Survey of Occupational Injuries and Ilnesses - State and Local

Notification of Requirement to
Participate in the Survey of
Occupational Injuries and
Illnesses – Calendar Year 2008
U.S. Department of Labor
Bureau of Labor Statistics

⎯⎯⎯ IMPORTANT ⎯⎯⎯
ƒ

Maintain the information required for all recordable work-related
injuries and illnesses that occur during calendar year 2008 for the
establishment(s) identified above under Keep Records for this
Location.

ƒ

Keep these records and use them to complete the Survey of
Occupational Injuries and Illnesses that we will send to you early
in 2009.

Dear Employer:
The U.S. Bureau of Labor Statistics is working with State agencies to survey employers
about work-related injuries and illnesses. You have been selected to participate in the
mandatory Survey of Occupational Injuries and Illnesses for calendar year 2008 (OMB
No. 1220-0045, approval expires xx-xx-xx). In order to obtain complete and accurate
information about the safety record of America’s work places, our survey must include a
sample of all establishments, regardless of size and industry. Thus, some establishments
who are normally exempt from keeping the enclosed Occupational Safety and Health
Administration (OSHA) records are included in the survey and must keep records for the
survey year. This year, we are notifying all survey participants in advance, including those
who normally keep OSHA records.
Beginning January 2008, record any work-related injuries and illnesses that occur in your
workplace during 2008 according to the OSHA recordkeeping regulations. We have
enclosed copies of the Log of Work-Related Injuries and Illnesses (OSHA Form 300), the
Summary of Work-Related Injuries and Illnesses (OSHA Form 300A), and the Injury
and Illness Incident Report (OSHA Form 301). You may obtain a complete copy of the
current OSHA recording forms and instructions by visiting OSHA’s website at
www.osha.gov/recordkeeping/RKforms.html. You can also send an e-mail to
[email protected]. By return e-mail, you will receive a set of the current
OSHA Forms for Recording Work-Related Injuries and Illnesses.
You will be mailed the Survey of Occupational Injuries and Illnesses early in 2009. You
will then be asked to provide the 2008 year-end summary information from the OSHA
300A form and the details about individual cases of injury or illness.
The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, will
use the information you provide for statistical purposes only and will hold the information
in confidence to the full extent permitted by law. In accordance with the Confidential
Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107347) and other applicable Federal laws, your responses will not be disclosed in identifiable
form without your informed consent.
Your participation in the recordkeeping activity and the Survey is mandatory under Public
Law 91-596. If you have questions regarding your responsibilities for this survey, go to
“If You Need Help …” on page 4 of this form and call the phone number listed for your
State.
Thank you for helping us collect accurate information and for helping in the effort to make
America’s work places safer and healthier.

Bureau of Labor Statistics
U.S. Department of Labor

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Overview of Your Recordkeeping Responsibilities
•

Maintain the information required for all recordable work-related injuries and
illnesses that occur during calendar year 2008 for the establishment(s) identified on
the cover under “Keep Records for this Location.”

•

Keep these records and use them to complete the Survey of Occupational Injuries
and Illnesses that we will send to you early in 2009.

•

The OSHA Forms for Recording Work-Related Injuries and Illnesses provides
instructions for filling out the Log of Work-Related Injuries and Illnesses (OSHA
Form 300), as well as information about which injuries and illnesses should be
recorded. During 2008, you are required to maintain the Log of Work-Related
Injuries and Illnesses (OSHA Form 300).

•

Please do not send the Log to us. Keep it at your establishment and enter the
information required whenever a work-related incident occurs throughout 2008.

•

At the end of 2008, complete the Summary of Work-Related Injuries and Illnesses
(OSHA Form 300A) according to the OSHA directions, even if you had NO workrelated injuries or illnesses.

•

Early in 2009, you will be mailed the Survey of Occupational Injuries and
Illnesses and asked to submit the data you recorded on the OSHA Form 300A. We
also will ask you to provide some additional information for selected cases as
described below.

What will the Survey of Occupational Injuries and
Illnesses require you to do?
•

When you receive your Survey, we will ask you to submit the summary data
you have recorded on the OSHA Form 300A. You will have the option of
entering your data via the Internet or via an electronic Word ® template. You
also will be asked to provide:
³ information about some of your injured workers, such as
approximate length of service, occupation, age, and race or ethnic
background, and
³ details about the incident, such as time of day it occurred, the time
the employee started work, what the injury or illness was, what
happened, and what object or substance directly harmed the
employee.

•

Most of the additional information we will request in the Survey is recorded on the
Injury and Illness Incident Report (OSHA Form 301) or on Workers’ Compensation
forms that you already maintain.

•

If you have any questions about your responsibilities for this mandatory survey, go to
“If You Need Help…” on page 4 of this form and call the phone number listed for
your State.

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If You Need Help. . .
If you have any questions or if you need help, call the phone number that is listed below for your
State. The phone number may be for an office outside of your State, but they will be able to help
you.
Alabama
(334) 242-3462
(334) 240-3417 fax

Illinois
(217) 524-2098
(217) 558-4122 fax

Alaska
(907) 465-4539
(800) 325-9872 fax

Indiana
(317) 232-2668
(317) 233-3790 fax

Arizona
(602) 542-3739
(602) 542-6360 fax

Iowa
(515) 281-3618
(515) 242-5076 fax

Arkansas
(501) 682-4542

Kansas
(785) 296-1640
(785) 296-2151 fax

California
(415) 703-3020
(415) 703-3029 fax
Colorado
(816) 426-2483
Connecticut
(860) 263-6941
(860) 263-6950 fax
Delaware
(302) 761-8221
(302) 761-6605 fax
District of
Columbia
(202) 442-5923, 5920
(202) 442-4833 fax
Florida
(850) 413-1611
(850) 922-0024 fax
Georgia
(404) 679-1746
(404) 679-0520 fax
Guam
(671) 475-7056
(671) 475-7063 fax
Hawaii
(808) 586-9001
Idaho
(415) 975-4473

Nebraska
(402) 471-3547, 1545
(800) 599-5155
(402) 742-2352 fax
Nevada
(775) 684-7081, 7083
(775) 687-3826 fax
New Hampshire
(617) 565-2302
(617) 565-3847 fax

Rhode Island
(401) 462-8820
(401) 462-8766 fax
South Carolina
(803) 896-7659, 7683
(803) 896-7670 fax
South Dakota
(312) 353-7253
(312) 353-7230 fax

New Jersey
(609) 633-0755
(609) 633-0618 fax

Tennessee
(615) 741-1748
(800) 778-3966
(615) 253-5501 fax

Kentucky
(502) 564-3070
ext. 276, 277, 278
(502) 564-1682 fax

New Mexico
(505) 476-8740
(505) 476-8735 fax

Texas
(866) 237-6405
(512) 804-4652 fax

Louisiana
(225) 342-3126
(225) 342-3269 fax

New York
(212) 621-9380
(212) 621-9328 fax

Utah
(801) 530-6926, 6823
(801) 536-7906 fax

Maine
(207) 624-6447
(207) 624-6450 fax

North Carolina
(919) 733-2758
(919) 733-2186 fax

Vermont
(802) 828-5076
(802) 828-2195 fax

Maryland
(410) 767-2371, 2373
(410) 333-7909 fax

North Dakota
(312) 353-7253
(312) 353-7230 fax

Virgin Islands
(340) 776-3700
ext. 2135
(340) 777-4803 fax

Massachusetts
(617) 727-3593
(617) 727-5726 fax

Ohio
(312) 353-7253
(312) 353-7230 fax

Michigan
(517) 322-1848
(517) 322-5117 fax

Oklahoma
(405) 528-1500
ext. 257, 236
(405) 528-3412 fax

Washington
(360) 902-5640
(360) 902-4249 fax

Minnesota
(651) 284-5428
(888) 589-6322
(651) 284-5726 fax

Oregon
(503) 947-7030
(503) 378-3134 fax

West Virginia
(800) 652-9033
(304) 558-3322

Pennsylvania
(215) 861-5638, 5625
(215) 861-5736 fax

Wisconsin
(800) 884-1273
(608) 221-6297 fax

Puerto Rico
(787) 754-5343, 5737,
2467
(787) 756-1172
(787) 756-1116 fax

Wyoming
(866) 518-6680
(307) 473-3863 fax

Mississippi
(404) 562-2518
Missouri
(573) 751-2719, 2663,
3802
(573) 751-2319 fax
Montana
(800) 541-3904
(406) 444-2638 fax

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Virginia
(804) 786-8011
(804) 786-8418 fax