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SH900 - Log of Work-Related Injuries and Illnesses Form
The SH900 - Log of Work Related Injuries and Illnesses Form is required by the Commissioner of Labor's Rules and Regulations Part 801 (12 NYCRR Part 801).
In order to record information on the Department of Labor's SH900 - Log of Work Related Injuries and Illnesses Form and before the log can be printed within the ARS Reports component, the PESH SH900 page within Injury/Illness must be completed for every work-related death and 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. Also, it must be completed for work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. This page must be completed as well for work-related injuries and illnesses that meet any of the specific recording criteria found in the Commissioner of Labor's Rules and Regulations Part 801 (12 NYCRR Part 801.7 through 801.12).
To view the Rules and Regulations under Part 801, go to the NYS Department of Labor's web site at http://www.labor.state.ny.us/workerprotection/safetyhealth/DOSH_PESH.shtm. Click on Part 801 under the subheading Employee Injury and Illness Recordkeeping Information and Forms. The SH901 Instructions for Recording and Reporting Public Employees' Occupational Injuries and Illnesses are also listed under the same subheading.
This page should be completed as soon as the incident is deemed reportable according to the Rules and Regulations above. The information contained on the page may need to be updated periodically as the details of an incident may change over time. The PESH SH900 page for an incident that is reportable should not be left blank until the SH900.1 Summary is required to be posted.
In order to complete the PESH SH900 page within Injury/Illness for a reportable incident, follow the instructions below:
Click on Workforce Monitoring from the side navigation Menu in ARS.
Within the Workforce Monitoring Menu, click on the folder labeled Injury Illness.
Click on Injury/Illness.
Enter the value of either the employee ID (EmplID) or Incident Number.
Once the EmplID or Incident Number is entered, press Search.
If the search is done by EmplID, there may be multiple incident numbers displayed for that employee. Click on the correct Incident Number. (Incident numbers are displayed by the employee's most recent incident reported at the top and the employee's earliest at the bottom.)
Click on the PESH SH900 page.
If the injured employee is involved in an incident that results in one of the outcomes stated above, click on the PESH Reportable Case checkbox.
Once the PESH Reportable Case box is checked, Fields (E.) and (F.) will auto-populate with data entered elsewhere in ARS for the same incident.
Users must review each auto-populated field to verify its accuracy. Edits can be made by entering the correct information in each of the fields. In Field (E.), users must provide the exact location where the incident occurred (e.g., loading dock, north end). In Field (F.), users must provide the injury or illness, parts of the body affected, severity of the injury, and the object/substance that directly injured or made the worker ill (e.g., second degree burns on right forearm from acetylene torch).
The maximum number of characters allowed for Fields (E.) and (F.) is 200 in order to encourage full reporting of incidents. Underneath each field, a character count is displayed.
If Fields (E.) and (F.) attempt to auto-populate with more than 200 characters, the data will be truncated and a warning message will appear. Users must condense the incident description so that it is accurately reported.
Click only the most serious result for each case using the categories of Death, Days Away From Work, Job Transfer or Restriction, or Other Recordable Cases.
Enter the number of calendar days, if any, in which the employee had an On Job Transfer or Restriction.
Also, enter the number of calendar days, if any, the employee was Away from Work.
Next, in section (M.), click the appropriate injury or illness that corresponds to the employee's incident.
Note the Privacy Case checkbox to the right of the selections for section (M.). You should check the Privacy Case checkbox if the employee's injury or illness is one of the following:
1. an injury or illness to an intimate body part or the reproductive system;
2. an injury or illness resulting from a sexual assault;
3. mental illnesses;
4. HIV infection, hepatitis, or tuberculosis;
5. needlestick injuries and cuts from sharp objects that are contaminated with another person's blood or other potentially infectious material; and
6. other illnesses, if the injured employee independently or voluntarily requests that his or her name not be entered on the SH900 Log.
If the Privacy Case checkbox is checked, "Privacy Case" will replace the employee's name on the SH900 Log.
**Note** If your SH900 Log includes privacy concern cases, you must keep a separate, confidential list of the case numbers and employee names for your privacy concern cases so you can update the cases and provide the information to the Department of Labor if asked to do so.
Save all information on the PESH SH900 page by clicking on the Save button.
After the PESH SH900 page within the Injury/Illness component of ARS has been completed for each individual reportable case, the SH900 - Log of Work-Related Injuries and Illnesses can be printed for a given calendar year.
Follow the instructions below to view how to create and print the SH900 log for all the reportable cases completed on the PESH SH900 page in the Injury/Illness component:
Begin by clicking on Workforce Monitoring from the side navigation Menu.
Within the Workforce Monitoring Main Menu, click on the folder labeled ARS Reports.
Next, click on the folder labeled DOSH Reports.
Click on DOL SH900 2004+.
If producing a new SH900, create a Run Control ID by following the steps below.
Click on Add a New Value.
Enter a Run Control ID and click Add.
**Note** The same Run Control ID from prior years may not be used for current reports.
Some examples of a Run Control ID are SH900LOG2010, 2010DEPT12345, or DOSHPRINT2010.
If the Run Control ID has already been created and you would like to run the same report again, access it by following the steps below.
Under Find an Existing Value, click on Search.
Select the appropriate Run Control ID.
Choose the language in which the report will be ran. English will automatically be populated.
Enter the Calendar Year of the incidents which you would like the report ran for.
Enter your agency's five-digit department ID (Dept ID) number.
If your agency has one or multiple locations associated with your five-digit department ID (Dept ID) number, check All Locations of this Department.
**Note** If your agency has multiple Dept ID's (for example, a Dept ID for a Main Office and other Dept ID's for other locations within the agency), selecting the Dept ID for the Main Office and selecting All Locations of this Department will NOT run the report for every location under every Dept ID. It will only run the report for the locations associated with the Main Office. The report must be ran separately for each individual Dept ID.
If you need to run a report for only one of your agency's multiple locations, check Only One Location of this Department.
In order to select the one location, click on the magnifying glass.
On the Look Up Location page, select the Description of the location in which you are running the report for.
If you would like to create and print the SH900 log for a select range of locations within your agency's five-digit department ID (Dept ID) number, check Specify Location Range associated with this Department.
Click on the magnifying glass to the right of Location Start Range.
On the Look Up Location page, click on the column label NYCS - Sub Agency to sort the column numerically.
Select the Description of the location in which you would like to start the range of locations from.
Click on the magnifying glass to the right of Location End Range.
Click on the column label NYCS - Sub Agency to sort the column numerically.
Select the Description of the location in which you would like to end the range of locations.
Once the Report Request Parameters are set to the applicable location or range of locations, click Save, and then Run.
Click on Process Monitor.
The most recent report created will be displayed at the top of all requests under the Process List. Under Run Status, you will see Queued, Initiated, Processing, then Success. (You may need to click the Refresh button until Success is shown.)
Once the Run Status displays Success and the Distribution Status displays Posted, click on Details.
On the Process Detail page, click on View Log/Trace.
Click on the .PDF report under File List.
Your report will open in Acrobat/Adobe Reader for viewing. Click on the Printer icon at the top of the page to print the SH900 log.
After the SH900 log is produced, the SH900.1 Summary of Work-Related Injuries and Illnesses Form for the same calendar year is able to be created. Go to the SH900.1 - Summary of Work-Related Injuries and Illnesses page to view instructions on how to create and print the SH900.1.