BLS 9300 N06 SOII Collection Form

U.S. Department of Labor
Bureau of Labor Statistics

OMB No. 1220-0045

Survey of Occupational Injuries
and Illnesses, 2024
YOUR RESPONSE IS REQUIRED BY LAW WITHIN 30 DAYS.

Please correct your company address as needed.

For your convenience, you can submit your survey response
on our website at https://idcf.bls.gov.

We estimate it will take you an average of 30 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 completing 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 email them to the Bureau of Labor Statistics, Occupational Safety and Health Statistics (1220-0045) at [email protected]. Persons
are not required to respond to the collection of information unless it displays a currently valid OMB control number. DO NOT EMAIL THE
COMPLETED FORM 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 (44 U.S.C. 3572) and other applicable Federal
laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity
Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity
screening of transmitted data.

BLS-9300 N06

Steps to Complete this Survey
This survey requires employers to provide information about work-related injuries and illnesses based upon the
information you have maintained for Calendar Year 2024 on your Occupational Safety and Health Administration
(OSHA) Forms for Recording Work-Related Injuries and Illnesses. Copies of these forms were sent to you in late 2024.
Under Public Law 91-596, all establishments that receive this mandatory survey must complete and return it within 30
days, even if they had no work-related injuries and illnesses during 2024. The instructions below outline the steps to
complete the survey regardless of whether or not your establishment had injuries or illnesses in 2024.
Step 1:

Complete this survey only for the establishment(s) noted on the front cover under “Report for this Location.” If
you are unsure, please call the number(s) listed on the front of this form in the “For Help Call:” section.

Step 2:

Check “Your Company Address” printed on the front cover. Make any necessary corrections directly on the
front cover.

Step 3:

Refer to your establishment’s OSHA Forms for Recording Work-Related Injuries and Illnesses. Copies of these
forms were sent to you in late 2024. Form 300A from that mailing is shown immediately below.
OSHA’s Form 300A

Year 20__ __

(Rev. 01/2004)

Summary of Work-Related Injuries and Illnesses

U.S. Department of Labor
Occupational Safety and Health Administration
Form approved OMB no. 1218-0176

All establishments covered by Part 1904 must complete this Summary page, even if no wor k-related injuries or illnesses occurred during the year. Remember to review the Log
to verify that the entries are complete and accurate before completing this summary .
Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you’ve added the entries from every page of the Log. If you
had no cases, write “0.”
Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limite d access to the OSHA Form 301 or
its equivalent. See 29 CFR Part 1904.35, in OSHA’s recordkeeping rule, for further details on the access provisions for these forms.

Number of Cases
Total number of
deaths

Copy this
information to
Section 2 of
this survey.

Total number of
cases with days
away from work

Total number of
cases with job
transfer or restriction

Total number of
other recordable
cases

_____________

_____________

____________

___________

(G)

(H)

(I)

(J)

Establishment information
Your establishment name______________________________________
Street

____________________________________________________

City

_______________________

State ____________ Zip

________

Industry description ( (e.g., Manufacture of motor truck trailers)

Standard Industrial Classification (SIC), if known (e.g., SIC 3715)
____ ____ ____ ____

Number of Days

OR

Total number of days away
from work

Total number of days of job
transfer or restriction

_____________

______________

(K)

(L)

North American Industrial Classification (NAICS, if known (e.g., 336212))
____ ____ ____ ____ ____ ____
Employment information (If you don’t have these figures, see the
Worksheet on the back of this page to estimate.)

Injury and Illness Types
Total number of …

Annual average number of employees

_____________

Total hours worked by all employees last year

_____________

(M)
(1) Injuries

______

(4) Poisonings
(5) Hearing loss

(2) Skin disorders
(3) Respiratory conditions

______
______

(6) All other illnesses

Sign here

______
______
______

Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my
knowledge the entries are true, accurate, and complete.

Post this Summary page from February 1 to April 30 of the year following the year covered by the form.
Public reporting burden for this collection of information is estimated to average 50 minutes per response, including time to review the instructions, search and gather the data needed, and
complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any
comments about the estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistics, Room N-3644, 200 Constitution Avenue, NW, Washington,
DC 20210. Do not send the completed forms to this office.

Company executive

Title

(
)
Phone

/ /
Date

DATA COLLECTION AGENCY
SURVEY STAFF
123 MAIN STREET
MY CITY, US 12345-0000

Address for Return Envelope:

DATA COLLECTION AGENCY
SURVEY STAFF
123 MAIN STREET
MY CITY, US 12345-0000

Example
Copy your
“User ID”
from the label
to Section 1.

Your Establishment ID:
77-123456789-3
Report for this Location:
SAME AS YOUR COMPANY ADDRESS
For Help Call:

(555) 111-2222

Your Company Address:

User ID:

YOUR COMPANY NAME
987 YOUR STREET
YOUR CITY, US 98765-0000

302123456789
Temporary Password:
9876Nsu
77-123456789-1
2020-1 NAICS 238000

▪
▪
▪

Copy this
information
to Section 1
of this
survey.

NAICS code
location.

12 P 60 00

If you had no work-related injuries or illnesses in 2024, answer all questions in Sections 1 and 4 of the survey.
If you had at least one work-related injury or illness in 2024, answer all questions in Sections 1, 2 and 4 of the
survey.
Report cases with Days Away From Work, or with Job Transfer or Restriction in Section 3.

Step 4:

In case we have questions, write the name of the person who completed this survey in Section 4: Contact
Information, on the last page of this survey.

Step 5:

Return this survey and any attachments in the enclosed envelope within 30 days of the date your establishment
received it.

2

Section 1: Establishment Information
Instructions: Using your completed Calendar Year 2024 Summary of Work-Related Injuries and Illnesses (OSHA Form
300A), copy the establishment information into the boxes. If these numbers are not available on your OSHA Form 300A, or
if your establishment does not keep records needed to answer (2) and (3) below, you can estimate using the steps that follow
on the next page.
1. Enter your “User ID” from the front cover.
2. Enter the annual average number of employees for 2024.
3. Enter the total hours worked by all employees for 2024.
4. Check any conditions that might have affected your answers to questions 2 and 3 above during 2024:
❑ Strike or lockout
❑ Shutdown or layoff
❑ Seasonal work
❑ Natural disaster or adverse weather
conditions
5.

❑ Shorter work schedules or fewer pay periods than usual
❑ Longer work schedules or more pay periods than usual
❑ Other reason: _________________________________
❑ Nothing unusual happened to affect our employment or hours figures

Did you have ANY work-related injuries or illnesses during 2024?
❑ Yes. Go to Section 2: Summary of Work-Related Injuries and Illnesses, 2024, directly below.
❑ No. Go to Section 4: Contact Information, on the back cover.

Section 2: Summary of Work-Related Injuries and Illnesses, 2024
Instructions:
1. Refer to the OSHA Forms for Recording Work-Related Injuries and Illnesses for the location referenced on the front
cover of the survey under “Report for this Location.” If you prefer, you may enclose a photocopy of your Summary
of Work-Related Injuries and Illnesses (OSHA Form 300A).
2. If more than one establishment is noted on the front cover of this survey, be sure to include the OSHA Form 300A
for all of the specified establishments.
3. If any total is zero on your OSHA Form 300A, write “0” in that total’s space below.
4. The total Number of Cases recorded in G + H + I + J must equal the total Injury and Illness Types recorded in
M (1 + 2 + 3 + 4 + 5 + 6).
Number of Cases
Total number of deaths

____________________
(G)

Total number of cases
with days away from
work

Total number of cases
with job transfer or
restriction

_________________
(H)

_________________
(I)

Total number of other
recordable cases

_________________
(J)

Number of Days
Total number of days
away from work

Total number of days
of job transfer or
restriction

____________________
(K)

__________________
(L)

Injury and Illness Types
Total number of …
(M)
(1) Injuries
(2) Skin disorders
(3) Respiratory conditions

________
________
________

(4) Poisonings
(5) Hearing loss
(6) All other illnesses

________
________
________

If you had any work-related deaths in 2024, please tell us on the line below where you assigned/classified each death
within the list of items (M1) through (M6) provided under Injury and Illness Types above (e.g., “fatal case was due
to injury resulting from fall” or “death resulted from respiratory conditions”)_________________________________
________________________________________________________________________________________________
3

Steps to estimate annual average number of employees for 2024:
Step 1:
To calculate the annual average number of employees your
establishment paid during 2024, you must calculate the total number
of employees your establishment paid for all periods. Add the
number of employees your establishment paid in every pay period
during Calendar Year 2024. Count all employees that you paid at any
time during the year and include full-time, part-time, temporary,
seasonal, salaried, and hourly workers. Note that pay periods could
be monthly, weekly, bi-weekly, etc.

Example:
Acme Construction paid its employees in 12 pay
periods during 2024:

Step 2:
Divide the total number of employees (from Step 1) by the number
of pay periods your establishment had in 2024. Be sure to count any
pay periods when you had no (zero) employees.

Example:
Acme Construction had 12 pay periods and paid a total of
392 employees during these pay periods.

Pay Period
1
2
3
4
5
6
7
8
9
10
11
12

Number of Employees Paid
Per Pay Period
30
0
35
37
37
40
43
42
37
35
30
+26
392 (total number of employees paid
over all pay periods)

392 divided by 12 = 32.67

Step 3:
Round the answer you computed in Step 2 to the next highest whole
number. Write that number in the box for Section 1, Question 2 on the
previous page.

Example:
Acme would round 32.67 to 33.

Steps to estimate total hours worked by all employees for 2024:
Step 1:
Determine the number of full-time employees at your establishment.

Example:
Of Acme’s 33 employees in 2024, 28 were full-time.

Step 2:
Determine the number of hours generally worked by a full-time
employee for a year. Multiply the number of full-time employees you
calculated in Step 1 by this number. This total number of full-time
hours worked should exclude vacation, sick leave, holidays, and any
other non-work time.

Example:
Each of Acme’s 28 full-time employees worked an
average of 2,000 hours per year after excluding vacation,
sick leave, holidays, and other non-work time. This
works out to 40 hours per week for 50 weeks of the year.
28 full-time employees
X 2,000 hours per year
56,000 total full-time hours

Step 3:
Determine the number of hours of overtime worked by your full-time
employees.
Determine the number of regular hours worked by your non-full-time
employees. (Non-full-time employees include part-time, seasonal, and
temporary employees.)
Add these numbers to the number you calculated in Step 2 above. This
is the estimated number of hours worked by all of your employees,
full-time and non-full-time, during 2024. Write this number in Section
1, Question 3 on the previous page.
4

Example:
Acme’s 28 full-time employees worked a total of 2,800
hours of overtime during 2024 and 56,000 regular
hours. Acme’s 5 part-time employees worked a total of
2,716 hours during 2024.
56,000 full-time hours from Step 2
2,800 over time hours
+ 2,716 part-time hours
61,516 total hours worked

Section 3: Reporting Cases
Instructions:
1. If you had NO cases with days away from work (Column H) and NO cases with days of job transfer or restriction
(Column I), please proceed to Section 4: Contact Information.
2. If you had cases with days away from work (Column H) or cases with days of job transfer or restriction (Column I),
please complete Section 3. To identify the individual cases to report, follow these steps:
Step 1:

Go to your completed OSHA Form 300.
Note each case that has a check in Column (H) or Column (I).
These are the only cases you should report.
See the illustration in Step 3 below.

Step 2:

Fill out one Injury and Illness Case Form for each case that you identified in Step 1. You can find most of
the information on a supplementary document such as the Injury and Illness Incident Report (OSHA Form
301), a workers’ compensation report, an accident report, or an insurance form.

Step 3:

If more than one establishment is noted on the front cover under “Report for this Location,” be sure to
look at all your OSHA Form 300’s to find which cases to report.

Section 3 asks about injuries
or illnesses with a check in
Column H, Days Away from
Work or Column I, Job
Transfer or Restriction, of
your Log.

Step 4:

We have designed this survey to ensure that you do not have to report more than 8 cases. If you have more
than 8 cases, please go to Section 5: If You Need Help . . . at the back of this booklet and call the phone
number(s) listed for your State for assistance. If you need additional Injury and Illness Case Forms, you may
either photocopy a blank form or go to Section 5: If You Need Help . . . at the back of this booklet and call
the phone number(s) listed for your State.

Step 5:

When you are finished, proceed to Section 4: Contact Information on the back cover of this booklet and
provide information for the person who completed this survey.

5

Injury and Illness Case Form
Tell us about each 2024 work-related injury or illness case if it resulted in days away from work (Column H in Section 2 on Page 3)
or days of job transfer or restriction (Column I in Section 2 on Page 3). One Injury and Illness Case Form should be completed for
each injury or illness case. We have designed this survey to ensure that you do not have to report more than 8 cases. If you have more
than 8 cases, please contact the office whose number appears on the front of the survey form.
Tell us about the Case
Go to your completed OSHA Form 300. Copy the case information from that form into the spaces below.

Employee’s name
(Column B)

Date of injury
or
onset of illness
(Column D)

Job title
(Column C)

/
month day

Number of days
away from work
(Column K)

Number of days
of job transfer
or restriction
(Column L)

/24
year

Tell us about the Employee

Tell us about the Incident

1. Check the category which best describes the employee's regular type
of job or work: (optional)

Answer the questions below or attach a copy of a supplementary
document that answers them.

❑

Office, professional, business,
or management staff
❑ Sales
❑ Product assembly,
product manufacture
Repair,
installation or service
❑
of machines, equipment
❑ Construction
❑ Other:____________________

❑
❑
❑
❑
❑
❑

Healthcare
Delivery or driving
Food service
Cleaning, maintenance
of building, grounds
Material handling (e.g.,stocking,
loading/unloading, moving, etc.)

Farming

❑no
7. Was employee hospitalized overnight as an in-patient? ❑yes ❑no
8. Time employee began work: __________ ❑am ❑pm
9. Time of event: __________ ❑am ❑pm OR ❑ Check if time cannot
be determined
Event occurred: (optional) ❑before ❑during ❑after work shift
10. What was the employee doing just before the incident occurred?
Describe the activity as well as the tools, equipment, or material the
employee was using. Be specific. Examples: “climbing a ladder
while carrying roofing materials”; “spraying chlorine from hand
sprayer”; “daily computer key-entry.”

2. Employee’s race or ethnic background: (optional-check one or more)

❑
❑
❑
❑
❑
❑
❑

6. Was employee treated in an emergency room? ❑yes

American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Not available

11. What happened? Tell us how the injury or illness occurred.
Examples: “When ladder slipped on wet floor, worker fell 20 feet”;
“Worker was sprayed with chlorine when gasket broke during
replacement”; “Worker developed soreness in wrist over time.”

NOTE: You may either answer questions (3) to (13) or attach a copy of a
supplementary document that answers them.
3. Employee’s age: ______ OR date of birth: ______/______/______
month

day

12. What was the injury or illness? Tell us the part of the body that
was affected and how it was affected; be more specific than “hurt,”
“pain,” or “sore.” Examples: “strained back”; “chemical burn,
hand”; “carpal tunnel syndrome.”

year

4. Employee’s date hired: ______/______/______
month

day

year

OR check length of service at establishment when incident
occurred:

❑
❑
❑
❑

13. What object or substance directly harmed the employee?
Examples: “concrete floor”; “chlorine”; “radial arm saw.” If this
question does not apply to the incident, leave it blank.

Less than 3 months
From 3 to 11 months
From 1 to 5 years
More than 5 years

5. Employee’s gender:
❑ Male
❑ Female
6

Injury and Illness Case Form
Tell us about each 2024 work-related injury or illness case if it resulted in days away from work (Column H in Section 2 on Page 3)
or days of job transfer or restriction (Column I in Section 2 on Page 3). One Injury and Illness Case Form should be completed for
each injury or illness case. We have designed this survey to ensure that you do not have to report more than 8 cases. If you have more
than 8 cases, please contact the office whose number appears on the front of the survey form.
Tell us about the Case
Go to your completed OSHA Form 300. Copy the case information from that form into the spaces below.

Employee’s name
(Column B)

Date of injury
or
onset of illness
(Column D)

Job title
(Column C)

/
month day

Number of days
away from work
(Column K)

Number of days
of job transfer
or restriction
(Column L)

/24
year

Tell us about the Employee

Tell us about the Incident

1. Check the category which best describes the employee's regular type
of job or work: (optional)

Answer the questions below or attach a copy of a supplementary
document that answers them.

❑

Office, professional, business,
or management staff
Sales
❑
❑ Product assembly,
product manufacture
❑ Repair, installation or service
of machines, equipment
❑ Construction
❑ Other:____________________

❑
❑
❑
❑
❑
❑

Healthcare
Delivery or driving
Food service
Cleaning, maintenance
of building, grounds
Material handling (e.g.,stocking,
loading/unloading, moving, etc.)

Farming

American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Not available

11. What happened? Tell us how the injury or illness occurred.
Examples: “When ladder slipped on wet floor, worker fell 20 feet”;
“Worker was sprayed with chlorine when gasket broke during
replacement”; “Worker developed soreness in wrist over time.”

NOTE: You may either answer questions (3) to (13) or attach a copy of a
supplementary document that answers them.

12. What was the injury or illness? Tell us the part of the body that
was affected and how it was affected; be more specific than “hurt,”
“pain,” or “sore.” Examples: “strained back”; “chemical burn,
hand”; “carpal tunnel syndrome.”

3. Employee’s age: ______ OR date of birth: ______/______/______
month

day

year

4. Employee’s date hired: ______/______/______
month

day

year

OR check length of service at establishment when incident
occurred:

❑
❑
❑
❑

❑no
9. Was employee hospitalized overnight as an in-patient? ❑yes ❑no
8. Time employee began work: __________ ❑am ❑pm
9. Time of event: __________ ❑am ❑pm OR ❑ Check if time cannot
be determined
Event occurred: (optional) ❑before ❑during ❑after work shift
10. What was the employee doing just before the incident occurred?
Describe the activity as well as the tools, equipment, or material the
employee was using. Be specific. Examples: “climbing a ladder
while carrying roofing materials”; “spraying chlorine from hand
sprayer”; “daily computer key-entry.”

2. Employee’s race or ethnic background: (optional-check one or more)

❑
❑
❑
❑
❑
❑
❑

8. Was employee treated in an emergency room? ❑yes

13. What object or substance directly harmed the employee?
Examples: “concrete floor”; “chlorine”; “radial arm saw.” If this
question does not apply to the incident, leave it blank.

Less than 3 months
From 3 to 11 months
From 1 to 5 years
More than 5 years

5. Employee’s gender:
❑ Male
❑ Female
7

Section 4: Contact Information
Fill in the name, title, and phone number of the person who completed this survey in case we have questions.
(

)

-

Printed name

Telephone number

Title

/
Today’s date

Ext.

( )
Fax number

/

Use the return envelope to send us the entire package – everything that we sent you – within 30 days of the date
your establishment received it. If the return envelope is missing, send the entire package to the return address on
the front cover (look for Address for Return Envelope).

Section 5: If You Need Help . . .
If you have any questions or if you need help completing this survey, call the phone number(s) that is listed below for
your State. The phone number(s) may be for an office outside your State, but they will be able to help you. If you
prefer to write, send your letter to the return address on the front of this package.
Alabama
(334) 956-7440, 7444
(334) 956-7492 fax
Alaska
(907) 465-6034
(907) 465-4506 fax
Arizona
(602) 542-3739
(602) 542-6360 fax
Arkansas
(501) 682-4872
(501) 682-4509
(501) 682-4754 fax
California
(415) 703-3020
(415) 703-3029 fax
Colorado
(720) 248-8379
(972) 850-4810 fax
Connecticut
(860) 263-6272
(860) 263-6263 fax
Delaware
(302) 451-3412
(302) 451-3497 fax
District of Columbia
(202) 442-9010, 5930, 5926
(202) 442-4833 fax
Florida
(908) 928-1327
(215) 861-5637
(215) 861-5736 fax
Georgia
(404) 893-1934, 8344
(404) 893-8343 fax
Guam
(671) 300-6339
(671) 475-7063 fax
Hawaii
(808) 586-9001
(808) 586-9022 fax
Idaho
(415) 625-2275, 2267
(415) 625-2294 fax

Illinois
(217) 524-2098
(217) 558-4122 fax
Indiana
(317) 232-2668
(317) 233-3790 fax
Iowa
(515) 725-5611
(515) 725-7924 fax
Kansas
(785) 581-7479
(785) 291-6084 fax
Kentucky
(502) 564- 4105, 4259
(502) 564-0539 fax
Louisiana
(225) 342-3126
(225) 342-3269 fax
Maine
(207) 623-7903
(207) 623-7937 fax
Maryland
(410) 527-4460, 4462
(410) 527-4497 fax
Massachusetts
(617) 626-6945
(978) 577-1556 fax
Michigan
(517) 284-7788
(517) 284-7815 fax
Minnesota
(888) 589-6322
(651) 284-5726 fax
Mississippi
(312) 353-7253
(312) 353-7230 fax
Missouri
(573) 751-3802, 2719
(573) 751-2319 fax
Montana
(406) 444-3297, 3235
(406) 444-4140 fax

Nebraska
(402) 471-3547, 1545
(800) 599-5155
(402) 471-6523 fax
Nevada
(866) 931-1215
(702) 486-9197, 9187
(702) 486-9175 fax
New Hampshire
(617) 565-2302
(617) 565-1840 fax
New Jersey
(609) 984-3604
(609) 633-0618 fax
New Mexico
(505) 699-6194
(505) 699-7188
(505) 476-8735 fax
New York
(888) 425-1323
(888) 807-0410 fax
North Carolina
(919) 707-7765
(919) 733-2186 fax
North Dakota
(312) 353-7253
(312) 353-7230 fax
Ohio
(866) 569-7806
(614) 995-8608
(614) 728-6460 fax
Oklahoma
(405) 521-6599, 6858
(405) 521-6021 fax
Oregon
(503) 947-7030
(503) 947-7312 fax
Pennsylvania
(800) 238-9412
(717) 772-8319 fax
Puerto Rico
(787) 754-5300, ext. 3032,
3036, 3051, 3056, 3057
(787) 754-5360 fax

8

Rhode Island
(617) 565-2302
(617) 565-1840 fax
South Carolina
(803) 896-7659, 7683
(803) 896-7670 fax
South Dakota
(312) 353-7253
(312) 353-7230 fax
Tennessee
(615) 741-1748
(800) 778-3966
(615) 253-5501 fax
Texas
(866) 237-6405
(512) 804-4652 fax
Utah
(801) 530-6926, 6823
(801) 526-9206 fax
Vermont
(802) 828-4327
(802) 760-7101
(802) 828-4050 fax
Virgin Islands
(340) 776-3700 ext. 2074
(340) 715-5740 fax
Virginia
(804) 786-1995
(804) 786-2376 fax
Washington
(360) 902-5640
(360) 902-5559 fax
West Virginia
(304) 558-2660
(304) 957-7635 fax
Wisconsin
(800) 884-1273
(608) 221-6292
(608) 221-6297 fax
Wyoming
(307) 473-3838
(307) 473-3863 fax