Online OSHA Forms OSHA's Online Injury/Illness Data Collectoin

Mockup of Proposed Web-Based Mechanism for
OSHA’s Injury/Illness Data Collection
(revised 4/29/2016)
Overview of Data Collection Mechanism Represented by the Mockup
LARGER (ANNUALLY): All establishments with
250+ employees and RK required under 1904.
Save

Registration*

Email
Login

Login

Online Form:
Page 2

Online Form:
Page 3+

Online Form:
Page 4

Establishment
Information

Complete Log
(Form 300)

Incident Reports
(Form 301)

Summary
(Form 300A)

SMALLER (ANNUALLY): All establishments in specified
industries with 20 to 249 employees and RK required under 1904.

User
Dashboard
(List complete/
incomplete
submissions)

General
Info
Contact
Us
Form

Save

Online Form:
Page 1

Save

Home

Save

Save

Print
Submission

Save

Online Form:
Page 1

Online Form:
Page 2

Establishment
Information

Log Summary &
Employment
Information
(Form 300A)

Review/Update
Submission
Submission
Options

Submit next
establishment (via
dashboard),
if an HQ
submitting
multiples.

Batch
Submit by
Excel or XML

Submit next
establishment (via
dashboard),
if an HQ
submitting
multiples.

Submit
Confirm

Logout
Confirm

Email
Confirm

(Multiples or
individual
larger establishment)

* Register as a Single-Entity or Enterprise submitter: A submitter must first create a system account by registering online as a user who will
submit information for a single-entity (i.e., either a smaller establishment [with 20 to 249 employees] or a larger establishment [with 250+ employees]
that is required to maintain injury/illness records under the rule) or as a corporate HQ submitting for multiple establishments within an enterprise.
Both types can submit using either the system’s online forms or the batch submission process (except that single-entities required to submit only a
Log summary would use the online Form 300A).

Mockup page 1

1.

Home Page

OSHA’s Injury/Illness Data Collection
[This page would include a welcome statement and explanation of the data collection, including
reference and links to the new rule.]
[This page would also inform users that they need to first register in order to obtain a unique user ID
and password to submit the OSHA injury/illness data.]
Register Now
[If the user has already registered and obtained an ID and password, the user would click the link below
to access the data submission dashboard.]

[Contact us information would also be displayed for questions, comments, etc.]

GENERAL NOTES:
This mockup conceptually addresses the following submission situations under the proposed rule that the
data collection system would be designed to accommodate.
Single-entity submission situations:
• Submission by small single entity. An individual smaller establishment (i.e., 20 to 249
employees) submitting Form 300A only.
• Submission by large single entity. An individual larger establishment (i.e., 250+ employees)
submitting Forms 300A, 300, and the accompanying 301 forms.
Enterprise submission situations (i.e., option to submit from corporate HQ):
• Submissions by enterprise HQ for small establishments only. An enterprise corporate
headquarters submitting Form 300A for each smaller establishment (i.e., 20 to 249 employees).
• Submissions by enterprise HQ for large establishments only. An enterprise corporate
headquarters submitting Form 300A, 300, and accompanying 301 forms for each 250+ size
establishment.
• Submissions by enterprise HQ for a combination of small and large establishments. An
enterprise corporate headquarters submitting Form 300A for each smaller establishment (i.e., 20
to 249 employees) and submitting for each 250+ size establishment the Form 300A, 300, and
accompanying 301 forms.

Mockup page 2

2.

Registration Page (1 of 3)

OSHA’s Injury/Illness Data Collection:

Submitter Registration
In order to submit your injury and illness data to OSHA, you must first register by completing the form
below. After submission of the registration form, a confirmation email will be sent to the email address
provided. This email will contain your ID and password to log into the data submission dashboard.
Select the type of submitter you are below to proceed:
•

Single-entity submitter >> (Either a single smaller establishment [i.e., 20 to 249 employees] or
a single larger establishment [i.e., 250+ employees] that is required to maintain injury/illness
records under the rule.)

•

Enterprise submitter >> (An “enterprise” has more than 1 submitting establishment, where
each is a smaller establishment [i.e., 20 to 249 employees] or a larger establishment [i.e., 250+
employees] that is required to maintain injury/illness records under the rule. Such an enterprise
has the option of submitting data for each applicable establishment from its corporate HQ.)

•

Special collection submitter >> (An establishment that has been notified by OSHA about
submitting injury/illness information in conjunction with a special data collection.)

GENERAL NOTES:
• The pages that follow include mockups of a registration page for a Single-Entity submitter and an
Enterprise submitter, respectively; a mockup for a special collection submitter is not included.

Mockup page 3

3.

Registration Page (2 of 3)

OSHA’s Injury/Illness Data Collection:

Single-Entity Submitter Registration
Please provide the following information for
submissions from your establishment: (* = required)
Submission Entity
* Establishment Name:
* Street Address:
* City:
* State:
* Zip:
* Contact First Name:
* Last Name:
* Title:
* Phone:
Extension:
* Email:
*Confirm Email:
*Select a Security
Question:
*Answer:

GENERAL NOTES:
• This page conceptually portrays the registration information that would be requested for a SingleEntity submitter. Registration will generate a unique user ID and Password, which will be sent to
the email address provided during registration when the user clicks the “submit” button. The user
ID and password will be used for year-to-year submissions by the same user. When registering,
the user will also be prompted to answer a hint question that will be used for a “Forgot your
password?” mechanism.

Mockup page 4

3.

Registration Page (3 of 3)

OSHA’s Injury/Illness Data Collection:

Enterprise Submitter Registration
Please provide the following information for submissions from the
enterprise’s headquarters: (* = required)
Enterprise Headquarters
* Company Name:
* Street Address:
* City:
* State:
* Zip:
* Contact First Name:
* Last Name:
* Title:
* Phone:
Extension:
* Email:
*Confirm Email:
*Select a Security
Question:
*Answer:
Provide information for each submitting establishment. Go to subpage >> [Not shown in mockup.]
(Note: On the subpage, registrant will be prompted to identify each establishment anticipated to be
included in the HQ submission.)

GENERAL NOTES:
• This page conceptually portrays the registration information that would be requested for an
Enterprise submitter. Registration will generate a unique user ID and Password for the HQ
submitter.

Mockup page 5

4.

Sample Registration Confirmation Email
Thank you for registering with OSHA’s Injury/Illness Data Collection website.
Your ID and password are:
ID: 123456789
Password: XYZ123CBA
Please login to [insert actual URL here] and submit your establishment-specific
data.
If you have any questions, please contact the Helpline at [xxx-xxx-xxxx] or via
email to [email protected]. Helpline staff is available Monday through Friday
from xx to xx.
This is an automated email. Please do not reply to this message.

Mockup page 6

5.

Login Page

OSHA’s Injury/Illness Data Collection: Log In*

Forgot your password?

OMB Disclosure Statement: [text etc. tbd]
*If you do not have an ID Number and Password, please go to the Registration page.

GENERAL NOTES:
• “Forgot your password?” link will prompt user to respond to the hint question with the answer
provided during user registration. If the correct answer is entered, an email will be sent (to the
user email address entered during registration) with a login and URL for resetting the user
password.

Mockup page 7

6.

Main Page

OSHA’s Injury/Illness Data Collection: Main Page
You have logged into OSHA’s website for online submission
of [insert collection year] work-related injury and illness
data. Based on your registration information, this system
recognizes that you are the following type of submitter. To
proceed with your submission, select the link below. (If the
submitter type information is incorrect, please update your
Submitter Registration or contact the Helpline staff.)

Questions
Contact Helpline Staff at [insert
phone number]. Helpline staff are
available Monday through Friday
from [insert time] to [insert time] EST.

Note also that as an alternative to submitting data via the online forms on this website, OSHA provides a
batch submission option (Excel or XML format). (View Batch submission instructions.)
[Page will display one of the following based on user’s login (i.e., registration information):]
•

Single-entity submitter >> (Either a single smaller establishment [i.e., 20 to 249 employees] or a
single larger establishment [i.e., 250+ employees] that is required to maintain injury/illness
records under the rule.)

•

Enterprise submitter: Corporate HQ >> (An “enterprise” has more than 1 submitting
establishment, where each is a smaller establishment [i.e., 20 to 249 employees] or a larger
establishment [i.e., 250+ employees] that is required to maintain injury/illness records under
the rule.)

•

Special collection submitter >> (An establishment that has been notified by OSHA about
submitting injury/illness information in conjunction with a special data collection.)

GENERAL NOTES:
• “Batch submission instructions” link above will present the user with how-to information on
generating and submitting batched data (e.g., multiples from an Enterprise HQ) in acceptable
formats (e.g., MS Excel or XML).
• As appropriate, submitter will proceed from this Main page to the submitter’s Dashboard page.
o NOTE: This Main page mockup is intended to be illustrative. It is anticipated that during
system development the Main page will be folded into the Dashboard page.

Mockup page 8

7.

Dashboard: Single-Entity Submitter

OSHA’s Injury/Illness Data Collection:

Single-Entity Submitter Dashboard
The table below lists Collection Year 2017 establishment submissions anticipated or received by OSHA
based on your registration/login. From this page, by selecting the establishment record link, you can go
to the online forms to input data or access a completed submission to review/update.

(Select the establishment name link to access the submission for that establishment.)

1

Company XYZ

Someplace

AR

11 Main Street

02/07/2017

NA

GENERAL NOTES:
• This page mockup broadly portrays the dashboard for a Single-Entity submitter. The dashboard
would likely include information on what submission components are anticipated, either in the
dashboard table or via a drill-down. (For instance, a dashboard display for a larger establishment
submitting Forms 300 and 301 could be similar but focusing the user’s attention on the particular
submission component action items.)
• Corrections/updates to submissions will be time-limited.

Mockup page 9

8.

Online Form: Page 1 – Establishment Information

OSHA’s Injury/Illness Data Collection:

Establishment Address Information

GENERAL NOTES:
• This is the first of multiple data entry screens for a submitting establishment. Users reach this
page by selecting an item in the submitter’s dashboard. Exact data fields will be determined
during system development. Many fields on this page will auto-fill (and be updatable) from
information provided during user/establishment registration for submitting data using this system.
• Basic form page validation will be included to ensure that required fields are completed and that
data is entered into the appropriate format (e.g., numeric entries only in phone fields.)
Mockup page 10

•

To minimize the level of effort per submission, data entered on the first form page (above) will be
saved in the system and displayed (and updatable) for the subsequent year’s submission.

Mockup page 11

9.

Online Form: Page 2 – Log Summary & Employment Information (Form 300A)

OSHA’s Injury/Illness Data Collection:

Log Summary Information (Form 300A)
Using your completed Summary of Work-Related Injuries and Illnesses (OSHA Form 300A) for
2016, copy the establishment information into the boxes below.
1.

For this particular establishment: Enter the annual average employment
for 2016.
(You can copy this from your OSHA Form 300A.)

2.

For this particular establishment: Enter the total hours worked for 2016.
(You can copy this from your OSHA Form 300A.)
Note: Total Hours Worked should exclude vacation, sick leave, holidays,
and other non-work time.

3. Check any conditions that might have affected your annual average number of
employees or total hours worked during 2016:

4. Did you have any recordable injuries or illnesses during 2016?

Mockup page 12

The person authorizing this submission is the person OSHA will contact to resolve any questions
that arise concerning the data.

Today’s Date
(e.g., mm/dd/yyyy)

Mockup page 13

GENERAL NOTES:
• Basic form page validation will be included on the Form 300A to ensure that required fields are
completed and that data is entered into the appropriate format (e.g., numeric entries only in phone
fields.)
• In addition, collection-specific validation can be incorporated to check for outlier data when the
user selects “submit.” See following mockup page for an example.
• Regarding authorization/submission: The specific point at which the submitter will be presented
with the Authorization and Submission box shown above will vary depending on the submission
situation (e.g., extent of submission required based on establishment size).
o As appropriate, some fields on this authorization/submission page will auto-fill (and be
updatable) based on user registration and/or establishment information.
• Following authorization/submission, submitter will receive online confirmation and an email
confirmation. (See items later in this mockup.)

Mockup page 14

10.

Example Data Validation Check

GENERAL NOTES:
• Upon submission, user will be alerted if data entered fall outside of set parameters and may have
the option to fix the data before continuing with data submission OR to ignore the edit
condition(s) presented and continue with data submission. (This is an assumption based on the
former OSHA Log data collection.) This alert is presented as a pop-up on the data entry page
when the user clicks the “submit” button.
• There are a number of edit condition checks that were in use on the former ODI Respondent’s
website that can be incorporated into the new data collection site. See example above. These
checks, however, are specific to the Form 300A data. New edit checks will need to be developed
and tested for the Forms 300 and 301 data.

Mockup page 15

11.

Online Confirmation

OSHA’s Injury/Illness Data Collection: Submission Confirmation
Meg Jones: Thank you for the data submission to OSHA’s data collection website. You can review,
update, and print a copy of your submission by returning to your dashboard. If you have any questions
regarding your submission, please contact the Helpline at [xxx-xxx-xxxx] or via email to [email protected].
Helpline staff is available Monday through Friday from xx to xx.

GENERAL NOTES:
• An establishment submitting as a single entity might not need to return to the dashboard after
completing the submission.
• An Enterprise submitter, however, could return to the dashboard to continue with submissions for
other submitting establishments.

12.

Email Confirmation
Thank you for submitting your [insert calendar year] OSHA injury/illness data to OSHA’s
data collection website. You can review, update, and print a copy of your submission by
returning to your dashboard. If you have any questions, please contact the Helpline at [xxxxxx-xxxx] or via email to [email protected]. Helpline staff is available Monday through
Friday from xx t xx.
This is an automated email. Please do not reply to this message.

Mockup page 16

13.

Logout Confirmation

You are now logged out of OSHA’s Injury/Illness Data Collection System

GENERAL NOTES:
• “Log back in” link will return the user to the login screen.

Mockup page 17

14.

Dashboard: Enterprise Submitter

OSHA’s Injury/Illness Data Collection:

Enterprise Submitter Dashboard
The table below lists Collection Year 2017 establishment submissions anticipated or received by OSHA
based on your registration/login. From this page, by selecting the establishment record link, you can go
to the online forms to input data or access a completed submission to review/update.

(Select the establishment name link to access the submission for that establishment. Also, to change the table sort
order, select a column header.)

1

Company A

Someplace

AR

11 Main Street

02/07/2017

2

Company B

Someplace

OH

2 North Avenue

02/09/2017

3

Company C

Someplace

PA

43 Arbor Way

03/10/2017

(Select the “Go” link to complete the submission for that establishment. Also, to change the table sort order, select
a column header.)

4

Company D

Someplace

CO

4 Spring Street

Go >>

5

Company E

Someplace

FL

12 South Street

Go >>

GENERAL NOTES:
• This page mockup broadly portrays the dashboard for an Enterprise submitter. For instance, this
display could indicate that the Enterprise HQ has completed the submission for three of six
identified establishments. For each establishment, the dashboard would likely include information
on what submission components are anticipated, either in the dashboard table itself or via a drilldown. For instance, the dashboard display for a larger establishment (i.e., submitting Forms 300
and 301) would be similar, but would provide more detail and focus the user’s attention on
incomplete components of the submission.
• Corrections/updates to submissions will be time-limited.
Mockup page 18

15.

Online Form: Page 2 – Complete Log (Form 300)

Go to Form 301 Page

Mockup page 19

GENERAL NOTES:
• This form will only be presented for submitting establishments with 250+ employees.
• The example above shows the types of data that will be captured on this page. Some aspects of the look and feel may be adjusted during
the development stage and will ensure that the data entry is straight-forward and intuitive.
• Submitters will have the option of adding another 300 log page. If they choose to “Add a Form Page,” they will get a blank form page like
this one. The “Save Input” button will prompt users to (1) continue entering 300 data or (2) go to a Form 301 data-entry screen.
• After entering Form 300 data, the submitter will click “Go to Form 301 Page” to input the Form 301 data. Data elements that are
redundant between the two forms will auto-fill in the Form 301 (i.e., case number, date of injury/illness).
• Following input of the Form 301 data, users will authorize and submit data (for both 300 and 301s). It is anticipated that the system will
give submitters the option to input data over multiple user sessions before the user authorizes the establishment’s submission.

Mockup page 20

16.

Online Form: Page 3 – Incident Reports (Form 301)

Information about whether a health care professional was involved
6) Was a physician or other health care professional involved?
□ Yes
□ No
7) Was any treatment given away from the worksite?
□ Yes
□ No
8) Was employee treated in an emergency room?
□ Yes
□ No
9) Was employee hospitalized overnight as an in-patient?
□ Yes
□ No

Mockup page 21

GENERAL NOTES:
• This form will only be presented for submitting establishments with 250+ employees.
• The example above shows the types of data that will be captured on this page. Some aspects of the look and feel may be adjusted during
the development stage and will ensure that the data entry is straight-forward and intuitive.
• Data elements that are redundant between the Form 300 and the Form 301 will auto-fill in the Form 301 (i.e., case number, date of
injury/illness).
• Submitters will have the option of adding more incident reports and, when finished, authorizing and submitting data. If they choose to
“Add a Form Page” (i.e., another incident report page), they will get a fresh page like this one. The “Save Input” button will prompt users
to (1) continue entering 301 data (i.e., get a blank 301 form) or (2) authorize and submit data. By choosing “Authorize and Submit Data,”
the submitter will go to the next screen.
o Possible Data Validation: When the user selects “Authorize and Submit Data” the system will compare the number of incident
reports entered to the number of rows entered on the Log 300 data page and notify the user about any discrepancies.
• It is anticipated that the system will give submitters the option to input data over multiple user sessions before the user authorizes the
establishment’s submission.

Mockup page 22

17.

Online Form: Page 4 – Log Summary & Employment Information (Form 300A)

OSHA’s Injury/Illness Data Collection:

Log Summary Information (Form 300A)
Using your completed Summary of Work-Related Injuries and Illnesses (OSHA Form 300A) for
2016, copy the establishment information into the boxes below.
1.

For this particular establishment: Enter the annual average employment
for 2016.
(You can copy this from your OSHA Form 300A.)

2.

For this particular establishment: Enter the total hours worked for 2016.
(You can copy this from your OSHA Form 300A.)
Note: Total Hours Worked should exclude vacation, sick leave, holidays,
and other non-work time.

3. Check any conditions that might have affected your annual average number of
employees or total hours worked during 2016:

4. Did you have any recordable injuries or illnesses during 2016?

GENERAL NOTES:
• For establishments with 250+ employees, the data collection system would logically generate the
Log summary (Form 300A) at this point in the sequence of the submission (i.e., generate the Log
summary after completion of the Form 300 Log and the Forms 301).
• However, the submitter would need to input the data for items #1 and #2 from the onsite Form
300A.
Mockup page 23

18.

Online Form: Authorize and Submit Data (Enterprise submission)

The person authorizing this submission is the person OSHA will contact to resolve any questions
that arise concerning the data.

Today’s Date
(e.g., mm/dd/yyyy)

GENERAL NOTES:
• As appropriate, some fields on this authorization/submission page will auto-fill (and be
updatable) based on user registration and/or establishment information.
• Following submission, submitter will receive online confirmation and an email confirmation.

Mockup page 24