Forms REFERENCED IN VA OSH PROGRAM

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Forms REFERENCED IN VA OSH PROGRAM 1. Department of Labor (DOL) Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation. 2. DOL Form CA-2, Notice of Occupational Disease and Claim for Compensation. 3. DOL Form CA-6, Official Superior's Report of Employee's Death. 4. OSHA Publication 2014, Appendix A, Log of Federal Occupational Injuries and Illnesses. 5. SF 91, Operator's Report of Motor Vehicle Accident. 6. VA Form 2162, Supervisor's Injury and Illness Investigation Report. 7. VA Form 2165, Safety, Occupational Health and Fire Protection Evaluation 8. VA Form 2180, VA Occupational Safety and Health Poster. 9. VA Form 10-2633, Report of Special Incident Involving a Beneficiary. 10. VA Form 3831c, Daily Report of Employees' Injuries.

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