Safety Incident Report

OSHA 300 Log Compliant Recording

OSHA Recordkeeping

This form captures information required for OSHA Form 300 (Log of Work-Related Injuries and Illnesses). All incidents will be stored and can be exported for compliance purposes.

Employee Information

Employee Name *

Job Title *

Incident Details

Date of Incident *

Location *

Type of Injury/Illness *

Body Part Affected

Object/Substance That Caused Harm

Description of Injury/Illness *

OSHA Classification (Columns G-M)

Check all that apply. Leave unchecked if not applicable.

Resulted in death

Days Away From Work

Days of Job Transfer or Restriction

Other recordable case (medical treatment beyond first aid)

Report Submitted By

Your Name (optional)