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Appendix B Cal/OSHA Form 300A (Rev. 7/2007) Annual Summary of Correlated Injuries and IllnessesYear2021Department of Industrial Relations Division of Occupational Safety & Healthful establishments
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Fill in the required information in the appropriate fields. This may include company name, address, industry classification, and employment information.
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Include the total number of cases and number of days away from work, restricted work activity, or job transfer.
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Anyone who is an employer covered by the Cal/OSHA recordkeeping requirements needs to fill out the www.pacificemployers.com/safety/pdf_files/calosha_form_300a_appendix. This includes employers in California who have more than 10 employees at any time during the year, and employers in certain industries with more than 20 employees.
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