Employment Law Handbook

8/9/2019 Employment Law Handbook

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National Federation of Independent Business1201 F Street NW, Suite 200 Washington, DC 20004 202-554-9000 Fax 202-479-9059

website: www.nfiblegal.com email: [email protected]


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beginningOctober 1, 1996

Employees under 20 years of age may be paid $4.25 per hour during their first 90 consecutive calendardays of employment with an employer.

Certain full-time students, student learners, apprentices, and workers with disabilities may be paidless than the minimum wage under special certificates issued by the Department of Labor.

claim a tip credit against their minimum wage obligation. If an employee's tips combined with theemployer's cash wage of at least $2.13 per hour do not equal the minimum hourly wage, the employermust make up the difference. Certain other conditions must also be met.

Overtime PayAt least 11/2 times your regular rate of pay for all hours worked over 40 in a workweek.

Child LaborAn employee must be at least 16 years old to work in most non-farm jobs and at least 18 to work innon-farm jobs declared hazardous by the Secretary of Labor. Youths 14 and 15 years old may workoutside school hours in various non-manufacturing, non-mining, non-hazardous jobs under thefollowing conditions:

$4.75per

hour

$5.15beginningSeptember1, 1997

Your Rights Under the Fair Labor Standards Act

FederalMinimumWage

per

hour

3 hours on a school day or 18 hours in a school week;8 hours on a non-school day or 40 hours in a non-school week.

Also, work may not begin before 7 a.m. or end after 7 p.m., except from June 1 through Labor Day,when evening hours are extended to 9 p.m. Different rules apply in agricultural employment.

EnforcementThe Department of Labor may recover back wages either administratively or through court action,for the employees that have been underpaid in violation of the law. Violations may result in civil orcriminal action.

Fines of up to $10,000 per violation may be assessed against employers who violate the child laborprovisions of the law and up to $1,000 per violation against employers who willfully or repeatedlyviolate the minimum wage or overtime pay provisions. This law prohibits discriminating againstor discharging workers who file a complaint or participate in any proceedings under the Act.

Note: Certain occupations and establishments are exempt from the minimum wage and/orovertime pay provisions.

Special provisions apply to workers in American Samoa.Where state law requires a higher minimum wage, the higher standard applies.

telephone directory under United States Government, Labor Department.

U.S. Department of LaborEmployment Standards Administration

Wage and Hour DivisionWashington, D.C. 20210 WH Publication 1088Revised October 1996

This postermay be viewed on the worldwide web at this address: http://www.dol.gov/dol/esa/public/minwage/main.htm

The law requires employers to display this posterwhereemployees can readily see it.

No more than

Tip Credit Employers of " tipped employees" must pay a cash wage of at least $2.13 per hour if they

ForAdditional Information,Contactthe Wage and Hour Division office nearest you listed in your


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Your Rightsunder the

Family and Medical Leave Act of 1993FMLA requires covered employers to provide up to 12

weeks of unpaid, job-protected leave to ''eligible''employees for certain family and medical reasons.Employees are eligible if they have worked for theiremployer for at least one year, and for 1,250 hours over

the previous 12 months, and if there are at least 50

employees within 75 miles. The FMLA permitsemployees to take leave on an intermittent basis or towork a reduced schedule under certain circumstances.

Reasons for Taking Leave:

Unpaid leave must be granted forany of the followingreasons:

to care for the employee's child after birth, or placementfor adoption or foster care;

to care for the employee's spouse, son or daughter, orparent who has a serious health condition; or

for a serious health condition that makes the employeeunable to perform the employee's job.

At the employee's or employer's option, certain kinds ofpaidleave may be substituted for unpaid leave.

Advance Notice and Medical

Certification:

The employee may be required to provide advance leave

notice and medical certification. Taking of leave may bedenied if requirements are not met.

The employee ordinarily must provide 30 days advancenotice when the leave is ''foreseeable.''

An employer may require medical certification tosupport a request for leave because of a serious healthcondition, and may require second or third opinions (atthe employer's expense) and a fitness for duty report toreturn to work.

Job Benefits and Protection:

For the duration of FMLA leave, the employer mustmaintain the employee's health coverage under any''group health plan.''

Upon return from FMLA leave, most employees mustbe restored to their original or equivalent positions withequivalent pay, benefits, and other employment terms.

The use of FMLA leave cannot result in the loss of anyemployment benefit that accrued prior to the start of anemployee's leave.

Unlawful Acts by Employers:FMLA makes it unlawful for any employer to:

interfere with, restrain, or deny the exercise of anyright provided under FMLA:

discharge or discriminate against any person foropposing any practice made unlawful by FMLA or forinvolvement in any proceeding under or relatingto FMLA.

-Enforcement:

The U.S. Department of Labor is authorized toinvestigate and resolve complaints of violations.

An eligible employee may bring a civil action againstan employer for violations.

FMLA does not affect any Federal or State lawprohibiting discrimination, or supersede any State orlocal law or collective bargaining agreement whichprovides greater family or medical leave rights.

For Additional Information:

If you have access to the Internet visit our FMLAwebsite: http://www.dol.gov/esa/whd/fmla. To

Wage-Hour toll-free information and help line at 1-866-4USWAGE (1-866-487-9243): a customer servicerepresentative is available to assist you with referralinformation from 8am to 5pm in your time zone; or logonto our Home Page at http://www.wagehour.dol.gov.

U.S. Department of LaborEmployment Standards AdministrationWage and Hour DivisionWashington, D.C. 20210

WH Publication 142

Revised August 200

*U.S. GOVERNMENT PRINTING OFFICE 2001-476-344/49051

locate your nearest Wage-Hour Office, telephone our


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You havethe right tonotify your employer or OSHA aboutworkplacehazards.You may ask OSHA to keep your name confidential.

You have the right to request an OSHA inspection if you believethat there are unsafe and unhealthful conditions in your workplace.You or your representative may participate in the inspection.

You can file a complaint with OSHA within 30 days of discriminationby your employer for making safety and health complaints or forexercising your rights under theOSHAct.

You have a right to see OSHA citations issued to your employer.Your employer must post the citations at or near the place of thealleged violation.

Your employer must correct workplace hazards by the date indicatedon the citation and must certify that these hazards have beenreduced or eliminated.

You have the right to copies of your medical records or records ofyour exposure to toxic and harmful substances or conditions.

Your employer must post this notice in your workplace.

The Occupational Safety and Health Act of 1970 (OSH Act), P.L. 91-596, assures safe and healthful working conditions for working men and

women throughout the Nation. The Occupational Safety and Health Administration, in the U.S. Department of Labor, has the primary

responsibility for administering the OSHAct.The rights listed here may vary depending on the particular circumstances.To file a complaint,

report an emergency, or seek OSHA advice, assistance, or products, visit our website at www.osha.gov or call 1-800-321-OSHA or your

nearest OSHA office:

Atlanta (404) 562-2300 Boston (617) 565-9860 Chicago (312) 353-2220 Dallas (214) 767-4731

Denver (303) 844-1600 Kansas City (816) 426-5861 NewYork (212) 337-2378 Philadelphia (215) 861-4900

San Francisco (415) 975-4310 Seattle (206) 553-5930 Teletypewriter (TTY) 1-877-889-5627

If you work in a state operating under an OSHA-approved plan, your employer must post the required state equivalent of this poster.

ITSTHELAW!

1-800-321-OSHA

You Have a Right to a Safeand Healthful Workplace.

U.S. Department of Laborwww.osha.gov OSHA 3165-09R


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Employers

Holding Federal

Contracts or

Subcontracts

Applicants to and employees of

companies with a Federal govern-ment contract or subcontract areprotected under the followingFederal authorities:

RACE, COLOR,RELIGION,

SEX,NATIONAL ORIGIN

Executive Order 11246, as amended,prohibits job discrimination on thebasis of race, color, religion,sex ornational origin, and requires affirma-tive action to ensure equality ofopportunity in all aspects ofemployment.

INDIVIDUALS WITH

DISABILITIES

Section 503 of the Rehabilitation Actof 1973, as amended, prohibits jobdiscrimination because of disabilityand requires affirmative action toemploy and advance in employmentqualified individuals with disabilitieswho, with reasonable accommodation,can perform the essential functionsof a job.

VIETNAM ERA, SPECIAL

DISABLED, RECENTLY

SEPARATED, AND OTHER

PROTECTEDVETERANS

38 U.S.C. 4212 of theVietnam EraVeterans Readjustment Assistance Actof 1974, as amended, prohibits jobdiscrimination and requires affirmativeaction to employ and advance inemployment qualifiedVietnam eraveterans, qualified special disabledveterans, recently separated veterans,and other protected veterans.

Any person who believes a contractorhas violated its nondiscrimination oraffirmative action obligations underthe authorities above should contactimmediately:

The Office of Federal Contract

Compliance Programs (OFCCP),Employment StandardsAdministration,U.S. Department of Labor,200 ConstitutionAvenue N W

Equal Employment Opportunity is

THE LAWPrivate Employment,

State and Local

Governments,

Educational Institutions

Applicants to and employees of most private employers,state

and local governments, educational institutions, employmentagencies and labor organizations are protected under the following

Federal laws:

RACE, COLOR, RELIGION, SEX, NATIONAL

ORIGIN

TitleVII of the Civil Rights Act of 1964, as amended, prohibitsdiscrimination in hiring, promotion,discharge,pay, fringe benefits,

job training,cl assification, referral,and other aspects of employment,

on the basis of race, color, religion, sex or national origin.

DISABILITY

The Americans with DisabilitiesAct of 1990, as amended, protects

qualified applicants and employees with disabilities from discrim-ination in hiring, promotion,discharge,pay, job training, fringe

benefits, classification, referral, and other aspects of employment onthe basis of disability. The law also requires that covered entities

provide qualified applicants and employees with disabilities withreasonable accommodations that do not impose undue hardship.

AGE

The Age Discrimination in EmploymentAct of 1967, as amended,

protects applicants and employees 40 years of age or older from

discrimination on the basis of age in hiring, promotion, discharge,compensation, terms, conditions or privileges of employment.

SEX (WAGES)

In addition to sex discrimination prohibited by TitleVII of the Civil

Rights Act of 1964,as amended (see above),the Equal PayAct of

1963,as amended, prohibits sex discrimination in payment of wages

to women and men performing substantially equal work in the sameestablishment.

Retaliation against a person who files a charge of discrimination,participates in an investigation, or opposes an unlawful employment

practice is prohibited by all of these Federal laws.

If you believe that you have been discriminated against under any ofthe above laws, you should contact immediately:

The U.S. Equal Employment Opportunity Commission (EEOC),

1801 L Street, N.W.,Washington, D.C. 20507 or an EEOC fieldoffice by calling toll free (800) 669-4000. For individuals with

hearing impairments, EEOCs toll free TDD number is (800) 669-6820.

Programs or

Activities Receiving

Federal Financial

Assistance

RACE,COLOR,RELIGION,

NATIONAL ORIGIN,SEXIn addition to the protection of Title

VII of the Civil Rights Act of 1964,as

amended,TitleVI of the Civil Rights

Act prohibits discrimination on thebasis of race, color or national origin

in programs or activities receiving

Federal financial assistance. Employ-

ment discrimination is covered byTitleVI if the primary objective of the

financial assistance is provision of

employment, or where employment

discrimination causes or may causediscrimination in providing services

under such programs. Title IX of the

Education Amendments of 1972

prohibits employment discriminationon the basis of sex in educational

programs or activities which receive

Federal assistance.

INDIVIDUALS WITH

DISABILITIES

Sections 501, 504 and 505 of the

Rehabilitation Act of 1973, asamended, prohibits employment

discrimination on the basis of disabil-

ity in any program or activity which

receives Federal financial assistance inthe federal government. Discrimina-

tion is prohibited in all aspects of

employment against persons withdisabilities who,wi th reasonableaccommodation, can perform the

essential functions

of a job.

If you believe you have been

discriminated against in a program

of any institution which receives

Federal assistance, you should contactimmediately the Federal agency

providing such assistance.


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The

(Form

300)is

use

dtoclassi

fyw

ork

-related

injuriesan

dillnessesan

dtonotetheextent

andseve

rityo

feachcase

.W

henan

inci

dent

occurs

,usethe

torecordspec

ificdetai

ls

aboutw

hat

happenedan

dhowit

happened

.

The

aseparate

form

(Form

300A)

showsthetota

lsfortheye

arin

each

category.

Attheen

doftheye

ar,p

ostthe

inavi

siblelocationsothatyou

r

emp

loye

esareawareo

fthe

injuriesan

d

illnessesoccurr

ing

intheirw

orkplace

.

Emp

loye

rsmu

stkeepa

foreach

esta

blishmentorsite

.If

you

havemorethan

oneesta

blishment,you

mu

stkeep

aseparate

and

foreachp

hys

icallocationthat

isexpecte

dto

beinoperat

ion

foroneye

aror

longer.

Notethatyou

remp

loye

eshavetherig

htto

revi

ewyou

rinjuryan

dillnessrecor

ds.For

more

informat

ion

,see

29Codeof

Federal

Regu

lationsPart

1904.35

,

Cases

liste

donthe

arenotnecessar

ilyel

igible

forw

orkers

compensationorother

insurance

benef

its.L

istingacaseonthe

doesnot

meanthattheemp

loye

rorw

orkerw

asat

fau

lt

orthatan

OSHAstan

dar

dw

asvio

late

d.

Recor

dthosew

ork

-related

injuriesan

d

illnessesthatresu

ltin

:

death

,

losso

fconsc

iou

sness,

daysaway

fromw

ork

,

restrictedw

orkactivi

tyor

jobtransfer,or

med

icaltreatment

beyon

dfirstai

d.

Youmu

stalsorecordw

ork-r

elated

in

juries

andillnessesthataresign

ificant

(as

defin

ed

belo

w)ormeetany

ofthead

ditionalcriter

ia

liste

dbelow

.

LogofWor

k-RelatedInjuriesan

dIllnesses

Log

Summary

Summary

Log

Log

Summary

EmployeeInvo

lvement.

LogofWork-Related

Injuriesan

dIllnesses

Log

Whenisaninjuryorillnessconsidered

work-related?

Whichwork-relatedinjuriesand

illnessesshouldyourecord?

An

injuryor

illness

isconsi

dered

wor

k-r

elated

ifaneventorexposu

reinthe

wor

kenvi

ronmentcau

sedorcontri

bute

dtothe

con

ditionorsign

ificantly

aggravate

da

preex

istingcon

dition

.Work-r

elate

dness

is

presumed

for

injuriesan

dillnessesresu

lting

fromeventsorexposuresoccurr

ing

inth

e

wor

kp

lace

,u

nlessanexceptionspec

ifically

app

lies

.See

29CFRPart

1904

.5(b)(2)fo

rthe

exceptions.

Thew

orkenvi

ronment

inclu

des

theesta

blishmentan

dother

locationswh

ere

oneormoreemp

loye

esarew

ork

ingora

re

presentasacon

ditiono

ftheiremp

loym

ent.

See

29CFRPart

1904

.5(b)(1).

Youmu

strecordany

sign

ificantw

ork

-

relate

dinjuryor

illnessthat

isdiagnosed

by

a

ph

ysicianorother

license

dhea

lthcare

pro

fess

ional

.Youmu

strecordanyw

ork-r

elated

case

invo

lvingcancer,chron

icirreve

rsible

disease

,afracture

dorcrac

kedbone,ora

pu

nctu

redeardrum

.See

29CFR

1904.7

.

You

mu

strecordthe

follo

wingcon

ditionsw

hen

theyarew

ork-re

late

d:

any

nee

dlest

ickinjuryorcut

fromasharp

objectthat

iscontam

inatedw

ithanother

person

sbloodorot

herpotential

ly

infect

iou

smater

ial;

any

caserequ

iringanemp

loye

eto

be

med

ical

lyremove

du

ndertherequ

irements

ofan

OSHAhea

lthstan

dar

d;

tubercu

losis

infect

ionasev

idence

dbya

pos

itivesk

intestor

diagnos

isb

yap

hys

ician

orot

her

license

dhea

lthcarepro

fess

ional

afterexposu

retoa

knowncaseo

factive

tubercu

losis.

anemp

loye

e's

hearingtest

(au

diogram

)

reve

als

1)thattheemp

loye

ehas

exper

ience

da

Stan

dar

dThreshol

dShift

(STS)inhearing

inoneor

bothears

(ave

rage

dat

2000,3000

,an

d4000Hz)

and

2)theemp

loye

e'stota

lhearing

leve

lis25

dec

ibels

(dB

)ormoreabove

audiometric

zero

(alsoaveragedat

2000,3000

,an

d4000

Hz)

inthesameear(s)asthe

STS.

Med

icaltreatment

inclu

desmanag

ingan

d

caring

forapat

ient

forthepu

rposeof

com

bating

diseaseor

disorder

.The

follow

ing

arenotconsi

deredmed

icaltreatmentsan

dare

NOTrecordab

le:

visitstoa

doctoror

hea

lthcarepro

fess

ional

solelyforo

bserva

tionorcou

nse

ling;

Whataretheadditionalcriteria?

Whatismedicaltreatment?

An

Overvie

w:

Record

ing

Work-Re

latedInjuriesan

dIllnesses

Whatdoyouneedtodo?

1.

Within7calendardaysafteryou

receiveinformationaboutacase,

decideifthecaseisrecordableunder

theOSHArecordkeeping

requirements.

Determinew

hethertheincidentisa

newcaseorarecurrenceofanexisting

one.

.

dentifytheemployeeinvo

lvedunless

itisaprivacyconcerncaseasdescribed

below.

dentifyw

henandw

herethecase

occurred.

Describethecase,a

sspecificallyasyou

can.

Identifyw

hetherthecaseisaninjury

orillness.Ifthecaseisaninjury,c

heck

theinjurycategory.I

fthecaseisan

illness,checktheappropriateillness

category.

2.

3.

4.

1.

2.

3.

4.

5.

Establishw

hetherthecasewaswork-

related

Ifthecaseisrecordable

,decidew

hich

formyouw

illfilloutastheinjuryand

illnessincidentreport.

Youmayuse

oranequ

ivalent

form.S

omestateworkerscompensa-

tion,i

nsurance,o

rotherreportsmay

beacceptablesubstitutes,aslongas

theyprovi

dethesameinformationas

theOSHA301.

I I Classifytheseriousnessofthecaseby

recordingthe

associatedw

iththecase,w

ithcolumnG

(Death)beingthemostseriousand

columnJ(Otherrecordablecases)

beingtheleastserious.

OSHAs301:Injuryan

d

IllnessInci

dentReport

HowtoworkwiththeLog

mostseriousoutcome

The

Occupa

tiona

lSa

fetyan

dHea

lth(OS

H)Ac

tof1970requ

ire

sce

rta

inemp

loye

rstop

repa

rean

dma

intainrec

ordso

fw

ork-re

latedinjurie

san

dillne

sse

s.

Use

the

se

de

fin

ition

sw

heny

ouc

lassifyca

se

sont

he

Log.

OSHAsrec

ordkeep

ing

regu

lation

(see

29CFRPa

rt1904)p

rov

ide

sm

oreinforma

tiona

bou

tthe

de

fin

ition

sbe

low.

U.S.DepartmentofLaborOccupationalSafetyandHealthAdministration


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diagnosticprocedures,including

administeringprescriptionmedica

tionsthat

areusedsolelyfordiagnosticpurp

oses;and

anyprocedurethatcanbelabeled

firstaid.

(

)

Youmustconsiderthefollowingtypesof

injuriesorillnessestobeprivacyconcerncases:

aninjuryorillnesstoanintimatebodypart

ortothereproductivesystem,

aninjuryorillnessresultingfromasexual

assault,

amentalillness,

acaseofHIVinfection,

hepatitis,or

tuberculosis,

aneedlestickinjuryorcutfromasharp

objectthatiscontaminatedwithbloodor

otherpotentiallyinfectiousmaterial(see

29CFRPart1904.8

fordefinition),and

otherillnesses,iftheemployee

independentlyandvoluntarilyrequeststhat

hisorhernamenotbeenteredonthelog.

Youmustnotentertheemployeesnameonthe

OSHA300

forthesecases.Instead,enter

privacycaseinthespacenormallyusedfor

theemployeesname.Youmustkeepaseparate,

confidentiallistofthecasenumbersand

employeenamesfortheestablishmentsprivacy

concerncasessothatyoucanupdatethecases

andprovideinformationtothegovernmentif

askedtodoso.

Ifyouhaveareasonablebasistobelieve

thatinformationdescribingtheprivacyconcern

casemaybepersonallyidentifiableeventhough

theemployeesnamehasbeenomitted,youmay

usediscretionindescribingtheinjuryorillness

onboththeOSHA300and301forms.You

mustenterenoughinformationtoidentifythe

causeoftheincidentandthegeneralseverityof

theinjuryorillness,butyoudonotneedto

includedetailsofanintimateorprivatenature.

contusion,chipped

tooth,

Seebelowformoreinformationabout

firstaid.

Log

Underwhatcircumstancesshouldyou

NOTentertheemployeesnameonthe

OSHAForm300?

Classifyinginjuries

Aninjuryisanywoundordamagetothebody

resultingfromaneventinthework

environment.

Cut,puncture,

laceration,

abrasion,

fracture,

bruise,

amputation,

insectbite,electrocution,or

athermal,chemical,electrical,orradiation

burn.

Sprainandstraininjuriestomuscles,

joints,andconnectivetissuesareclassifiedas

injurieswhentheyresultfromaslip,trip,

fallor

othersimilaraccidents.

Examples:

Whatisfirstaid?

Iftheincidentrequiredonlythefollo

wingtypes

oftreatment,consideritfirstaid.

DoNOT

recordthecaseifitinvolvesonly:

usingnon-prescriptionmedication

satnon-

prescriptionstrength;

administeringtetanusimmunizations;

cleaning,

flushing,orsoakingwou

ndsonthe

skinsurface;

usingwoundcoverings,suchasba

ndages,

BandAids,gauzepads,etc.,orusing

SteriStripsorbutterflybandages

.

usinghotorcoldtherapy;

usinganytotallynon-rigidmeans

ofsupport,

suchaselasticbandages,wraps,no

n-rigid

backbelts,etc.;

usingtemporaryimmobilizationd

evices

whiletransportinganaccidentvictim

(splints,slings,neckcollars,orbac

kboards).

drillingafingernailortoenailtorelieve

pressure,ordrainingfluidsfromblisters;

usingeyepatches;

usingsimpleirrigationoracotton

swabto

removeforeignbodiesnotembeddedinor

adheredtotheeye;

usingirrigation,tweezers,cottons

wabor

othersimplemeanstoremovesplintersor

foreignmaterialfromareasotherthanthe

eye;

usingfingerguards;

usingmassages;

drinkingfluidstorelieveheatstress

Restrictedworkactivityoccurswhen,asthe

resultofawork-relatedinjuryorillness,an

employerorhealthcareprofessionalkeeps,

or

recommendskeeping,anemployeefromdo

ing

theroutinefunctionsofhisorherjoborfrom

workingthefullworkdaythattheemployee

wouldhavebeenscheduledtoworkbeforet

he

injuryorillnessoccurred.

Iftheoutcomeorextentofaninjuryorillness

changesafteryouhaverecordedthecase,

simplydrawalinethroughtheoriginalentryor,

ifyouwish,

deleteorwhite-outtheoriginal

entry.Thenwritethenewentrywhereit

belongs.Remember,youneedtorecordthe

mostseriousoutcomeforeachcase.

Howdoyoudecideifthecaseinvolved

restrictedwork?

Howdoyoucountthenumberofdays

ofrestrictedworkactivityorthe

numberofdaysawayfromwork?

Whatiftheoutcomechangesafteryou

recordthecase?

Countthenumberofcalendardaysthe

employeewasonrestrictedworkactivityorwas

awayfromworkasaresultoftherecordable

injuryorillness.

Donotcountthedayonwh

ich

theinjuryorillnessoccurredinthisnumber

.

Begincountingdaysfromtheday

the

incidentoccurs.

Ifasingleinjuryorillness

involvedbothdaysawayfromworkandday

sof

restrictedworkactivity,enterthetotalnumb

er

ofdaysforeach.

Youmaystopcountingday

sof

restrictedworkactivityordaysawayfromwork

oncethetotalofeitherorthecombinationo

f

bothreaches180days.

after



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Classifyingillnesses

Skindiseasesordisorders

Respiratoryconditions

HearingLoss

Allotherillnesses

Skindiseasesordisordersareillne

ssesinvolving

theworkersskinthatarecausedb

ywork

exposuretochemicals,

plants,

oro

ther

substances.

Contactdermatitis,

eczema,or

rashcausedbyprimaryirritantsan

dsensitizers

orpoisonousplants;oilacne;frictionblisters,

chromeulcers;inflammationoftheskin.

Respiratoryconditionsareillnesse

sassociated

withbreathinghazardousbiologicalagents,

chemicals,dust,

gases,

vapors,

orfumesatwork.

Silicosis,asbestosis,

pneumonitis,

pharyngitis,

rhinitisoracutecongestion;

farmerslung,

berylliumdisease,t

uberculosis,

occupationalasthma,reactiveairways

dysfunctionsyndrome(RADS),chronic

obstructivepulmonarydisease(CO

PD),

hypersensitivitypneumonitis,

toxicinhalation

injury,

suchasmetalfumefever,ch

ronic

obstructivebronchitis,

andother

pneumoconioses.

Noise-inducedhearinglossisdefinedfor

recordkeepingpurposesasachangeinhearing

thresholdrelativetothebaselineaudiogramof

anaverageof10dBormoreineitherearat

2000,

3000and4000hertz

Allotheroccupationalillnesses.

Heatstroke,sunstroke,

heat

exhaustion,

heatstressandothereffectso

f

environmentalheat;freezing,

frostbite,and

othereffectsofexposuretolowtemperat

ures;

decompressionsickness;effectsofionizing

radiation(isotopes,

x-rays,radium);effectsof

nonionizingradiation(weldingflash,

ultr

a-violet

rays,lasers);anthrax;bloodbornepathog

enic

diseases,

suchasAIDS,

HIV,

hepatitisBo

r

hepatitisC;brucellosis;malignantor

Examples:

Examples:

Examples:

Poisoning

Poisoningincludesdisordersevide

ncedby

abnormalconcentrationsoftoxicsubstancesin

blood,

othertissues,otherbodilyfluids,orthe

breaththatarecausedbytheingestionor

absorptionoftoxicsubstancesinto

thebody.

Poisoningbylead,m

ercury,

cadmium,

arsenic,

orothermetals;poisoningby

carbonmonoxide,hydrogensulfide,oro

ther

gases;poisoningbybenzene,benzol,carb

on

tetrachloride,

orotherorganicsolvents;

poisoningbyinsecticidesprays,

suchas

parathionorleadarsenate;poisoningby

other

chemicals,suchasformaldehyde.

Examples:

benign

tumors;histoplasmosis;coccidioidomyc

osis.

,

andtheemployees

totalhearinglevelis25decibels(dB)orm

ore

aboveaudiometriczero(alsoaveragedat

2000,

3000,

and4000hertz)inthesameear(s).

WhenmustyouposttheSummary?

HowlongmustyoukeeptheLog

andSummaryonfile?

Doyouhavetosendtheseformsto

OSHAattheendoftheyear?

Howcanwehelpyou?

Youmustpostthe

only

notthe

byFebruary1oftheyearfollowingthe

yearcoveredbytheformandkeepitposted

untilApril30ofthatyear.

Youmustkeepthe

and

for

5yearsfollowingtheyeartowhichthey

pertain.

No.

Youdonothavetosendthecompleted

formstoOSHAunlessspecificallyaskedto

doso.

Ifyouhaveaquestionabouthowtofillout

the

,

or

Summary

Log

Log

Summary

Log

visitusonlineatwww.osha.gov

callyourlocalOSHAoffice.



43/57

Whatisanincidencerate?

Howdoyoucalculateanincidence

rate?

WhatcanIcomparemyincidence

rateto?

Anincidencerateisthenumberofrecordable

injuriesandillnessesoccurringamo

ngagiven

numberoffull-timeworkers(usually100full-

timeworkers)overagivenperiodoftime

(usuallyoneyear).Toevaluateyour

firms

injuryandillnessexperienceovertimeorto

compareyourfirmsexperiencewiththatof

yourindustryasawhole,youneedtocompute

yourincidencerate.

Becauseaspecificnumber

ofworkersandaspecificperiodoft

imeare

involved,theseratescanhelpyouid

entify

problemsinyourworkplaceand/or

progress

youmayhavemadeinpreventingw

ork-

relatedinjuriesandillnesses.

Youcancomputeanoccupationalin

juryand

illnessincidencerateforallrecordablecasesor

forcasesthatinvolveddaysawayfro

mworkfor

yourfirmquicklyandeasily.

Theformula

requiresthatyoufollowinstructionsin

paragraph(a)belowforthetotalrecordable

casesorthoseinparagraph(b)forc

asesthat

involveddaysawayfromwork,

forboth

ratestheinstructionsinparagraph(c).

(a)

countthenumberoflineentrieson

your

OSHAForm300,orrefertotheOS

HAForm

300Aandsumtheentriesforcolum

ns(G),(H),

(I),and(J).

(b)

count

thenumberoflineentriesonyourOSHA

Form300thatreceivedacheckmar

kin

column(H),orrefertotheentryforcolumn

(H)ontheOSHAForm300A.

(c)

.RefertoOSHAForm

300Aandoptionalworksheettocalculatethis

number.

Youcancomputetheincidencerateforall

recordablecasesofinjuriesandillnessesusing

thefollowingformula:

(The200,0

00figureintheformularepresents

thenumberofhours100employeesworking

40hoursperweek,

50weeksperyearwou

ld

work,andprovidesthestandardbasefor

calculatingincidencerates.)

Youcancomputetheincidenceratefor

recordablecasesinvolvingdaysawayfrom

work,

daysofrestrictedworkactivityorjob

transfer(DART)usingthefollowingformu

la:

Youcanusethesameformulatocalculate

incidenceratesforothervariablessuchascases

involvingrestrictedworkactivity(column(I)

onForm300A),casesinvolvingskindisord

ers

(column(M-2)onForm300A),etc.

Just

substitutetheappropriatetotalforthesecases,

fromForm300A,

intotheformulainplace

of

thetotalnumberofinjuriesandillnesses.

TheBureauofLaborStatistics(BLS)cond

ucts

asurveyofoccupationalinjuriesandillnes

ses

eachyearandpublishesincidenceratedat

aby

variousclassifications(e.g.,

byindustry,

by

employersize,etc.).Youcanobtainthese

publisheddataatwww.b

ls.gov/iiforbycallinga

BLSRegionalOffice.

and

Tofindoutthetotalnumberofrecordable

injuriesandillnessesthatoccurreddurin

gtheyear,

Tofindoutthenumberofinjuriesand

illnessesthatinvolveddaysawayfromwork,

Thenumberofhoursallemployeesactua

lly

workedduringtheyear

Totalnumberofinjuriesandillnesses

200,00

0

Numberofhoursworkedbyallemployees=Total

recordablecaserate

(NumberofentriesincolumnH+Numberof

entriesincolumnI)

200,0

00Numberofhours

workedbyallemployees=DARTincidencerate

X

X

Optional

Calculating

InjuryandIllnessIncidenceRates

Worksheet


Numberofentriesin

ColumnH

ColumnI

+

DARTincidence

rate

Numberof

hoursworked

byallemployees

Totalnumberof

injuriesandillnesses

X

200,0

00

=

Totalrecordable

caserate

Numberof

hoursworked

byallemployees

X

200,0

00

=


44/57

The

is

usedtoclassifywork-relatedinjuriesand

illnessesandtonotetheextentandseverity

ofeachcase.Whenanincidentoccurs,use

the

torecordspecificdetailsaboutwhat

happenedandhowithappened.

Wehavegivenyouseveralco

piesofthe

inthispackage.Ifyouneedmorethan

weprovided,youmayphotocopyanduseas

manyasyouneed.

The

aseparateform

showsthework-relatedinjuryan

dillness

totalsfortheyearineachcategory.Atthe

endoftheyear,countthenumbe

rof

incidentsineachcategoryandtransferthe

totalsfromthe

tothe

Then

postthe

inavisiblelocationsothat

youremployeesareawareofinju

riesand

illnessesoccurringintheirworkp

lace.

LogofWor

k-RelatedInjuriesandIllnesses

Log

Log

Summary

Log

Summary.

Summary

Ifyourcompanyhasmore

thanone

establishmentorsite,youmust

keep

separaterecordsforeachphysicallocation

thatisexpectedtoremaininop

erationfor

oneyearorlonger.

YoudontposttheLog.You

postonly

theSummaryattheendofthey

ear.

HowtoFill

OuttheLog


Revisethelogiftheinjuryorillness

progressesandtheoutcomeismore

seriousthanyouoriginallyrecordedfor

thecase.Crossout,erase,orwhite-out

theoriginalentry.

Beasspecificaspossible.You

canusetwolinesifyouneed

moreroo

m.

Notewhetherthe

caseinvolvesan

injuryoranillness.

Choose

ONLYONEofthese

categories.Classifythecase

byreco

rdingthemost

serious

outcomeofthecase,

withco

lumnG(Death)being

themostseriousandcolumn

J(Othe

rrecordablecases)

beingtheleastserious.

}

ChecktheInjurycolumnor

chooseonetypeofillness:

R

Describeinjuryorillness,partsofbodyaffected,

andobject/substancethatdirectlyinjured

ormadepersonill

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

(I)

(J)

(K)

(L)

(1)

(2)

(3)

(4)

(5)

(6)

Skindisorders


Poisoning

Hearingloss

Allotherillnesses

Injury

Youmu

strec

ordinforma

tiona

bou

teve

ryw

ork-re

lateddea

tha

nda

bou

teve

ryw

ork-re

latedinjuryorillne

sstha

tinv

olve

slossofc

on

sc

iou

sne

ss

,restrictedw

orkac

tiv

ity

orjob

tran

sfe

r,

day

saway

from

work

,orme

dica

ltrea

tmen

tbey

on

dfirsta

id.Y

oumu

sta

lsorec

ordsign

ifican

tw

ork-re

latedinjurie

san

dillne

sse

stha

ta

rediagn

ose

dbyap

hys

ician

orlicen

se

dheal

th

ca

rep

rofessiona

l.Youmu

sta

lsorec

ordw

ork-re

latedinjuriesan

dillne

sse

stha

tmee

tany

ofthe

spec

ificrec

ordingc

riteria

listedin29CFRPa

rt1904

.8throug

h1904

.12

.Fee

lfreet

o

use

twoline

sfora

sing

leca

se

ify

ounee

dto

.Youmu

stc

omp

letean

Injuryan

dIllne

ssInc

iden

tRep

ort(OSHAForm

301)orequ

iva

len

tform

foreac

hinjuryorillne

ssrec

orde

donth

is

form

.Ify

ou

ren

otsu

rew

he

the

raca

se

isrec

orda

ble

,ca

lly

ourloca

lOSHAoffice

forhe

lp.

(M)

Attention:Thisfor

mc

ontainsinformationrelatingto

employeehealthand

mustbeusedinamannerthat

protectstheconfiden

tialityofemployeestotheextent

possiblewhiletheinformationisbeingusedfor

occupationalsafetyandhealthpurposes.

XYZCompany

Anywhere

MA

FormapprovedOMBno.1218-0176

Death

Daysaway

fromw

ork

Jobtransfer

orrestriction

RemainedatWork

Otherrecord-

ablecases

Away

from

work

Onjob

transferor

restriction

Enterthenumberof

daystheinjuredor

illworkerwas:

CHECKONLYONEboxforeachcase

basedon

themostseriousoutcomefor

thatcase:

(Rev.

01/2004

)


45/57

U.S.DepartmentofLabor

OccupationalSafetyandHealthAdministration

OSHAsForm3

00(Rev.

01/2004)

Year20____

LogofWork-Related

InjuriesandIllnesses

Youmu

strec

ordinforma

tiona

bou

teve

ryw

ork-re

lateddea

than

da

bou

teve

ryw

ork-re

latedinjuryorillne

sstha

tinv

olve

slossofc

on

sc

iou

sne

ss

,restr

ictedw

orkac

tiv

ity

orjobtran

sfer,

day

saway

from

work

,orme

dica

ltrea

tmen

tbey

on

dfirsta

id.

Youmus

ta

lsorec

ordsign

ifican

tw

ork-re

latedinjurie

san

dillne

sse

stha

ta

rediagn

osed

byap

hy

sician

orlicen

se

dhea

lth

ca

rep

rofessiona

l.Youmu

sta

lsorec

ordw

ork-re

latedinjurie

san

dillne

sse

stha

tmee

tany

ofthe

spec

ificrec

ordingc

riteria

listedin29CFRPa

rt1904

.8throug

h1904

.12

.Fee

lfree

to

use

twoline

sfora

sing

leca

se

ify

ounee

dto

.Youmu

stc

omp

letean

Injuryan

dIllne

ssInc

iden

tRep

ort(OSHAForm

301)orequ

iva

len

tform

foreac

hinjuryorillne

ssrec

orde

don

this

form

.Ify

ou

ren

otsu

rew

he

the

raca

se

isrec

orda

ble

,ca

lly

ou

rloca

lO

SHAoffice

forhe

lp.

FormapprovedOMBno.

1218-0176

Page____

of____

Skindisorder

Respiratorycondition

Poisoning

Hearingloss

Allotherillnesses

Be

su

retotran

sferthe

se

totalstothe

Summa

rypage

(Form

300A)be

forey

oup

ostit

.

Pagetotals

Establishmen

tname

___________________________________________

City

________________________________

State

___________________

Injury

Enterthenumberof

daystheinjuredor

illworkerwas:

ChecktheInjurycolumnor

chooseonetypeofillness:

month/day

month

/day

month

/day

month/day

month

/day

month

/day

month

/day

month

/day

month

/day

month/day

month

/day

month/day

month

/day

Publicreportingburdenforthiscollectionofinformationisestimatedtoaverage

14minutesperresponse,

includingtimetoreview

theinstructions,searchandgatherthedataneeded,andcompleteandreviewth

ecollectionofinformation.

Personsarenotrequired

torespondtothecollectionofinformationunlessitdisplaysacurrentlyvalidOM

Bcontrolnumber.

Ifyouhaveanycomments

abouttheseestimatesoranyotheraspectsofthisdatacollection,contact:USDep

artmentofLabor,OSHAOfficeofStatistical

Analysis,

RoomN-3644,

200ConstitutionAvenue,NW,

Washington,

DC20210.Donotsendthecompletedformstothisoffice.

(A)

(B)

(C)

(D)

(E)

(F)

(M)

(K)

(L)

(G)

(H)

(I)

(J)

Death

Daysaway

fromw

ork

Onjob

transferor

restriction

Away

from

work

Attention:Thisformc

ontainsinformationrelatin

gto

employeehealthandmustbeusedinamannerthat

protectstheconfidentialityofemployeestotheex

tent



CHECKONLYONEboxforeachcase

basedonthemostseriousoutcomefor

thatcase:

Jobtransfer

orrestriction

Otherrecord-

ablecases

RemainedatWork

(1)

(2)

(3)

(4)

(5)

(6)

(1)

(2)

(3)

(4)

(5)

(6)

Skindisorder

Respiratorycondition

Poisoning

Hearingloss

Allotherillnesses

Injury

Identifytheperson

De

scribethecase

Classifythecase

Case

Emp

loyee

sname

Jobtitle

Dateof

injury

Wheretheeventoccurred

Descr

ibe

injuryor

illness,pa

rtso

fbo

dyaf

fected

,

ofillness

ormadeperson

ill(

no

.

oro

nset

andob

ject

/su

bstancethat

directly

injure

d

e.g.,Secon

ddegree

burnson

e.g.,Wel

der

e.g.,Loa

ding

docknort

hen

d

rightforearm

fromacetylenetorch

(

)

(

)

)

_____

________________________

____________

_____

_/___

___

____

__________________

____

___________________

____________

____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

________________________________

___________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

______________________

_________

____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

______________________

_________

____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

___________________

____________

____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

______________________________

_

_____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

______________________________

_

_____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

______________________________

_

_____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

______________________________

_

_____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

___________________

____________

_____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

______________________________

_

_____________________

____

____

_____

________________________

____________

_____

_/___

___

____

___________________

______________________________

_

_____________________

____

____

_____

________________________

____________

_____

_/___

___

____

__________________

____

___________________

____________

_____________________

____

____

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days

days


46/57

U.S.

DepartmentofLabor


OSHAsForm3

00A(Rev.

01/2004)

Year20____

SummaryofWo

rk-RelatedInjuriesandIllnesses

FormapprovedOMBno.

1218-0176

Totalnumberof

deaths

__________________

Totalnumberof

caseswithdays

awayfromwork

__________________

Num

bero

fCases

Totalnumberofdaysaway

fromwork

___________

Totalnum

berofdaysofjob

transfero

rrestriction

________

___

Num

bero

fDays

Pos

tthisSummarypage

from

Fe

bruary

1toA

pri

l30o

ftheyear

follow

ing

theyearcovere

dby

the

form.

Alle

stablishmen

tsc

ove

redby

Pa

rt1904mu

stc

omp

letethisSumma

rypage,

even

ifn

ow

ork-re

latedinjurie

sorillne

sse

soccu

rre

ddu

ring

theyea

r.Remem

be

rtorev

iew

the

Log

tove

rifytha

ttheen

triesa

rec

omp

letean

daccu

ratebe

fore

comp

leting

thissumma

ry.

Using

the

Log,

coun

tthe

individua

len

triesy

ouma

de

for

eac

hca

teg

ory

.Thenw

ritethe

totalsbe

low,

ma

king

su

rey

ou

vea

dde

dtheen

triesfrom

eve

rypage

ofthe

Log.

Ify

ou

ha

dn

oca

se

s,

write0

.

Emp

loyee

s,

forme

remp

loyee

s,

an

dthe

irrep

resen

tatives

have

the

rig

httorev

iew

the

OSHAForm

300initsen

tirety

.Theya

lsohave

lim

ite

dacce

sstothe

OSHAForm

301or

itsequ

iva

len

t.See

29CFRPa

rt1904

.35

,inOSHAsrec

ordkeep

ing

rule

,forfurthe

rde

tailson

theacce

ssp

rov

ision

sforthe

se

forms

.

Establishmentinformation

Employmentinforma

tion

Youres

tablishmen

tname__________________________________________

Street

________________

_________

_______

City

________________

____________

State______

ZIP_________

Industrydescription(

)

________________

_______________________________________

StandardIndustrialClassificat

ion(SIC),ifknown(

)

_____________

___

NorthAmericanIndustrialClassification(NAICS),ifknown(e.g.,

336212)

e.g.,

Manufactureofmotortrucktrailers

e.g.,

3715

(I

eethe

Worksheetonthebackofthispage

toestimate.)

_____________________

OR

_____________

___________

Annualaveragenumberofem

ployees

______________

Totalhoursworkedbyallemp

loyeeslastyear

______________

fyoudonthavethesefigures,s

Signhere

Knowinglyfalsifyingthi

sdocumentmayresultinafine.

IcertifythatIhaveexaminedthisdocumentandthattothebestofmy

knowledgetheentriesaretrue,accurate,andcomplete.

___________________________________________________________

___________________________________________________________

Companyexecutive

Title

Phone

Date

(

)

-

/

/

Publicreportingburdenforthiscollectionofinformationisestimatedtoaverage50minutesperresponse,

includingtimetoreviewtheinstructions,searchandgatherthedataneeded,and

completeandreviewthecollectionofinformation.

PersonsarenotrequiredtorespondtothecollectionofinformationunlessitdisplaysacurrentlyvalidOM

Bcontrolnumber.

Ifyouhaveany

commentsabouttheseestimatesoranyotheraspectsofthisdatacollection,contact:USDepartmentofLabor,OSHAOfficeofStatisticalAnalysis,

RoomN-36

44,

200ConstitutionAvenue,NW,

Washington,

DC20210.

Donotsendthecompletedformstothisoffice.

Totalnumberof...

Skindisorders

______


______

Injuries

______

Injuryan

dIllness

Types

Poisonings

______

Hearingloss

Allotherillnesses

______

______

(G)

(H)

(I)

(J)

(K)

(L)

(M)

(1)

(2)

(3)

(4)

(5)

(6)

Totalnumberof

case

swithjob

tran

sferorrestriction

_____

_____________

Totalnumberof

otherrecordable

cases

__________________


47/57

Attheen

dofthey

ea

r,OSHArequ

iresy

out

oen

tertheav

erag

enu

mberofemp

loy

eesan

dthetotalhou

rsw

orkedbyy

ouremp

loy

eeson

thesu

mma

ry.

Ify

ou

don

thav

ethesefigu

res

,y

oucanu

sethe

informa

tion

on

thispag

etoestima

tethenu

mbersy

ouw

illn

eedtoen

teron

theSu

mma

rypag

ea

ttheen

dofthey

ea

r.

Forexample,AcmeConstructionfigureditsaverageemploymentthisway:

Forpayperiod

Acmepaidthisnum

berofemployees

1

10

2

0

3

15

4

30

5

40

24

20

25

15

26

+830

10

Howtofiguretheaveragenum

berofemployees

whoworkedforyourestablish

mentduringthe

year:

Add

Count

Divide

Roundtheanswer

thetotalnumberofemplo

yeesyour

establishmentpaidinallpayperiodsduringthe

year.

Includeallemployees:full-time,part-time,

temporary,seasonal,salaried,andhourly.

thenumberofpayperiodsyour

establishmenthadduringtheyear.

Besureto

includeanypayperiodswhen

youhadno

employees.

thenumberofemployeesbythenumberof

payperiods.

tothenext

highestwhole

number.Writetheroundednu

mberintheblank

markedAnnualaveragenumber

ofemployees.

Thenumberofemployees

paidinallpayperiods=

Thenumberofpay

periodsduringtheyear= =

Thenumberrounded

=

Howtofigurethetotalhoursworkedbyalle

mployees:

Includehoursworkedbysalaried,hourly,part-time

andseasonalworkers,as

wellashoursworkedbyotherworkerssubjecttodaytodaysupervisionby

yourestablishment(e.g.,temporaryhelpserviceswo

rkers).

Donotincludevacation,s

ickleave,holidays,ora

nyothernon-worktime,

evenifemployeeswerepaidforit.I

fyourestablishm

entkeepsrecordsofonly

thehourspaidorifyouhaveemployeeswhoarenotpaidbythehour,please

estimatethehoursthattheemployeesactuallyworked.

Ifthisnumberisntavailable,youcanusethisop

tionalworksheetto

estimateit.

Optional

Worksheett

oHelpYouFillOutth

eSummary


Find

Multiply

Add

Roundth

enumberoffull-timeemployeesinyour

establishmentfortheyear.

bythenumberofw

orkhoursforafull-time

employeeinayear.

Thisisthenumberoffull-timehoursworked.

thenumberofanyovertimehoursaswellasthe

hoursworkedbyotheremp

loyees(part-time,

temporary,seasonal)

theanswertothene

xthighestwholenumber.

Writetheroundednumber

intheblankmarkedTotal

hoursworkedbyallemployeesl

astyear.

x +OptionalWorksheet

Numberofemployeespaid=830

Numberofpayperiods=26

=

31.92

26

31.92roundsto32

32istheannualaveragenumberofemployees

830


48/57

Informationabouttheemployee

Informationaboutthephysicianoroth

erhealthcare

professional

Fullname

Street

City

State

ZIP

Dateofbirth

Datehired

Male

Female

Nameofphysicianorotherhealthcareprofessional

Iftreatmentwasgivenawayfromtheworksite,

wherewasitgiven?

Facility

Street

City

State

ZIP

Wasemployeetreatedinanemergencyroom?

Yes

No

Wasemployeehospitalizedovernightasanin-patient?

Yes

No

____________________________________________

_________________

________________________________________________________________

______________________________________

_________

___________

______

/_____

/______

______

/_____

/______

_____

_____________________

______________________________________________________

__________________

_________________________________________________________________

_____________________________________________

__________________

______________________________________

_________

___________

U.S.

DepartmentofLabor


OSHAsForm3

01

InjuryandIllne

ssIncidentReport

FormapprovedOMBno.1218-0176

This

isoneofthe

firstformsyoumustfilloutwhenarecordablework-

relatedinjuryorillnesshasoccurred.Togetherw

ith

the

andth

e

accompanying

theseformshelpthe

employerandOSHAdevelopapictureoftheextent

andseverityofwork-relatedincidents.

Within7calendardaysafteryoureceive

informationthatarecordablework-relatedinjuryor

illnesshasoccurred,youmustfilloutthisformoran

equivalent.Somestateworkerscompensation,

insurance,orotherreportsmaybeacceptable

substitutes.Tobeconsideredanequivalentform,

anysubstitutemustcontainalltheinformation

askedforonthisform.

AccordingtoPublicLaw91-596and29CFR

1904,OSHAsrecordkeepingrule,youmustkeep

thisformonfilefor5yearsfollowingtheyearto

whichitpertains.

Ifyouneedadditionalcopiesofthisform,yo

u

mayphotocopyanduseasmanyasyouneed.

Injuryan

dIllnessIncidentReport

LogofWor

k-RelatedInjuriesan

dIllnesses

Summary,

Informationaboutthecase

Casenumberfromthe

Dateofinjuryorillness

Timeemployeebeganwork

Timeofevent

Checkiftimecannotbedetermined

Dateofdeath

Log

_______________

______

(Trans

ferthecasenum

ber

fromtheLogafteryourecordthecase.)

______

/_____

/______

____________________

____________________

______

/_____

/______

AM/PM

AM/PM

Whatwastheemployeedoingjustbeforetheincidentoccurred?

Whathappened?

Whatwastheinjuryorillness?

Whatobjectorsubstancedirectlyharmedtheemployee?

Iftheemployeedied,whendiddeathoccur?

Describetheactivity,

aswellasthe

tools,

equipment,ormaterialtheemployeewasusing.

Bespecific.

climbingaladderwhile

carryingroofingmaterials;sprayingchlorinefromhandsprayer;dailycomputerkey-entry.

Tellushowtheinjury

occurred.

Whenladderslippedonwetfloor,worker

fell20feet;Workerwassprayedwith

chlorinewhengasketbrokeduringreplacement;Worker

developedsorenessinwristovertime.

Tellus

thepartofthebodythatwasaffectedandhowitwasaffected;be

morespecificthanhurt,

pain,

orso

re.

strainedback;chemicalburn,

hand;carpal

tunnelsyndrome.

concretefloor;chlorine;

radialarmsaw.

Examples:

Examples:

Examples:

Examples:

Ifthisquestiondoesno

tapplytotheincident,leaveitblank.

Completedby

Title

Phone

Date

_______________________________________________________

_________________________________________________________________

(________)_________--_____________

_____/___

___

/_____

Publicreportingburdenforthiscollectionofinformationisestimatedtoaverage22minutesperresponse,includingtimeforreviewinginstructions,searchingexistingdatasources,gatheringandmaintainingthedataneeded,andcompletingandreviewingthecollectionofinformation.Personsarenotrequiredtorespondtothe

collectionofinformationunlessitdisplaysacurrentvalidOMBcontrolnu

mber.Ifyouhaveanycommentsaboutthisestimateoranyotheraspectsofthisdatacollection,includingsuggestionsforreducingthisburden,contact:USDepartmentofLabor,O

SHAOfficeofStatisticalAnalysis,RoomN-3644,200ConstitutionAvenue,NW,

Washington,DC20210.Donotsendthecompletedformstothisoffice.

10)

11)

12)

13)

14)

15)

16)

17)

18)

1) 2) 3) 5) 6) 7) 8) 9)4)

Attention:Thisformc

ontainsinformationrelatingto

employeehealthandmustbeusedinaman

nerthat

protectstheconfidentialityofemployeestotheextent




49/57

Ifyouneedhelpdecidingwhetheracaseisrecordable,

orifyouhavequestionsabouttheinformationinthispackage,feelfreeto

contactus.

Wellgladlyansweranyquestio

nsyouhave.

IfYouNeed

Help

Visitusonlineatwww.osha.gov

CallyourOSHARegional

office

andaskfortherecordkeeping

coordinator

orCallyourStatePlanoffic

e

FederalJurisdiction

StatePlanStates

Region1-617/565-9860

Region2-212/337-2378

Region3-215/861-4900

Region4-404/562-2300

Region5-312/353-2220

Region6-214/767-4731

Region7-816/426-5861

Region8-303/844-1600

Region9-415/975-4310

Region10-206/553-5930

Connecticut;Massachusetts;Maine;Ne

w

Hampshire;RhodeIsland

NewYork;NewJersey

DC;Delaware;Pennsylvania;WestVirginia

Alabama;Florida;Georgia;Mississippi

Illinois;Ohio;Wisconsin

Arkansas;Louisiana;Oklahoma;Texas

Kansas;Missouri;Nebraska

Colorado;Montana;NorthDakota;South

Dakota

Idaho

Alaska-907/269-4957

Arizona-602/542-5795

California-415/703-5100

*Connecticut-860/566-4380

Hawaii-808/586-9100

Indiana-317/232-2688

Iowa-515/281-3661

Kentucky-502/564-3070

Maryland-410/767-2371

Michigan-517/322-1848

Minnesota-651/284-5050

Nevada-702/486-9020

*NewJersey-609/984-1389

NewMexico-505/827-4230

*NewYork-518/457-2574

NorthCarolina-919/807-2875

Oregon-503/378-3272

PuertoRico-787/754-2172

SouthCarolina-803/734-9669

Tennessee-615/741-2793

Utah-801/530-6901

Vermont-802/828-2765

Virginia-804/786-6613

VirginIslands-340/772-1315

Washington-360/902-5554

Wyoming-307/777-7786

*PublicSectoronly



50/57

Havequestio

ns?

Ifyouneedhelpinfillingoutthe

or

orifyou

havequestionsaboutwhetheracaseisrecordable

,contact

us.Wellbehappyto

helpyou.

Youcan:

Visitusonlineat:

Callyourregion

alorstateplanoffice.

Youllfindthe

phonenumberlistedinsidethiscover.

Log

Summary,

www.osha.gov



51/57

INSTRUCTIONS

Anti-Discrimination Notice. It is illegal to discriminate against any individual (other than an alien not authorized to work in the U.S.) ihiring, discharging, or recruiting or referring for a fee because of that individual's national origin or citizenship status. It is illegal to

discriminate against work eligible individuals. Employers CANNOT specify which document(s) they will accept from an employee. The

refusal to hire an individual because of a future expiration date may also constitute illegal discrimination.

Section 1- Employee. All employees, citizens andnoncitizens, hired after November 6, 1986, must complete Section 1

of this form at the time of hire, which is the actual beginning of

employment. The employer is responsible for ensuring that

Section 1 is timely and properly completed.

examine any document that reflects that the employis authorized to work in the U.S. (see List A orC),

Preparer/Translator Certification. The Preparer/TranslatorCertification must be completed if Section 1 is prepared by a person

other than the employee. A preparer/translator may be used only

when the employee is unable to complete Section 1 on his/her own.

However, the employee must still sign Section 1 personally.

record the document title, document number and

expiration date (if any) in Block C, and

Photocopying and Retaining Form I-9.A blank I-9 may be

reproduced, provided both sides are copied. The Instructions mu

be available to all employees completing this form. Employers m

retain completed I-9s for three (3) years after the date of hire or o

(1) year after the date employment ends, whichever is later.Section 2 - Employer. For the purpose of completing thisform, the term "employer" includes those recruiters and referrers for a

fee who are agricultural associations, agricultural employers or farmlabor contractors.

For more detailed information, you may refer to the Departm

of Homeland Security (DHS) Handbook for Employers, (FormM-274). You may obtain the handbook at your local U.S.

Citizenship and Immigration Services (USCIS) office.

Employers must complete Section 2 by examining evidence of

identity and employment eligibility within three (3) business days of

the date employment begins. If employees are authorized to work,

but are unable to present the required document(s) within three

business days, they must present a receipt for the application of the

document(s) within three business days and the actual document(s)

within ninety (90) days. However, if employers hire individuals for a

duration of less than three business days, Section 2 must be

completed at the time employment begins. Employers must record:

1) document title; 2) issuing authority; 3) document number, 4)

expiration date, if any; and 5) the date employment begins.

Employers must sign and date the certification. Employees mustpresent original documents. Employers may, but are not required to,

photocopy the document(s) presented. These photocopies may only

be used for the verification process and must be retained with the I-9.

However, employers are still responsible for completing the I-9.

Privacy Act Notice. The authority for collecting this information i

the Immigration Reform and Control Act of 1986, Pub. L. 99-603

USC 1324a).

This information is for employers to verify the eligibility of individu

for employment to preclude the unlawful hiring, or recruiting or

referring for a fee, of aliens who are not authorized to work in the

United States.

This information will be used by employers as a record of their ba

for determining eligibility of an employee to work in the United

States. The form will be kept by the employer and made available

for inspection by officials of the U.S. Immigration and CustomsEnforcement, Department of Labor and Office of Special Counse

Immigration Related Unfair Employment Practices.

Submission of the information required in this form is voluntary.

However, an individual may not begin employment unless this fo

is completed, since employers are subject to civil or criminal

penalties if they do not comply with the Immigration Reform and

Control Act of 1986.

Section 3 - Updating and Reverification. Employersmust complete Section 3 when updating and/or reverifying the I-9.

Employers must reverify employment eligibility of their employees on

or before the expiration date recorded in Section 1. Employers

CANNOT specify which document(s) they will accept from an

employee.

Reporting Burden. We try to create forms and instructions that a

accurate, can be easily understood and which impose the least

possible burden on you to provide us with information. Often this

difficult because some immigration laws are very complex.

Accordingly, the reporting burden for this collection of information

computed as follows: 1) learning about this form, 5 minutes; 2)completing the form, 5 minutes; and 3) assembling and filing

(recordkeeping) the form, 5 minutes, for an average of 15 minute

per response. If you have comments regarding the accuracy of th

burden estimate, or suggestions for making this form simpler, you

can write to U.S. Citizenship and Immigration Services, Regulato

Management Division, 111 Massachuetts Avenue, N.W.,

Washington, DC 20529. OMB No. 1615-0047.

If an employee's name has changed at the time this form isbeing updated/reverified, complete Block A.

If an employee is rehired within three (3) years of the datethis form was originally completed and the employee is stilleligible to be employed on the same basis as previouslyindicated on this form (updating), complete Block B and thesignature block.

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM.

Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-9 (Rev. 05/31/EMPLOYERS MUST RETAIN COMPLETED FORM I-9

PLEASE DO NOT MAIL COMPLETED FORM I-9 TO ICE OR USCIS

OMB No. 1615-0047; Expires 03/3

Employment Eligibility Verificati

If an employee is rehired within three (3) years of the date

this form was originally completed and the employee's work

authorization has expired orif a current employee's work

authorization is about to expire (reverification), complete

Block B and:

complete the signature block.

NOTE: This is the 1991 edition of the Form I-9 that has been

rebranded with a current printing date to reflect the recent transit

from the INS to DHS and its components.


52/57

A citizen or national of the United States

Please read instructions carefully before completing this form. The instructions must be available during completi

of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible individuals. Employ

CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because

a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Verification. To be completed and signed by employee at the time employment begins.

Print Name: Last First Middle Initial Maiden Name

Address (Street Name and Number) Apt. #

(month/day/year)

Date of Birth (month/day/year)

StateCity Zip Code Social Security #

Address (Street Name and Number, City, State, Zip Code)

and that to the best of my knowledge the employee

I attest, under penalty of perjury, that I am (check one of the following):I am aware that federal law provides for

imprisonment and/or fines for false statements or

use of false documents in connection with the

completion of this form.

A Lawful Permanent Resident (Alien #) A

An alien authorized to work until

(Alien # or Admission #)

is eligible to work in the United States. (State employment agencies may omit the date the employee began employment.)

Employee's Signature Date (month/day/year)

Preparer and/or Translator Certification. (To be completed and signed if Section 1 is prepared by a personother than the employee.) I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best

of my knowledge the information is true and correct.

Print NamePreparer's/Translator's Signature

Date (month/day/year)

Section 2. Employer Review and Verification. To be completed and signed by employer. Examine one document from List A ORexamine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number and expiration date, if

any, of the document(s).

ANDList B List CORList A

Document title:

Issuing authority:

Document #:

Expiration Date (if any):

Document #:

Print Name TitleSignature of Employer or Authorized Representative

Address (Street Name and Number, City, State, Zip Code) Date (month/day/year)Business or Organization Name

Section 3. Updating and Reverification. To be completed and signed by employer.

B. Date of Rehire (month/day/year) (if applicable)A. New Name (if applicable)

C. If employee's previous grant of work authorization has expired, provide the information below for the document that establishes current employment

eligibility.Document #: Expiration Date (if any):Document Title:

l attest, under penalty of perjury, that to the best of my knowledge, this employee is eligible to work in the United States, and if the employee

presented document(s), the document(s) l have examined appear to be genuine and to relate to the individual.

Date (month/day/year)Signature of Employer or Authorized Representative

employee began employment on

Expiration Date (if any):

Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-9 (Rev. 05/31/05)Y Pa

Employment Eligibility VerificatioOMB No. 1615-0047; Expires 03/3

NOTE: This is the 1991 edition of the Form I-9 that has been rebranded with acurrent printing date to reflect the recent transition from the INS to DHS and itscomponents.

CERTIFICATION - Iattest, under penalty of perjury, that I have examined the document(s) presented by the above-named

employee, that the above-listed document(s) appear to be genuine and to relate to the employee named, that the


53/57

LISTS OF ACCEPTABLE DOCUMENTS

LIST A LIST B LIST C

Documents that Establish

Identity

Documents that Establish

Employment EligibilityOR AND

Certificate of U.S. Citizenship

(Form N-560 or N-561)

2.

7.

1. 1.

9.

1.Driver's license or ID card issued

by a state or outlying possession of

the United States provided it

contains a photograph or

information such as name, date of

birth, gender, height, eye color and

address

Unexpired Temporary Resident

Card (Form I-688)

U.S. Passport (unexpired or

expired)

School ID card with a

photograph

Certificate of Naturalization

(Form N-550 or N-570)

2.3. ID card issued by federal, state or

local government agencies or

entities, provided it contains a

photograph or information such as

name, date of birth, gender, height,eye color and address

Certification of Birth Abroad issued

by the Department of State (Form

FS-545 or Form DS-1350)

4. Unexpired foreign passport,with I-551 stamp orattached

Form I-94 indicating unexpired

employment authorization3. Original or certified copy of a

birth certificate issued by a state,

county, municipal authority or

outlying possession of the United

States bearing an official seal

3.

5.4. Voter's registration card

5. U.S. Military card or draft record

6. Military dependent's ID card 4. Native American tribal document6.

7.

5. U.S. Citizen ID Card (Form I-197)7.

8. Native American tribal documentUnexpired Employment

Authorization Card

(Form I-688A)

6.Unexpired Reentry Permit

(Form I-327)

ID Card for use of Resident

Citizen in the United States

(Form I-179)For persons under age 18 who

are unable to present a

document listed above:Unexpired Refugee Travel

Document (Form 1-571) Unexpired employment

authorization document issued byDHS (other than those listed

under List A)

10. School record or report card10. Unexpired Employment

Authorization Document issued by

DHS that contains a photograph

(Form I-688B)

11. Clinic, doctor or hospital record

12.

Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274)

Documents that Establish Both

Identity and Employment

Eligibility

Form I-9 (Rev. 05/31/05)Y Pag

Permanent Resident Card or

Alien Registration Receipt Card

with photograph

(Form I-151 or I-551)

8.

9.

2.

U.S. Coast Guard MerchantMariner Card

Driver's license issued by a

Canadian government authority

Day-care or nursery school

record

U.S. social security card issued by

the Social Security Administration

(other than a card stating it is not

valid for employment)


54/57


55/57

BLANK


56/57

OSHA

FormsforRecording

Work-RelatedInjuriesandIllnesses

WhatsInside

Inthispackage,youllfindeverythingyouneedtocomplete

OSHAs

andthe

forthenextseveralyear

s.Onthefollowingpages,youllfind:

Generalinstructions

forfillingouttheformsinthispackage

anddefinitionsoftermsyoushouldusewhenyouclassify

yourcasesasinjuriesorillnesses.

Anexampletoguideyouinfilling

outthe

properly

.

Severalpagesofthe

(butyoumaymakeasmanycopiesof

the

asyouneed.)Noticethatthe

isseparatefrom

the

Remova

ble

pages

foreasypostingatth

eendoftheyear.

Notethatyoupostthe

only,

notthe

Aworksheetfor

figuringtheaverage

numberofemployeeswhoworkedfor

yourestablishmenta

ndthetotalnumberofhoursworked.

Acopyof

theOSHA301to

providedetailsabou

ttheincident.You

maymakeasmanyc

opiesasyouneedor

useanequivalentform.

Takeafewminutestore

viewthispackage.Ifyouhaveany

questions,

Wellbehappytohelpyou.

Log

Sum

maryofWork-RelatedInjuriesandIllnesses

Log

Log

Log

Log

Summary.

Summary

Summary

Log.

AnOverview:Record

ingWork-RelatedInjuriesandIllnesses

HowtoFillOuttheL

og

LogofWork-Related

Injuriesand

Illnesses

SummaryofWork-Re

latedInjuriesand

Illnesses

WorksheettoHelpYouFillOuttheSummary

OSHAs301:InjuryandIllnessIncident

Report

or

.

visitusonlinea

twww.osha.gov

callyourlocalOSHAoffice


DearEmployer:

Thisbookletincludestheformsneededformaintaining

occupationalinjuryandillness

recordsfor2004.Thesenewformshave

changedinseveralimportantwaysfromthe2003recordkeepingforms.

Inthe

,

OSHAannounceditsdecision

toaddanoccupationalhearingloss

columntoOSHAsForm300,LogofWork-RelatedInjuriesand

Illnesses.ThisformspackagecontainsmodifiedForms300and

300Awhichincorporatethead

ditionalcolumnM(5)HearingLoss.

Employersrequiredtocomple

tetheinjuryandillnessformsmustbegin

tousetheseformsonJanuary

1,2004.

Inresponsetopublicsuggestions,OSHAalsohasmadeseveral

changestotheformspackagetomaketherecordkeepingmaterials

clearerandeasiertouse:

OnForm300,weveswitchedthepositionsofthedaycount

columns.Thedaysawa

yfromworkcolumnnowcomesbefore

thedaysonjobtransferorrestriction.

Weveclarifiedtheform

ulasforcalculatingincidencerates.

Weveaddednewrecordingcriteriaforoccupationalhearingloss

totheOverviewsectio

n.

OnForm300,wevema

dethecolumnheadingClassifythe

Casemoreprominenttomakeitclearthatemployersshould

markonlyoneselection

amongthefourcolumnsoffered.

TheOccupationalSafetyandHealthAdministrationshareswithyou

thegoalofpreventinginjuries

andillnessesinournationsworkplaces.

Accurateinjuryandillnessrecordswillhelpusachievethatgoal.

December17,2002

FederalRegister(67FR77165-77170)

OccupationalSafetyandHealthA

dministration

U.S.DepartmentofLabor


57/57

Employment Law Handbook

Documents

Transcript of Employment Law Handbook