Monthly Safety Report

S.N Description Current Month Cumulative Total

Total Man-Hours since the last
1 Man – Days LWC
Cumulative Total Man-Hours

2 Man-Hours Worked

S.N Project Safety Activities Code Current Month Current Year Cumulative

1 Lost Workday Cases LWC

2 First Aid Cases FAC
3 Restricted Workday Cases RWC
4 Medical Treatment Only Cases MTOC
5 Vehicle Accident / Incident VA/VI
6 Fire F
7 Incident (others) Inc.
8 Fatal Accidents F Inc.
9 Near-Miss NM
10 HSE Violations HSEV
11 Monthly EHS Meeting HSEM
12 HSE Audits HSEA

Cumulative
Number of Cumulative
Total Man Number of
Culculation Code Events Man-hours
Hours Utilized Events
Conducted utilized
Conducted
13 HSE Induction/Orientation Program HSEI
14 Tool Box Meeting TBM
15 HSE Training HSET
Total Man Hours utilized for HSE
16 HSETMH
Awareness Training (hrs.)

Brief Summary of Significant or Noteworthy EHS Activities:

* LWC: [Total number of cases of the days lost due to occurrence of any accident which leads to injury or illness to the employees
which made him unable to attend next scheduled assignment / work]
* LWD: [The number of workdays the employee was away from work because of work related injury or illness]
* RWC : [A Restricted Work Day Case (RWC) is when the injured person is not able to conduct his/her own job and is given
alternative duties or when the person can function only for part of the full working day]
* MTOC [Medical Treatment Only Cases which allow the employees to perform their duties after
consultation with medical professionals. It can be a Lost Work Days or Restricted Work Days]

** Total Man Hours Utilized = No. of events * No. of Attendees * Duration period of an event conducted.

HSE Manager: Project Manager:

Signature: Signature: