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KUWAIT GULF OIL COMPANY

AL-KHAFJI JOINT OPERATIONS

(Proponent's Department Name)


KJO-6495-01 V1.0

CONTRACTOR SAFETY PERFORMANCE REPORT


Date:

Name of Project

Project Location

Name of Contractor

Date Started

Target Date of
Completion

Total Work Force

Man Hours Worked

Motor Vehicle

Name of

No. of

Previous

This

Total

Number of

Kilometer

Sub-Contractor (if any)

Workers

Month

Month

Todate

Vehicles

Driven

Total
Note: If there is no sub-contractor, please write the data on the space provided in total.
SAFETY PERFORMANCE

Key Areas

Number

Number

Total No.

This Month

Previous Month

Todate

Remarks

Fire
Lost Workdays
Disabling Injury
Medical Treatment Cases
First Aid cases
Motor Vehicle Accidents
Property Damage Accidents
Safety Training
Safety Peptalks/Tool box
Safety Committee Meeting
Emergency Drills

Comments/Remarks:

Prepared by:
Name

Designation/Position

Signature

Date

Name

Designation/Position

Signature

Date

Approved by:

Distribution:

Project's Proponent Department, ISD Safety Division, File

Note: Please submit this report every 25th day of each month or after project completed.

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