Form 300A (Rev. 01r2004)
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. Rememberto review the Log to verify that the entn'es are complete and awurate
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. it you had no cases mite 

Employees employees, and their representatives have the right to review the OSHA Four: 300 in its
entirety. They also have limited awess to the OSHA Form 301 orits equivalent See 29 CFR 1904.35, in
OSHA 25 Recordkeeping rule, for further details on the access provisions for these 

NuMerdCasas

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
0 139 507 59

(G) (H) (I) (J)
Number of Days
Total number of days Total number of days of
away from work job transfer or restriction

4468 1 8035

(K) 
Injury and Rhea Type:
Total number 

(M)
(1) Injury 705 (4) Poisoning 0
(2) Skin Disorder 0 (5) Hearing Loss 0
(3) Respiratory
Condition 0 (6) All Other Illnesses 

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 ofintormation is estimated to average 58 minutes per response, including time to revierr the instruction, search and gatha
the data needed, and complete and review the collection of intorrnaiion Persons are not required to respond to the collection of information unless it displays a
cunently valid OMB control number If you have any comments about these estimates or any aspects of this data collection, cartact: US Department of Labor,
OSHA Of?ce of Statistics, Room N3644, 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 

Faun wed 

 

 

Establishment information

Your establishment name Tesla Factory
Street 45500 Fremont 
City Fremont State CA

Industry description (e 9., Manufacture of motortnick trailers)
Automobile Manufacturing

Standard industrial Classi?cation (SIC), if known (e SIC 3715)
3 7 1 1
OR North American Industrial Classi?cation (NAICS), if known (e 336212Employment information

Annual average number of employees 3173

Total hours worked by all employees last
year 16335417

Sign here

Knowingly falsifying this document may result in a ?ne.

  

 

Combarrymeu?ve 

650-681 
Phone

is document and that to the best of my knowledge the entries are true, accurate, and

Zip 94535


Title

1?Feb-17
Date

 

 

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