OSHA's Form 300A (rev. 01/2004) Year 2018 <>
Summary of Work-Related Injuries and Illnesses 5. enatenent st babes
Occupstional Safery and Heaitn Administration
Form approved OMA no, 1218-0176
All establishments covered by Pan 1304 must complete this Summary page, even if no injuwtes or
liinesses occurred dung Ihe year. Remember to review the Log to vevify that the anines are complete
Using the Log, coun! the individual entries you made foreach category. Then write the totais below, Establishment information
making sure you've added the entries fromevery page of the log, Ifyou had mo cases write "0."
Employees former employees, end their representatives have fhe ight to review the OSHA Fort 300 in Your establishment name Schroeder Construction Management. linc.
#s entirety, They also have limited access fo Ihe OSAA Form 307 or its equivalent. See 29 CFR
1804.35, 1 OSHA's Recordkeeping rule, for further details on.the access provisions for these fons. Street 2 Townsend West#3
Number of Cases. City Nashua State __New Hampshire Zip 03063
Industry deserption (e.g_, Manufacture of motor truck trailers)
Total number of Totalnumberof Total number of cases Total number of
deaths cases with days with job transfer or other recordable
away from work = restriction cases Standard Industrial Classification (SIC), if known (e.g, SIC 3775)
i") 0 0 (*] a, OF
(G) (H) (lh) (J) OR North American Industrial Classification (NAICS), if known (2.g., 336212)
—2 8 8.
Number of Days Employment information
Total number of Total number of days of
days away fram job transfer or resinction Annual average number of employees 12
rk
= Total hours worked by aa employees last
0 ft] year 22,560
(K) (Ly
j 2 i!
Injury and Iliness Types ; _ _——_ Sign here Hg HK
, ,
Total number of... Knowingly falsifying this document may rest in a Fine, ‘
(M) ra
(1). Injury _ os (4) Poisoning 0 -
in Disorder ing Loss fi]
2) Skin Gh e —— 1 ___ (8), Heanng ee | certify that | have examined this document and that to the best of my knowledge the entries are true, accurate, and
(3) Respiratory complete
Condition "] (6) Al Other Ilinesses o
John E. Schroeder President
Company executive Title
603-882-1822. ers et)
Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date:
Public reporing burden for this cofection of information is estimaled lo avetage 58 minutes per tesponse, including fime to review ihe instruction, search and
gather the data needed, snd complete and reviews the collection of mformation. Persons are not required fo respond! to the cofecton of information unless t
displays a current valid OME coninel number. Il'you have any comments about these esimales or any aspects af itis data collection, contact US Department
atLabor, OSHA Ofiies of Statistics, Room M3644, 200 Constitution Ave, Will, Washington, DC-20270, Da nal send Gye competed. forms to this office,
