Authorization Number : 580-0249
Agency Series No. : SAF-01
Status : Active
Agency Web Link :
Agency : DMH
Confidential Description :
Division :
Vital Description :
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Record Title : Accident or Illness Report (ADM-4303) (OSHA-101)
Revision : 0
Record Description : Used to report an occupational injury or illness occurring to an employee and provide Workmen's Compensation certification information to the Department of Administrative Services. Also used as OSHA-101 for the Public Employee's Safety and Health Program in order to report and document "OSHA" recordable injuries and illnesses.