Statewide Monthly Accident Report

June 2024-May 2025

"*" indicates required fields

Cooperative*

Select the reporting cooperative:

Month*

Select the reporting month:

Total Man Hours Worked

Number of OSHA Recordables Reported with No Lost Time

Number of OSHA Recordables with Lost Time

Number of Days Lost

Number of Days Restricted

Vehicle Miles Driven

Number of Vehicle Accidents

Number of Occupational Illnesses

Number of Public Injuries

Number of Public Deaths

Reportable Employee Accidents

Employee Name

Injury

Date

# of Days Lost

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Public Accidents

Date

Description

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Consent

I acknowledge to the best of my knowledge and belief the information submitted is correct.

Name

First Last

Electronic Signature: Please type your name.

Association of Louisiana Electric Cooperatives