HR Forms and Checklists

Workplace Safety Forms

• Accident Injury and Illness Investigation
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  Use this form whenever a workplace accident, injury or illness occurs to properly document your investigation.​
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• CalOSHA Forms 300 300A and 301
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  A CalOSHA-created spreadsheet containing all three required forms to report workplace injuries.
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• Emergency Action Plan
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  Use this form to set up an Emergency Action Plan (EAP) for the workplace. The EAP includes which employees are in charge in case of an emergency and emergency contact phone numbers.
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• Fire Prevention Checklist
  Use this checklist to collect information related to fire prevention and to make sure you are taking proper measures to prevent fires in the workplace. This includes auditing those measures to ensure that they are being followed. This information should be integrated into your Fire Prevention Plan.  ​
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• Fire Prevention Plan
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  Use this form to set up a Fire Prevention Plan (FPP) for the workplace. The FPP inlcudes which employees are in charge in case of a fire and emergency contact phone numbers for local fire departments. 
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• Hazard Assessment and Correction Record
  When a workplace safety hazard is identified, use this form to document and evaluate the hazard, and then record all actions taken to correct the unsafe condition.
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• Hazard Communication Information Summary
  Use this form to collect information about potential hazards in your workplace. This information is critical for creating an effective and thorough Hazard Communication Program (HAZCOM).
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• Hazard Communication Program
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  Use this form to create a Hazard Communication Program (HAZCOM). An effective program includes a list of persons responsible for maintaining the program, how often the program is reviewed and updated, and how employees can receive safety data sheets. ​
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• Heat Illness Prevention Plan — Outdoor Employees — Spanish
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  Use this sample form to develop your company's plan and procedures for complying with Cal/OSHA regulations on heat illness prevention for outdoor workers. This form describes minimal steps applicable to most outdoor work settings to help prevent heat illness. Make sure to modify this sample form with specific procedures tailored to your workplace and the specific conditions at your worksites. Additional helpful information is available from Cal/OSHA.
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• Heat Illness Prevention Plan — Indoor Employees
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  Use this sample form to develop your company's plan and procedures for complying with Cal/OSHA regulations on heat illness prevention for indoor workers. This form provides information applicable to most indoor work settings to help prevent heat illness. Make sure to modify this sample form with specific procedures tailored to your workplace and the specific conditions at your worksites.  Additional helpful information is available from Cal/OSHA.
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• Heat Illness Prevention Plan — Indoor Employees — Spanish
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  Use this sample form to develop your company's plan and procedures for complying with Cal/OSHA regulations on heat illness prevention for indoor workers. This form provides information applicable to most indoor work settings to help prevent heat illness. Make sure to modify this sample form with specific procedures tailored to your workplace and the specific conditions at your worksites. Additional helpful information is available from Cal/OSHA.
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• Heat Illness Prevention Plan — Outdoor Employees
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  Use this sample form to develop your company's plan and procedures for complying with Cal/OSHA regulations on heat illness prevention for outdoor workers. This form describes minimal steps applicable to most outdoor work settings to help prevent heat illness. Make sure to modify this sample form with specific procedures tailored to your workplace and the specific conditions at your worksites. Additional helpful information is available from Cal/OSHA.
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• Human Trafficking Model Notice
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  Certain businesses must post this model notice providing information relating to how to report suspected human trafficking and access to help and services. Information on who must post this notice​ can be found on the Office of the Attorney ​General's Human Trafficking​​ webpage.​
  
  The notice to be posted must be at least 8.5 x 11 inches and size 16 font.​
  
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• Human Trafficking Model Notice - English and Spanish
  Free

  ​​​Certain businesses must post this model notice providing information relating to how to report suspected human trafficking and access to help and services. Information on who must post this notice​ can be found on the Office of the Attorney ​General's Human Trafficking​​​ webpage.​
  

  The notice to be posted must be at least 8.5 x 11 inches and size 16 font.​
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• Human Trafficking Model Notice - Spanish
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  Certain businesses must post this model notice providing information relating to how to report suspected human trafficking and access to help and services. Information on who must post this notice​ can be found on the Office of the Attorney ​General's Human Trafficking​​ webpage.​

  The notice to be posted must be at least 8.5 x 11 inches and size 16 font.​

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• Individual Safety Training Certificate
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  Use this certificate to document training provided to an employee, and to satisfy Cal/OSHA standard compliance. Keep the certificate in the employee's personnel file. Provide a copy of the certificate to the employee if requested.
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• Initial Safety Training Certificate
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  Use this sample form to record an employee's initial formal training regarding potential occupational hazards and Codes of Safe Practices.
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• Injury and Illness Incident Report - Form 301
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  Along with an accompanying Summary, you must fill out this form or an equivalent within 7 calendar days after you receive information that a recordable work-related injury or illness has occurred. Some state workers’ compensation, insurance, or other reports may be acceptable substitutes if the forms contain all the information asked for on this form. You must keep this form on file for 5 years following the year to which it pertains.​
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• Injury and Illness Prevention Program Administration Guide
  Begin using this Injury and Illness Prevention Program (IIPP) administration guide before your business opens, or as soon after as possible, to ensure you meet Cal/OSHA requirements. For easy reference, print out this guide along with each form listed and review them in conjunction with one another. This will assist you in completing each of the forms.​
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• Injury and Illness Prevention Program for Non-High Hazard Employers
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  Use this form to create an Injury and Illness Prevention Program to meet the written program requirements of the California Division of Occupational Safety and Health (Cal/OSHA) (8 CCR sec. 3203).
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• Injury or Illness at the Workplace Checklist
  Use this checklist to make sure you respond properly to a reported illness or injury in your workplace.​
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• Last Chance Agreement Checklist for Employee with Substance Abuse Problem
  Use this checklist when creating a Last Chance Agreement to give employees that were once productive and valuable but have developed recent performance problems — and have failed to correct them when identified — a last chance to improve their performance before termination. For example, a last chance agreement might be used with an employee that has developed a recent substance abuse problem.
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• Law Enforcement Encounter Policy Checklist

  Use this checklist to create policies and procedures for your workplace in the event of any type of law enforcement encounter in the workplace.

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• Office and Commercial Establishment Safety Including Ergonomics and Office Chemical Safety
  General office and commercial establishment safety is not regulated by Cal/OSHA standards. However, the Injury and Illness Prevention Standard requires employers to identify and prevent any hazards that may be present. Use this data sheet to identify and address office hazards.​
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• Optional Worksheet to Help You Fill Out the Annual Summary - Form 300A
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  Use this worksheet to gather the data needed to prepare the Summary of Work-related Injuries and Illnesses (Form 300A).
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• OSHA Log 300 - Guidelines for Determining Recordability
  These guidelines help you determine whether you need to record a work-related injury or illness on Log 300 forms.
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• Periodic Self-Inspection Requirements
  This list helps you identify self-inspection requirements contained in Cal/OSHA standards. Keep as a reminder to perform periodic inspections.
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• Safe Practices for Construction Workplaces - Sample Code
  The sample code in this form was developed by the California Department of Occupational Safety and Health. It is a suggested code, is general in nature and is intended as a basis for preparation of a code that fits the specific contractor's operations more exactly.
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• Safety Inspection for General Work Areas and Offices Checklist
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  Use this checklist to ensure that general work areas and offices are free of potential health or safety hazards.
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• Safety Inspection for Work Spaces and Surfaces Checklist
  Use this checklist to ensure that work spaces and surfaces are free of potential health or safety hazards.
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• Safety Program Self Audit Checklist
  Use this checklist to help ensure that your workplace safety program complies with state requirements and is well tailored to reducing risks and claims in your workplace.
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• Serious Incident Report
  Send this report to the nearest Cal/OSHA District Office within eight hours of a serious injury or death.
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• Work Surfaces and Work Space Safety
  Specific Cal/OSHA standards govern workplace conditions and structures. Use this form to help you identify and meet these standards.
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• Workplace Security Profile
  Fill out this Cal/OSHA form in order to assess the risk of violence in a particular workplace.
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• Workplace Violence Factors and Control Checklist — OSHA
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  This checklist can help employers identify present or potential workplace violence problems. This checklist was created for late-night retail establishments and contains various factors and controls commonly encountered in that setting. Not all of the questions listed here fit all types of retail businesses, and this checklist does not include all possible topics specific businesses need. Employers should expand, modify and adapt this checklist to fit their own circumstances.
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• Workplace Violence Incident Log
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  Effective July 1, 2024, employers are required by law to maintain violent incident logs for every workplace violence incident. Use this form to record all information related to workplace violence incidents.
  
  For more information on the workplace violence prevention plan law, see California Workplace Violence Prevention Standards.
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• Workplace Violence Inspection Checklist — OSHA
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  This checklist can help employers identify present or potential workplace violence problems. This checklist was created for late-night retail establishments and contains various factors and controls commonly encountered in that setting. Not all of the questions listed here fit all types of retail businesses, and this checklist does not include all possible topics specific businesses need. Employers should expand, modify and adapt this checklist to fit their own circumstances.
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• Workplace Violence Prevention Plan Key Definitions
  Contains key definitions for terms required in your workplace violence prevention plan.
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• Work-Related Injuries and Illnesses Log - Form 300
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  You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, medical treatment beyond first aid, that are diagnosed by a physician or licensed health care professional, or meet any criteria listed in CCR Title 8 sec. 14300.8 through 14300.12. You must complete an Injury and Illness Incident Report (Cal/OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable, call your local Cal/OSHA office for help.
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• Work-Related Injuries and Illnesses Summary- Form 300A
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  All establishments covered by 8 CCR sec. 14300 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the log to verify that the entries are complete and accurate before completing this summary. Post this Summary page from February 1 to April 30 of the year following the year covered by the form.
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• Worksite Ergonomics Evaluation Form
  Use this form to evaluate if employee workspaces meet ergonomic standards.
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