Monthly HSE PerformanceReport REV2

Weekly HSE Performance Report Page 1 of 2
LOGO
MONTHLY CONTRACTOR HSE
RELATED DOCUMENT
PERFORMANCE REPORT
Last Reviewed: Version: 02
* Mandatory reporting fields *Week : Year:

*Business Area : Civil Works Electrical Transportation Erection Commissioning:
Operation / Project:

*CONTRACT COMPANY:

Prime Contractor? Yes No
SUB – CONTRACTOR

COMPANIES:
Contacts: Name Contact Number
Project Manager
Site Manager
HSE Manager
QSE Coordinator
Environmental Quality

Manager :
CUBE HSE Manager :
WEEKLY HS&E PERFORMANCE

LAGGING INDICATORS Monthly Year to
By Business Area Total Date LEADING INDICATORS Monthly Year to
By Business Area Total Date
* OHS Near Misses (#)

*Environmental Near Misses Inductions

*Environmental Accidents (#) Pre job meetings

*First Aids (#) Toolbox meetings

*Medical Treatments (#) OHS Hazardous Observations

*Lost Time ( # > 3 days) Environmental Hazardous Observations

*Lost Time ( 1 < # < 3 days) Corrective actions

*Other Recordable (#) Corrective actions closed
*Lost Work Days Good Ideas reports
*Restricted / Modified Work Days Inspections ( foremen )
*Occupational Illnesses (#) Audits ( Supervisors )

*Injury Incidents Investigations
Audits ( HSE & Project Management )
closed (#)
*Reportable Environmental

Incidents (#)
*Total Number of Workers
*Hours Worked (Regular)
*Hours Worked (Overtime)
*Total Exposure Hours

Total Recordable Injury
Frequency
REGULATORY ACTIONS OR INSPECTIONS
Weekly HSE Performance Report Page 2 of 2
Yes No
If yes, provide regulatory agency and description of action taken
Injury Statistic Definitions

Near Miss – An incident that could have, but did not, result in unintended harm or damage.
Environmental Accident: Any hazardous chemical release to the soil or the aquatic environment , accidental animal killing or poisoning due to contact
with hazardous chemicals , any construction activity in areas of botanical importance or areas of endangered flora species.
First Aid Injury – An Occupational Injury/Illness that requires first aid treatment only and does not result in loss of time from work or Restricted Work.
First Aid Injuries include:
a) Use of non-prescription medications at a non-prescription strength, including antiseptics;
b) Administration of tetanus or diphtheria shot(s) or booster(s). Other immunizations such as Hepatitis B vaccine or rabies
vaccine related to an injury are considered medical treatment;
c) Cleaning, flushing or soaking wounds on skin surface;
d) Use of wound coverings such as bandages including liquid bandages, gauze pads, steristrips or butterfly bandages, etc. Wound
closing devices such as staples, sutures and skin glue are considered medical treatment;
e) Use of any hot/cold therapy (e.g., compresses, soaking, whirlpools, non-prescription skin creams / lotions for local relief, etc.);
f) Use of any totally non-rigid, non-immobilization means of support (e.g., elastic bandages, wraps);
g) Use of temporary immobilization devices while transporting an accident victim;
h) Drilling of a nail to relieve pressure or to drain fluid from a blister;
i) Use of eye patches;
j) Removal of foreign bodies not embedded in the eye if only irrigation or removal with a cotton swab is required;
k) Removal of splinters or foreign material from areas other than eyes by irrigation, tweezers, cotton swabs or other simple means;
l) Use of finger guards;
m) Use of massages; and,
n) Drinking of fluids for relief of heat stress.
Medical Treatment – A classification of Occupational Injury/Illness for Medical Treatment beyond First Aid Injury where there has been no Lost Days.
The following are not considered Medical Treatment Injuries:
a) Visit(s) to a health care provider limited to observation or counseling or prescribed Restricted Work;
b) Diagnostic procedures (e.g., X-rays, blood tests), including the use of prescription medications solely for diagnostic purposes (e.g.,
eye drops to dilate pupils).
Lost-Time Injury – An injury/illness resulting in Lost Days beyond the date of injury as a direct result of an Occupational Injury/Illness incident.
Other Recordable Injury/Illness
Restricted Work – When an employee, due to a work-related injury/illness, is medically determined to be unable to perform one or more routine
functions or unable to work the normal time period of their pre-injury/illness work day, they are working in a “restricted” capacity. Routine functions
are the work activities that employee regularly performs at least once a week.
Loss of Consciousness – Is a work-related, altered state of consciousness that can vary from disorientation to time, place or person, to coma.
For reporting purposes, the Loss of Consciousness must be witnessed or medically substantiated as related to a work activity or exposure.
Recordable Injury – Any Occupational Injury/Illness that results in an employee experiencing:
a) Fatality;
b) Lost-Time Injury;
c) Medical Treatment Injury; or
d) Other Recordable injury/illness (not captured above), which has:
i) Restricted Work; or
ii) Significant Occupational Injury./Illness; or
iii) Loss of Consciousness.
Lost Days – The number of calendar days that the employee is unable to work beyond the day of injury/illness recommended by a physician or other
health care professional. Lost time ends as of the date that the employee is deemed fit to work either full or Restricted Work or to a maximum of 180
calendar days for any individual case. For cases where the disability will continue beyond the closing date, Lost Days and Restricted Days shall be
estimated on the basis of medical opinion as to probable ultimate disability and included in the data submission. Lost Days are only recorded for the
period that the injured person is in the employ of the company.
Restricted Days – The number of calendar days to a maximum of 180 days during which the employee is subject to Restricted Work, based on the
recommendation of a physician or licensed health care professional, for an individual case. For cases where the disability will continue beyond the
closing date, Lost Days and Restricted Days shall be estimated on the basis of medical opinion as to probable ultimate disability and included in the data
submission. Restricted Days are only recorded for the period that the injured person is in the employ of the company.
Exposure Hours – Exposure to injuries shall be measured by the total number of hours of employment (i.e., the actual worked hours) of all employees
for each contractor and sub-contractor companies for the reporting period.
Total Recordable Injury = Number of Recordable Injuries X 200,000

Frequency Rate Total Exposure Hours

Monthly HSE PerformanceReport REV2

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Weekly HSE Performance Report Page 1 of 2

* Mandatory reporting fields *Week : Year:

Operation / Project:

Project Manager

Site Manager

HSE Manager

WEEKLY HS&E PERFORMANCE

*Lost Work Days Good Ideas reports

*Restricted / Modified Work Days Inspections ( foremen )

*Occupational Illnesses (#) Audits ( Supervisors )

*Hours Worked (Regular)

*Hours Worked (Overtime)

*Total Exposure Hours

Injury Statistic Definitions

Total Recordable Injury = Number of Recordable Injuries X 200,000

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