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Report an occupational disease or injury

Reporting occupational injuries and diseases is required by 105 CMR 300.180. You should report cases should within 10 days of diagnosis or identification.
Learn more about occupational disease and injury reporting 

Contacts

Occupational Health Surveillance Program

Phone

Main office Call Occupational Health Surveillance Program, Main office at (617) 624-5632

The Details   of Report an occupational disease or injury

What you need   for Report an occupational disease or injury

Any health care provider who diagnoses or identifies a reportable condition must report the case to the Massachusetts Department of Public Health (DPH). Providers include physicians, nurses, psychologists, and social workers. The health care provider may designate a staff person to complete the report. They may report a case online, by mail or fax with this form (DOC), or by phone (617-624-5632). Reports may not be submitted by email. See more instructions below in How to report.

Reporting of occupational injuries and diseases as required by 105 CMR 300.180: OHSP collects and analyzes data on occupational injuries and diseases. Below is a list of conditions which health care providers are required to report to OHSP, pursuant to 105 CMR 300.180.

Learn more before submitting your report: Occupational Illness and Injury Reporting Brochure (DOCX)

  • Your name, address and phone number
  • Your patient’s name, address, phone number, race, sex, date of birth, occupation
  • The employer’s name, location, and type of business where the exposure/injury occurred
  • The confirmed or suspected diagnosis
  • Date of diagnosis
  • The suspected hazard or exposure, if known

How to report   Report an occupational disease or injury

Complete and submit the Confidential Report of Occupational Disease and Injury online form

Note: The online form, provided by REDCap (Research Electronic Data Capture), is a secure, HIPAA compliant web-based application for the electronic collection and management of data.

You may report an occupational disease or injury by calling the Occupational Health Surveillance Program at (617) 624-5632.

Note:

  • Disease outbreaks/clusters should be reported by phone

  1. Download and complete the Occupational Illness and Injury Reporting Guidelines and Confidential Reporting Form – for fax/mail submission (PDF) (DOCX)
  2. Fax the completed form to (617) 624-5696

  1. Download and complete the Occupational Illness and Injury Reporting Guidelines and Confidential Reporting Form – for fax/mail submission (PDF) (DOCX)
  2. Mail the completed form to:

    DPH Occupational Health Surveillance Program
    250 Washington St.
    4th floor
    Boston, MA 02108

Next steps   for Report an occupational disease or injury

What happens after a case is reported?

  • You may be contacted to see if immediate action is needed. In some cases, DPH may request patient medical records or other information, as authorized by law (105 CMR 300.191).
  • In some cases, the patient may be contacted for a telephone interview about the conditions at work that contributed to the disease or injury. Only patients who provide informed consent are interviewed.
  • Worksite follow-up may be initiated after considering:
    • Seriousness of the hazard
    • Number of similar cases
    • Advice of the reporting health care provider
    • The wishes of the patient
  • If appropriate, workplace evaluations will be conducted by a federal, state or local agency.
  • You will be informed of referrals or other efforts made on behalf of your patients to reduce workplace hazards.
  • Data are periodically summarized to identify industries and occupations in which workers are at risk.

More info   for Report an occupational disease or injury

Conditions health care providers are required to report

  • Work-related lung diseases
    • Asthma
    • Asbestosis
    • Silicosis
    • Chemical pneumonitis
    • Beryllium disease
  • Serious work-related injuries to persons less than 18 years of age. A serious work-related traumatic injury is defined as an injury which results in death or hospitalization, or, in the judgment of the treating physician, results in, or will result in:
    • Significant scarring or disfigurement; OR
    • Permanent disability; OR
    • Protracted loss of consciousness; OR
    • Loss of a body part of bodily function; OR
    • Is less significant but similar to injuries sustained by other patients at the same place of employment.
  • Work-related acute chemical poisoning
    • Carbon monoxide poisoning
    • Pesticide poisoning
    • Other acute poisoning
  • Work-related heavy metal absorption
    • Cadmium
    • Mercury
    • Lead (reported to the Occupational Lead Registry)
    • Other heavy metals
  • Work-related carpal tunnel syndrome
  • Work-related disease outbreaks
Required reporting of sharps injuries as required by 105 CMR 130.1001 et seq.

OHSP also collects and analyzes information regarding percutaneous injuries among healthcare workers providing care in a hospital or satellite unit covered by the hospital's license. The instructions and the Annual Summary for Sharps Injuries are listed in the downloads below.

Downloads   for Report an occupational disease or injury

Open PDF file, 23.7 KB,  Instructions for MDPH Annual Summary of Sharps Injuries (English, PDF 23.7 KB)
Open DOC file, 58 KB,  Instructions for MDPH Annual Summary of Sharps Injuries (English, DOC 58 KB)
Open XLS file, 240 KB,  Form for Annual Summary of Sharps Injuries, 2010 forward (English, XLS 240 KB)
Open PDF file, 11.06 KB,  Instructions for MDPH Bloodborne Pathogen Exposure Incident Recording (English, PDF 11.06 KB)
Open DOC file, 30.5 KB,  Instructions for MDPH Bloodborne Pathogen Exposure Incident Recording (English, DOC 30.5 KB)

Contact   for Report an occupational disease or injury

Address
250 Washington St., 4th Floor, Boston, MA 02108-4619
Directions 
Phone
Main office Call Occupational Health Surveillance Program, Main office at (617) 624-5632
Fax
(617) 624-5676
Confidential Reporting Fax (617) 624-5696

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