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Form No. OSHA 6-40.1.

Serious Event Reporting Online Form

Validation Check - Enter State of Event to determine reporting requirements.


*State  

  

NOTE: For employers covered by Federal OSHA that are located in State Plan States, to make a report

  • Call the nearest OSHA office.
  • Call the OSHA 24-hour hotline at 1-800-321-6742 (OSHA).

OMB Control Number: 1218-0176 Expiration Date: March 31, 2022
Public reporting for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid Office of Management and Budget Control Number. If you have any comments regarding this estimate or any other aspect of this information collection, including suggestions for reducing this burden, please send them to OSHAPRA@dol.gov or to OSHA's Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210.

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