VOSHA Injuries/Illnesses Report

Mandatory Reporting of Injuries/ Illnesses to VOSHA Online Form
Basic Requirements -1904.39(a):

Within eight (8) hours after the death of any employee as a result of a work-related incident, you must report the fatality to the Occupational Safety and Health Administration (OSHA), U.S. Department of Labor or the Vermont Occupational Safety and Health Administration (VOSHA).
Within twenty-four (24) hours after the in-patient hospitalization of hon or more employees or an employee’s amputation or an employee’s loss of an eye, as a result of a work-related incident, you must report the in-patient hospitalization, amputation, or loss of an eye to OSHA or VOSHA.
You must report the fatality, in-patient hospitalization, amputation, or loss of an eye using one of the following methods:

By telephone or in person to the OSHA Area Office that is nearest to the site of the incident.
By Telephone to the OSHA toll-free central telephone number, 1-800-321-OSHA (1-800-321-6742).
By electronic submission using the form below.)

Establishment Name*
Location of the work related incident*
Date of the work related incident*
Time of the work related incident*
: HH
MM
Type of Event (fatality, inpatient hospitalization or 1 or more employees, amputation, loss of an eye*
Number of injured employee(s)*
Names and job titles of injured empoyee(s)*
Employer's Contact Person and Phone number(s)*
Brief description of the work related incident*
Report submitted by:
Name*
FirstLast
Email*
Phone*
Address*
Street AddressAddress Line 2CityStateZIP Code

Report submitted by: