Form 192002 with OSHA 301 info 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the Claimant section, including your name, Social Security number, address, and telephone number.
  3. In the Felony Convictions Involved section, provide details about each felony conviction, including the date, county, and court file number.
  4. Fill in the Dates of Incarceration and Places of Incarceration fields accurately to reflect your incarceration history.
  5. Indicate whether you received a Pardon of Innocence or if charges were dismissed by a three-judge panel. Provide the relevant dates as required.
  6. State your claim for compensation clearly in the designated area, specifying the amount and duration of incarceration.
  7. Attach any necessary supporting documents such as certified copies of judgments or pardons as indicated on the form.
  8. Finally, sign and date the petition before submitting it to the North Carolina Industrial Commission as instructed.

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Occupational Safety and Health Administration (OSHA) Form 301, Injury and Illness Incident Report, is used by employers to keep a record of a single injury, illness, or death in a workplace.
You are only required to give the authorized employee representative information from the OSHA 301 Incident Report section titled Tell us about the case. You must remove all other information from the copy of the OSHA 301 Incident Report or the equivalent substitute form that you give to the authorized employee
The instruction Within 7 days of receiving information that a recordable work-related injury or illness has occurred, you must fill out this form or the Cal/OSHA Form 301.
Whats the difference between OSHA form 300, 301, and 300A? Heres a quick breakdown: OSHA Form 300 This is an incident summary form that outlines what happened and who was involved in a specific injury event. OSHA Form 301This is a business location-based log that includes a line item for every workplace incident.

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