OSHA's Form 300A irev. 01/2004) Year 2019 <>
Summary of Work-Related Injuries and Illnesses US. Department of Labor
Occupational Satety and Health Administration
Form approved OMB no. 1218-0176
All establishments covered by Part 1904 must complete this Summary page, even if no injuries or
illnesses occurred during the year. Remember to review the Log to verify that the entries are complete
Using the Log, count the individual entries you made for each category. Then write the totals below, Establishment information
making sure you've added the entries from every page of the fog. If you had no cases write "0."
Emp. former employees, and their repr it have the right to review the OSHA Form 300 in Your establishment name Schroeder Construction Management, Inc.
its entirety. They also have limited access to the OSHA Form 301 or ifs equivalent. See 29 CFR
1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms. Street 2 Townsend West #3
City Nashua State New Hampshire Zip 03063
Industry description (e.g., Manufacture of motor truck trailers)
Total number of Total number of — Total number of cases Total number of
deaths cases with days with job transfer or other recordable
away from work restriction cases Industrial Classification (SIC), if known (e.g., SIC 3715)
0 0 0 wt 7 5 1
{G) (H) (I) (J) OR North American Industrial Classification (NAICS), if known (e.g., 336212)
2 3 6 2 2 0
Employment information
Total number of Total number of days of
days away from Job transfer or restriction Annual average number of employees 11
te
wor Total hours worked by all employees last
0 e] year 22,287
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me aoe : é : ae Sign here A i ML
Total number of... Knowingly ifying this may result ina fine.
(M)
(1) Injury 0 (4) Poisoning 0 F
(2) Skin Disorder 0 (5) Hearing Loss 0 | . . .
. ——_a eo | certify that | have examined this document and that to the best af my knawledge the entries are true, accurate, and
(3) Respiratory complete.
Condition 0 (8) All Other Illnesses 0
John E. Schroeder President
Company executive Title
603-882-1822 162020
Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date
Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instruction, search and
gather the data needed, and complete and review the collection of information. Persons are not required to respond to the calfection of information unless it
displays a currently valid OMB control number. If you have any comments about these astimates or any aspects of this data collection, contact’ US Department
of Labor. OSHA Office of Slatistics. Room N-3644, 200 Constitution Ave. NW. Washinaton. OC 20210. Do not send the completed forms to this affice.
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