Request Injury and Illness Records 

[Date] 

[Company Manager] 
[Title] 
[Name of Company] 
[Address of Company] 
[City, State, Zip] 

Dear [ _________________ ]: 

This Local Union, as designated employee representative, is very interested in the health and safety of our members employed in the (name of the facility) located at (address of the facility). Pursuant to the requirements of 29 CFR 1904, please provide this office with copies of the OSHA 300 Logs for (previous 1-5 years, specify length) including names of all employees listed on the form (except privacy cases).

We would appreciate a response to this request within one (1) working day* of receipt of this letter. Thank you, in advance, for your consideration of this matter. 

Sincerely yours, 
[ __________________ ] 
[ __________________ ] 

cc: International Brotherhood of Teamsters Safety and Health Department 
25 Louisiana Avenue, N.W., Washington, D.C. 20001 

*The employer must provide to the requester (employees, former employees, and their authorized representatives) one free copy of the OSHA 300 Log(s) by the end of the next business day, (29 CFR 1904.35).