Doc No.

AP/SFT/408/MSSR

ADVENT PROJECTS & CONSULTANCY SERVICES PVT. LTD. Rev 01

MONTHLY SAFETY STATISTICAL REPORT

PROJECT HSE REPORT

Name of Project: - Execution Start Date: -

Scope of Work: - Month Name:-
Date of report: - Report No:-

DESCRIPTION THIS MONTH CUMULATIVE

Total Strength(Staff + worker)

Number of HSE Meeting organized at site

Number of HSE awareness programs

conducted at site Including Mass Trainings

Number of near Miss happened

Number of Fatal Accidents

Number of Loss Time Accidents(other than

fatal)

Other accidents(Non loss time)

Number of First Aid reported.

Total man-hours worked(staff + workman) Hrs Hrs

Man –days lost due to Accidents(including

Fire)

Accident free Man – hours (i.e. period worked

without encountering any LTA)

Frequency Rate (No of LTA X 10 / Total Man-

hours worked)
Severity Rate (No of Man-days lost due to LTA
X 10 / Man-hours worked.)

Advent Projects and Consultancy services Pvt. Ltd. Pune|India

 Doc No. AP/SFT/408/MSSR

ADVENT PROJECTS & CONSULTANCY SERVICES PVT. LTD. Rev 01

MONTHLY SAFETY STATISTICAL REPORT

MONTHLY SAFETY REPORT

Sl. No. Description of activity Nos.

1 No. of Persons Given Safety Induction
2 No. of tool box meetings conducted
3 No of Daily Hazard Observation Issued
4 No of Daily Hazard Observation not complied
5 No. of Safety NCR’s Issued
6 No. of NC Not complied
7 No. of Safety Instructions Issued
8 No. of weekly safety walk conducted

Achievement of this Month:-

Target for next Month:-

Note/Remarks:-

Advent Projects and Consultancy services Pvt. Ltd. Pune|India

 Doc No. AP/SFT/408/MSSR

ADVENT PROJECTS & CONSULTANCY SERVICES PVT. LTD. Rev 01

MONTHLY SAFETY STATISTICAL REPORT

Signature of Signature of Signature of

Safety In-Charge Safety Manager Project Manager

Advent Projects and Consultancy services Pvt. Ltd. Pune|India