IDCF Collection Screenshots

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including case details. Please review the imported information and
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Updated tooltip for finding OSHA ITA number

Section 1 instructions displayed if user does import data from OSHA’s ITA.

Section 1 instructions displayed if user does import not data from OSHA’s ITA.

Instructions displayed after user successfully imports case data from OSHA’s ITA and has 8 or less cases that resulted
in days away from work, job transfer, or restriction.

Make sure that you have excluded Other recordable cases (Column J) and nonrecordable cases.

Instructions displayed after user successfully imports case data from OSHA’s ITA and has 9 or more cases that
resulted in days away from work, job transfer, or restriction.

Make sure that you have excluded Other recordable cases (Column J) and nonrecordable cases.

Instructions displayed if user does not import case data from OSHA’s ITA and has 9 or more cases that resulted in
days away from work, job transfer, or restriction.

Make sure that you have excluded Other recordable cases (Column J) and nonrecordable cases.

Instructions displayed if user does not import case data from OSHA’s ITA and has 8 or LESS cases that resulted in
days away from work, job transfer, or restriction.

Make sure that you have excluded Other recordable cases (Column J) and nonrecordable cases.

2. Employee's race or ethnic background: (optional-check one or more)
El American Indian or Alaska Native

� Asian

□
□
□

Black or African American
Hispanic or Latino

Native Hawaiian or Other Pacific Islander

E] White

B Not available
3. Employee's age: I
Date of Birth:

I

MM

4. Employee's date hired:
OR

33

·11�11 ·I
I
I I� 1
I
yyyy

02-Feb

•

2014

•

Select length of service at establishment when incident occurred:

fJ Less than 3 months

EJ From 3 to 11 months
EJ From 1 to 5 years

□

More than 5 years

5. Employee's sex:
� Male

□

Female

Section 3. Cases with Days Away from Work or Job Transfer or Restriction
Case 1
Employee Name: John
Job Title: Janitor
Date of Injury or onset of Illness: 02/03/2021
Number of days away from work: 13
Number of days of job transfer or restriction: 0
1. Type of Job or Work: Material handling
2. Employee's race or ethnic background:
o Asian
3. Employee's age: 33
Employee's date of birth:
4. Employee's date hired: 02/21/2014
Employee's length of service when incident ocrurred:
5. Employee's sex: Male
6. Treated in emergency room? No
7. Hospitalized overnight as in-patient No
8. Time employee began work: 10:00 AM
9. Time of event: 4:00 PM
t
Event Occurred: During work shif
10. What was the employee doing before the incident?
carrying items
11. What happened?
lipped on floor
12. What was the Injury or Illness?
sprain wrist
13. What object or sub51:ance directly harmed the employee?
water on floor
Case Comments:

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