4.4b EMRUSR 02-11-2025OSHArs Form 300A (Rev.0412004)
Summary of Work -Related Injuries and Illnesses
Year 20 23
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ate paGenal Safety and Hcatth Admintstratten
Fotm approved OMB no. 1218-0176
All establishments covered by Part 1904 must complete this Summary page, even if no work -related injuries oril/nesses 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 Ifyou had no cases, write "0.'
Employees, former employees, and th eir representatives have the right to review the OSHA Form 300 in its enfirety. 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.
Total number of
Total number of
Total number of cases
Total number of
deaths
cases with days
with job transfer or
other recordable
away from work
restriction
cases
0
1
0
5
(G)
(H)
(1)
(J)
Number of Days
Total number of days
Total number of days of
away from work
job transfer or restriction
5
49
(K)
{L}
Injury and Illness Types
Total number of.. .
(M)
(1) Injuries
6
(4).Poisonings
0
(2) Skin disorders
0
(5) Hearing loss
0
(3) Respiratory conditions 0
(6) All other illnesses
0
Post this Summary page from February Ito 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 perrespome, including time to mview the instructions, search and gather the data needed, and
complete and review the collection of information. Petsons tie nat inquired to respond to the collection of information unless it displays a currently valid OMB control number_ Iryou have any
comments about these estimates or any other aspects of this data coflection, contact US Deportment 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.
Establishment information
Your establishment name Elk River Municipal Utilities
street 13069 Orono Parkway
CityElk River state MN Zip 55330
Industry description (e_g., Manufacture ofmotor truck trailers)
Municipal Utility - Electric and Water
North American Industrial Classification (NAICS), if known (e.g., 336212)
221122
Employment information (Ifyou don't have these figures, see the
Warksheet on the next page to estimate.)
Annual average number of employees 46
Total hours worked by all employees last year 84,026.00
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 Ivledge e ntrie,34e true, accurate, and complete
Company executive Title
Phone763-441-2020 Date February 6, 2024
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