CASC Semi-Annual Report

The top portion of the form is self-explanatory. The person completing the semi-annual report should fill in the “Submitted by” information.

(1) Date of Most Recent Lost-Time Injury or Illness: This is the date of the most recent injury that resulted in an employee missing at least one full day of work. The date does not necessarily have to be during this reporting period. If no injuries have ever occurred, you may leave the date blank.

(2) and (3) Average Number of Employees/Total Hours Worked: Multiply the average number of employees x the average number of hours worked per week x the number of weeks in the six-month period. (i.e. 725 employees x 40 hours = 29,000 hours x 26 weeks in the six month period = 754,000 hours)

(4) Deaths: Taken from OSHA 300 column G or PERRP Form 300P Log, the number of deaths that resulted from an occupational accident during this six-month period.

(5) Number of Injuries/Number of Workdays Lost: Taken from OSHA 300 or PERRP Form 300P Log, column H, the number of occupational injuries or illnesses resulting in days away from work.

(6) Number of Workdays Lost: Taken from OSHA 300 or PERRP Form 300P, column K, the total number of days away from work as a result of occupational accidents during the six-month period. NOTE: If the days away from work resulted from an accident which occurred in a previous six-month period, please report the additional workdays missed.

IMPORTANT:

If the date of last injury or illness resulting in days away from work (1) was during the current six-month period within which you are reporting, there should be at least a 1 for (5) the number of injuries or illnesses, and (6) the number of days away from work.
If the date of last injury or illness resulting in days away from work was during a previous six-month period, (5) and (6) should be 0.

OHIO PUBLIC EMPLOYERS: All Ohio Public Employers must complete the Public Employment Risk Reduction Program (PERRP) Form 300P (Rev. 1/2011). Questions on the Form 300P are consistent with the OSHA 300 Log and should be used to complete the safety council semi-annual report form.

Co-sponsored by BWC’s Division of Safety and Hygiene – SEMI-ANNUAL REPORT

Time Period:*
- This report is for period: January 1 — June 30
- This report is for period: July 1 — December 31
Name*
First Last
Email*
Company:*
Address:
Street Address City State ZIP Code
Telephone:*
Fax:
Submitted By:
1) Date of most recent injury or illness resulting in day(s) away from work (mm/dd/yyyy)
Report all information below for the current six month period.
2) Average number of employees
3) Total hours worked (entire six month period, all employees)
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 OSHA 300 Log.
4) Number of deaths (column G in OSHA 300 Log)
5) Number of occupational injuries and/or illnesses resulting in days away from work (column H in the OSHA 300 Log)
6) Number of days away from work as a result of occupational injuries and/or illnesses (column K in the OSHA 300 Log)
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.
Enter email address

Enter your email address to receive a copy of the completed report. Leave this field blank if you don't want to email a copy.