Building 12, Room 158 2026

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The document is a summary form (SH-900.1) from the New York State Department of Labor, detailing work-related injuries and illnesses for the calendar year 2016. It mandates all establishments covered by PART 801 to complete this summary annually, regardless of whether any incidents occurred. The form includes sections for establishment and employment information, as well as categories for reporting injuries, illnesses, and days away from work. It also provides instructions for calculating employment data.

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Click ‘Get Form’ to open the Building 12, Room 158 document in our editor.
Begin by filling out the 'Establishment Information' section. Enter your establishment name, street address, city, state, and ZIP code accurately.
Next, provide the 'Employment Information.' Input the average number of employees and total hours worked by all employees last year. If you need assistance with calculations, refer to the instructions provided within the form.
In the 'Number of Cases' section, enter totals from your Log of Occupational Injuries and Illnesses for each category. If there are no cases for a category, simply enter '0.'
Complete the 'Certification' section at the end of the form. Ensure you sign, print your name, title, and date to validate your submission.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (238 Votes)
2005	4.1 Satisfied (41 Votes)
2003	4.2 Satisfied (51 Votes)

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Building 12, Room 158 2026

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