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OSHArs Form 300A (Rev.0412004) <br />Summary of Work -Related Injuries and Illnesses <br />Year 20 23 <br />Note: You can type input into this form and save it. <br />Because the forms in this recordkeeping package are "fillable/writable" <br />PDF documents, you can type into the input form fields and <br />— <br />U.S. Department of Labor <br />then save your inputs using the free Adobe PDF Reader. <br />ate paGenal Safety and Hcatth Admintstratten <br />Fotm approved OMB no. 1218-0176 <br />All establishments covered by Part 1904 must complete this Summary page, even if no work -related injuries oril/nesses occurred during the year. <br />Remember to review the Log to verify that the entries are complete and accurate before completing this summary. <br />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 <br />every page of the Log Ifyou had no cases, write "0.' <br />Employees, former employees, and th eir representatives have the right to review the OSHA Form 300 in its enfirety. They also have limited access <br />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 <br />these forms. <br />Total number of <br />Total number of <br />Total number of cases <br />Total number of <br />deaths <br />cases with days <br />with job transfer or <br />other recordable <br />away from work <br />restriction <br />cases <br />0 <br />1 <br />0 <br />5 <br />(G) <br />(H) <br />(1) <br />(J) <br />Number of Days <br />Total number of days <br />Total number of days of <br />away from work <br />job transfer or restriction <br />5 <br />49 <br />(K) <br />{L} <br />Injury and Illness Types <br />Total number of.. . <br />(M) <br />(1) Injuries <br />6 <br />(4).Poisonings <br />0 <br />(2) Skin disorders <br />0 <br />(5) Hearing loss <br />0 <br />(3) Respiratory conditions 0 <br />(6) All other illnesses <br />0 <br />Post this Summary page from February Ito April 30 of the year following the year covered by the form. <br />Public reporting burden for this collection of information is estimated to average 58 minutes perrespome, including time to mview the instructions, search and gather the data needed, and <br />complete and review the collection of information. Petsons tie nat inquired to respond to the collection of information unless it displays a currently valid OMB control number_ Iryou have any <br />comments about these estimates or any other aspects of this data coflection, contact US Deportment of Labor, OSHA Office of Statistical Analysis, Room N-3644. 200 Constitution Avenue, NW, <br />Washington, DC 20210- Do not send the completed forms to this office. <br />Establishment information <br />Your establishment name Elk River Municipal Utilities <br />street 13069 Orono Parkway <br />CityElk River state MN Zip 55330 <br />Industry description (e_g., Manufacture ofmotor truck trailers) <br />Municipal Utility - Electric and Water <br />North American Industrial Classification (NAICS), if known (e.g., 336212) <br />221122 <br />Employment information (Ifyou don't have these figures, see the <br />Warksheet on the next page to estimate.) <br />Annual average number of employees 46 <br />Total hours worked by all employees last year 84,026.00 <br />Sign here <br />Knowingly falsifying this document may result in a fine. <br />I certify that I have examined this document and that to the best of <br />MY Ivledge e ntrie,34e true, accurate, and complete <br />Company executive Title <br />Phone763-441-2020 Date February 6, 2024 <br />Reset <br />a <br />