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OSHA FORM 1 This form is available online at http://www.osah.ga.gov or by telephone request at (404)6572800. OSHA USE ONLY DOCKET NUMBER AGENCY CODE INS CASE TYPE DOCKET NUMBER COUNTY JUDGE NAME OF
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Who needs name of referring agencydepartment?

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The name of referring agency/department is needed by:
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The name of the referring agency/department is usually provided by the organization or individual who is making the referral.
The individual or organization making the referral is typically responsible for providing the name of the referring agency/department.
The name of the referring agency/department can be filled out on the referral form or document provided.
The purpose of providing the name of the referring agency/department is to give credit to the organization or individual who made the referral.
The name of the referring agency/department is the main information that needs to be reported.
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