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Instructions

This assignment is in three parts. All three parts must be completed.

PART 1

Your boss has asked you to review the accident information for the CSU Widget Factory. The information he sent you is provided here.

Using the provided CSU Widget Factory OSHA 300A log, calculate the total recordable incidence rate (TRIR), the days away, restricted, or transferred (DART) rate, the lost workday injury and illness rate (LWDII), and the severity rate (SR). Be sure to show your calculations in a Word document.

PART 2

Using the CSU Widget Factory OSHA 300A log (from Part I), distinguish some of the leading indicators that you would use if examining the CSU Widget Factory Safety Management System. Prepare a summary of your findings, including any suggestions for improvement.

PART 3 

Your boss wants more information on one of the accidents listed on the CSU Widget Factory OSHA 300 log. He has sent you the OSHA Form 301, Injury and Illness Incident Report, for the accident involving William Smith (available here). Mr. Smith’s supervisor filled out the form, but it only includes basic information. To prepare to conduct a more thorough investigation, do the following:

  • Develop a list of five questions to ask Mr. Smith’s supervisor about the circumstances surrounding the incident. Explain the importance of each question you create.
  • Select two theories of accident causation, and explain how you would use them to help in the accident investigation.

Your submission must be a minimum of two pages, not including title and reference pages, and follow APA guidelines. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations.   

CSU Widget Factory OSHA 300A log (from Part I) and OSHA Form 301, Injury and Illness Incident Report are uploaded to this assignment

ALOrange Beach

15

month / day /

daysdays Reset 1 Jane Doe Widget Welder 1 18 Welding Area Burned Retinas – both eyes ● 2 ●

month / day /

daysdays Reset 2 William Smith Warehouse Worker 2 24 Storeroom Lumbar Strain ● 4 ●

month / day /

daysdays Reset 3 Nellie Kershaw Production Line Worker 5 18 Main Production Floor Respiratory Condition ● 2 14 ●

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U.S. Department of Labor Occupat ional Safety and Health Administrat ion

OSHA’s Form 300 (Rev. 01/2004) Year 20Log of Work-Related

Injuries and I llnesses You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR Part 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you’re not sure whether a case is recordable, call your local OSHA office for help.

Page

In ju

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Sk in

d is

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R es

pi ra

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co

nd iti

on

Page totals

Establishment name

City

Enter the number of days the injured or ill w orker w as:

Select the “Injury” column or choose one type of illness:

Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time to review the instructions, 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 other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.

(A) (B) (C) (D) (E) (F)

(M)

(K) (L)(G) (H) (I) (J) Death

Days aw ay from w ork

On job transfer or restrict ion

Aw ay from w ork

Attent ion: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes.

SELECT ONLY ONE box for each case based on the most serious outcome for that case:

Job transfer or restrict ion

Other record- able cases

Remained at Work

(1) (2) (3) (4) (5) (6)

(1) (2) (3) (4) (5) (6)

Case no.

Job title (e.g., Welder)

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 acetylene torch)

Date of injury or onset of illness (e.g., 2/10)

Ident ify the person Describe the case Classify the case

Employee’s name

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H ea

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A ll

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Form approved OMB no. 1218-0176

State

CSU Widget Factory

of

Note: You can type input into this form and save it . Because the forms in this recordkeeping package are “fillable/writable” PDF documents, you can type into the input form fields and then save your inputs using the free Adobe PDF Reader. In addition, the forms are programmed to auto-calculate as appropriate.

0 3 0 0 8 14 2 0 1 0 0 0

1 1Save Input Add a Form Page

OSHA’s Form 300A (Rev. 01/2004) Summary of Work-Related Injuries and I llnesses

Form approved OMB no. 1218-0176

Total number of deaths

Total number of cases with days away from work

Number of Cases

Total number of days away from work

Total number of days of job transfer or restriction

Number of Days

Post this Summary page from February 1 to April 30 of the year follow ing the year covered by the form.

All establishments covered by Part 1904 must complete this Summary page, 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 OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR Part 1904.35, in OSHA’s recordkeeping rule, for further details on the access provisions for these forms.

Establishment information Your establishment name

Street

City

Industry description (e.g., Manufacture of motor truck trailers)

Standard Industrial Classification (SIC), if known (e.g., 3715)

Public reporting burden for this collection of information is estimated to average 50 minutes per response, including time to review the instructions, 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 other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.

Total number of . . .

Skin disorders

Respiratory conditions

Injuries

Injury and I llness Types

Poisonings

Hearing loss

All other illnesses

(G) (H) (I) (J)

(K) (L)

(M)

(1)

(2)

(3)

(4)

(5)

(6)

Total number of cases with job transfer or restriction

Total number of other recordable cases

U.S. Department of Labor Occupat ional Safety and Health Administrat ion

Year 20

OR

North American Industrial Classification (NAICS), if known (e.g., 336212)

Employment information (If you don’t have these figures, see the Worksheet on the next page 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 knowledge the entries are true, accurate, and complete.

________________________________ ___________________ Company executive Title

Phone ______ – _______ – ___________ Date _____ / _____ / ______

0

Note: You can type input into this form and save it . Because the forms in this recordkeeping package are “fillable/writable” PDF documents, you can type into the input form fields and then save your inputs using the free Adobe PDF Reader.

State Zip

0

8

0

0

Save Input

0 3 0 0

14

2

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CSU Widget Factory

21982 University Lane Orange Beach AL 36561

Widget Manufacturing

326199

27 58675