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

1/18/2019

Serious Event Reporting Online Form | Occupational Safety and Health Administration
UNITED STATES
DEPARTMENT OF LABOR

OSHA

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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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NOTE: For employers covered by Federal OSHA that are located in State Plan States, to make a report
Call the nearest OSHA office.
Call the OSHA 24-hour hotline at 1-800-321-6742 (OSHA).

OMB Control Number: 1218-0176

Expiration Date: June 30, 2021

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.

UNITED STATES
DEPARTMENT OF LABOR

Occupational Safety and Health Administration
200 Constitution Ave NW
Washington, DC 20210
 800-321-6742 (OSHA)
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www.OSHA.gov
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Reporting Online Form | Occupational Safety andAccessibility
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https://www.osha.gov/pls/ser/serform.html

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