Section 350.240  Injury and Illness Incident Report – OSHA 301

a)         In addition to the OSHA 300 log of injuries and illnesses, each employer shall maintain in each workplace a supplementary record of each recordable occupational injury and illness for that workplace.  The employer shall complete the incident report and make it available as early as practicable, but no later than seven calendar days after receiving information that a recordable injury or illness has occurred.  The OSHA 301, or the Illinois Workers' Compensation Commission Form 45 or a suitable substitute that contains the same information may be used as the supplementary record.  Records shall be available to any agency requesting them pursuant to Section 4(b) of the Health and Safety Act.

b)         The OSHA 301 injury and illness incident report shall contain the following information for each recordable injury and illness:

1)         Information about the employee:

            A)        Full name and address.

            B)        Date of birth and date of hire.

            C)        Gender.

2)         Information about the physician or other health care professional:

            A)        Name of physician or health care professional.

            B)        Location where treatment was administered.

C)        If an emergency room was visited or if the employee was hospitalized overnight as an in-patient.

3)         Information about the case:

            A)        Case number corresponding to the Log of Injuries/Illnesses.

            B)        Date of Injury or Illness.

            C)        Time employee began work and time of event, if known.

            D)        What the employee was doing just before the incident occurred.

            E)         What happened.

            F)         What was the injury or the illness.

            G)        What object or substance directly harmed the employee.

            H)        If the employee died, date of death.

c)         The name and title of the individual who completed the form, along with the telephone number and the date of completion.

d)         This form must be kept on file for five years following the year to which it pertains.  The Incident Report Form has to be completed within 7 days after notice of the injury or illness.  These forms shall be maintained for at least 5 years.