Which States Have Their Own OSHA Plan: The Full List for Healthcare Employers

Before you can answer any recordkeeping question, you have to answer a prior one: whose rules apply to this establishment. For a large share of American healthcare employers the answer is not federal OSHA, and most guidance quietly assumes otherwise.

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, which means private hospitals in those states are regulated by federal OSHA.

The three categories, and why the middle one catches people

1. State Plan covering private employers

Twenty-two states. If your hospital is private and sits in one of them, your regulator is the state, your forms may be the state's own, and your reporting number is a state number. Federal OSHA guidance is a decent approximation and is not the rule you are held to.

2. State Plan covering public employees only

Seven jurisdictions. This is the category that produces the most confusion, because two hospitals in the same city can have different regulators. The county hospital follows the state plan; the private hospital across town follows federal OSHA. Staff who move between them carry the wrong assumptions with them.

3. No State Plan

Federal OSHA covers private employers directly. State and local government employees in these states are generally not covered by OSHA at all, which is its own surprise for a county-run facility.

How to find your answer in five minutes

1. Take each establishment separately. A health system spanning states has more than one answer.
2. Check OSHA's State Plans directory for that state, and read whether the plan covers private employers or public employees only.
3. Confirm your own status: private, non-profit private, county, city, or state.
4. Write the answer down per establishment, because it determines everything downstream.

What stays the same in a State Plan state

A state plan must be "at least as effective as" federal OSHA, so the core does not move:

• The recording criteria: death, days away, restricted work or transfer, medical treatment beyond first aid, loss of consciousness, significant diagnosis.
• The definition of work-relatedness and its exceptions.
• A log, an annual summary, an incident report per recordable case.
• Five-year retention of the log, summary and incident reports.

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

What actually differs

• The forms. Several states publish their own. California's Cal/OSHA 300, 300A and 301 are field-identical to the federal versions but carry a different caption, agency, authority and citations, plus one added falsification warning on the 300A. Using the wrong masthead is the sort of finding that makes a routine inspection into a citation for something trivial.
• Severe-event reporting deadlines. Federal gives 8 hours for a fatality and 24 for an in-patient hospitalization. California gives 8 hours for both, and counts any inpatient admission rather than an overnight stay. That single difference is the most consequential item on this page.
• Additional standards with no federal equivalent. California's aerosol transmissible diseases standard and its healthcare workplace violence standard are the clearest examples. Washington requires an investigation of every violent incident.
• Where electronic submission goes. Most state plan states participate in the federal Injury Tracking Application, but confirm rather than assume, especially in a first filing year.

If you operate in more than one state

Two rules that prevent most of the damage:

• Keep the log per establishment. Required anyway, and it stops a Cal/OSHA establishment being folded into a federal one at year end.
• Do not standardize on your largest site's forms or process. It is the natural instinct and it produces the wrong form everywhere else.

Where to check

OSHA maintains the directory of approved State Plans with links to each state's own guidance. Because states amend their own plans, verify against your state rather than any secondary source, this one included, before relying on it for a filing.

Related reading: what changes for recordkeeping under a state plan, and how carefoundryESC handles jurisdiction differences.