District Requirements for Reporting A Serious Injury/ Illness to CalOSHA

Reporting must be done within 8 hours of the incident or knowledge of the incident

Cal/OSHA Enforcement Unit District Office

Phone: (707) 649-3700
Fax: (707) 649-3712

American Canyon District Office
3419 Broadway Street
Suite H8
American Canyon, CA 94503

Cal OSHA Reporting Checklist:

• Time and date of accident
• Employer’s name, address, and telephone number
• Name and job title or badge number of person reporting the accident
• Address of accident or event
• Name of person to contact at the site of accident
• Names & address of injured employee(s)
• Nature of Injury
• Location where injured employee(s) was (were) taken for medical treatment
• List and identity of other law enforcement agencies present at the site of accident/event
• Description of accident/event and whether the accident scene or instrumentality has been altered