Recordkeeping and Reporting Guidelines for Federal Agencies: Under the Williams-Steiger Occupational Safety and Health Act of 1970U.S. Department of Labor, Occupational Safety and Health Administration, 1986 - Industrial accidents - 4 pages |
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Common terms and phrases
accident or exposure address of reporting address of third Appendix H birth Mo CHARGEBACK CODE BLOCK 12 COMPENSATION CLAIM concealment of fact DATA Date Mo Date of Injury Day Yr Department of Labor DESCRIBE HOW INJURY disease or illness DUTY STATION ZIP EMPLOYMENT STANDARDS ADMINISTRATION EQUIPMENT ESTABLISHMENT fatalities and lost FATALITY AND CATASTROPHE FEDERAL AGENCY PROGRAMS felony criminal prosecution IDENTIFY ILLNESS/DISEASE INCIDENT INJURIES AND ILLNESSES INJURY OCCURRED INJURY/ILLNESS knowingly LOG OF OCCUPATIONAL lost time disabilities Name and Address NONSTANDARD OCCUPATION CODES Occupational Disease occupational health program occupational illness OCCUPATIONAL INJURIES OCCUPATIONAL SAFETY OFFICE OF FEDERAL OFFICE OF WORKERS OSHA SITE CODE OWCP AGENCY CODE OWCP FORMS CA-1 PAY COP Pay Stopped Region REVISED SAFETY AND HEALTH safety and occupational SECRETARY OF LABOR SHADED BOX Signature of Supervisor SOURCE CODES Standards Administration Office STATION ZIP CODE STRUCK SUPPLEMENTARY RECORDS Telephone Third Party TYPE AND SOURCE TYPE CODE U.S. Department