Forms

OSHA-1 

• Largely correlates to the "Inspection" tab in OSHA Express. 
• Needs to be completed for every inspection, even for those where the company could not be found (e.g., temporary construction site). 
• When printing out hard copy, write State CSHO ID and EIN. 

Submittal

Refer to the Routing page.

OSHA Express

• Assignment Nr. is located on the OSHA-168 Assignment form.  The OSHA-168 is also now integrated into OX. 
• Ownership Private or Public 
• Legal Entity Corporation, Sole Owner, Partnership, Subsidiary 
• Previous Activity Has there been previous Health inspections with this company by KYOSH—not just at this site. 
• Related Activity 
  • Type C[omplaint], R[eferral], F[ollow-up] 
  • Number The complaint no., referral no., etc. 
  • Satisfied Health or Safety 
• Inspection Type 
  • Complaint, Referral, Follow-up, etc. 
• Scope of Inspection 
  • Partial, Complete 
• Entry – Case Closed Dates of each 
• Days On Site – How many days on-site as of OSHA-1 submission 
• Substance information – If there are any substances mentioned on the OSHA-168:  
  • Type – refers to the IMIS classification (?)—N, typically 
  • ID – refers to IMIS classification # 
  • Optional Information 
    • Includes name of material in question (Lead, Chrome(VI), etc.) 
    • N-11-LOG... information does NOT go on the OSHA-1. 
• Controlling Corp, Employer ID, Warrant info – Leave blank. 
• Classification, Strategic Initiatives, National Emphasis, Local Emphasis – Leave blank unless specified or needed. 
• Extra Information 
  • If a follow-up to a settlement agreement, put N 20 SETTLEMENT in optional information. 

Additional Information

Diane's email on 1/27/14

When you open an inspection, a labeled blue file is created and put in a file cabinet up front.  This is done for a number of reasons (we put extra paperwork, like warrants, etc.) in there, waiting there expectantly for the day the file is turned in for review.  Then when the file is turned in, Jenifer pulls the blue file and fills it with all the hard work you’ve done, and ships it on to me or Clayton.  The key to this whole choreographed dance is turning in the OSH-1.    Lately, when Jenifer has gone to the file cabinet to pull the blue file, there is no blue file.  So, please, please, please---when you first create your OSH-1 in OSHA Express, route a copy to Jenifer so she can make the file.  She has no way of knowing you opened an inspection (hence, make the blue folder) unless she see an OSH-1.

Now, for the encore.....if you get one of those inspections with a name that is too long to fit in the 45-character-limited name field, please print out a copy of your OSH-1 and fill in the rest of the name on the “Establishment Name” line, and give her a paper copy so her file label is right (and we can find the darn thing when we have to go looking for it later in legal or imaging).

Now for the instruction portion of our presentation.....   To print a paper copy of the OSH-1:

1. Complete all the information on the OSH-1 in OSHA Express. 
2. SAVE the information (the form will look blank when you pull it up until you save the information). 
3. CLICK on the SHEET OF PAPER icon on the menu bar (It’s the 11th one from the left, right before the one that looks like a hand writing on the back of an envelope).  You should now see an OSH-1 form. 
4. CLICK on TOOLS at the top of the screen (3rd word from the left at the top of the screen). 
5. CLICK on PRINT from the drop-down menu.  (It’s the last choice in my drop-down menu.) 
6. WRITE IN all the EXTRA LETTERS of the ESTABLISHMENT NAME. 
7. TAKE or MAIL this form to Jenifer.  Make a copy for yourself if you want.

That concludes this email, and in the words of the Gallo brothers, “Thanks for your support”.

OSHA-1-MOD

Download

• Complete everything from 1 through 4 and 8.  Only complete that which is to be changed for numbers greater than 8.
• Complete the MOD Date field as the date of MOD/submission.  
• Circle number for any section that’s changed. 
• If a National Emphasis Program code is left off, for example, it should be submitted on an OSHA-1-MOD and not left for the OSHA-167 I.  Everything but the total days on-site, citations recommended, and activities satisfied needs to be updated/corrected through an OSHA-1-MOD. 
• Make sure to sign and date at the bottom. 
• Submission
  • Timestamp and give to Jenifer H. or Renee.  She’ll return it to you after she’s corrected the data. 
  • Place it in the case file after it's returned to you. 

OSHA-7: Employee Complaint Form

IMPORTANT: When report is finished and ready to be submitted, the OSHA-7 has a Comments section that must be completed.  It includes the following: 

• Dates contact was made with complainant. 
• Brief summary of what was done across each span of dates. 
  • Typically, when you discussed the case and/or walkaround.  When you discussed the closing/citations.  Etc. 

OSHA-31

• Friday date = Friday of week in question 
• Optional Information is NOT required. 
• During training, 37.5 hours of Field Training under Enforcement Inspection. 
• Subtract hours for comp leave, sick leave, annual leave, etc. 

• Conferences are considered Formal Training.

• OTI, of course, is Formal Training. 

OSHA-36: Fatality/Catastrophe Report

This form is linked to the OSHA-170 "Investigation Summary" form.  The OSHA-170 always designates an event, which is designated on the OSHA-36.

OSHA Express

• OX has this form listed as the Accident/Event form. 
• The OSHA-170 form is integrated as the Investigation tab. 

OSHA-90: Referral Report When a referral is made between Safety and Health Branches or when a referral is made by this office to an outside agency, this form is used.

OSHA-91(S) Download here  Refer to IMIS Chapter 23 for specifics of entry procedure.  When more than 4 analytes, perform the following steps:  White out Line #’s

OSHA-93 Direct Reading Report Download here.  This form is for recording data from shift sampling where direct reading instruments are used.  Essentially, if you're not doing air sampling to a media (such as MCEF, PVC, charcoal tube, etc.) that must be sent for sampling, you're using an "instant read"-type instrument.  It performs its own analysis.  The lines under "Direct Reading Data" are for marking measurements throughout the sampling where you observe the sampled employee at a certain location, including remarks related to what they were doing at the time, what PPE they were wearing, what other processes were occurring around them, etc.  Direct Reading Report vs. Screening Report  The main difference here can be attributed to the goal of the sampling.  Screening is not going to result in a citation.  However, its results are important since they may indicate a need for full-shift sampling.

OSHA-98 Screening Report Download here.  Direct Reading Report vs. Screening Report  The main difference here can be attributed to the goal of the sampling.  Screening is not going to result in a citation.  However, its results are important since they may indicate a need for full-shift sampling.  Full-shift sampling using a direct read instrument may lead to citations.

OSHA-167-I This form is used to update the information submitted on the OSHA-1 when the inspection is done.  It does not need submitted separately as the OSHA-1 is.  Original stays in report.  Citation No(s) → List the citation numbers from the report.  Example: Citation 1 Item 1, Citation 2 Item 1, etc. Then write 1, 2, etc.  Failure to Abate’s are listed as “FTA” first.  CSHO completes 2 – 7, 10, 11, 13, 14   Diane: 8 and 9 are also required. (4/14/14)

OSHA 300 Logs Titled “Log of Work-Related Injuries and Illnesses”  Recordkeeping Notes  Do not count the day of the injury in total days.  If a case involves both DA and RT, check only the DA box (H) but divide up the day numbers in (K) and (L).  Physician or other Licensed Health Care Professional (PLHCP) recommends days off whether EE takes it or not counts in to Days Away from Work.   PLHCP recommends EE goes back to work, stop counting days.

OSHA 300-A Titled “Summary of Work-Related Injuries and Illnesses”  If using a form other than the OSHA 300-A, you must include the employee access and employer penalty statements found on the OSHA 300-A Summary form.  Post the summary no later than February 1 of the year following the year covered by the records and keep the posting in place until April 30.

OSHA 300-I This hardcopy form is no longer submitted.  The information formerly included here is included digitally in OSHA Express.  Even if there are non-recordables in their 300 logs, include these for 300 I calculations.

OSHA 301 Titled “Injury and Illness Incident Report”