OSHA for NEMT Companies in 2027: Injury Logs, Severe Injury Reports, Bloodborne Pathogens, and Who Is Exempt

OSHA, the federal job safety agency, protects your drivers, dispatchers, and office staff. It does not regulate how you treat riders. For a van company the real hazards are lifting and transfers, blood and body fluids, angry or confused passengers, heat, and the road. A few rules start the day you hire your first employee, and a few more start once you pass 10.

Does OSHA apply to a NEMT company?

Yes, once you have employees. The OSH Act gives every covered employer two duties (section 5). The first, called the general duty clause, is to keep the workplace free from recognized hazards that are causing or likely to cause death or serious physical harm. The second is to follow OSHA’s written standards.

• Who counts. Self-employed people are not covered, and the owners of a sole proprietorship or partnership are not counted as employees for recordkeeping. Temporary or leased workers you supervise day to day are yours to record (29 CFR 1904.31). If you use 1099 drivers, see NEMT drivers: 1099 or W-2.
• Your industry code. The 2022 federal industry manual puts NEMT companies in NAICS 485991, Special Needs Transportation, and ambulance companies in 621910. OSHA’s exemption and filing lists use these codes.
• Federal OSHA or your state. As of October 2026, 22 State Plans cover private employers: Alaska, Arizona, California, Hawaii, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Oregon, Puerto Rico, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, and Wyoming. Seven more cover only public workers. In Connecticut, Illinois, Maine, Massachusetts, New Jersey, New York, and the Virgin Islands, private companies answer to federal OSHA.

State Plans must use the same rules as federal OSHA for which injuries are recordable and how they are recorded (29 CFR 1904.37). They can add rules of their own, covered below.

What applies at each size

The duties grow with headcount. The first row applies to every company with an employee.

Your company	What OSHA requires
Any number of employees	Post the OSHA poster, report deaths and serious injuries, follow the standards that fit your work, and never punish anyone for reporting an injury
More than 10 employees at any time last calendar year	Keep the OSHA 300 log and 301 reports, post the 300A summary from February 1 to April 30, and keep it all 5 years
20 or more employees at one location	Also file the 300A summary online by March 2 each year
100 or more employees at one location	Also file the 300 log and 301 reports online by March 2

The online filing rows apply because NAICS 4859, which holds 485991, and 6219, which holds ambulance services, are both on OSHA’s filing lists (29 CFR 1904.41). Data for 2026 is due in OSHA’s Injury Tracking Application by March 2, 2027.

Injury and illness records: the 10-employee rule

If your company had 10 or fewer employees at all times during the last calendar year, you do not need to keep OSHA injury records unless OSHA or the Bureau of Labor Statistics tells you in writing (29 CFR 1904.1). The count is your peak for the whole company, not per location. OSHA counts full-time, part-time, temporary, and seasonal employees, and corporate officers who are paid, but not the owners of a sole proprietorship or partnership.

There is no second way out. OSHA’s list of partially exempt industries skips every ground passenger transportation code and ambulance services (29 CFR part 1904, Appendix A to subpart B). So an 11th employee at any point this year means a log starting next January 1.

What goes on the log

A work-related injury is recordable if it leads to death, days away from work, restricted work or a job transfer, medical treatment beyond first aid, or loss of consciousness, or if a doctor diagnoses a significant injury (29 CFR 1904.7). First aid has a fixed list, including:

• Nonprescription medicine at nonprescription strength, and tetanus shots
• Cleaning a wound, bandages, and butterfly strips
• Hot or cold packs, elastic wraps, and non-rigid back belts
• Massage, and drinking fluids for heat stress

Stitches, rigid braces, physical therapy, and chiropractic care are medical treatment. A driver who strains a back helping a rider and is sent to physical therapy is a recordable case. A work-related cut from a needle or a sharp object with another person’s blood on it is always recordable, and the name stays off the log as a privacy case (29 CFR 1904.8).

For a driver, the van and every stop are part of the work environment, because OSHA counts any place employees work and the equipment they use (29 CFR 1904.5). One exception helps: a crash in your company parking lot while an employee is commuting is not work-related.

The three forms and their deadlines

Form	What it is	Deadline
OSHA 300	The log: one line per recordable case	Enter each case within 7 calendar days of learning about it
OSHA 301	The incident report for each case. An insurance form with the same information can stand in.	Within 7 calendar days
OSHA 300A	The yearly summary, with zeros if you had no cases	Certify it and post it from February 1 to April 30

A company executive certifies the 300A: an owner of a sole proprietorship or partnership, a corporate officer, the highest-ranking official at the location, or that official’s direct supervisor (29 CFR 1904.32). Keep the log, the summary, and the 301 forms for 5 years after the year they cover (29 CFR 1904.33). An employee who asks for the log gets a copy by the end of the next business day, and an OSHA inspector gets your records within 4 business hours (29 CFR 1904.40).

Reporting a death or serious injury to OSHA

This rule applies to every employer, including companies too small to keep a log (29 CFR 1904.39). Report an employee’s work-related death within 8 hours. Report an in-patient hospital admission, an amputation, or the loss of an eye within 24 hours. Call your OSHA area office, call 1-800-321-6742, or report online. If the area office is closed, use the 800 number or the online form, never a voicemail or email.

Five details change the answer for a NEMT company:

1. Road crashes are excluded. A death or hospital admission from a motor vehicle accident on a public street or highway needs no OSHA report, unless it happened in a construction work zone. It still goes on your log if you keep one.
2. Injuries at the curb are not crashes. A driver who falls on a wheelchair lift or hurts a back during a transfer and is admitted must be reported within 24 hours.
3. Heart attacks count. A work-related death or admission from a heart attack must be reported, and the area director decides whether to investigate.
4. Timing limits. Report a death only if it happens within 30 days of the incident, and an admission only if it happens within 24 hours of it.
5. Observation does not count. An admission only for observation or diagnostic tests is not reportable.

Your broker, insurer, and state have their own deadlines for the same event. See NEMT vehicle accident for the crash steps and the incident report form for your own file.

Bloodborne pathogens: when drivers are covered

The bloodborne pathogens standard applies to employees with occupational exposure: reasonably anticipated contact with blood or other potentially infectious materials from doing their job (29 CFR 1910.1030). That includes any body fluid visibly mixed with blood. OSHA’s enforcement directive says an employee trained in first aid and identified as responsible for giving it as part of the job is covered (CPL 02-02-069, effective November 27, 2001). So is anyone whose job includes cleaning blood out of a van. A true Good Samaritan act, voluntarily helping a coworker, is not covered.

Several NEMT programs require the training outright:

• Kentucky. Drivers and escorts in the human service transportation program need orientation and safety training that includes bloodborne pathogens (603 KAR 7:080, certified April 25, 2025). See the Kentucky guide.
• Oregon. CareOregon’s manual (February 2024) requires first aid, CPR, and blood spill procedures courses before a driver carries any member, and a bloodborne pathogens spill kit in every vehicle. Greater Oregon Behavioral Health’s manual (revised July 2025) asks for bloodborne pathogens training every year. See GOBHI.
• Virginia. Stretcher van drivers and assistants need DMAS-approved training in handling bloodborne pathogens, and every vehicle carries a spill kit with absorbent, gloves, waste bags, a scrub brush, disinfectant, and deodorizer (DMAS, updated May 26, 2026).

What the standard requires

• A written exposure control plan that employees can see, reviewed at least once a year.
• An exposure determination listing the job titles with exposure, such as drivers, attendants, and whoever cleans vans.
• Gloves and other protective equipment at no cost to the employee.
• The hepatitis B vaccine, offered free after training and within 10 working days of first assignment. Anyone who declines signs the statement in Appendix A of the standard and can change their mind later.
• A free medical evaluation and follow-up after any exposure incident.
• Training at first assignment and within one year of the last session, at no cost, during working hours, in words your staff understand, with a chance to ask questions of someone who knows the subject.
• Records. Training records list the dates, a summary of the content, the trainer’s name and qualifications, and each attendee’s name and job title, kept 3 years. Medical records are kept for the length of employment plus 30 years.

For cleanup, OSHA’s March 9, 2010 letter calls EPA-registered tuberculocidal disinfectants, and household bleach (5.25 percent) diluted between 1:10 and 1:100 with water, appropriate for blood. Soap and water is fine for routine cleaning but not for blood. The vehicle cleaning checklist turns the rest of the standard’s housekeeping rules into a routine.

The first aid exception, and why it rarely fits

The same directive lets OSHA skip citing an employer that does not offer the vaccine in advance to a designated first aid provider, under strict conditions. First aid must be a side duty that responds only to workplace incidents, every incident involving blood must be reported before the end of the shift, and the full vaccine series must be offered within 24 hours of any such incident. The exception does not apply to health care, emergency, or public safety staff expected to give first aid in the course of their work. The directive does not say whether a driver who gives first aid to riders fits the exception, so the safe course is to offer the vaccine within 10 working days.

Lifting and transfer injuries

OSHA has no requirement on how much an employee may lift or carry. Its April 9, 2014 letter says so, and cites a recommended 35-pound maximum for patient handling under the revised NIOSH lifting equation, which is a voluntary guideline. OSHA’s nursing home guidelines (OSHA 3182-3R, 2009) add that an employer’s duty to address ergonomic hazards, such as lifting people, comes from the general duty clause, and they recommend keeping manual lifting to a minimum in all cases.

In practice, lifting is where the log fills up. Three habits keep it shorter:

• Match the move to the rider. A rider who needs more than 35 pounds of help needs equipment or a second person, not a stronger driver. The methods are in passenger transfer techniques.
• Keep lifts and ramps working. A lift that sticks turns into a manual lift. Log every repair on the wheelchair lift inspection log.
• Record back injuries honestly. Physical therapy or chiropractic care makes a case recordable. The claim side is in workers’ comp for NEMT drivers.

Workplace violence, heat, and driving

Violence. As of October 2026, OSHA has no specific workplace violence standard, so the general duty clause applies. OSHA lists working alone, working with volatile people, providing services and care, and late-night or high-crime areas as risk factors, and names taxi and ride share drivers and health care workers among those at higher risk. In 2023, 740 of the 5,283 fatal work injuries in the United States came from violent acts. The prevention program and the driver’s response in the moment are in difficult NEMT passengers.

Heat. There is no final federal heat standard as of October 2026. OSHA proposed one on August 30, 2024, and the 2026 regulatory agenda targets a supplemental proposal in December 2026 and a final rule in October 2027. Meanwhile OSHA runs a National Emphasis Program on indoor and outdoor heat hazards (CPL 03-00-024, April 10, 2026) and points to the general duty clause. Several states have their own heat rules, including Washington, Minnesota, California, Oregon, Colorado, and Maryland. Maryland’s standard, in effect since September 30, 2024, covers work at a heat index of 80 degrees or more but not a vehicle whose air conditioning or fan keeps the heat index below 80 (COMAR 09.12.32). A driver waiting in a parked van on a summer afternoon is exposed, so keep the air conditioning working and water on board.

Driving. OSHA’s motor vehicle standards are written for agriculture, maritime, and construction work. For other employers, its guidance calls for a mandatory seat belt policy, dispatch and rerouting procedures that do not distract drivers, and workloads that let drivers keep a safe speed. If you install an in-vehicle monitoring system, OSHA suggests telling drivers why and how it works. See the driver phone policy guide.

Chemicals, first aid, extinguishers, and the poster

• Cleaning chemicals. OSHA’s hazard communication standard exempts a consumer product used for its intended purpose, with no more exposure than a consumer would get (29 CFR 1910.1200). A driver who disinfects a van several times a shift may go past that. Then the standard applies: keep a safety data sheet for each product, keep a label on every container, and train staff on the hazards.
• First aid. Where no clinic or hospital is in near proximity, someone must be adequately trained in first aid, and supplies must be readily available (29 CFR 1910.151). A van on a rural route is often far from one. The course options are in CPR requirements for NEMT drivers, and the supplies are in the first aid kit checklist.
• Fire extinguishers. If you provide extinguishers for employees to use, inspect each one visually every month, give it a yearly maintenance check with the date recorded, and teach employees how to use it at hire and every year (29 CFR 1910.157).
• The poster. Every employer posts the OSHA Job Safety and Health poster, or the State Plan’s poster. For transportation companies it goes where employees report each day (29 CFR 1903.2).
• Injury reporting. Set a reasonable way for employees to report injuries, and tell every employee that they have the right to report and that you cannot punish them for it (29 CFR 1904.35). An employee who is punished can file a retaliation complaint with OSHA within 30 days (29 CFR 1977.15).

State Plan rules beyond federal OSHA

A State Plan can require written programs that federal OSHA does not. Three a NEMT owner will meet:

• California, Injury and Illness Prevention Program. Every employer has needed a written program since July 1, 1991 (8 CCR 3203). It names who runs it, sets inspections for hazards, investigates injuries, and trains staff. Employers with fewer than 10 employees may give safety instruction orally.
• California, workplace violence prevention plan. Required since July 1, 2024 (Labor Code 6401.9). Train employees when the plan starts and every year, log every violent incident, and keep the log 5 years. Places with fewer than 10 employees at a time are exempt only if the public cannot enter them and the employer follows the IIPP rule.
• Washington, accident prevention program. Every employer keeps a written program, with safety training, that is effective in practice (WAC 296-800-140).

Check your own State Plan’s rules before you rely on the federal minimum. See the California guide and the Washington guide.

OSHA penalties and free help

Penalties did not rise in 2026. The Department of Labor cancelled the 2026 inflation adjustment on May 27, 2026 (91 FR 31358), because the October 2025 price data it depends on was never published. So the 2025 amounts in 29 CFR 1903.15 still apply. A serious, other-than-serious, or posting violation can cost up to $16,550, and a failure to correct one up to $16,550 a day. A willful or repeated violation can cost up to $165,514, and a willful one at least $11,823.

As of October 2026, OSHA’s Field Operations Manual cuts the proposed amount by 70 percent for employers with 1 to 25 workers, 30 percent for 26 to 100, and 10 percent for 101 to 250. It can take off 20 percent more for history, up to 25 percent for good faith, and 15 percent for a quick fix. You have 15 working days from receiving a citation to contest it in writing.

Before any inspection, use OSHA’s On-Site Consultation Program. It is free, confidential, separate from enforcement, and run by state agencies or universities. Finding a hazard during a consultation does not lead to a citation or penalty, but you must fix any serious hazard within the agreed time (29 CFR part 1908). Requests from smaller businesses in higher-hazard industries get priority.

An OSHA checklist for a small NEMT company

1. Hang the poster where drivers report each day.
2. Write a one-page injury reporting procedure and give it to every employee with a note on their right to report.
3. Count your peak headcount for last year, drivers and office staff together. More than 10 means a log this year.
4. Set up the 300 log and 301 reports, and enter each case within 7 days. Post the 300A from February 1 to April 30.
5. Put the 8-hour and 24-hour reporting rules on a card in every van and at the dispatch desk.
6. List the jobs with blood exposure, write the exposure control plan, and offer the hepatitis B vaccine within 10 working days.
7. Train on bloodborne pathogens at hire and every year, and keep the sign-in sheets 3 years.
8. Stock gloves, a spill kit, and a first aid kit in every van, and train drivers to use them.
9. Keep safety data sheets for every cleaner your drivers use heavily.
10. Set a check-in routine for drivers alone on the road, and a rule for refusing an unsafe ride.
11. Plan for heat: working air conditioning, water in the van, and breaks on long waits.
12. Call your state’s consultation program for a free visit before an inspector or a broker audit finds the gaps.

OSHA paperwork sits next to your broker and Medicaid files. For how long to keep each kind of record, see NEMT record retention.