Templates
Cal/OSHA form 300

Cal/OSHA form 300

Discover how to effectively use the Cal/OSHA form 300 template to document workplace incidents, ensure compliance, and enhance safety. This guide provides step-by-step instructions and practical tips for safety managers and HR professionals.

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Cal/OSHA form 300

Discover how to effectively use the Cal/OSHA form 300 template to document workplace incidents, ensure compliance, and enhance safety. This guide provides step-by-step instructions and practical tips for safety managers and HR professionals.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

Track and document workplace injuries and illnesses with our Cal/OSHA Form 300 template, designed specifically for California employers who need to maintain compliant safety records. This template provides a structured format for recording incident details, from minor injuries to serious accidents, as mandated by California’s Division of Occupational Safety and Health.

You must document each recordable workplace incident within seven calendar days, and this template ensures you capture all required information efficiently. Use it to maintain accurate records, identify workplace safety trends, and demonstrate regulatory compliance during inspections.

Related categories

Preview of the template
Page 1
Establishment Information
Establishment name
Street
City
State
Zip
Industry description (e.g., Manufacture of motor truck trailers)
Standard Industrial Classification (SIC), if known (e.g., 3715)
Employment information
Log of Work-Related Injuries and Illnesses
Case No.
Employee's Name
Job Title (e.g., Welder)
Date of Injury or Onset of Illness (mm/dd/yyyy)
Where the event occurred (e.g. Loading dock north end)
Describe injury or illness, parts of body affected, and object/substance that directly injured or made person ill (e.g., Second degree burns on right forearm from welder)
Job Title (e.g., Welder)
Employee Died?
Replaced or Transferred?
Days Away from Work
Days of Restricted Work Activity or Job Transfer
Injury or Illness Classification
Establishment Summary
Total number of deaths
Total number of cases with days away from work
Total number of cases with job transfer or restriction
Total number of other recordable cases
Injury and Illness Types

Frequently asked questions

Which employers are required to maintain a Cal/OSHA Form 300?

Employers with 10 or more employees must maintain Cal/OSHA Form 300 records, unless they’re in certain low-hazard industries under specific exemption by regulation. All employers, regardless of size, must report serious injuries, illnesses, and fatalities to Cal/OSHA and maintain these records for at least five years .

How do I handle privacy concerns when completing this Cal/OSHA Form?

For privacy concern cases, enter “privacy case” instead of the employee’s name on Form 300. Privacy cases include injuries to intimate body parts, sexual assault injuries, mental illnesses, HIV/hepatitis/tuberculosis infections, needlestick injuries, and cases where employees voluntarily request confidentiality. Maintain a separate confidential list connecting case numbers with employee names.

What’s the difference between Cal/OSHA Forms 300, 300A, and 301?

Cal/OSHA Form 300 is the ongoing log of workplace injuries and illnesses. You must post Form 300A, the annual summary of these incidents, from February 1 to April 30. You must complete Form 301, the detailed incident report, for each case you record on the Form 300. All three forms work together as a comprehensive record keeping system

How do I determine if an injury is “work-related” for Cal/OSHA Form 300?

Consider an injury or illness work-related when an event or exposure in the work environment causes or contributes to the condition or significantly aggravates a pre-existing condition. The work environment includes locations where employees work or are present as a condition of employment. Some exceptions exist for cases occurring during commuting or personal tasks.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.