HomeMy WebLinkAboutTotal OSHA Form 300ACal/OSHA Form 300A
Summary of Work -Related Injuries and Illnesses
All establishments covered by CCR Title 8 Section 14300 must complete this Annual Summary, even if no work-
related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are
'complete and accurate before completing this summary.
Using the Log, count the individual entries you made for each category. Then write the totals below, making sure
you've added the entries from every page of the Log. If you had no cases, write "0."
Employees, former employees, and their representatives have the right to review the Cal/ OSHA Form 300 in its
entirety. They also have limited access to the Cal/ OSHA Form 301 or its equivalent. See CCR Title 8 Section 14300.
35, in Cal/ OSHA's recordkeeping rule, for further details on the access provisions for these forms.
amber of Cases
Total number of Total number of cases Total number of
Total number of deaths cases with days with job transfer or other recordable
away from work restriction cases
1 20 0 27
(G) (H) (1) (J)
Number of Days
Total number of days of Total number of
job transfer or restriction days away from
work
194 691
(K) (L)
Injury and Illness Types
otal number of...
(M)
(1) Injuries 63 Poisonings 0
(2) Skin Disorders 2 All other illnesses 2
(3) Respiratory conditions 1
Post this Annual Summary from February 1 t o April 30 of the year following the year covered by the form.
Year: 2009«,
Facility Information:
Establishment name: City of San Luis Obispo
Street 990 Palm Street
City San Luis Obispo State CA ZIP 93401
Industry description: Miimcipal Government
Standard Industrial Classification (SIC)
if known
Employment Information (If you don't have these figures, see the
Worksheet on the back of OSHA Form 300A to estimate)
Annual average number of employees
Total hours worked by all employees last year
Sign here
Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my
.knnorYI�dge the entr' are trJe, accurate, and complete.
j� r %--i rel►_ A-
1( 805 ) 781-7250
0
1
7751
Cal/OSHA Form 300A
Summary of Work -Related Injuries and Illnesses
All establishments covered by CCR Title 8 Section 14300 must complete this Annual Summary, even if no work-
related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are
complete and accurate before completing this summary.
Using the Log, count the individual entries you made for each category. Then write the totals below, making sure
you've added the entries from every page of the Log. If you had no cases, write "0."
Employees, former employees, and their representatives have the right to review the Cal/ OSHA Form 300 in its
entirety. They also have limited access to the Cal/ OSHA Form 301 or its equivalent. See CCR Title 8 Section 14300.
35, in Cal/ OSHA's recordkeeping rule, for further details on the access provisions for these forms.
Number of Cases
Total number of
Total number of deaths cases with days
away from work
0 18
(G) (H)
Number of Days
Total number of days of Total number of
job transfer or restriction days away from
work
552 446
(K) (L)
Total number of cases Total number of
with job transfer or other recordable
restriction cases
Injury and Illness Types
Total number of...
(M)
(1) Injuries 54 (4) Poisonings 0
(2) Skin Disorders 1 (5) All other illnesses 4
(3) Respiratory conditions
1
36
M
Post this Annual Summary from February 1 t o April 30 of the year following the year covered by the form.
Year: 2011 --8!w�_]]
Facility Information:
Establishment name: City of San Luis Obispo
Street 990 Palm Street
City San Luis Obispo State CA ZIP 93401
Industry description: Municipal Government
Standard Industrial Classification (SIC)
if known
Employment Information (If you don't have these figures, see the
Worksheet on the back of OSHA Form 300A to estimate)
Annual average number of employees 655
Total hours worked by all employees last year 962,528
Sign here
Knowingly falsifying this document may result In a fine.
I certify that I have examined this document and that to the best of my
knowl dge the entries a e true,ccurate, and complete.
i Human Resources Director
Company executive Mlle
-7 1-12- ► z7 12_
Phone I Data
Cal/OSHA Form 300A
Summary of Work -Related Injuries and Illne
Summary, even if no work- related injuries or illnesses occurred during the year.
Remember to review the Log to verify that the entries are complete and accurate before
completing this summary.
Using the Log, count the individual entries you made for each category. Then write the
totals below, making sure you've added the entries from every page of the Log. If you
had no cases, write "0."
Employees, former employees, and their representatives have the right to review the Cal/
OSHA Form 300 in its entirety. They also have limited access to the Cal/ OSHA Form
301 or its equivalent. See CCR Title 8 Section 14300. 35, in Cal/ OSHA's recordkeeping
Number of Cases
Total
Total number of
number of cases with
deaths days away
from work
0
12
(G)
(H)
Number of Days
number of
Total
Total
number of
number of
days of job
days away
transferor
20
(1)
from work
rPstrirtion
134
745
(K)
(L)
Injury and Illness Types
Total number of...
(M)
(1) Injuries 27
Skin
(2) Disorders 6
(4) Poisonings 0
(5) All other illnesses 2
Year: 2012
Facility Information:
Establishment name: City of San Luis Obispo
Street 990 Palm Street
City San Luis Obispo State CA
Industry description: Municimal Government
Standard Industrial Classification (SIC)
if known
Employment Information (If you don't have these figures, see the
Worksheet on the back of OSHA Form 300A to estimate)
Annual average number of employees
Total hours worked by all employees last year
Sign here
Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my
kno ledge the eniri s are t e, accurate, and complete.
�y [ Human Resources Director
Company executive Tdie
1(805) 781-7250
Respiratory
(3) conditions 2
Post this Annual Summary from February 1 t o April 30 of the year following the year covered by the form.
January 31, 2013
ZIP 93401
698
965,573
Total
Total number of
number of
cases with job
other
transfer or
recordable
restriction
cases
5
20
(1)
(J)
(4) Poisonings 0
(5) All other illnesses 2
Year: 2012
Facility Information:
Establishment name: City of San Luis Obispo
Street 990 Palm Street
City San Luis Obispo State CA
Industry description: Municimal Government
Standard Industrial Classification (SIC)
if known
Employment Information (If you don't have these figures, see the
Worksheet on the back of OSHA Form 300A to estimate)
Annual average number of employees
Total hours worked by all employees last year
Sign here
Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my
kno ledge the eniri s are t e, accurate, and complete.
�y [ Human Resources Director
Company executive Tdie
1(805) 781-7250
Respiratory
(3) conditions 2
Post this Annual Summary from February 1 t o April 30 of the year following the year covered by the form.
January 31, 2013
ZIP 93401
698
965,573
Cal/OSHA Form 300A
Summary of Work -Related Injuries and Illnesses
All establishments covered by CCR Title 8 Section 14300 must complete this Annual Summary, even if no work-
related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are
complete and accurate before completing this summary.
Using the Log, count the individual entries you made for each category. Then write the totals below, making sure
you've added the entries from every page of the Log. If you had no cases, write '0.'
Employees, former employees, and their representatives have the right to review the Cal! OSHA Form 300 in its
entirety. They also have limited access to the Call OSHA Form 301 or its equivalent. See CCR Title 8 Section
14300, 35, in Call OSHA's recordkeeping rule, for further details on the access provisions for these forms.
Number of Cases
Total number
Total number
Total number
Total number of cases with
of cases with
ofother
of deaths days away
job transfer
recordable
from work
or restriction
cases
0 9
14
23
(0) (H)
(O
(J)
Number of Days
Total number
of days ofjob Total number
transfer or of days away
restriction from work
358 516
(K) (L)
Injury and Illness Types
Total number of...
(M)
Injuries 37 (4)
Poisonings 0
Skin
All other
Disorders 5 (5)
illnesses 3
Respiratory
conditions 1
Post this Annual Summary from February 1 t 0 April 30 of the year following the year covered by the form.
Year: 2013
Facility Information:
Establishment name: City of San Luis Obispo
Street 990 Palm Street
City San Luis Obispo State CA
description:
Industrial Classification (SIC)
Information (If you don't have these figures, see the
back of OSHA Form 300A to estimate)
average number of employees
>urs worked by all employees last year
Sign here
Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my
k�+Ip I ge the,en es ¢flit e, accyl/�,t�e, and complete.
1 t nf.tr l(�// Human Resourcesl
U.
ZIP
OSHA's Form 300A
Summary of Work -Related Injuries and Illnesses
All establishments covered by Part 1904 must complete this Summary page, even if no injuries or
illnesses occurred during the year. Remember to review the Log to verify that the entries are complete
Using the Log, count the individual entries you made for each category. Then write the totals below,
making sure you've adoed the entries from every page of the log. If you had no cases write "0."
Employees former employees, and their representatives have the right to review the OSHA Form 300 in
its entirely. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR
1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms.
Number of Cases
Total number of
Total number of
Total number of cases
Total number of
deaths
cases with days
with job transfer or
other recordable
away from work
restriction
cases
0
17
15
20
(G)
(H)
(1)
(J)
Number of Days
Total number of Total number of days of
days away from job transfer or restriction
work
548 519
(K) (L)
Injury and Illness Types
Total number of
(M)
(1) Injury 51 (4) Poisoning 0
(2) Skin Disorder 0 (5) Hearing Loss 0
(3) Respiratory
Condition 0 (6) All Other Illnesses t
Post this Summary page from February 1 to April 30 of the year following the year covered by the form
Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instruction, search and
gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it
displays a currently valid OM3 control number. If you have any comments about these estimates or any aspects of this data collection, contact: US Department
of I ahnr nSHA nffire of Statistics Arom N-1644 9nn Cnn.Ohitinn A-- NW W-hinntnn M. 9mtn nn nnl send the completed forms In Inn nmire
Year 2014
40
U.S. Department of Labor
occupational Safety and Health Admintelration
Form approved OMB no 1218-0176
Establishment information
Your establishment name Citv of San Luis Obispo
Street 990 Palm Street
City San Luis Obispo State CA Zip 93401
Industry description
Municipal Government
Standard Industrial Classification (SIC), if known (e.g., SIC 3715)
OR North American Industrial Classification (NAICS), if known (e.g., 336212)
Employment information
Annual average number of employees 676
Total hours worked by all employees last
year 684,419.61
`-tet
Sign here r
Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and
complete
Monica Irons HR Director
Company executive Title
805-781-7250 1/29/2014
Phone Date
OSHA's Form 300A (Rev. 01/2004)
Summary of Work -Related Injuries and Illnesses
All establishments covered by Part 1904 must complete this Summary page, even if no injuries or
illnesses occurred during the year. Remember to review the Log to verify that the entries are complete
Using the Log, count the individual entries you made for each category. Then write the totals below,
making sure you've added the entries from every page of the log. If you had no cases write V."
Employees former employees, and their representatives have the right to review the OSHA Form 300 in
its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR
1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms.
Number of Cases
Total number of Total number of Total number of cases Total number of
deaths cases with days with job transfer or other recordable
away from work restriction cases
0 23 10 27
(G) (H) (1) (J)
!Number of Days
Total number of Total number of days of
days away from job transfer or restriction
wnrk
807 447
(K) (L)
Injury and Illness Types -
Total number of...
(M)
(1) Injury
(2) Skin Disorder
(3) Respiratory
Condition
48 (4) Poisoning
7 (5) Hearing Loss
0
2
1 (6) All Other Illnesses 2
Post this Summary page from February 1 to April 30 of the year following the year covered by the form
Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instruction, search and
gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it
displays a currently valid OMB control number. If you have any comments about these estimates or any aspects of this data collection, contact: US Department
of Labor, OSHA Office of Statistics, Room N-3644, 200 Constitution Ave, NW, Washinqton, DC 20210. Do not send the completed forms to this office.
IEstablishment information
Your establishment name Citv of San Luis
Street 990 Palm Street
City San Luis
State
Industry description (e.g., Manufacture of motortruck trailers)
Municioal Government
Standard Industrial Classification (SIC), if known (e.g., SIC 3715)
OR North American Industrial Classification (NAICS), if known (e.g., 336212)
Employment information
Annual average number of employees 655
Total hours worked by all employees last
year 834,086
Sign here,a. U_0
rrr
Knowingly falsifying this document may result in a fine.
CA
Year 2015
4>>
U.S. Department of Labor
Occupational Safety and Health Administration
Form approved OMB no 1218-0176
Zip 93401
I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and
complete.
Monica Irons
Company executive
805-781-7250
Phone
HR Director
Title
1 A
Dat
OSHA's Form 300A (Rev. 0112004)
Summary of Work -Related Injuries and Illnesses
All establishments covered by Part 1904 must complete this Summary page, even if no injuries or
illnesses occurred during the year. Remember to review the Log to verify that the entries are complete
Using the Log, count the individual entries you made for each category. Then write the totals below,
making sure you've added the entries from every page of the log. If you had no cases write "0. "
Employees former employees, and their representatives have the right to review the OSHA Form 300 in
its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR
1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms.
Number of Cases
Total number of Total number of Total number of cases
deaths cases with days with job transfer or
away from work restriction
0 19 9
(G) (H) (1)
Number of Days
Total number of Total number of days of
days away from job transfer or restriction
xninrk
825 891
(K) (L)
Injury and Illness Types
Total number of...
(M)
(1) Injury
(2) Skin Disorder
(3) Respiratory
Condition
37 (4) Poisoning
3 (5) Hearing Loss
Total number of
other recordable
cases
21
(J)
0
0
1 (6) All Other Illnesses 8
Post this Summary page from February 1 to April 30 of the year following the year covered by the form
Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instruction, search and
gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it
displays a currently valid OMB control number. If you have any comments about these estimates or any aspects of this data collection, contact: US Department
of Labor, OSHA Office of Statistics, Room N-3644, 200 Constitution Ave, NW, Washinqton, DC 20210. Do not send the completed forms to this office.
Establishment information
Your establishment name City of San Luis Obispo
Street 990 Palm Street
City San Luis Obispo State
Industry description (e.g., Manufacture of motor truck trailers)
Municipal Government
Standard Industrial Classification (SIC), if known (e.g., SIC 3715)
OR North American Industrial Classification (NAICS), if known (e.g., 336212)
Employment information
Annual average number of employees 569
Total hours worked by all employees last
year 1,077,306
Sign here
crQ,VW�
Knowingly falsifying this document may result in a fine.
CA
Year 2016
ep
U.S. Department of Labor
Occupational Safety and Health Administration
Form approved OMB no 1218-0176
Zip 93401
I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and
complete.
Monica Irons
Company executive
805-781-7250
Phone
HR Director
Title
1/30/2017
Date
OSHA's Form 300A (Rev. 01/2004)
Summary of Work -Related Injuries and Illnesses
All establishments covered by Part 1904 must complete this Summary page, even if no injuries or
illnesses occurred during the year. Remember to review the Log to verify that the entries are complete
Using the Log, count the individual entries you made for each category. Then write the totals below,
making sure you've added the entries from every page of the log. If you had no cases write "0."
Employees former employees, and their representatives have the right to review the OSHA Form 300 in
its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR
1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms.
ftmber of Cases
Total number of Total number of Total number of cases Total number of
deaths cases with days with job transfer or other recordable
away from work restriction cases
0 15 8 25
(G) (H) (I) (J)
Number of Days
Total number of Total number of days of
days away from job transfer or restriction
wnrk
417 598
(K) (L)
Injury and Illness Types
Total number of...
(M)
(1) Injury
(2) Skin Disorder
(3) Respiratory
Condition
35 (4) Poisoning
5 (5) Hearing Loss
0 (6) All Other Illnesses
0
1
6
Post this Summary page from February 1 to April 30 of the year following the year covered by the form
Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instruction, search and
gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it
displays a currently valid OMB control number. If you have any comments about these estimates or any aspects of this data collection, contact: US Department
of Labor, OSHA Office of Statistics, Room N-3644, 200 Constitution Ave, NW, Washington, DC 20210. Do not send the completed forms to this office.
Year 2017 402
U.S. Department of Labor
Occupational Safety and Health Administration
Form approved OMB no. 1218-0176
Establishment information
Your establishment name City of San Luis Obispo
Street 990 Palm Street
City San Luis Obispo _ State CA Zip ` 93401
Industry description (e.g., Manufacture of motor truck trailers)
Municipal Government
Standard Industrial Classification (SIC), if known (e.g., SIC 3715)
OR North American Industrial Classification (NAICS), if known (e.g., 336212)
Employment information
Annual average number of employees 588
Total hours worked by all employees last
year 1,102,569
Sign here
Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and
complete,
Monica Irons ` HR Director
Company executive Title
805-781-7250 1/30/2018
Phone Date
OSHAas Form 300A (Rev. 01/2004)
Summary of Work -Related Injuries and Illnesses
All establishments covered by Part 1904 must complete this Summary page, even if no injuries or
Illnesses occurred dudng the year. Remember to review the Log to verify that the entries are complete
Using the Log, count the Individual entries you made for each category. Then write the totals below,
making sure you've added the entries from every page or the log. If you had no cases write "0."
Employees former employees, and their representatives have the right to review the OSHA Form 300 in
its entirety. They also have limited access to the OSHA Form 301 or Its equivalent. See 29 CFR
1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms
Rumba of Cases
Total number of
Total number of
Total number of cases
Total number of
deaths
cases with days
with job transfer or
other recordable
awav from work
restriction
cases
0
20
10
33
(0)
(H)
(1)
W)
Number of Days
Total number of
days away from
734
(K)
Injury and Illness Typos
Total number of days of
job transfer or restriction
453
(L)
Total number of,
(M)
(1) Injury 50 (4) Poisoning
(2) Skin Disorder 5 (5) Hearing Loss
(3) Respiratory
Condition 0 (6) All Other Illnesses
0
1
Post this Summary page from February 1 to April 30 of the year following the year covered by the form
Public reporting burden for this collection of information Is estimated to average 5B minutes per response, Including Ilme to review the instruction, search and
gather the data needed, and complele and review the collection of inlorrnalion Persons am not required to respond to be collection of Information unless It
displays a currently valid OMB control number. Il you have any comments about these estimates orany aspects of [his data collection, contact: US
Department of Labor, OSHA Office of Statistics, Room N3644, 200 Constitution Ave, NW, Washington, DC 20210 Do not send the completed loans to this
Year 2018
U.S. Department of Labor
Oetuprb_A gwrwy a 14"bh I,CmWYrallen
Fnm approved OMB no 1219-0176
Information
Your establishment name Citty Of San Luis Obispo
Sireel 990 palm Sirm
City San Luis Obispo State California Zip 93401-3249
Industry description (e g., Manufacture of motortruck trailers)
Municipal Government
Standard Industrial Classification (SIC), If known (eg., SIC 3715)
OR North American Industrial Classification (NAICS), if known (eg., 336212)
Employment information
Annual average number of employees 572
Total hours worked by all employees last
year 905,334
Sign here
Knows agly falsifying Ilia docu men[ may rssull In a (In a.
I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and
complete, �er.r'�
Monica Irons * -� •
r • `� ��yA■ ���tj� y/j
HR Director
company axocutivo
Title
005-781-7250
Phone
11912019
Date