The OSHA 300 Log
Work Relatedness/Causality:
An injury or illness is considered work-related if the condition Arose Out of Employment during the Course Of Employment (AOE/COE), due to an event or exposure at the workplace. A condition is not work related if it arose coincidentally while at the work place, but due to factors outside the workplace, or while performing personal or volunteer activities at the workplace. Thus the condition must be caused or significantly aggravated by an identifiable event or exposure arising from work.
General OSHA Injuries Recording Criteria:
- Death
- Days away from work
- Restricted work
- Transfer to another job
- Medical treatment beyond first aid
- Loss of Consciousness
- Diagnosis of a significant injury or illness
Death:
Any work-related death must be recorded on the OSHA 300 log, and also reported to OSHA within 8 hours.
Days Away From Work:
Even one day! If the patient has worked today and returns to full duty tomorrow, no time loss has occurred and the case is not recordable. Weekends and holidays count! Even if tomorrow is Christmas, return them tomorrow if you are treating a first aid case, otherwise time loss will have to be recorded. The fact that the worker doesn’t usually work the following day, be it the weekend, holiday, vacation or “they don’t work Thursday” is irrelevant. If they are ABLE to work tomorrow, no matter what day it is, release them for tomorrow. All too often I see patients being treated on a Friday released for Monday to full duty. Well, you have just given them a medically excused absence for Saturday and Sunday and the case is now OSHA recordable.
Restricted Work:
A worker is considered restricted when they are prevented from performing any of their regular duties performed within the last week, or if work is restricted to less than the full workday they normally would have worked. Always ask the patient what their job duties are and determine if the injury prevents them from doing normal job functions. If in doubt, call the employer and ask about specific duties. If they would have a restriction that is not part of their regular job functions, you don’t need to specify unnecessary restrictions.
Medical Treatment beyond First Aid:
This is the area where treating physicians can easily make an otherwise non-recordable injury recordable. According to OSHA, the following list is considered First Aid: (a) Using a nonprescription medication at nonprescription strength; (b) Administering tetanus immunizations; (c) Cleaning, flushing or soaking wounds on the surface of the skin; (d) Using wound coverings such as bandages, Band-Aids, gauze pads, etc.;or using butterfly bandages or Steri-Strips; (e) Using hot or cold therapy; (f) Using any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc.; (g) Using temporary immobilization devices while transporting an accident victim; (h) Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister; (i) Using eye patches; (j) Removing foreign bodies from the eye using only irrigation or a cotton swab; (k) Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs or other simple means; (l) Using finger guards; (m) Using massages; or (n) Drinking fluids for relief of heat stress.
Let’s examine some of these a bit more closely: (members only content)
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Dr. Earl, the example that I use at the most basic, is when a prescription strength pain reliever is prescribed that could be purchased over the counter. I have seen Doctors, (usually PCP’s) prescribe 600mg Motrin, when a patient could take 3 over the counter 200mg tablets.
This is no longer “First Aid” and therefore recordable.
It just makes good business sense to avoid a recordable event when possible. Patient care comes first, but in the example I use, it is the same result for the patient.
Bill, agree with you, but even here you have to be careful. The rule is first aid if prescription med AT PRESCRIPTION STRENGTH. So if you tell a patient to take 3, 200mg Ibuprofens, that is Rx strength, so would still be recordable. If 400mg Ibuprofen is enough, that is what the physician should tell the patient, and all else being first aid, the case would not be recordable.
Yep, let’s all pretend we are putting the patient first when in reality, as soon as we start talking about changing our normal course of action as a physician, we introduce a conflict of interest bound to comprimise the patient in exchange for the mighty dollar.
Dear “s”,
Since you have not identified yourself, I really don’t know from what perspective or from what experience or knowledge on the subject your comment emanates. Are you a physician treating worker’s comp patients?
Mine come from 28 years of evaluating and treating worker’s comp patients successfully for hundreds of satisfied employers.
You accuse me of “pretending” to put the patient first, but really having a conflict of interest.
From what part of my message do you draw this conclusion? The part where I advocate choosing OTC meds instead of Rx meds when appropriate? You talk about changing our normal course of action. Is over-prescribing your normal course of action? Many more physicians are guilty of over- rather then under-prescribing. See my post on Physician dispensing.
Isn’t in our patients’ best interest to prescribe Tylenol or Ibuprofen 400 instead of a narcotic or a stronger NSAID when in our clinical judgement the former will do the job with less side effects and reduced cost?
Or how about the part where I advocate early return to work strategies? There is a large and growing body of medical literature on the positive effects for the patient on early return to productive work.
“Exchange for the mighty dollar?” As a physician, are you unconcerned with our healthcare financial crisis in this country? Strategies in my post are intended to reduce prescription costs, insurance costs, and costs to both the employer AND patient in terms of lost productivity and livelihood. Whose “mighty dollar” are you concerned about here?