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Survey Respondents
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Download Forms

SOII forms are available for download as PDF files. You will need Adobe Acrobat Reader to view the form. Adobe Acrobat Reader is a free software program that allows you to view Portable Document Files (PDF). You may download it at no cost from Adobe's Web site.

Form Form Name Description
Notification to Participate Notification of Requirement to Participate in the Survey of Occupational Injuries and Illnesses - Calendar Year 2022 This form is sent to establishments selected to participate in the 2022 SOII. This notification instructs survey participants to maintain the required information for all recordable work-related injuries and illnesses that occur during calendar year 2022 for the location identified on the front under the heading "Maintain Records for:" Establishments will receive the survey form to report their 2022 information in early 2023.
OSHA Forms (subset) OSHA's Form 300, "Log of Work-Related Injuries and Illnesses"

OSHA's Form 300A, "Summary of Work-Related Injuries and Illnesses"

OSHA's Form 301, "Injury and Illness Incident Report"		 This is a subset of the full OSHA Recordkeeping forms package. It includes the OSHA Form 300, OSHA Form 300A, and the OSHA Form 301. To obtain a complete set of OSHA Recordkeeping forms, you can download them from OSHA's website: http://www.osha.gov/recordkeeping/RKforms.html
Instructions for Electronic Survey Instructions for the Survey of Occupational Injuries and Illnesses, 2021 (Form BLS-9300-IDCF) These instructions explain how to submit your data electronically. This set of instructions is sent to all sampled establishments who are in the 2021 SOII sample.
Downloadable Survey Form Survey of Occupational Injuries and Illnesses, 2021 (Form BLS-9300 N06) This is the standard 8-page survey form for reporting your work-related injuries and illnesses to the Bureau of Labor Statistics. This form can be printed, completed by hand, and mailed to BLS.
Spanish Survey Form Encuesta Sobre Lesiones y Enfermedades Occupacionales, 2021 (Form BLS-9300 N06) This is the standard 12-page survey form in Spanish that our sampled establishments in Puerto Rico use.
FAX Form FAX Response Form 2021 (Form BLS-9300 FAX) If there were few or no work-related injuries and illnesses at your sampled establishment in calendar year 2021, you may respond to us via FAX using a FAX form.

 

Last Modified Date: December 6, 2021