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OSHA Form 300A – Summary of Work-Related Injuries and Illnesses Template
Prepare and certify your annual OSHA injury and illness summary in a clear, structured format for posting and audits.
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OSHA Form 300A – Summary of Work-Related Injuries and Illnesses Template
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OSHA Form 300A – Summary of Work-Related Injuries and Illnesses Template
[Company / Establishment Name]
[Street Address]
[City, State, ZIP Code]
[Industry Description or NAICS Code]
1. Year and Establishment Information
Calendar Year Covered by This Summary: [Year]
Establishment Name: [Name of Individual Establishment or Site]
Address: [Street Address, City, State, ZIP Code]
Industry / Business Description: [Short description, e.g., “Warehouse and distribution,” “Metal fabrication,” “Office – professional services,” etc.]
NAICS Code (if known): [NAICS Code]
Average Number of Employees During the Year: [Number]
Total Hours Worked by All Employees Last Year: [Total Hours]
2. Summary of OSHA-Recordable Cases
Use totals from your OSHA 300 log for the same calendar year. Enter “0” for any category where no cases occurred.
2.1 Number of Cases
Total number of:
Deaths: [Number]
Cases with days away from work: [Number]
Cases with job transfer or restriction (but no days away): [Number]
Other recordable cases (no days away or restriction, but OSHA-recordable): [Number]
2.2 Number of Days
Total number of:
Days away from work: [Number of calendar days]
Days of job transfer or restriction: [Number of calendar days]
2.3 Injury and Illness Types
Total number of cases in each category:
Injuries: [Number]
Skin disorders: [Number]
Respiratory conditions: [Number]
Poisonings: [Number]
Hearing loss: [Number]
All other illnesses: [Number]
3. Establishment Information for Posting
This section is typically visible when the summary is posted where employees can see it.
Company / Establishment Name: [Name]
City: [City]
State: [State]
Contact Person for More Information About This Summary:
Name: [Full Name]
Title: [Title – e.g., Safety Manager, HR Manager]
Phone: [Phone Number]
Email (optional): [Email Address]
4. Certification by Company Executive
OSHA requires that a company executive review the injury and illness records and certify that the OSHA 300A summary is correct and complete, based on the OSHA 300 log.
I certify that I have examined this OSHA-style summary of work-related injuries and illnesses for the calendar year indicated above and that, to the best of my knowledge, the entries are true, accurate, and complete.
Name of Certifying Official: [Full Name]
Title (check or describe):
Owner of the company (only if the company is a sole proprietorship or partnership)
Officer of the corporation
Highest ranking company official working at this establishment
Immediate supervisor of the highest ranking company official working at this establishment
Other (describe): [Description]
Signature of Certifying Official: _______________________________
Date Signed: [MM/DD/YYYY]
5. Posting Information
This section helps you organize how and where the summary is posted for employees.
Date Summary Prepared: [MM/DD/YYYY]
Posting Period (typically required by OSHA rules):
From: [MM/DD/YYYY]
To: [MM/DD/YYYY]
Location(s) Where This Summary Will Be Posted (break room, main bulletin board, time clock area, etc.):
[Description of posting locations]
Name or Role of Person Responsible for Posting: [Name/Title]
6. Recordkeeping and Additional Notes
Recordkeeping Reminder:
Keep this OSHA-style summary, your OSHA 300 log, and any OSHA 301 or equivalent incident reports for at least five years following the end of the calendar year to which they relate (or longer if required by law or company policy).
During the retention period, you may need to update your OSHA 300 log if case outcomes change (for example, additional days away from work).
Internal Notes (optional):
[Use this section for internal references, such as “Totals checked against 300 log on 01/20/2026,” “Updated after reclassification of Case #7,” or references to internal safety reviews.]
7. Attachments Checklist (Internal Use)
You may keep the following documents together with this OSHA 300A-style summary in your injury and illness recordkeeping file:
OSHA 300 log for this calendar year
OSHA 301 forms or equivalent incident reports for each recordable case
Internal accident / incident investigation reports
Workers’ compensation or insurance claim summaries
Safety committee or management review notes related to this year’s cases
Any correspondence with OSHA or regulatory agencies about recorded cases
Other supporting documents: [Describe]
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OSHA Form 300A – Summary 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.
OSHA FORM 300A – SUMMARY OF WORK-RELATED INJURIES AND ILLNESSES TEMPLATE FAQ
What is OSHA Form 300A – Summary of Work-Related Injuries and Illnesses?
OSHA Form 300A is the annual summary that shows totals of OSHA-recordable work-related injuries and illnesses for a specific calendar year. It pulls information from your OSHA 300 log and includes total cases, total days away/restricted, and total types of injuries and illnesses, along with establishment information and a certification by a company executive.
Who must complete and post an OSHA 300A summary?
Most U.S. employers that are required to keep OSHA injury and illness records (typically those with 10 or more employees in non-exempt industries) must complete a 300A summary at the end of each calendar year and post it in a visible location at the establishment for a specified period, even if there were zero recordable cases. Some small employers and low-risk industries are partially exempt, so you should always check current OSHA guidance for your business.
What information goes into an OSHA 300A summary?
An OSHA 300A summary typically includes: basic establishment details (name, address, industry, average number of employees, total hours worked); total number of cases by classification (death, days away from work, job transfer/restriction, other recordable); total days away from work and days of job transfer/restriction; and total number of injury and illness cases (injury, skin disorder, respiratory condition, poisoning, hearing loss, other illness). A company executive then certifies that the summary is true and complete.
Where and when must the OSHA 300A summary be posted?
Under OSHA rules, the completed and certified 300A summary is generally required to be posted in a conspicuous place where employee notices are normally displayed at the establishment. It must be posted for a specific period (often from February 1 to April 30 of the year following the year covered by the form). Some employers in certain industries may also have to submit 300A data electronically to OSHA, depending on size and classification.
Does this OSHA 300A template replace legal or safety advice?
No. This OSHA Form 300A – Summary template is a simplified document organizer based on OSHA concepts. It is not an official OSHA form and does not replace legal advice, official OSHA instructions, or up-to-date regulatory guidance. For questions about recordkeeping requirements, posting rules, or electronic submission, you should review current OSHA materials or consult a qualified safety or legal professional.
How can AI Lawyer help with OSHA 300A compliance?
AI Lawyer can help you take totals from your OSHA 300 log and organize them into a clean, readable OSHA 300A-style summary using this template. You still need to confirm which cases are recordable, verify your totals, and follow current OSHA rules. This template and any AI-generated content are for document organization only and are not legal or safety advice.
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