Holmes Area Safety Council Semi-Annual Report

Co-sponsored by BWC's Division of Safety and Hygiene

Reporting Period

1st - Due by July 15

for the current period January 1–June 30, 2023

2nd - due by January 15

for the current period July 1–December 31, 2023

Safety Council Account Number

Company Name

Phone

Fax

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Submitted by

Most Recent Injury or Illness Resulting in Day(s) Away from Work

Report all information below for CURRENT SIX-MONTH PERIOD ONLY (corresponds with period identified above)

Average Number of Employees

Total Hours Worked

(entire six-month period, all employees)

The following items are based on the Recordkeeping Requirements under the Occupational Safety & Health Act of 1970 (rev. 1/2/02). The columns listed below correspond to the columns in the OSHA 300 Log.

Number of Deaths

(column G in OSHA 300 Log)

Number of occupational injuries and/or illnesses resulting in days away from work

(column H in OSHA 300 Log)

Number of days away from work as a result of occupational injuries and/or illnesses

(column K in OSHA 300 Log)

Note: if you report a death, injury or illness resulting in days away from work in the current six month period, the most recent date of death, injury, or illness must correspond with the date provided above.