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Cal/OSHA Forms <br /> Injury and Illness Incident Report <br /> This Injury and Illness Incident Report(Form 301) is one of the first forms you must fill out when a recordable <br /> work related injury 929 CFR 1904.7(b)(1) - death, days away from work, restricted work or transfer to another <br /> job, medical treatment beyond first aid, loss of conscious, injury or illness diagnosed by a physician or other <br /> licensed health professional0 has occurred. Together with accompanying Annual Summary(Form 300 and 300A) <br /> these forms help the employer and Cal/OSHA develop a picture of the extent and severity of work-related <br /> incidents. <br /> Within 7 calendar days after you receive information that a recordable work-related injury or illness has occurred, <br /> you must fill out this form or an equivalent. Some state workers' compensation, insurance, or other reports may <br /> be acceptable substitutes. To be considered an equivalent form, any substitute must contain all the instructions <br /> and information asked for on this form. <br /> According to CCR Title 8 Section 14300.33 Cal/OSHA's recordkeeping rule, you must keep this form on file for 5 <br /> years following the year to which it pertains. <br /> Attention: This form contains information relating to employee health and must be used in a manner that <br /> protects the confidentiality of employees to the extent possible while the information is being used for <br /> occupational safety and health purposes. See CCR Title 8 14300.29(b)(6) to (10). <br /> L <br /> 9; <br /> OIL <br /> 1_1^rl JV <br /> AEI Health&Safety,Injury&Illness Prevention Plan Page 16 of 25 <br /> June 24, 2011 <br />