BWC Div. of Safety & Hygiene Semi-Annual Report
Fields marked with an * are required.

Contact Information

Report Information
Report all information below for CURRENT SIX MONTH PERIOD ONLY (corresponding with period identified above).

Recordkeeping Requirements
The following items are based on the Recordkeeping Requirements under the Occupational Safety & Health Act of 1970. The columns listed below correspond to the columns in the OSHA 300 Log and PERRP Form 300P.

(Column G in OSHA 300 Log/PERRP Form 300P)

(Column H in the OSHA 300 Log/PERRP Form 300P) 

(Column K in the OSHA 300 Log/PERRP Form 300P)

Note: If you report a death, injury, or illness resulting in days away from work in the current
six month period (item 4 or 5), the most recent date of death, injury or illness must correspond with item 1.