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OSHA 300 Log Form Template

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Log of Work-Related Injuries and Illnesses
Job title
Date of injury or onset of illness
Where the event occurred
Type of incident
Describe injury or illness, parts of body affected, and object/substance that directly injured or made person ill.
Upload photos of incident
Classify the case. Check only one box for each case based on the most serious outcome for that case:
Please specify
No. of days the injured or ill worker was away from work
No. of days the injured or ill worker was on a job transfer or restriction
Observations and comments
Full Name and Signature of Record Keeper
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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