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{"sheet":"PERRP Form 300P","index":0,"n_rows":48,"n_cols":19,"rows_kept":48,"cut":false,"hidden":false,"merged":[[17,5,24,5],[41,18,46,18],[20,11,23,11],[17,4,20,4],[41,17,46,17],[19,17,23,17],[40,1,40,17],[41,1,42,5],[41,16,46,16],[14,1,15,3],[8,12,8,18],[39,1,39,5],[22,9,23,9],[20,9,21,10],[19,11,19,12],[17,2,24,2],[20,12,23,12],[11,10,11,12],[9,12,9,18],[15,7,17,10],[13,9,13,17],[20,13,23,13],[19,15,23,15],[19,16,23,16],[17,3,24,3],[6,12,7,18],[14,7,14,18],[15,13,17,18],[10,11,10,18],[11,14,11,18],[15,11,17,12],[2,14,2,15],[3,12,3,18],[1,1,2,7],[17,1,24,1],[20,8,21,8],[6,1,11,6],[10,9,10,10],[22,10,23,10],[22,8,23,8],[14,4,15,6],[21,4,24,4],[22,7,23,7],[20,7,21,7],[19,14,23,14],[0,8,3,11],[0,14,1,16],[3,1,4,6],[0,1,0,7],[0,12,1,13],[4,12,4,18],[41,14,46,14],[41,15,46,15],[41,13,46,13],[44,5,46,7],[42,10,46,12],[41,6,41,12],[18,13,18,18],[18,11,18,12],[18,7,18,10],[17,6,24,6],[19,7,19,10],[19,18,23,18]]}
[null,"State of Ohio — Public Employment Risk Reduction Program — Form 300P (Rev. 09/2020)"]
[null,"Log of Work-Related Injuries and Illnesses"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Year"]
[null,null,null,null,null,null,null,null,null,null,null,null,"             "]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,"Establishment name"]
[null,null,null,null,null,null,null,null,null,"City ",null,null,null,"State","Ohio"]
[]
[]
[null,"Identify the person",null,null,"Describe the case",null,null,"Classify the case"]
[null,null,null,null,null,null,null,"CHECK ONLY ONE BOX for each case based on the most serious outcome for that case:",null,null,null,"Enter the number of days the injured or ill worker was:",null,"Check the injury column or choose one particular type of illness. If completing this form electronically, enter an X to indicate an injury or type of illness."]
[null,"(A)","(B)","(C)","(D)","(E)","(F)"]
[null,"Case number","Employee's name         (Last name, First name)","Job title      (e.g., welder)","Date of injury or onset of illness","Where the event occurred    (e.g., loading dock north end)","Describe injury or illness, parts of body affected and object/substance that directly injured or made person ill (e.g., second-degree burns on right forearm from acetylene torch)"]
[]
[null,null,null,null,null,null,null,"Enter a \"X\" to indicate case outcome if filling out electronically.",null,null,null,null,null,"(M)","Skin disorder","Respiratory condition","Poisoning","Hearing loss","All other illnesses"]
[null,null,null,null,null,null,null,"Death","Days away from work","Remained at work",null,"Away from work   (days)","On the job transfer or restriction (days)","Injury"]
[null,null,null,null,"(mo./day)"]
[null,null,null,null,null,null,null,null,null,"Job transfer or restriction","Other record- able cases"]
[]
[null,null,null,null,null,null,null,"(G)","(H)","(I)","(J)","(K)","(L)","(1)","(2)","(3)","(4)","(5)","(6)"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"Page totals    ",{"$f":"COUNTIF(H26:H39,\"=x\")","v":0},{"$f":"COUNTIF(I26:I39,\"=x\")","v":0},{"$f":"COUNTIF(J26:J39,\"=x\")","v":0},{"$f":"COUNTIF(K26:K39,\"=x\")","v":0},{"$f":"SUM(L19:L39)","v":0},{"$f":"SUM(M19:M39)","v":0},{"$f":"COUNTIF(N26:N39,\"=x\")","v":0},0,0,0,0,0]
[]
[null,null,null,null,null,null,"Be sure to transfer these totals to the Summary page (Form 300AP) before you post it. ",null,null,null,null,null,null,"Injury","Skin disorder","Respiratory condition","Poisoning","Hearing loss","All other illnesses"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"(1)","(2)","(3)","(4)","(5)","(6)"]

{"sheet":"PERRP Form 300AP","index":1,"n_rows":66,"n_cols":37,"rows_kept":66,"cut":false,"hidden":false,"merged":[[66,16,66,37],[60,17,61,30],[60,32,61,36],[62,32,62,36],[59,32,59,36],[62,17,62,30],[59,16,60,16],[56,32,58,36],[46,17,46,35],[52,17,54,36],[59,17,59,30],[22,17,23,36],[25,17,25,36],[26,30,26,32],[26,17,26,24],[30,17,31,36],[32,17,32,36],[41,17,41,35],[42,17,44,35],[48,17,48,35],[51,3,52,3],[22,1,23,7],[24,1,24,7],[65,11,65,14],[65,1,66,5],[25,4,30,4],[36,2,42,4],[25,7,27,7],[25,1,27,1],[43,1,43,7],[25,2,30,2],[44,1,45,7],[64,11,64,14],[36,6,42,7],[37,5,40,5],[37,1,40,1],[7,1,7,37],[28,16,28,37],[26,26,26,28],[11,17,11,22],[17,18,18,26],[25,5,27,5],[25,6,30,6],[12,18,13,36],[14,18,15,26],[15,34,15,35],[18,35,18,36],[20,17,21,36],[34,1,35,7],[25,3,27,3],[8,8,56,15],[67,1,67,37],[46,1,46,7],[47,3,48,7],[49,6,50,6],[47,2,51,2],[49,4,51,4],[64,28,64,36],[65,17,65,26],[65,28,65,36],[64,17,64,26],[56,17,58,30],[54,16,56,16],[50,16,50,37],[64,1,64,5],[64,6,64,10],[65,6,65,10],[0,37,1,37],[0,1,0,36],[2,1,3,16],[3,17,3,37],[1,1,1,34],[2,17,2,37],[5,1,5,37],[18,28,18,34],[8,16,9,37],[14,30,15,33],[10,24,11,36],[6,1,6,37],[8,1,21,7]]}
[]
[null,"State of Ohio — Public Employment Risk Reduction Program — Form 300AP (Rev. 09/2020)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Year",{"$f":"'PERRP Form 300P'!O3","v":0}]
[null,"Summary of Work-Related Injuries and Illnesses"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Establishment information"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'PERRP Form 300P'!L11","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Your establishment name"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Street"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'PERRP Form 300P'!K12","v":0},null,null,null,null,null,null,null,null,null,null,null,"Ohio"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"City",null,null,null,null,null,null,null,null,null,null,"State",null,null,null,null,null,"Zip code"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"County",null,null,null,null,null,null,null,null,null,null,"Entity code",null,null,null,null,null,null,"Select code from list"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Establishment description (e.g., elementary school, maintenance garage, wastewater treatment plant, administration building, MRDD workshop, library, hospital, extended care facility, etc.)"]
[]
[null,"Number of cases"]
[]
[]
[null,"Total number of deaths",null,"Total number of cases with days away from work",null,"Total number of cases with job transfer or restriction",null,"Total number of other recordable cases",null,null,null,null,null,null,null,null,null,"BWC policy number (e.g., 12345678-000)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Employment information"]
[]
[null,{"$f":"'PERRP Form 300P'!H40","v":0},null,{"$f":"'PERRP Form 300P'!I40","v":0},null,{"$f":"'PERRP Form 300P'!J40","v":0},null,{"$f":"'PERRP Form 300P'!K40","v":0},null,null,null,null,null,null,null,null,null,"For use ONLY by state agencies, special districts, counties, cities, villages and townships"]
[null,"(G)",null,"(H)",null,"(I)",null,"(J)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"By your definition, enter the total number of full-time and part-time employees, which includes seasonal workers. Enter police, fire, EMT and paramedics separately below."]
[]
[null,"Number of days",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Full time:       "]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Part time:           ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,"Total number of days away from work",null,null,null,"Total number of days of job transfer or restriction"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Fire/EMT Paramedic:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Police/Fire/EMT:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[]
[null,{"$f":"'PERRP Form 300P'!L40","v":0},null,null,null,{"$f":"'PERRP Form 300P'!M40","v":0},null,null,null,null,null,null,null,null,null,null,null,"For use ONLY by educational institutions (universities, colleges, technical schools, school districts)"]
[null,"(K)",null,null,null,"(L)",null,null,null,null,null,null,null,null,null,null,null,"Enter the total number of full-time and part-time employees that fit in the classification below. Do NOT include substitutes or volunteers in your employee count."]
[]
[null,"Injury and illness types"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Teachers/instructors:"]
[null,"Total number of…"]
[null,"(M)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"All others/support staff (e.g., administration, bus drivers, custodial, coaches, etc.)"]
[null,"(1)  Injury",null,{"$f":"'PERRP Form 300P'!N40","v":0},null,"(4)  Poisoning",null,{"$f":"'PERRP Form 300P'!Q40","v":0}]
[null,"(2)  Skin disorder",null,{"$f":"'PERRP Form 300P'!O40","v":0},null,"(5)  Hearing loss",null,{"$f":"'PERRP Form 300P'!R40","v":0},null,null,null,null,null,null,null,null,"Sign here"]
[null,"(3)  Respiratory",null,{"$f":"'PERRP Form 300P'!P40","v":0},null,"(6) All other illnesses",null,{"$f":"'PERRP Form 300P'!S40","v":0},null,null,null,null,null,null,null,null,null,"Knowingly falsifying this document may result in a fine."]
[null,"       condition",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"I certify that I have examined this document and that the entries are true, accurate and complete to the best of my knowledge."]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Administrator name (Print)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Title"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Administrator name (Signature)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[]
[]
[null,"Name of person completing or filing 300AP (print or type)",null,null,null,null,"Email address",null,null,null,null,"Phone number",null,null,null,null,null,"Phone",null,null,null,null,null,null,null,null,null,null,"E-mail address"]

{"sheet":"PERRP Form 301P","index":2,"n_rows":48,"n_cols":24,"rows_kept":48,"cut":false,"hidden":false,"merged":[[15,8,15,16],[29,9,29,16],[29,19,32,28],[30,9,30,16],[16,9,16,11],[16,12,16,16],[16,19,16,21],[16,25,16,28],[15,18,15,28],[50,1,50,28],[48,1,48,28],[49,1,49,28],[47,25,47,28],[47,19,47,24],[30,1,31,6],[28,8,30,8],[42,9,42,16],[41,18,46,18],[43,1,43,2],[43,3,43,6],[45,1,45,2],[45,9,46,16],[45,3,45,4],[44,1,44,2],[44,3,44,4],[42,1,42,3],[42,4,42,6],[40,1,40,3],[40,4,40,6],[31,9,31,16],[41,1,41,3],[41,4,41,6],[36,9,36,16],[34,9,34,16],[37,9,37,10],[37,11,37,12],[38,9,38,16],[39,1,39,6],[39,9,39,16],[32,8,38,8],[32,9,32,16],[33,9,33,10],[33,11,33,16],[8,7,47,7],[8,9,8,16],[9,8,9,16],[34,18,39,18],[35,9,35,10],[35,11,35,16],[22,10,22,11],[17,18,17,28],[18,9,18,11],[18,12,18,16],[19,8,19,16],[19,18,25,18],[25,9,26,16],[20,9,20,11],[20,12,20,16],[22,19,25,28],[18,19,20,28],[17,8,17,16],[26,19,28,28],[14,9,14,10],[14,11,14,12],[14,19,14,21],[14,24,14,28],[13,8,13,16],[10,23,10,28],[11,8,11,16],[11,18,11,28],[12,9,12,10],[12,11,12,16],[12,19,12,21],[12,23,12,28],[8,17,47,17],[8,18,9,18],[8,19,8,28],[42,19,46,29],[40,19,41,28],[36,19,39,28],[33,19,35,28],[9,19,9,28],[13,18,13,28],[10,9,10,11],[10,12,10,16],[1,1,2,15],[4,1,4,28],[5,1,5,28],[0,20,2,23],[7,1,7,28],[6,1,6,25],[6,26,6,28],[8,1,29,6],[1,25,1,28],[2,25,2,28],[27,9,27,16],[27,18,32,18],[28,9,28,16],[10,19,10,21]]}
[null,"State of Ohio — Public Employment Risk Reduction Program — Form 301P (Rev. 02/2021)"]
[null,"Injury and Illness Incident Report  "]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,"Information about the employee",null,null,null,null,null,null,null,null,null,"Information about the case"]
[]
[null,null,null,null,null,null,null,null,"1)","Full name",null,null,null,null,null,null,null,null,"12)","Case number from the Log",null,null,null,"(Transfer the case number from the Log after you record the case.)"]
[]
[null,null,null,null,null,null,null,null,"2)","Street",null,null,null,null,null,null,null,null,"13)","Date of injury or illness"]
[]
[null,null,null,null,null,null,null,null,null,"City",null,null,null,"State",null,"Zip code",null,null,"14)","Time employee began work",null,null,null,"(AM/PM)"]
[]
[null,null,null,null,null,null,null,null,"3)","Date of birth",null,null,null,null,null,null,null,null,"15)","Time of event",null,null,null,"(AM/PM)"]
[]
[null,null,null,null,null,null,null,null,"4)","Date hired",null,null,null,null,null,null,null,null,"16)","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.)"]
[]
[null,null,null,null,null,null,null,null,"5)","Job title"]
[]
[]
[null,null,null,null,null,null,null,null,"6)"]
[]
[null,null,null,null,null,null,null,null,null,"Information about the physician or other health-care professional"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"17)","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.)"]
[null,null,null,null,null,null,null,null,"7)","Name of physician, other health-care professional or first-aid provider"]
[]
[]
[null,"     "]
[null,null,null,null,null,null,null,null,"8)","If treatment was given away from the work site, where was it given?"]
[]
[null,null,null,null,null,null,null,null,null,"Facility",null,null,null,null,null,null,null,null,"18)","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 just using the words \"hurt,\" \"pain\" or \"sore.\" (Examples: strained lower back; chemical burn, right hand; carpal tunnel syndrome, left wrist.)"]
[]
[null,null,null,null,null,null,null,null,null,"Street"]
[]
[null,null,null,null,null,null,null,null,null,"City",null,null,null,"State",null,"Zip code"]
[]
[null,null,null,null,null,null,null,null,"9)","Was employee treated in an emergency room?"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"19)","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."]
[null,"Completed by"]
[null,null,null,null,null,null,null,null,"10)","Was employee hospitalized overnight as an in-patient?"]
[null,"Title"]
[]
[null,"Phone",null,null,null,"Date",null,null,"11)","Did the employee receive treatment classified as first aid at the work site or hospital?"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"20)","If the employee died, when did death occur?  Date of death"]

{"sheet":"Entity Codes","index":3,"n_rows":22,"n_cols":2,"rows_kept":22,"cut":false,"hidden":true,"merged":[]}
[null,"Entity Codes"]
[null,"Select code from list"]
[null,"ODNR  110"]
[null,"ODOT  120"]
[null,"ODRC  130"]
[null,"Other state agency  140"]
[null,"County commissioner 210"]
[null,"County engineer  220"]
[null,"County home (care center)  230"]
[null,"County MRDD  240"]
[null,"Other county agency  250"]
[null,"City  310"]
[null,"Township  410"]
[null,"Village  510"]
[null,"Comm./Tech College  610"]
[null,"College branch 620"]
[{"$f":"IF(C16=0,\"\",C15/C16)","v":""},"Joint vocational district  630"]
[null,"School district  640"]
[null,"Educational service center  650"]
[null,"University  660"]
[null,"University branch  670"]
[null,"Special district  710"]