Form 300A (Rev. o1r2004)
Summary of Work-Related Injuries and Illnesses

All establishments covered by Part 1904 must complete this Summary page, even if no 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 

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 1904. 35, in
OSHA 's Recordkeepr?ng rule, for further details on the access provisions for these forms.

 

Number of Cases
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
0 267 493 80
(G) (H) (J)

Number of Days

Total number of days of
job transfer or restriction

Total number of days
away from work

 

13608 33314
(K) (L)
Injury and Illness Types

Total number 

(M)
(1) Injury A (4) Poisoning 
(2) Skin Disorder 0 (5) Hearing Loss 0
(3) Respiratory
Condition 0 (6) All Other 0

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 instruction, 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 aspects of this data collection, contact: US Department of Labor.

OSHA Of?ce of Statistics, Room N-3644, 200 Constitution Ave, NW, Washington, DC 20210. Do not send the completed forms to this of?ce.

Year 

U.S. Department of Labor

Occupational Safety and Health Administration

Form approved OMB no. 1218-0176

 

 

Establishment information

Your establishment name Tesla Factory
Street 45500 Fremont 

City Fremont State CA

Industry description Manufacture of motor truck trailers)
Manufacturing Electric Vehicles

Standard Industrial Classi?cation (SIC), if known SIC 3715)

 

3 7 1 1
OR North American Industrial Classi?cation (NAICS), if known 336212Employment information

Annual average number of employees 9173

Total hours worked by all employees last
year 2083511529

Sign here

Knowingly falsifying this document may result in a ?ne.

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

Company executive

(57g) (903* 67009.?

Phone

complete. 
Git/Warm?


vr ?owered

Zip 94538

Title

.J. 
ET ?3 

Date