CONTRACTOR’S

WEEKLY EHS STATISTIC

REPORT FORM

 CONTRACTOR INFORMATION
CONTRACTOR PACKAGE NO.

COVERING DAYS: FROM TO

COMPILED BY SIGNATURE

 MAN-HOURS INFORMATION
NUMBER OF EMPLOYEES MAN-HOURS WORKED FOR THE WEEK

INJURY FREE DAYS NO. OF SAFETY PERSONNEL ON SITE

TOTAL MAN HOURS WORKED (PTD)

DATE OF LAST LOST TIME INJURIES (LTI)

LOST TIME INJURIES FREE WORK HOURS (LTIFWH)

 LAGGING INDICATORS

FATALITIES LOST TIME INJURY (LTI) MEDICAL TREATMENT INJURIES

RESTRICTED WORK INJURY FIRST AID INJURIES SECURITY INCIDENTS

FIRES DAMAGE BEHAVIOURAL VIOLATIONS

HEAT STRESS NO. OF DAYS LOST DUE TO HEAT STRESS

ENVIRONMENTAL INCIDENTS  LEVEL 1  LEVEL 2  LEVEL 3

 LEADING INDICATORS

REVISED RISK ASSESMENT WORK PERMITS

NEAR MISS REPORTS CLINIC VISITS

TASK HAZARD ANALYSIS EHS MEETINGS

EHS INDUCTIONS WEEKLY TOOLBOX MEETINGS

EHS SITE WALK DAILY SAFETY CREW MEETINGS

EHS INSPECTIONS SITE SPECIFIC TRAINING

EHS AUDITS SAFE PRACTICE OBSERVATIONS (SPO)

503406-AD0000-68AF-01702_R02 (2013-02-27)
 CONTRACTOR’S
WEEKLY EHS STATISTIC
REPORT FORM

EMERGENCY DRILLS WE CARE EHS BEHAVIOUR RECOGNITIONS

503406-AD0000-68AF-01702_R02 (2013-02-27)