Form OSHA 6-40.1 OSHA 6-40.1 Serious Event Reporting Online Form

Serious Event Reporting Online Form

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Form No. OSHA 6-40.1.

Serious Event Reporting Online Form
Validation Check - Enter State of Event to determine reporting requirements.
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Select A State

Validation
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OMB Control Number: 1218-0176

Expiration Date: July 31, 2017

Public reporting for this collection of information is estimated to average 30 minutes per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Persons are not required to respond to the collection of information unless
it displays a currently valid Office of Management and Budget Control Number. If you have any comments regarding
this estimate or any other aspect of this information collection, including suggestions for reducing this burden, please
send them to [email protected] or to OSHA's Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue,
NW, Washington, DC 20210.

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https://www.osha.gov/pls/ser/serform.html[2/11/2016 1:27:57 PM]

Serious Event Reporting Online Form

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Telephone: 800-321-OSHA (6742)  |  TTY
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https://www.osha.gov/pls/ser/serform.html[2/11/2016 1:27:57 PM]