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The OSHA 300 form serves as a critical tool for employers to document work-related injuries and illnesses within their organizations. This form requires the recording of various incidents, including work-related deaths and injuries that lead to loss of consciousness, restricted work activity, job transfers, days away from work, or medical treatment beyond first aid. Employers must also note significant work-related injuries and illnesses diagnosed by a healthcare professional. Each entry on the form must adhere to specific recording criteria outlined in federal regulations. To ensure accurate tracking, an Injury and Illness Incident Report (OSHA Form 301) must accompany each recorded case. Maintaining the confidentiality of employee information is essential while using this form for occupational safety and health purposes. Employers should seek guidance from their local OSHA office if there is uncertainty about whether a case is recordable. The form includes sections for identifying the employee, describing the case, and classifying the nature of the injury or illness, all of which are vital for maintaining workplace safety and compliance.

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OSHA’s Form 300 (Rev. 01/2004)

Log of Work-Related Injuries and Illnesses

Attention: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes.

Year 20__ __

U.S. Department of Labor

Occupational Safety and Health Administration

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, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR Part 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (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 OSHA office for help.

Form approved OMB no. 1218-0176

Establishment name ___________________________________________

City ________________________________ State ___________________

 

 

 

 

 

 

 

 

 

 

 

 

 

Identify the person

 

 

Describe the case

 

 

Classify the case

 

 

 

 

 

 

 

 

 

 

 

 

CHECK ONLY ONE box for each case

 

 

 

 

(A)

(B)

(C)

 

(D)

(E)

(F)

 

 

Enter the number of

 

Check the “Injury” column or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

based on the most serious outcome for

 

days the injured or

 

Case

Employee’s name

Job title

 

Date of injury

Where the event occurred

Describe injury or illness, parts of body affected,

 

that case:

 

ill worker was:

 

choose one type of illness:

no.

(e.g., Welder)

or onset

(e.g., Loading dock north end) and object/substance that directly injured

 

Remained at Work

 

 

 

 

 

 

 

of illness

or made person ill (e.g., Second degree burns on

 

Away

On job

 

 

 

 

 

 

 

 

 

right forearm from acetylene torch)

 

 

 

 

 

 

 

Job transfer

Other record-

from

transfer or

 

 

 

Days away

 

 

 

Death from work

or restriction

able cases

work

restriction

(M)

Injury

Skindisorder

Respiratory condition

Poisoning

Hearingloss

Allother illnesses

_____

________________________

____________

/___

__________________

__________________________________________________

 

 

 

month/day

 

 

_____

________________________

____________

/___

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

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month/day

 

 

(G)

(H)

(I)

(J)

(K)

(L)

(1) (2) (3) (4) (5) (6)

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Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time to review the instructions, search and gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.

Page totals

Be sure to transfer these totals to the Summary page (Form 300A) before you post it.

Page ____ of ____

Injury

(1)

Skindisorder

Respiratory condition

Poisoning

Hearingloss

Allother illnesses

(2)

(3)

(4)

(5)

(6)

 

 

 

 

 

 

OSHA’s Form 300A (Rev. 01/2004)

Year 20__ __

 

Summary of Work-Related Injuries and Illnesses

 

 

Occupational Safety and Health Administration

 

U.S. Department of Labor

 

 

 

 

Form approved OMB no. 1218-0176

All establishments covered by Part 1904 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.

Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you’ve added the entries from every page of the Log. If you had no cases, write “0.”

Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR Part 1904.35, in OSHA’s recordkeeping rule, for further details on the access provisions for these forms.

Number of Cases

Establishment information

Your establishment name __________________________________________

Street

_____________________________________________________

City

____________________________ State ______ ZIP _________

Total number of deaths

__________________

(G)

Total number of cases with days away from work

__________________

(H)

Total number of

Total number of

cases with job

other recordable

transfer or restriction

cases

__________________

__________________

(I)

(J)

Industry description (e.g., Manufacture of motor truck trailers)

_______________________________________________________

Standard Industrial Classification (SIC), if known (e.g., 3715)

____ ____ ____ ____

OR

North American Industrial Classification (NAICS), if known (e.g., 336212)

Number of Days

Total number of days away

Total number of days of job

from work

transfer or restriction

___________

___________

____ ____ ____ ____ ____ ____

Employment information (If you don’t have these figures, see the Worksheet on the back of this page to estimate.)

Annual average number of employees

______________

(K)

Injury and Illness Types

Total number of . . .

 

(M)

 

(1)

Injuries

______

(2)

Skin disorders

______

(3)

Respiratory conditions

______

(L)

(4)

Poisonings

______

(5)

Hearing loss

______

(6)

All other illnesses

______

Total hours worked by all employees last year ______________

Sign here

Knowingly falsifying this document may result in a fine.

I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and complete.

___________________________________________________________

Company executive

 

Title

(

)

-

/ /

Phone

 

 

Date

Post this Summary page from February 1 to April 30 of the year following the year covered by the form.

Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instructions, search and gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.

OSHA’s Form 301

Injury and Illness Incident Report

Attention: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes.

U.S. Department of Labor

Occupational Safety and Health Administration

Form approved OMB no. 1218-0176

This Injury and Illness Incident Report is one of the first forms you must fill out when a recordable work- related injury or illness has occurred. Together with the Log of Work-Related Injuries and Illnesses and the accompanying Summary, these forms help the employer and OSHA develop a picture of the extent and severity of work-related incidents.

Within 7 calendar days after you receive information that a recordable work-related injury or illness has occurred, you must fill out this form or an equivalent. Some state workers’ compensation, insurance, or other reports may be acceptable substitutes. To be considered an equivalent form, any substitute must contain all the information asked for on this form.

According to Public Law 91-596 and 29 CFR 1904, OSHA’s recordkeeping rule, you must keep this form on file for 5 years following the year to which it pertains.

If you need additional copies of this form, you may photocopy and use as many as you need.

Completed by _______________________________________________________

Title _________________________________________________________________

Phone (________)_________--_____________

Date _____/ _____ / _____

Information about the employee

1)Full name _____________________________________________________________

2)Street ________________________________________________________________

City ______________________________________ State _________ ZIP ___________

3)Date of birth ______ / _____ / ______

4)Date hired ______ / _____ / ______

5)￿ Male

￿ Female

Information about the physician or other health care professional

6) Name of physician or other health care professional __________________________

________________________________________________________________________

7)If treatment was given away from the worksite, where was it given?

Facility _________________________________________________________________

Street _______________________________________________________________

City ______________________________________ State _________ ZIP ___________

8)Was employee treated in an emergency room?

￿Yes

￿No

9)Was employee hospitalized overnight as an in-patient?

￿Yes

￿No

Information about the case

10)Case number from the Log _____________________ (Transfer the case number from the Log after you record the case.)

11)

Date of injury or illness

______ / _____ / ______

 

12)

Time employee began work ____________________

AM / PM

13)

Time of event

____________________

AM / PM ￿ Check if time cannot be determined

14)What was the employee doing just before the incident occurred? Describe the activity, as well as the tools, equipment, or material the employee was using. Be specific. Examples: “climbing a ladder while carrying roofing materials”; “spraying chlorine from hand sprayer”; “daily computer key-entry.”

15)What happened? Tell us how the injury occurred. Examples: “When ladder slipped on wet floor, worker fell 20 feet”; “Worker was sprayed with chlorine when gasket broke during replacement”; “Worker developed soreness in wrist over time.”

16)What was the injury or illness? Tell us the part of the body that was affected and how it was affected; be more specific than “hurt,” “pain,” or sore.” Examples: “strained back”; “chemical burn, hand”; “carpal tunnel syndrome.”

17)What object or substance directly harmed the employee? Examples: “concrete floor”; “chlorine”; “radial arm saw.” If this question does not apply to the incident, leave it blank.

18) If the employee died, when did death occur? Date of death ______ / _____ / ______

Public reporting burden for this collection of information is estimated to average 22 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Persons are not required to respond to the collection of information unless it displays a current valid OMB control number. If you have any comments about this estimate or any other aspects of this data collection, including suggestions for reducing this burden, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.

Form Specifications

Fact Name Description
Purpose The OSHA 300 form is used to log work-related injuries and illnesses.
Recordable Cases Every work-related death and injuries or illnesses requiring medical treatment beyond first aid must be recorded.
Confidentiality Information on the form must be handled confidentially to protect employee privacy.
Incident Report Requirement An Injury and Illness Incident Report (OSHA Form 301) must be completed for each case recorded.
Specific Criteria Injuries and illnesses that meet specific criteria in 29 CFR Part 1904.8 through 1904.12 must be recorded.
Completion Time It typically takes about 14 minutes to complete the form, including gathering necessary data.
State-Specific Forms Some states may have additional requirements or specific forms governed by state laws.
Posting Requirement Totals from the OSHA 300 form must be transferred to the Summary page (Form 300A) and posted.

Osha 300: Usage Guidelines

Filling out the OSHA 300 form is an important task that requires attention to detail. After completing the form, you will need to transfer the totals to the Summary page (Form 300A) and post it as required. Here’s how to fill out the form step by step.

  1. Start with the Establishment name. Write the name of your company or workplace.
  2. Next, enter the City and State where the establishment is located.
  3. Identify the person filling out the form. Include their name and job title.
  4. For each case, fill in the following details:
    • Employee’s name: Write the full name of the injured or ill employee.
    • Job title: Indicate the employee's job title.
    • Date of injury: Enter the date when the injury or illness occurred.
    • Where the event occurred: Specify the location, such as "Loading dock north end."
    • Describe injury or illness: Provide a detailed description of the injury or illness, including parts of the body affected and the object or substance involved (e.g., "Second degree burns on right forearm from acetylene torch").
  5. Classify the case by checking one box for the most serious outcome:
    • Remained at Work
    • Days away from work
    • Job transfer or work restriction
    • Death
  6. Enter the number of days the employee was away from work or had restrictions.
  7. Complete the remaining sections, ensuring you fill in all applicable details for each case.
  8. Finally, total the numbers at the bottom of the form and ensure they match the cases recorded.

Your Questions, Answered

What is the OSHA 300 Form?

The OSHA 300 Form is a log used to record work-related injuries and illnesses. It helps employers track incidents that affect their employees' health and safety. This form is essential for maintaining workplace safety and ensuring compliance with federal regulations.

Who needs to complete the OSHA 300 Form?

Employers with more than 10 employees, and those in certain industries, must complete the OSHA 300 Form. If your workplace experiences a work-related death, injury, or illness that meets specific criteria, you are required to record it on this form.

What types of incidents must be recorded on the OSHA 300 Form?

You must record any work-related death, as well as injuries or illnesses that result in loss of consciousness, restricted work activity, job transfer, days away from work, or medical treatment beyond first aid. Significant work-related injuries diagnosed by a healthcare professional must also be logged.

How do I determine if an incident is recordable?

To determine if an incident is recordable, consider whether it meets the criteria outlined in 29 CFR Part 1904.8 through 1904.12. If you're unsure, contact your local OSHA office for assistance.

Is there a specific format for completing the OSHA 300 Form?

Yes, the OSHA 300 Form has specific sections to fill out, including the employee's name, job title, date of injury, and a description of the incident. You should classify each case based on the most serious outcome and record any days away from work or job transfer.

What should I do if I have multiple injuries from a single incident?

You can use two lines for a single case if necessary. Make sure to provide all relevant details for each injury or illness on the form to ensure accurate reporting.

Do I need to complete the OSHA Form 301 for each entry on the OSHA 300 Form?

Yes, for every injury or illness recorded on the OSHA 300 Form, you must complete an Injury and Illness Incident Report (OSHA Form 301) or an equivalent form. This ensures detailed documentation of each case.

How often should I update the OSHA 300 Form?

The OSHA 300 Form should be updated regularly as incidents occur. It's important to keep it current throughout the year, especially before posting the summary page (Form 300A) at the end of the year.

What happens if I fail to complete the OSHA 300 Form?

Failure to complete the OSHA 300 Form can lead to penalties from OSHA. It is crucial to comply with the requirements to avoid fines and ensure a safe working environment for your employees.

Where should I send the completed OSHA 300 Form?

You do not send the completed OSHA 300 Form to OSHA. Instead, keep it on file at your workplace for at least five years. You should only post the summary page (Form 300A) in a visible area for employees to review.

Common mistakes

  1. Failing to record all relevant incidents: Every work-related death, injury, or illness must be documented. This includes cases involving loss of consciousness, restricted work activity, or medical treatment beyond first aid. Omitting any of these can lead to compliance issues.

  2. Inaccurate descriptions: Providing vague or incomplete descriptions of the injury or illness can create confusion. It’s important to detail the nature of the injury, the parts of the body affected, and the object or substance involved.

  3. Incorrect classification of cases: Each case must be classified based on the most serious outcome. Selecting the wrong category can misrepresent the severity of incidents and affect workplace safety assessments.

  4. Neglecting to complete required forms: Each incident recorded on the OSHA 300 form must also have an accompanying Injury and Illness Incident Report (OSHA Form 301). Failing to do this can lead to incomplete records.

  5. Not verifying recordability: If unsure whether an incident is recordable, it’s crucial to seek guidance from your local OSHA office. Ignoring this step can result in missing critical cases that should be documented.

Documents used along the form

The OSHA 300 form is essential for tracking work-related injuries and illnesses in the workplace. Along with this form, there are several other documents that play a crucial role in maintaining workplace safety and compliance. Each of these documents serves a specific purpose, helping employers and employees understand and respond to workplace incidents effectively.

  • OSHA Form 301: This form is used to provide detailed information about each individual work-related injury or illness. It includes specifics such as the nature of the injury, the circumstances surrounding it, and any medical treatment required. This report is essential for accurately completing the OSHA 300 form.
  • OSHA Form 300A: This is a summary of the information recorded on the OSHA 300 form. It is posted in the workplace to inform employees about the total number of injuries and illnesses that occurred during the year. Employers must display this form from February 1 to April 30 each year.
  • Incident Report: An incident report is a document that outlines the details of a specific workplace accident or near-miss. It typically includes information about what happened, when it happened, and who was involved. This report helps in identifying potential hazards and preventing future incidents.
  • First Aid Record: This record is used to document any first aid treatment provided to employees. It includes details about the nature of the injury, the treatment given, and any follow-up actions required. Keeping this record is important for tracking minor injuries that may not require further medical attention.
  • Safety Data Sheets (SDS): These documents provide detailed information about hazardous substances used in the workplace. They include information on handling, storage, and emergency measures in case of exposure. SDS are essential for ensuring that employees understand the risks associated with chemicals they may encounter.
  • Employee Training Records: These records document the safety training that employees have received. They include details about the training topics covered, dates, and the names of employees who attended. Maintaining these records is crucial for compliance with safety regulations and ensuring that employees are adequately trained to handle workplace hazards.

Understanding these documents and their purposes can significantly enhance workplace safety. By keeping accurate records and following safety protocols, employers can create a safer environment for all employees. This proactive approach not only helps in compliance with OSHA regulations but also fosters a culture of safety within the organization.

Similar forms

The OSHA 300 form is essential for tracking work-related injuries and illnesses. Several other documents serve similar purposes in workplace safety and health reporting. Here are ten documents that share similarities with the OSHA 300 form:

  • OSHA Form 301: This form is used to provide detailed information about each individual injury or illness recorded on the OSHA 300 form. It includes specifics about the incident and the affected employee.
  • OSHA Form 300A: This is the summary of the OSHA 300 log. It consolidates the information from the OSHA 300 form and must be posted in the workplace for employees to see.
  • First Report of Injury (FROI): Similar to the OSHA 300, this document is used to report workplace injuries to insurance companies. It includes basic information about the incident and the injured employee.
  • Workers' Compensation Claim Form: This form is filed to initiate a claim for benefits after a work-related injury. It often requires information similar to what is found on the OSHA 300 form.
  • Incident Report: Companies often create their own incident reports to document accidents. These reports typically include details about the injury and the circumstances surrounding it, similar to the OSHA 300.
  • Safety Data Sheets (SDS): While not a direct reporting form, SDS provide crucial information about hazardous substances in the workplace. They are essential for understanding potential risks related to injuries and illnesses.
  • Return to Work (RTW) Form: This document is used to outline the employee's ability to return to work after an injury. It often references the details recorded on the OSHA 300 form.
  • Accident Investigation Report: This report analyzes the causes of workplace accidents. It is similar to the OSHA 300 form in that it seeks to prevent future incidents by understanding what went wrong.
  • Health and Safety Audit Reports: These reports assess workplace safety compliance. They often reference data from the OSHA 300 form to evaluate the effectiveness of safety measures.
  • Employee Health Records: These documents track employees' health over time, especially in relation to work-related illnesses. They can provide context for the injuries listed on the OSHA 300 form.

Dos and Don'ts

Filling out the OSHA 300 form correctly is crucial for maintaining workplace safety and ensuring compliance with regulations. Here’s a list of things to do and avoid when completing this important document.

  • Do record every work-related death and any injury or illness that results in loss of consciousness, restricted work activity, or medical treatment beyond first aid.
  • Do include significant injuries and illnesses diagnosed by a physician or licensed health care professional.
  • Do ensure you classify each case based on the most serious outcome.
  • Do use two lines for a single case if necessary; clarity is key.
  • Do complete an Injury and Illness Incident Report (OSHA Form 301) for each recorded case.
  • Don't overlook any injury or illness that meets the specific recording criteria outlined in 29 CFR Part 1904.8 through 1904.12.
  • Don't guess whether a case is recordable; if unsure, contact your local OSHA office for guidance.
  • Don't forget to transfer totals from the OSHA 300 form to the Summary page (Form 300A) before posting.
  • Don't share personal health information that could compromise employee confidentiality.
  • Don't delay in completing the form; timely reporting is essential for accurate record-keeping.

By following these guidelines, you can help ensure that the OSHA 300 form is filled out accurately and effectively, contributing to a safer workplace for everyone.

Misconceptions

Understanding the OSHA 300 form is essential for maintaining workplace safety and compliance. However, there are several misconceptions that can lead to confusion. Below are nine common misconceptions, along with clarifications to provide a clearer understanding.

  1. The OSHA 300 form is optional for all employers. Many believe that completing this form is optional. In reality, employers with more than ten employees must maintain this log for work-related injuries and illnesses.
  2. Only severe injuries need to be recorded. Some think that only serious injuries, such as those requiring hospitalization, need to be documented. However, the form requires recording any work-related injury that results in loss of consciousness, restricted work activity, job transfer, or medical treatment beyond first aid.
  3. All injuries must be reported immediately. There is a misconception that all injuries need to be reported as soon as they happen. While prompt reporting is important, the OSHA 300 form allows for recording injuries within a specific timeframe, typically by the end of the calendar year.
  4. Employers can decide what to record. Some employers believe they have the discretion to choose which injuries to log. In fact, OSHA provides specific criteria that must be followed, and any work-related injury or illness meeting these criteria must be recorded.
  5. Confidentiality is not a concern. It is often assumed that employee confidentiality is not an issue when completing the form. In truth, the form contains sensitive information, and employers must take steps to protect the confidentiality of their employees.
  6. Only physical injuries are recorded. Many think that the OSHA 300 form is limited to physical injuries. However, it also includes work-related illnesses, which can be just as significant in terms of workplace safety.
  7. Once recorded, the information cannot be changed. There is a belief that once an injury is logged on the OSHA 300 form, it cannot be altered. In reality, corrections can be made if new information comes to light or if an error is identified.
  8. OSHA does not require a separate report for each case. Some employers think that they can simply record injuries on the OSHA 300 form without any additional documentation. However, each case must also be documented on an Injury and Illness Incident Report (OSHA Form 301) or an equivalent form.
  9. It is not necessary to consult OSHA for guidance. Many believe they can handle the reporting process without external assistance. However, if there is uncertainty about whether a case is recordable, it is advisable to contact the local OSHA office for guidance.

Addressing these misconceptions can lead to a better understanding of the OSHA 300 form and its importance in promoting workplace safety and health.

Key takeaways

When it comes to filling out and using OSHA's Form 300, understanding the requirements is essential for ensuring workplace safety and compliance. Here are some key takeaways:

  • Record All Relevant Incidents: You must document every work-related death, injury, or illness that results in loss of consciousness, restricted work activity, job transfer, days away from work, or medical treatment beyond first aid.
  • Consult a Professional: If there is uncertainty about whether a case is recordable, it is advisable to reach out to your local OSHA office for guidance.
  • Use of Form 301: For each incident recorded on Form 300, you are required to complete an Injury and Illness Incident Report (OSHA Form 301) or an equivalent form.
  • Confidentiality Matters: The information on Form 300 relates to employee health and must be handled in a way that protects employee confidentiality while fulfilling occupational safety purposes.
  • Multiple Lines for One Case: If necessary, you can use two lines to record a single case, ensuring that all relevant details are captured.
  • Transfer Totals Accurately: Be sure to accurately transfer the totals from Form 300 to the Summary page (Form 300A) before posting it, as this is crucial for compliance and reporting.