OSHA 301

This report provides the OSHA's Form 301 (Injury and Illness Incident Report). A report for each incident in the selected injury log is provided.

You can run this report from the Reports Directory or from the Injuries screen.

  • PureSafety tab > Reports > OSHA Reports > OSHA 301. The report provides a list of only recordable records when run from this view.
  • PureSafety tab > IMS > Injuries > OSHA 301 button. The report provides a list of incidents regardless of the OSHA status when run from this view.

OSHA 301 Form

For privacy-cases, the system leaves both gender check boxes unchecked when you print the OSHA 301 report.

Report Parameters

Parameter Default Value Details

Date Range

Month To Date

Required

Annual Average number of employees

Blank

Enter this figure based on your calculations, often calculated using the optional OSHA 300A worksheet. This field will print in the field of the same name on the Establishment Information section of the report.

Total hours worked by all employees last year

Blank

Enter this figure based on your calculations, often calculated using the optional OSHA 300A worksheet. This field will print in the field of the same name on the Establishment Information section of the report.

Injury Log ID

None selected.

Required. You can select a single Injury Log.

The table below describes the OSHA 301 form fields and the corresponding PureSafety source fields. Go to IMS > Injuries > Create or IMS > Injuries > Edit > Select an injury record to view the source fields. The capitalized words in the PureSafety Source field column represent the tab on the Create Injury screen where the field displays.

Form Field LSMS Source Field

Completed by

Blank field to be entered at a later point manually.

Title

Blank field to be entered at a later point manually.

Phone

Blank field to be entered at a later point manually.

Date

Blank field to be entered at a later point manually.

Information about the employee

(1) Full Name

EMPLOYEE: First Name, Middle Name, Last Name

(2) Street Address

EMPLOYEE: Address

City

EMPLOYEE: City

State

EMPLOYEE: State

Zip

EMPLOYEE: Zip

(3) Date of birth

EMPLOYEE: Birthday

(4) Date hired

EMPLOYEE: HIRE DATE

(5) Male or Female

EMPLOYEE: Gender

Information about the physician or other health care professional

(6) Name of physician or other health care professional

TREATMENT: Name of Physician

(7) If treatment was given away from the worksite, where was it given?

Facility

TREATMENT: Name of Medical Facility

Street

TREATMENT: Address

City

TREATMENT: City

State

TREATMENT: State

ZIP

TREATMENT: Zip

(8) Was employee treated in an emergency room?

TREATMENT: Emergency Room

(9) Was employee hospitalized overnight as an in-patient?

TREATMENT: Overnight

Information about the case

(10) Case number from the Log

CASE: Case Number

(11) Date of injury or illness

INJURY: Injury Date

(12) Time employee began work

CASE: Time Began Work

(13) Time of event

INJURY: Injury Time

(14) What was the employee doing just before the incident occurred? Describe the activity, as well as the tools, equipment, or material the employee was using. Be specific.

INJURY: What was the employee doing just before the incident occurred?

(15) What happened? Tell us how the injury occurred.

INJURY: What Happened?

(16) What was the injury or illness? Tell us the part of the body that was affected and how it was affected; be more specific than "hurt", "pain", or "sore".

INJURY: Brief Description

(17) What object or substance directly harmed the employee? If this question does not apply to the incident, leave it blank.

INJURY: What object or substance directly harmed the employee?

(18) If the employee died, when did the death occur? Date of Death

INJURY: Date of Death