Safety Forms

Supervisors Report of Injury

Employers should have a procedure to investigate occupational injuries and illnesses. Employers may use the Supervisor’s Report of Injury Form or a similar form to document facts about the investigation. Employers must also complete a Cal/OSHA 301 – Injury and Illness Incident Report for all non-first aid injuries. These requirements are in addition to the workers’ compensation reporting requirements.

Hazard Inspection Forms (PDF) (Excel)

Records of scheduled and periodic inspections should be maintained for 1 year. When performing a workplace inspection document your efforts on an inspection checklist. Make sure to record the date, person conducting the inspection and any unsafe conditions or work practices that were identified. Additionally document any actions that are taken to correct the unsafe conditions and work practices.

Multi-Employer Safety Meeting Report

This form can be used to record each safety meeting.

This form can be used to record each safety meeting.

Employee Training Record

Cal/OSHA requires all employees, including managers and supervisor, to have training and instruction on general and job-specific safety and health practices. Records of the training need to include employee name or other identifier, training date(s), type(s) of training, and the name of the training provider. Training records need to be maintained for at least one year.

Serious Workplace Injury Reporting Requirement

Cal/OSHA requirements dictate that every employer shall report any work-related serious injury or illness, or death of an employee immediately (not longer than 8 hours) after the employer knows of the injury or death. Serious injuries must be reported to the nearest Cal/OSHA Enforcement office by phone. This publication describes these requirements.

Serious Work-Related Injuries – Employer’s Worksheet for Reporting

This form is intended to be used by the employer to prepare the information Cal/OSHA will request during the phone call report of a serious injury or death.

Employers with outdoor operations are required to comply with Cal/OSHA heat illness prevention standard 3395. This procedure can be adopted to match your operations and used as your written plan; this plan may be incorporated into your Injury & Illness Prevention Program.

You may use this checklist as a guide for implementation in conjunction with the Armstrong & Associates Sample Heat Illness Prevention Plan.

This worksheet can be used as a way to insure that your supervisors are in compliance at the jobsite.

Use this chart to determine the heat index relative to temperature and humidity