State of California

  M E M O R A N D U M

  REFERENCE CODE:
  2001-071

  DATE:
  December 28, 2001

  TO:
  Health and Safety Officers
  Return-to-Work/Claims Coordinators
  Personnel Officers

  FROM:
  Department of Personnel Administration
  Benefits Division

  SUBJECT:
  California Occupational Safety and Health Reporting 
  Requirements, Cal/OSHA Form 300, Cal/OSHA Form 300A and 
  Cal/OSHA Form 301

  CONTACT:
  Sandi Becker, Workers' Compensation and Safety Coordinator
  (916) 327-1438, CALNET 467-1438
  FAX: (916) 322-3769
  Email: sandibecker@dpa.ca.gov


  The purpose of this memorandum is to notify departments of 
  changes in the California Code of Regulations, Title 8.  
  This has resulted in changes in the reporting requirements 
  for recording work-related injuries and illnesses.
  
  Effective January 1, 2002, employers are required to use 
  the Cal/OSHA Form 300 (Log of Work-Related Injuries and 
  Illnesses) in place of the Cal/OSHA Form 200 (Log and 
  Summary of Occupational Injury and Illness), to record 
  work-related injuries and illnesses.  Recordable injuries 
  and illnesses are those which result in:
  
  Death;
  Days away from work;
  Restricted work or transfer to another job;
  Medical treatment beyond first aid;
  Loss of consciousness; or
  A significant injury or illness diagnosed by a 
  physician or other licensed health professional 
  even if it does not result in any of the above, 
  (1-5).
  
  The Cal/OSHA Form 300 must be completed within seven (7) 
  calendar days of notice that a work-related injury or 
  illness has occurred.  Departments must also report any 
  work-related fatality or serious injury or illness to the 
  Division of Occupational Safety and Health within eight (8) 
  hours, as required by Title 8, Section 342.
  Departments are required to retain and update the Cal/OSHA 
  Form 300 for a period of five (5) years following the end 
  of the calendar year for which it pertains.
  
  The Cal/OSHA Form 301 (Injury and Illness Incident Report) 
  must be completed, along with the Cal/OSHA Form 300, for 
  every recordable occupational injury or illness.  The 
  Cal/OSHA Form 301 is a supplementary record of the 
  occupational injury or illness.  The completion of the 
  Employer's Report of Occupational Injury or Illness (SCIF 
  3067), or an equivalent form previously met this 
  requirement.  Due to changes in the reporting requirements 
  of the Cal/OSHA Form 301, the SCIF 3067 can no longer be 
  used for this purpose.  The Cal/OSHA Form 301 must be 
  completed within seven (7) calendar days of notice that a 
  work-related injury or illness has occurred.  These records 
  must be retained for a period of five (5) calendar years 
  following the end of the calendar year for which they 
  pertain.
  
  The Cal/OSHA Form 300A (Annual Summary of Work-Related 
  Injuries and Illnesses) is to be completed at the end of 
  the calendar year for which it pertains.  The annual 
  summary must be posted from February 1st through April 30th 
  in a conspicuous place or places where notices to employees 
  are customarily posted.  The Cal/OSHA Form 300A must be 
  retained for five (5) years following the end of the 
  calendar year for which it pertains.
  
  The Cal/OSHA forms can be downloaded from this website:
  http://www.dir.ca.gov/DOSH/DoshReg/EmpRecPropReg.html
  
  Departments must still maintain copies of the Cal/OSHA Form 
  200 (Log and Summary of Occupational Injury and Illnesses) 
  and supplementary records for each occupational injury or 
  illness for five (5) years following the calendar year for 
  which they pertain.  Departments are required to provide 
  access to the data as though these forms were the Cal/OSHA 
  300 and 301 forms, as specified in Title 8, Sections 
  14300.35 and 14300.40.  Departments are not required to 
  update the old Cal/OSHA 200 forms and supplementary 
  records.  Additionally a 2001 annual summary of 
  occupational injuries and illnesses, from the Cal/OSHA Form 
  200, must be posted from February 1, 2002 through March 1, 
  2002 in a conspicuous place or places where notices to 
  employees are customarily placed.
  
  If you have any questions or require additional 
  information, please contact Sandi Becker at (916) 327-
  1438/CALNET 467-1438.
  
  
  
  Terri Westbrook, Chief
  Benefits Division