Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory

DISTRICT OF COLUMBIA DEPARTMENT OF LABOR
STATE SECONDARY NAME
STREET ADDRESS
MONTGOMERY, AL 36130-3500

2016 Establishment ID:

U.S. Department of Labor
Bureau of Labor Statistics
For Help
Call:

01-203479880-1

Fax:

334-242-3462 ext. 9999
334-242-3463 ext. 9999
334-242-3462 ext. 9999
334-242-3463 ext. 9999
334-242-3333

Report for:
The Unit Description goes here
User ID:

302203479880

Temporary Passw ord:

AnsU5155

NAICS: 512110 - Motion Picture and Video Production
12345

50

PRIMARY COMPANY NAME
{SECONDARY COMPANY NAME}
ADDRESS LINE 1
ADDRESS LINE 2
CITY, STATE ZIP-PLUS+4
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MANDATORY REPORT – DATED MATERIAL
U.S. GOVERNMENT DOCUMENTS ENCLOSED

Instructions for Completing the
2016 Survey of Occupational Injuries and Illnesses
YOUR PARTICIPATION IS REQUIRED BY LAW IN 30 DAYS
How to Report Your Data
If you receive multiple forms, please check the User IDs and establishment IDs
as you may have more than one establishment to report.
Report your data through the Bureau of Labor Statistics (BLS) Internet Data Collection
Facility (IDCF) at: https://idcf.bls.gov
For alternate reporting methods, please contact your state office at the telephone
number(s) listed above.

We estimate it will take you an average of 24 minutes to complete this survey (ranging from 10 minutes to 5 hours per package ), including time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and compl eting and reviewing this
information. If you have any comments regarding the estimates or any other aspect of this survey, including suggestions for reducing this burden,
please send them to the Bureau of Labor Statistics, Occupational Safety and Health Statistics (1220-0045), 2 Massachusetts Avenue, N.E.,
Washington, DC 20212. Persons are not required to respond to the collection of information unless it displays a currently va lid OMB control
number. DO NO T SEND THE CO MPLETED FO RM TO THIS ADDRESS.
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.

OMB No. 1220-0045
BLS-9300-IDCF

Under Public Law 91-596, all establishments that receive this surv ey must complete and return it w ithin 30 days, ev en if they had no w ork related inj uries and illnesses during 2016.

In December 2015, you were notified of your participation in the BLS 2016 Survey of Occupational Injuries and Illnesses (SOII) and
asked to maintain records of workplace injuries and illnesses throughout 2016.

Forms to help you complete the survey

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OSHA’s Form 300 - Log of Work-Related Injuries and Illnesses; includes all injuries and illnesses for the year
OSHA’s Form 300A - Summary of Work-Related Injuries and Illnesses; includes average employment and total hours worked
OSHA’s Form 301 - Injury and Illness Incident Report; includes detailed injury and illness data
If the detailed case information requested is not recorded on your OSHA forms, please refer to other sources of information y ou
may have (including your Workers’ Compensation records). Please note, however, that OSHA’s rules
(www.osha.gov/recordkeeping) concerning which injuries and illnesses to record differ from your state’s Workers’
Compensation reporting.

Use the BLS Internet Data Collection Facility
Before reporting your data, you must register online with the BLS even if you have done so in previous years or for other BLS surveys.
Please ensure that the individual registering this account will be the one entering data for the Survey of Occupational Injuries
and Illnesses.
1. Type https://idcf.bls.gov directly into your Internet browser. The “s” in “https” is required.
2. Enter the 12-digit User ID in the field labeled “User ID” and the Temporary Password in the field labeled “Password”. Click I
Accept.
U.S. Department of Labor
Bureau of Labor Statistics

For Help
Call: 555-555-5555
555-555-5555
Fax: 555-555-5555

Example
You will need your User ID and
temporary password if you report
using the Internet.

User ID:
302203479880
Temporary Password:
AnsU5155

NAICS: 512110 - Motion Picture and Video Production

Your NAICS

3. Complete the “Check Email Address”, “Enter New User Information” and “Create a Permanent Password” pages.
4. Click Continue on the “Confirmation Notice” page.
5. Report your data and click Submit when you are finished. Print a copy of the completed survey for your records.
6. You may log onto the website using your User ID number and permanent password at any time to make corrections to your data.
You can report for additional establishment IDs by logging into the survey again, clicking the Continue button on the “Dear
Employer” page, and then clicking Add Establishment.
For alternate reporting methods, please contact your state office at the telephone number listed under “For Help” on the front page.

Need help?





For step-by-step account creation instructions or website technical help, go to http://www.bls.gov/idcf/instructions.htm.
For questions about this survey, contact us using the telephone number(s) listed on the front of this form.
For information about SOII, including frequently asked questions and to download forms, go to
http://www.bls.gov/respondents/iif/.
For information about OSHA record keeping guidelines, go to http://www.osha.gov/recordkeeping/handbook/index.html.

To see how your data will be used, please visit our website at http://www.bls.gov/iif.