Southern Buckeye Safety Council
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Semi-Annual Report

 You can complete the online form below or send your form by any of the methods listed on our CONTACT page.
Click here to download the instruction form.
    *Name of Person Completing this Form

    Report All Information Below For CURRENT SIX MONTH PERIOD ONLY (corresponds with period identified above)


    Items 4, 5, & 6 are based on the Recordkeeping Requirements under the Occupational Safety & Health Act of 1970.

    The questions listed below correspond to the columns in the OSHA 300 Log/PERRP Form 300P.
     * (column G in the OSHA 300 Log/PERRP Form 300P)

    * (column K in the OSHA 300 Log/PERRP Form 300P)
    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.
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