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Cal/OSHA Form 300 – Log of Work-Related Injuries and Illnesses Template
Maintain a clear, California-specific log of work-related injuries and illnesses for compliance, audits, and safety tracking.
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Cal/OSHA Form 300 – Log of Work-Related Injuries and Illnesses Template
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Cal/OSHA Form 300 – Log of Work-Related Injuries and Illnesses Template
[Company / Establishment Name]
[Street Address]
[City, State, ZIP Code]
[Industry Description]
Cal/OSHA Form 300 – Log of Work-Related Injuries and Illnesses
Year Covered by This Log: [20__]
1. Establishment Information
Establishment Name: [Name of physical location or site]
Address of Establishment: [Street, City, State, ZIP Code]
Industry / Business Description: [Short description, e.g., “warehouse and distribution,” “food service,” “office – professional services,” etc.]
Contact Person for Recordkeeping Questions:
Name: [Full Name]
Title: [Title – e.g., Safety Manager, HR Manager]
Phone: [Phone Number]
Email (optional): [Email Address]
2. General Instructions for Using This Log
Keep a separate Cal/OSHA Form 300 log for each establishment that is expected to operate for a year or more.
Use one “Log Entry” (Section 3) for each Cal/OSHA-recordable case. Assign case numbers in order (1, 2, 3, …).
Use an incident report (Cal/OSHA Form 301 or an equivalent internal form) to capture detailed information for each case listed here.
Enter or update each recordable case on the log within the time frame required by Cal/OSHA after you learn that the case is recordable.
Update days away from work and restricted/transfer days if they change later, in line with the counting rules that apply to your workplace.
Do not list names for qualifying “privacy concern” cases; use “Privacy Case” and maintain a separate confidential list.
3. Cal/OSHA 300 Log Entry Template
(Repeat this block for each recordable case.)
Log Entry – Case [Case Number]
3.1 Basic Case Information
Case Number: [Sequential case number for this calendar year]
Employee Name: [First, Middle, Last]
(If this is a privacy concern case, enter “Privacy Case” here and keep a separate confidential list.)
Employee Job Title: [Job title at time of incident]
Date of Injury or Onset of Illness: [MM/DD/YYYY]
Where the Event Occurred (work area or location):
[Example: “Warehouse – Loading Dock B,” “Kitchen – prep area,” “Office – Room 210,” “Construction site – roof area,” etc.]
3.2 Description of Injury or Illness
Describe the injury or illness, the part(s) of the body affected, and the object or substance that directly injured or made the employee ill. Keep this short but specific.
[Examples:
“Sprain – lower back while lifting box from pallet to conveyor.”
“Laceration – left index finger from box cutter.”
“Contusion – right hip and elbow after slip and fall on wet floor near entrance.”
“Respiratory symptoms after inhalation of cleaning chemical.”]
3.3 Case Classification – Most Serious Outcome
Check only one category to show the most serious outcome for this case:
Death
Days away from work
Job transfer or restricted work
Other recordable case (no days away or restriction, but still recordable)
3.4 Days Away from Work and Days of Job Transfer/Restriction
Number of calendar days away from work: [Number of days]
Number of calendar days of job transfer or restricted work: [Number of days]
3.5 Type of Case – Injury or Illness Category
Check the category that best describes the case:
Injury
Skin disorder
Respiratory condition
Poisoning
Hearing loss
Other illness
3.6 Privacy Case Indicator (If Applicable)
Is this case treated as a privacy concern case under applicable rules?
No – employee’s name appears on the log.
Yes – “Privacy Case” appears on the log instead of the name; details and identity are kept in a separate confidential file.
3.7 Internal Notes (Optional)
Use this space for brief internal notes such as updates or cross-references:
[Examples: “Days away updated to 10 on 05/15,” “Doctor released employee to light duty,” “See Incident Report #IR-2025-014 for full details.”]
4. Privacy Concern Case List (Confidential – Internal Use Only)
Use this section only if you have privacy concern cases. Keep it in a secure, confidential file separate from the posted log.
Privacy Case List for Calendar Year: [20__]
For each privacy case:
Case Number (from Cal/OSHA 300 log): [Case Number]
Employee Identifier (name or internal ID): [Confidential info – do not post]
Notes (optional – e.g., “Privacy concern case per internal criteria.”)
5. Annual Review and Cal/OSHA Form 300A Preparation
At the close of the calendar year:
Review all entries on this Cal/OSHA Form 300 log for accuracy and completeness.
Confirm totals for:
Number of deaths.
Number of cases with days away from work.
Number of cases with job transfer or restriction.
Number of other recordable cases.
Total days away from work.
Total days of job transfer or restriction.
Total number of cases for each injury/illness category.
Use these totals to prepare the Cal/OSHA Form 300A – Annual Summary of Work-Related Injuries and Illnesses.
Have a company executive review and certify the annual summary as required.
Post the 300A summary during the required posting period at the establishment, in a place where employee notices are normally displayed.
6. Internal Certification of the Log
I certify that I have reviewed this Cal/OSHA-style Log of Work-Related Injuries and Illnesses for the year indicated, and that, to the best of my knowledge, it is a true and complete record of the recordable cases for this establishment.
Name of Certifying Official: [Full Name]
Title: [Title – e.g., Owner, Corporate Officer, Highest Ranking Official at This Establishment]
Signature: _______________________________
Date: [MM/DD/YYYY]
7. Attachments and Supporting Records Checklist
You may keep the following documents with this Cal/OSHA Form 300 log (paper or electronic):
Cal/OSHA Form 301 or equivalent incident report for each case on the log
Internal accident / incident investigation reports
Medical or work-status notes related to the case (where appropriate and allowed)
Employee and witness statements
Photos or sketches of the incident area (if kept)
Workers’ compensation claim records or summaries
Any corrective action or safety review documentation
Other supporting documents: [Describe]
Record Retention Reminder: Keep this log and all associated records for at least the minimum number of years required by Cal/OSHA and your internal policies, and be prepared to update it if case outcomes change during the retention period.
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Cal/OSHA Form 300 – Log of Work-Related Injuries and Illnesses Template
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
CAL/OSHA FORM 300 – LOG OF WORK-RELATED INJURIES AND ILLNESSES TEMPLATE FAQ
What is Cal/OSHA Form 300?
Cal/OSHA Form 300 is California’s version of the “Log of Work-Related Injuries and Illnesses.” Employers who are required to keep records use it to list each recordable work-related injury or illness for a given calendar year, including who was hurt, what happened, how serious the case was, and how many days of work were affected.
Who has to keep a Cal/OSHA Form 300 log?
Most California employers with more than a small number of employees, and who are not in a fully exempt low-hazard industry, must maintain injury and illness records, including a log (Form 300), an annual summary (Form 300A), and incident reports (Form 301 or equivalent) for each recordable case. Some small or low-hazard employers may be exempt, so it’s important to confirm your status under current Cal/OSHA rules or with a qualified safety/HR professional.
What goes on the Cal/OSHA Form 300 log?
For each recordable case, the log normally includes: the employee’s name and job title, the date of injury or illness onset, where the event occurred, a short description of what happened and which body parts were affected, how serious the outcome was (death, days away from work, restricted work or transfer, or other recordable), and the number of days away from work and/or days of job transfer or restriction. You also classify whether the case is an injury or an illness (and what type of illness).
How is this different from the federal OSHA Form 300?
The Cal/OSHA log is very similar to the federal OSHA Form 300 but aligned with California’s regulations and enforcement system. Many of the core concepts — such as keeping one log per establishment, recording recordable cases within a set number of days, and preparing an annual summary — are parallel, but employers in California must follow Cal/OSHA’s specific requirements, definitions, and any California-only rules. This template is written in a general way so it can be adapted to your internal system while remaining California-focused.
Does this Cal/OSHA Form 300 template count as legal or compliance advice?
No. This Cal/OSHA Form 300 – Log of Work-Related Injuries and Illnesses Template is only a drafting and organization tool. It does not replace official Cal/OSHA forms, regulations, or up-to-date guidance, and it does not determine whether a particular case is recordable. For questions about coverage, recordability, posting and retention requirements, or reporting serious injuries directly to Cal/OSHA, you should consult official state resources or a qualified safety/HR professional or attorney.
How can AI Lawyer help with Cal/OSHA injury and illness logs?
AI Lawyer can help you take the information you already collect about workplace incidents — names, dates, locations, outcomes, and case classifications — and organize it into a clear Cal/OSHA-style log using this template. You remain responsible for deciding which cases are recordable under Cal/OSHA, supplying accurate information, and reviewing your final documents. Any AI-generated text is for document structure and organization only and is not legal or safety advice.
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