The Greater Cleveland Safety Council — Hanna Building — 1422 Euclid Ave. Suite 327 — Cleveland, OH 44115-1901 Voice: 216-621-0059 — Fax: 216-621-0062 — Secure Contact Form

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

Semi-Annual Report
1^st   [ X ] due by July 31 (for current period January 1 – June 30, 2010)
2^nd   [   ] due by January 15 (for period July 1 – December 31, 2010)

Safety Council Account Number Risk Number
Company Name (DBA)
Address
City
State
Zip
Phone
Fax
Email
Submitted By
Date
DATE OF MOST RECENT INJURY OR ILLNESS RESULTING IN DAY(S) AWAY FROM WORK / / This date must be June 30, 2010 or prior Report All Information Below For CURRENT SIX MONTH PERIOD ONLY (January 1 – June 30, 2010) Average Number of Employees ( Full & Part Time) 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. Number of Deaths (You may use your OSHA 300 Log) Number of occupational injuries and/or illnesses resulting in days away from work (You may use your OSHA 300 Log) If you entered a date in the current 6 month period for Line 1 you must enter a number on line 5 Number of days away from work as a result of occupational injuries and/or illnesses (You may use your OSHA 300 Log) Must be equal to or greater than line 5 and can include any days taken from 1/1/10 – 6/30/10 even if injury or illness occurred outside of this six month period. 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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