Guidance: Outside the US, map the fields above to the national rule. Examples only, not legal advice. -->

| Jurisdiction | Pointer | Official source |
|---|---|---|
| UK | RIDDOR 2013 requires reporting of certain workplace injuries, diseases and dangerous occurrences to HSE. | https://www.hse.gov.uk/riddor/ |
| EU | Member States set reporting rules under the OSH Framework Directive 89/391/EEC, which requires employers to keep a list of occupational accidents causing more than three working days of incapacity (Article 9). | https://eur-lex.europa.eu/eli/dir/1989/391/oj/eng |

## Standard and licence note

Based on US OSHA 29 CFR Part 1904 (sections 1904.1, 1904.7, 1904.29,
1904.32, 1904.33, 1904.35, 1904.39 and 1904.41) and the OSHA Forms 300,
300A and 301 package (forms marked Rev. 04/2004, package file dated June 2019), checked on osha.gov on 2026-10-30,
and the BLS incidence rate method. Original text written for this
collection; it does not replace the official forms. Organisations,
people and figures are fictional. Not legal advice: check the current
official text and a qualified professional. Template licence: MIT.