OSHA Data Initiative (State,Local or Tribal Gov't)

2011 OSHA WOrk-relAted Injury And
IllneSS dAtA COlleCtIOn
2 0 1 1

U.S. Department of Labor
Occupational Safety and Health Administration

OMB No. 1218-0209
Approval Expires 4/30/2013
OSHA Form 196B
(1/2012)

Public Law 91-596
requires you to
participate in the data
initiative collection.

Place Label Here

OSHA estimates that it
will take you, on average,
10 minutes to complete
this data collection, includ­
ing the time you’ll spend
reviewing the instructions,
searching and gathering the
data needed, and submitting
the information. Persons are
not required to respond to
the collection of information
unless it displays a currently
valid OMB control number.
If you have any comments
regarding these estimates or
any other aspects of this data
collection, send them to:
U.S. Department of Labor
Occupational Safety and
Health Administration
Directorate of Evaluation
and Analysis
Office of Statistical Analysis
Room N-3644
200 Constitution Ave. N.W.
Washington, DC 20210

To Report Your Data:
OSHA Log
Data Collection

1. Go to http://www.osha.gov/form196/collection.htm and select Log In.
2. Enter your establishment-specific ID Number and Password provided on the mailing
label to access the secure electronic reporting site.
3. Enter any corrections to your establishment information (e.g., address, SIC, NAICS).
Then enter totals from your 2011 Summary of Work-Related Injuries and Illnesses
(OSHA No. 300A).
4. Submit data only for the establishment noted under Your Reporting Site on the
mailing label. Print a copy for your records.
If you are unable to report electronically, you can download a PDF version of the 2011
OSHA Work-Related Injury and Illness Data Collection Form after logging in to the Web
site. Complete the hard copy and return it to the collecting agency indicated on the mailing
label. If you need help, please call the collecting agency indicated on the mailing label.
For more details, see the reverse side of this mailer.

Dear Employer:

The U.S. Department of Labor, Occupational Safety and
Health Administration (OSHA) is working with State agen­
cies to compile work-related injury and illness data from
employers within specific industry and employment size
specifications. The information will be used to focus OSHA
activities (inspections, outreach, consultations, technical
assistance, and leveraging programs) and to measure the
performance of the Agency in meeting its goal of reducing
workplace injuries and illnesses.
We are asking for the totals from your 2011 Summary of
Work-Related Injuries and Illnesses (OSHA No. 300A),
as well as information about hours worked and employment
at your establishment. The Occupational Safety and Health
Act, 29 U.S.C. §§ 657 & 673, and reporting regulations
at 29 C.F.R. Part 1904 authorize OSHA to collect the
requested information. Please note that establishments that
fail to submit a completed 2011 survey may be subject to
OSHA enforcement actions, including the issuance of a
citation and assessment of penalties.
At this time the Bureau of Labor Statistics (BLS) and its
State partners are conducting the 2011 Survey of Occu­
pational Injuries and Illnesses, Part 1 of which solicits
information very much like what OSHA is collecting.
Be aware that employers who receive the BLS survey as
well as the OSHA data collection form are required by
law to respond to both of them, since these are separate
data collection efforts. However, if you have already
received the BLS survey, OSHA affords you an option
intended to streamline the effort involved in respond­
ing to both collections: That is, you may either (1)
complete the OSHA form in its entirety, in addition to
the BLS form, or (2) simply send OSHA a copy of your
responses to the BLS survey (Parts 1A and 1B), which
OSHA will accept as your response to the Agency’s
collection.

We recognize that responding to our questions may be time
consuming for some employers and have made every effort
to reduce the completion time while still obtaining the nec­
essary information. Please submit your data electronically
using the secure electronic reporting site on OSHA’s Web
site. Instructions for use of the electronic form are displayed
at the Web site. To submit data, go to http://www.osha.
gov/form196/collection.htm and then, when prompted,
input your establishment-specific ID number and password
(provided on the mailing label). Use your browser’s print
function to print a copy for your records. If you need help
submitting data or if you have questions, please call the
phone number printed on the mailing label.
2

OSHA has initiated a comprehensive approach to monitor­
ing and improving data quality. As part of this approach,
OSHA will audit the injury and illness records of a ran­
domly chosen sample of establishments included in this
data collection. We will continue to evaluate this initiative
and will build on the lessons learned to improve OSHA’s
ability to protect the health and safety of America’s workers
sensibly and appropriately. We invite your comments as we
proceed with this effort. Thank you for helping us collect
accurate information and for participating in the effort to
make America’s workplaces safer and healthier.
Occupational Safety and Health Administration
U.S. Department of Labor

Who must complete this form?
All establishments that receive this notification should
submit data via the Internet within 30 days, even if they
had no work-related injuries and illnesses recorded on their
2011 OSHA No. 300. If you are unable to report elec­
tronically, you can download a PDF version of the 2011
OSHA Work-Related Injury and Illness Data Collection
Form after logging in to the Web site. Complete the hard
copy and return it to the collecting agency indicated on the
mailing label. If you need help, please call the collecting
agency indicated on the mailing label (see reverse side of this
mailer).

What else do you need?
from your 2011 Summary of WorkRelated Injuries and Illnesses (OSHA No. 300A).

 � Information

What do you need to do?


Check the establishment and address information
printed on the mailing label. Note any corrections.



Go to http://www.osha.gov/form196/collection.htm
to report data.



Log in with ID number and Password provided on
mailing label.



Instructions for submitting data are displayed at the
Web site.



Submit data only for the establishment noted under
Your Reporting Site.