Note: Nature of Injury: say, Cut, Laceration, Bruises, Abrasion, Contusion, Fracture, etc.

Soma Enterprise Limited

(DFCC - Western Freight Corridor Project)

Monthly Injury Record

(To be recorded by the Site Safety Representative)
Month: ____________________
Name of the Construction Site / Bridge No.: ________________________

Body part First aid Whether

Date and Type of
Name of the Injured Sex/ Name of the injured and treatment given/ Brief description of the activity resumed
Sr. time of Injury
Person / Designation Age Contractor Nature of and name of the during accident duty or sent
No. accident (FAC/MTC/LTI)
Injury First Aider to hospital

Signature of the Site Safety Supervisor: _______________________

Name: _________________________________________________