2022 DART Rate Survey Loss Recording Form for WEBSITE ONLY

2022 DART Rate Survey Loss Recording Form
Please record the following requested information which can be obtained from the completed

OSHA Form 300A for the 2022 Calendar Year
Injury Illness CASES for 2022:*
( Total in Column A )
Injury and Illness CASES with days away from work:*
( Total in Column H )
Injury and Illness CASES with job transfer or restrictions:*
( Total in Column I )
STOP!

The SUM of columns H & I

MUST NOT EXCEED the total in column A.
DAYS AWAY FROM WORK:*
( Total in Column K )
DAYS OF JOB TRANSFER OR RESTRICTIONS:*
( Total in Column L )
2022 HOURS WORKED BY ALL EMPLOYEES (Including per diem):*
(Obtain from HR or Payroll: This Figure is REQUIRED to calculate ALL Rates)

2022 DART Rate Survey Loss Recording Form