PLEASE COMPLETE FOR JANUARY 1, 2017 - JUNE 30, 2017
The time has arrived to submit your January 1 - June 30th 2017 Safety Council Semi-Annual Report. Please take a few moments and complete your first half Semi-Annual Safety Council report. It is absolutely critical that you return your report by no later than July 15th so that we can ensure that you receive your Safety Council rebate and/or award. Please contact info@hfcsafetycouncil.com or 937-382-2737 with any questions.
Business Information
BWC Account Number *
Your answer
Company *
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Phone *
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Address *
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City *
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State *
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Zip *
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Fax *
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Submitted by *
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E-mail *
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Has information provided above been updated on this report? *
SAFETY REPORT PART 1
Report All Information Below For CURRENT SIX MONTH PERIOD ONLY:
JANUARY 1, 2017 - JUNE 30, 2017
DATE OF MOST RECENT INJURY OR ILLNESS RESULTING IN DAY(S) AWAY FROM WORK *
mm/dd/yyyy
Your answer
AVERAGE NUMBER OF EMPLOYEES *
Your answer
TOTAL HOURS WORKED *
(ENTIRE SIX MONTH PERIOD, ALL EMPLOYEES)
Your answer
SAFETY REPORT PART 2
THE FOLLOWING ARE BASED ON THE RECORDKEEPING REQUIREMENTS UNDER THE OCCUPATIONAL SAFETY & HEALTH ACT OF 1970 (REV. 1/1/2002).

THE QUESTIONS LISTED BELOW CORRESPOND TO THE COLUMNS IN THE OSHA 300 LOG AND PERRP FORM 300P.

NUMBER OF DEATHS *
(COLUMN G IN OSHA 300 LOG/PERRP FORM 300P)
Your answer
NUMBER OF OCCUPATIONAL INJURIES AND/OR ILLNESSES RESULTING IN DAYS AWAY FROM WORK *
(COLUMN H IN OSHA 300 LOG/PERRP FORM 300P)
Your answer
NUMBER OF DAYS AWAY FROM WORK AS A RESULT OF OCCUPATIONAL INJURIES AND/OR ILLNESSES *
(COLUMN K IN OSHA 300 LOG/PERRP FORM 300P)
Your answer
PLEASE 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.
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