Sh 900 2 2025

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The document is an Injury and Illness Incident Report form (SH 900.2) from the New York State Department of Labor, designed to be filled out when a recordable work-related injury or illness occurs. It emphasizes the importance of confidentiality regarding employee health information and outlines the necessary details to be recorded, including employee information, incident description, and treatment received. The form must be completed within 7 days of the incident and retained for 5 years as per state regulations.

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Click ‘Get Form’ to open the SH 900.2 in the editor.
Begin by entering the 'Completed by' section with your name, ensuring you provide accurate information.
Fill in the 'Physician/Health Care Professional Information' section, including the name and contact details of the treating physician or facility.
Complete the 'Employee Information' section with full name, address, date of birth, and gender. Be thorough to avoid any discrepancies.
Document the incident details: date and time of injury, what the employee was doing prior to the incident, and a clear description of how it occurred.
Specify the nature of the injury or illness and identify any objects or substances that caused harm. This is crucial for accurate reporting.
If applicable, check the box regarding privacy concerns for illness cases before finalizing your form.

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Versions	Form popularity	Fillable & printable
2005	4.9 Satisfied (43 Votes)
2002	4.4 Satisfied (59 Votes)

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What is the summary of work related injuries and illnesses form?

The Log of Work-Related Injuries and Illnesses (Form 300) is used to classify work-related injuries and illnesses and to note the extent and severity of each case. When an incident occurs, use the Log to record specific details about what happened and how it happened.

What is SH900?

Log of Work Related Injuries and Illnesses Form. SH-900. 1. This form is required by the Commissioner of Labors Rules and Regulations Part 801 (12 NYCRR Part 801) and must be kept in the establishment for five years.

What is the number for OSHA in NY?

If you work for a private company or the federal government, call the Occupational Safety and Health Administration at 1-800-321-OSHA. If you work for a non-federal public employer in New York, visit the Public Employee Safety and Health Bureau (PESH) website or call 518-457-5508 for more information.

What is the New York State Public Employee Safety and Health Act?

The PESH Act requires that an employer furnish employees with a job and a workplace free from recognized hazards, provide reasonable and adequate protection to the lives, safety and health of its employees, and comply with all Health and Safety Standards promulgated by the NYS Department of Labors Division of Safety