Attachment 12 Form OSHA.xlsx

Attachment 12 is an OSHA Recordable Injuries and Illnesses tracking spreadsheet template designed for the Federal Law Enforcement Training Centers (FLETC). The form captures comprehensive health and safety incident data for both students and FLETC/contracting organization (PO) staff across the four Training Delivery Points (TDPs): Glynco, Georgia; Artesia, New Mexico; Charleston, South Carolina; and Cheltenham, Maryland. The template requires documentation of incident date, initial treatment date, affected individual's name and status, class information for students, position description for staff, location of incident, description of activities at time of injury, clinical diagnosis (excluding pain), number of restricted duty days if applicable, and complete medication information including drug name, dosage, and frequency. The example provided documents a student injury occurring on December 15, 2024, involving a femur fracture sustained during a raid exercise at the Glynco location, with subsequent prescription of Motrin 800 mg administered twice daily and a two-day restricted duty period. This form serves as a compliance and reporting mechanism for occupational health and safety monitoring under the Enterprise Health Unit Services contract (Solicitation 70LGLY26RGLB00005) with the Department of Homeland Security's Federal Law Enforcement Training Centers.