Your Address
City, State, Zip
Date
Address
City, State, ZipDear (Name of Administrator):
As an employee (or union representative) of and pursuant to Federal OSHA regulation 29 CFR 1904.7, I request that a copy of the OSHA No. 200 Log and Summary of Occupational Injuries and Illnesses for the last calendar year be made available to me within 72 hours from the date of this request. The Log and Summary for the entire establishment is requested.
Sincerely,
(Signature)
(Print Name)
