State OSHA plans: What changes when you are not under federal OSHA

If your hospital is in California, Michigan, Kentucky, one of eighteen other states, or Puerto Rico, you are not regulated by federal OSHA. You are regulated by a state plan: a state-run program that OSHA has approved as being at least as effective as its own.

The short answer

There are 29 OSHA-approved State Plans. Twenty-two cover private-sector employers as well as state and local government workers; the remaining seven cover only state and local government employees, leaving private hospitals in those states under federal OSHA. A state plan must be at least as effective as federal OSHA, so the core of recordkeeping is identical. What changes is the regulator, sometimes the forms, and the number you call. Confirm which applies to your establishment before answering any other recordkeeping question.

Most guidance written for occupational health quietly assumes federal jurisdiction. That assumption is wrong for a large share of American healthcare employers, and the places it is wrong are exactly the places that carry a penalty.

Who is actually under a state plan?

There are 29 OSHA-approved State Plans. Twenty-two cover private-sector employers as well as state and local government workers. The remaining seven cover only state and local government employees, leaving private employers in those states under federal OSHA.

That second category trips people up. A private hospital in a state-and-local-only plan state follows federal rules, while the county hospital down the road follows the state plan. Two employers, one city, different regulators.

Before anything else, confirm which applies to you. It is a five-minute check on OSHA's State Plans page and it determines everything below.

What stays the same everywhere

A state plan must be "at least as effective as" federal OSHA. In practice that means the core of recordkeeping is identical, and you should not expect these to differ:

• The recording criteria in 1904.7, death, days away, restricted work or transfer, medical treatment beyond first aid, loss of consciousness, and significant diagnoses.
• The definition of work-relatedness and its exceptions.
• The requirement to keep a log, complete an annual summary, and produce an incident report for each recordable case.
• The five-year retention of the log, summary and incident reports.

If a clinical decision about recordability would be right under federal rules, it is almost certainly right under a state plan too. The judgment does not change.

What differs

The forms may not be called 300, 300A and 301

Several states publish their own versions. California's are the Cal/OSHA Form 300, 300A and 301, recognizably the same documents with state-specific headers and instructions. Using the federal form where a state form is required is the sort of finding that turns a routine inspection into a citation for something trivial.

Reporting deadlines for severe events can be shorter or broader

Federal rules require reporting a work-related fatality within 8 hours, and an in-patient hospitalization, amputation or loss of an eye within 24 hours. State plans may define the triggering events more broadly, or require reporting to a state number rather than to federal OSHA.

This is the difference most worth getting right, because the clock starts at the moment you learn of the event and there is no version of "we were checking the rule" that recovers the time.

Some states add requirements federal OSHA does not have

State plans may adopt standards with no federal equivalent. California's requirement for a written Injury and Illness Prevention Program is the best-known example, a documented program with responsibility assigned, hazard identification and correction, training and recordkeeping. Several other states have comparable program requirements.

Electronic submission may run through a different portal

Federal electronic submission goes to OSHA's Injury Tracking Application. Most state plan states participate, but confirm the destination and the deadline rather than assuming, particularly in the first year you are required to submit.

What this means if you operate in more than one state

A health system spanning a state plan and a federal state has two compliance regimes at once. Two consequences follow.

First, keep the log per establishment. That is a federal requirement regardless, but it also keeps a Cal/OSHA establishment from being folded into a federal one at year end.

Second, do not standardize on whichever form your largest site uses. It is a natural instinct and it produces the wrong form at every other site.

A short checklist

• Confirm, per establishment, whether you are under federal OSHA or a state plan.
• Download that jurisdiction's current forms rather than reusing last year's file.
• Write the severe-event reporting number and time limit somewhere a charge nurse can find it at 3 a.m.
• Check whether your state adds a program requirement, a written prevention program, additional training, or extra postings.
• Confirm where your electronic submission goes before the filing window opens.

None of this changes what belongs on the log. It changes the paperwork the log lives in, which is the part an inspector looks at first.

Where to check

OSHA maintains a directory of approved State Plans with links to each state's own recordkeeping guidance. Because plan details are amended by the states themselves, verify against your state's plan rather than a secondary source, including this one, before relying on it for a filing.