Semi Annual Report

Semi-Annual Report (1st due by July 15 ) (2nd due by January 15) (for current period January 1 – June 30, 2017) (for current period July 1 – December 31, 2017)

Please make sure to enter a valid e-mail address to ensure you receive a copy of your semi-annual report.

Safety Council Account Number (Please insert if you know your number, if you do not we will provide the number for you)

Company Name: * This field is required

Street: * This field is required

City: * This field is required

Zip: * This field is required

Phone: * This field is required

Email: * A valid email address is required

Submitted By: *

This field is required

Date Submitted: * This field is required

Please verify if information provided above has been updated on this report. * This field is required

1.) Date of 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) *

This field is required

2.) Average number of employees: * This field is required

3.) Total Hours Worked (entire six moth period, all employees) * This field is required

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

4.) Number of Deaths. (column G in OSHA 300 Log) * This field is required

5.) Number of occupational injuries and/or illnesses resulting in days away from work (column H in the OSHA 300 Log) * This field is required

6.) Number of days away from work as a result of occupational injuries and/or illnesses (column K in the OSHA 300 Log) * This field is required

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. * This field is required

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Mailing Address:
P.O. Box 153
Ontario, Ohio 44862

Phone: (419) 525-0615

Meeting Location:
1495 W. Longview Ave.
Mansfield, Ohio 44906

Office Hours:
Tues. & Thurs.
9:00am - 12:00pm

Email:
businessmanager@richlandcountysafetycouncil.com