FROM THE MONTH OF:

Site Details
1

Contact Nos.

Name

Name of the Site

2
3
4
5
6
7

Location
Weight age
%

For
the
Mont

4
10

0
0

0
0

Target/
Sl. No

2
3

Elements

Leadership

Planning
Implementation
& Training

Leading Indicator

Safety meeting chaired by Project

Coordinator
Safety walk down participated by Project
Coordinator
Tool Box talk conducted by Project
Coordinator
Method statement Prepared &
implemented
Safety visit conducted by QHSE Engineer
Safety meeting conducted by QHSE
Engineer
Safety Walk down conducted
UA/UC identified(daily visit, walk down) &
closed in %

month

4
100%

Score

Training program conducted to staf

Training Program conducted to worker
Tool Box Talk conducted by Safety officer
Tool Box Talk conducted by Engineer
Safety reward for positive safety acts to
the workers
Safety Promotional activities(Emergency

4
5

Checking
Learning

1
1
30
30

4
4
10
10

5
15
4
1
2

1
100%
1
1
4

rehearsals, Demonstration & etc)

Essential PPE &usage compliance
Monthly Site safety audit conducted
Monthly Safety Report
Weekly Safety Report
Near miss Incident reporting &
implementation

Lead Score

100

Lagging Indicator
Average
Sl. No
1

Parameters

Target

Weighted MIR for 500 workers

Weight
age

Workmen

No.
of case
s

Scor
e

#DIV/0
!

#DIV/0
!

#DIV/0
!

-1
2

Weighted LTIR for 500 workers

0
-10

Weighted FAR for 500 workers

0
-100

Lag Score

Site Score
Acrony
ms

#DIV/0!
#DIV/0!

JSA
RCM
LTIR
CAPA

Job Safety Analysis

Resident Construction Manager
Lost Time Incident Rate
Corrective action Preventive action

HIRA
FAR
MIR

Hazard Identification & Risk Assessment

Fatal Accident Rate
Minor Injury Rate
Only Box should be filled