Cal/OSHA Form 300
Client Admin ▸ Safety ▸ Fresno Distribution Center ▸ 2026
Cal/OSHA Form 300
Log of Work-Related Injuries and Illnesses — California (Title 8)
Kept under 8 CCR § 14300 (California Code of Regulations, Title 8) · Cal/OSHA
Establishment: Fresno Distribution Center
Fresno, CA
Company: Acme Manufacturing
Year: 2026
Attention: 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.
Log entries — 2 recordable cases on this log
| Case no. (A) | Employee's name (B) | Job title (C) | Date of injury or onset of illness (D) | Where the event occurred (E) | Describe injury or illness (F) | G | H | I | J | Days away (K) | Days restr. (L) | M1 | M2 | M3 | M4 | M5 | M6 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Dana Ruiz | Forklift operator | 2026-03-14 | Loading dock, Bay 3 | Strained lower back lifting a 60 lb carton from floor level | ✓ | · | · | · | 0 | 0 | ✓ | · | · | · | · | · |
| 3 | Privacy casename withheld | Line lead | 2026-06-20 | — | Injury to an intimate body part | · | · | · | ✓ | 0 | 0 | ✓ | · | · | · | · | · |
| Totals | 1 | 0 | 0 | 1 | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | |||||
Columns. A Case number · B Employee's name · C Job title · D Date of injury or onset of illness · E Where the event occurred · F Describe injury or illness · G Death · H Days away from work · I Remained at work — job transfer or restriction · J Remained at work — other recordable cases · K Days away from work · L Days on job transfer or restriction · M1 Injury · M2 Skin disorder · M3 Respiratory condition · M4 Poisoning · M5 Hearing loss · M6 All other illnesses.
Totals feed the annual Cal/OSHA Form 300A summary.
Totals feed the annual Cal/OSHA Form 300A summary.
1 privacy case on this log. The employee's name is withheld and shown as “Privacy case”, as required for certain case types. The names are held on a separate confidential list, visible only to staff granted privacy-list access. Open the confidential list ▸
Voided and non-recordable cases are retained on the case list and do not appear here · the certified 300A summary comes next