Attachment 12 Form Weekly OSHA Recordable Injuries Illnesses.xlsx

This is a spreadsheet template for tracking OSHA recordable injuries and illnesses at Federal Law Enforcement Training Centers (FLETC). The form is designed to capture detailed incident information for both students and FLETC/Training Delivery Point (TDP) staff across FLETC locations. Required data fields include: date of injury/illness, date of initial treatment, individual name and status (student or staff), class name/number, position description, incident location, activity being performed at time of injury, medical diagnosis, number of restricted days if applicable, prescribed medications, dosage, and frequency of medication administration. The example provided documents a student injury occurring on December 15, 2024, at the Glynco location involving a femur fracture sustained during a raid exercise, treated with Motrin 800 mg prescribed at twice-daily dosage with a two-day restriction period. This template serves as a compliance and record-keeping tool for the Enterprise Health Unit Services contract (Solicitation 70LGLY26RGLB00001) supporting DHS FLETC operations at four Training Delivery Points: Glynco, Georgia; Artesia, New Mexico; Charleston, South Carolina; and Cheltenham, Maryland.