Mistake 1 — Treating Diagnostic Imaging as Medical Treatment
X-rays, CT scans, MRIs, ultrasounds, and laboratory tests used for diagnostic purposes are explicitly not medical treatment under 29 CFR 1904.7(b)(5)(i). A worker can be evaluated in the emergency department, undergo a CT scan of the head after a struck-by event, receive OTC ibuprofen at OTC strength, and be sent home. The case is not recordable on a treatment basis.
The error appears most often when employers assume that any ER visit is automatically recordable. The setting is irrelevant. What matters is what was done — diagnostic imaging plus first aid does not equal medical treatment.
The flip side: imaging used for treatment, such as fluoroscopy during a closed reduction, is part of medical treatment because the imaging is integral to the procedure.
Mistake 2 — Counting OTC at OTC Strength as Treatment
Non-prescription medications at non-prescription strength are first aid. Ibuprofen 400 mg, naproxen 220 mg, acetaminophen 500 mg — all over the counter. Recording a case as recordable on the basis of OTC analgesics is one of the most frequent over-recording errors.
The reverse is also a mistake. A provider who prescribes ibuprofen 800 mg three times daily has prescribed at prescription strength. The OTC product is the same molecule, but the prescribed regimen is medical treatment. Document the dose recommended, not the brand.
Clinical note: A common chart phrase like “ibuprofen as directed” without a specific dose is ambiguous. Confirm with the provider whether the recommendation was OTC strength or prescription strength before classifying.
Mistake 3 — Ignoring the Recommendation Rule
29 CFR 1904.7(b)(5)(ii) makes clear that medical treatment recommended but not received still triggers recordability. The most common version: a physician prescribes a course of physical therapy, the employee never schedules an appointment, the employer concludes there was no treatment, the case is not recorded.
That conclusion is wrong. The recommendation alone is the trigger. The same rule applies to prescription medications declined by the employee, surgery declined, or sutures refused at the time of evaluation — if a professional recommended treatment, the case is recordable on that recommendation.
Mistake 4 — Confusing Splint and Brace Rigidity
An elastic wrap or non-rigid support is first aid. A rigid stay, thermoplastic shell, plaster cast, or thumb-spica with metal stay is medical treatment. The presence of any rigid component used for immobilization shifts the case.
The exception is temporary immobilization during transport — a sling, splint, or back board placed to move an injured worker to definitive care is first aid even though it is rigid, because it is being used for transport, not for ongoing treatment. Once the rigid device is dispensed for the worker to wear during their shift or at home, it is medical treatment.
Mistake 5 — Excluding Cases for Employee Fault
OSHA recordability is no-fault. Whether the employee violated a safety rule, ignored training, used drugs, was speeding, or was negligent has no bearing on recording. The presumption of work-relatedness in 29 CFR 1904.5(a) attaches to events occurring in the work environment regardless of fault.
The narrow exceptions in 1904.5(b)(2) — a personal task unrelated to employment, recreational activity, common cold and flu, willful self-inflicted harm, voluntary participation in wellness programs, food consumed for personal nutrition — are exceptions to the work-environment presumption itself, not exceptions for misbehavior. A worker injured while breaking a posted safety rule on a job task is still recordable.
Mistake 6 — Misclassifying Personal Task Exceptions
The 1904.5(b)(2)(v) exception for tasks unrelated to employment is narrow. It applies when the employee is voluntarily performing personal tasks unrelated to work, during the work shift but outside assigned duties. Eating lunch is the canonical example.
Errors arise when employers stretch the exception to cover routine work activities. A worker injured walking to a workstation is in the work environment and is recordable. A worker injured reaching for personal belongings during a break still raises a fact question — was the employee on duty, was the task voluntary, was it for the employee's personal benefit? Apply the exception conservatively.
Mistake 7 — Mishandling Pre-Existing Condition Aggravation
Pre-existing conditions become recordable when the work environment significantly aggravates them — meaning the workplace caused the condition to require treatment beyond what would have been needed without work exposure, or to result in days away, restriction, or transfer that would not have occurred otherwise.
The error pattern: a worker with chronic low back pain has an acute flare on a normal lifting task, sees a provider, gets a prescription muscle relaxant, the employer declines to record because “the back was already bad.” If the muscle relaxant prescription exceeds the prior baseline of care, the work significantly aggravated the condition. Recordable.
Mistake 8 — Counting Only Work Days for Days-Away
Calendar days govern. The day count includes weekends, scheduled days off, and holidays during the period the employee was unable to work. A worker injured Friday and released back to work the following Monday has at least two days away, even if they were not scheduled to work on the weekend.
Mistake 9 — Recording Recurrence as a New Case
When the same condition in the same employee recurs without a new injurious event, the recurrence is added to the original case. A worker recorded with three days away in March who is out two more days in July with the same lumbar strain has 5 days on the original line.
When a new event causes a separate injury, even if to the same body part, a new case is recorded. The distinction is whether a new event occurred. New event, new case. No new event, update the original.
Mistake 10 — Failing to Update for Seroconversion or Late Diagnosis
29 CFR 1904.33(b) requires updates to the 300 Log during the five-year retention period when new information becomes available. The most operationally important examples are seroconversion after a recorded needlestick (HIV, hepatitis B, hepatitis C), reclassification of a recorded injury to an illness when a chronic disease emerges, and re-categorization to fatality when a previously recorded case results in death.
Updates are not optional. A 300 Log that ignores developments creates inaccurate records and exposes the employer to recordkeeping citations.
Mistake 11 — Confusing Restriction with Transfer
Restriction means the employee is in the same job but cannot perform one or more routine functions or full hours. Transfer means the employee is performing a different job. Both fall in Column I (job transfer/restriction) on the 300 Log, so the column selection error is rare. The classification matters for internal management of the case, including return-to-work planning, but does not change recordability.
Mistake 12 — Treating Observation Visits as Treatment
A visit for evaluation, observation, or counseling without a treatment provided does not make a case recordable. A worker sent to the company clinic after a near-miss for a wellness check, evaluated, found uninjured, and released without treatment has had an observation visit. Not recordable on the basis of that visit alone.
Conversely, a visit that produces a recommended course of physical therapy, even if not yet started, has produced a recommendation for medical treatment and is recordable.
Mistake 13 — Misclassifying Infectious Disease
The common cold and flu are excluded from work-relatedness by 29 CFR 1904.5(b)(2)(viii). Other infectious diseases are evaluated under the general work-relatedness rule — did an event or exposure in the work environment contribute? In healthcare, food service, schools, and congregate settings, the contribution analysis often results in recordable cases for tuberculosis, hepatitis, meningitis, and other transmissible illness when there is a documented workplace exposure source.
COVID-19 work-relatedness analysis followed the same general rule when active enforcement criteria were in place. Without a documented workplace exposure source, attribution was difficult; with a known case in close contact, the workplace contribution was usually established.
Mistake 14 — Recording Only When the Employee Reports
The employer's recordkeeping obligation does not depend on a formal employee report. Information from medical providers, supervisors, witnesses, security cameras, workers' compensation filings, and external healthcare claims can each trigger the obligation to evaluate a case for recordability. Once the employer has notice of a potential case, the evaluation begins.