HSE REPORTING REQUIREMENTS

Location Month

MAN HOURS Staff Contractors

Manhours No. of Persons Manhours No. of Persons
Office - 0 - 0 Contractors1
SITE 1 - Contractors2
SITE 2 Contractors3
SITE 3 Contractors4
SITE 4 Contractors5
SITE 5 Contractors6
Other Other

Total - -

SAFETY
FMO Staff Contractors 3rd Party Incident Risk Potential
Very High High Medium Low
Fatality 0 0
Total Lost Time Injury (LTI) 0 0
Days Unfit for work 0 0
Restricted Work Day Case (RWDC) 0 0
Medical Treatment Case (MTC) 0 0
First Aid Case (FAC) 0 0
Property Damage (>£500) (PD) 0 0
Minor Property Damage (<£500) 0 0
Near Miss (NM) 0 0

3rd Party Incident

No. of Observation Cards 0.00

Monthly HSE Activities: No. of HSE Audits 0.00 Description:

No. of HSE Exercises/Drills 0.00 Description:
No. of HSE Meetings 0.00 Description:
No. of HSE Training 0.00 Description:

Vehicle Information
Incident Category
C M S L
Motor Vehicle Crash 0 0 0 0 0 0

Incident Risk Potential

Very High High Medium Low
Other Vehicle Incident/NM 0 0 0 0 0 0

Vehicle Travel Distance 0 Miles - Miles

0 Miles 0 Miles
FAT LTI RWDC MTC
Key HSE Management System Issues and Improvements: 0 0 0 0
FAC PD MPD NM

0 0 0 0

Compiled by: . Checked by:

HSE REP Name
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