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Mandatory Prenote email

ICR 201712-1220-004 · OMB 1220-0045 · Object 79261701.

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Mandatory Prenote email
Mockovak, William - BLS
Writer
2016-06-03
2026-10-05
complete

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Prenote Email Mandatory
From: [email protected]
To: [Respondent Email]
Subject: Notice of mandatory [Survey Year]  Survey of Occupational Injuries and Illnesses 
Dear [Respondent Name],
Welcome to the [Survey Year] Survey of Occupational Injuries and Illnesses.

Why am I receiving this email?
The establishment(s) listed in the PDF attachment were selected to participate in the [Survey Year] survey.  
How do I open the attached PDF? 
The PDF attachment is password protected to keep your information secure. You will receive a second email with the password shortly.

What am I expected to do? 
    1. Keep records of all Occupational Safety and Health Administration (OSHA) recordable work-related injuries and illnesses that occurred at the establishment(s) included in the PDF throughout calendar year [Survey Year].
    2. Use separate forms for each establishment.  OSHA forms are available here: http://www.bls.gov/respondents/iif/forms/oshaforms.pdf
    3. In addition, please record the race and ethnicity of your injured or ill workers. 

At the beginning of [Survey Year + 1], we will send you instructions on how to submit this information to us.

Is this survey mandatory?
Yes, your participation is required by law.  Your participation in our survey is essential for understanding the nature and frequency of work-related injuries and illnesses in your industry.  
Even if you are normally exempt from keeping OSHA records, you are still included in this survey and must keep records for [Survey Year]. 
More information about this survey, including state-specific contact telephone numbers, can be found at: www.bls.gov/respondents/iif.
Thank you, 
U.S. Department of Labor 
Bureau of Labor Statistics 

This survey, which is conducted by the Bureau of Labor Statistics in cooperation with state agencies, is mandatory under Public Law 91-596, and is approved under OMB No. 1220-0045.
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 107-347) and other applicable federal laws, your responses will not be disclosed in identifiable form without your informed consent.
The Bureau of Labor Statistics (BLS) is committed to the responsible treatment of confidential information and takes rigorous security measures to protect confidential information in its possession. This email contains confidential information. If you believe you are not the intended recipient of this message, please notify the sender and delete this email without disclosing, copying, or further disseminating its contents.

Attachment content
Establishment(s) in the [survey year] Survey of Occupational Injuries and Illnesses: 

Establishment ID
Company Address
Report for:
NAICS
For help call:
1
37-565989865-2017
Company B
ATTN: HR Manager
66 King St
Alexandria, VA 22301

Warehousing at 123 Linden St, Chapel, NC 32301
112511 – Finfish farm & fish hatcheries
NC Dept of Labor and industry
841-555-5555
2
32-888989862-2017
Company B
ATTN: HR Manager
66 King St
Alexandria, VA 22301

Corporate headquarters
551114 – Managing Offices
VA Dept of Labor and industry
757-555-5555