MONTHLY HSSE STATISTIC AND PERFORMANCE

Name of Project /
Division / Area

This Month
No. Data Required Units Sub-
PESB TOTAL
contractor
GENERAL
1.1 Man hours worked NO.
1.2 Man hours since last LTI NO.
2 Senior Management Site Visits (Mgr's and above) NO.
3 Site HSE Committee Meetings NO.
4.1 A Internal HSE-MS Audits NO.
U
4.2 D Internal HSE-MS Audit Action Items Closure %
I
4.3 T Contractor HSE-MS Audits NO.
6.1 Contractors HSE-MS Evaluation during bidding NO.
6.2 Contractors Performance Evaluation for completed projects NO.
SAFETY
7 Noise Mapping NO.
8 CHRA NO.
9 PTW Assessment/Review NO.
10 Medical Evacuation (MEDEVAC) NO.
HSE DRILLS
11 Please Indicate :
NO.

U-SEE-U-ACT
12 Unsafe Act NO.
13 Unsafe Condition NO.
INCIDENTS
14 Fatalities NO.
15.1 Permanent Total Disabilities NO.
15.2 L Permanent Partial Disabilities NO.
T
15.3 I Lost Workday Case NO.
15.4 Workdays Lost Days
16 Restricted Work Cases NO.
17 Medical Treatment Cases NO.
18 First Aid Cases NO.
19.1 P Property Damage/Loss NO.
D
19.2 Property Damage/Loss Costing (estimated cost) MYR
20 Fire or Explosions NO.
21 Near Misses NO.
22 Man Overboard NO.
23.1 O Occupational Illnesses NO.
H
23.2 Total Sickness Absentism Days
24 High Potential (HiPo) Incidents (from incidents stated above) NO.
25 Commuting/Traffic Incidents (Company owned) NO.
26 Commuting/Traffic Incidents (Privately owned) NO.
 27 Security Incidents NO.
HEALTH
28 Medical Referral Cases NO.
29 Hygiene Inspections NO.
30 Medical Health Declaration with health conditions NO.
31 Audiometric Testing NO.
ENVIRONMENT
Scheduled Wastes + Dangerous Drugs Wastes (please attach
32 Kg
inventory)
33 Non-scheduled Wastes (solid wastes) (please attach inventory) Kg

Non-scheduled Wastes (construction wastes) (please attach

34 Kg
inventory)
35 Air Emission g/Nm3
36 Oil Spill Drills NO.
37 Fuel Consumption Litres
38 Bilge/Industrial Effluent Discharge
38.1 - Onshore Facilities (Oil & Grease) ppm
38.2 - Offshore Facilities (Oil in Water) ppm
38.3 ŸŸŸ Barge/Vessels ppm
38.4 Ÿ Mobile Offshore Drilling Unit ppm
38.5 Ÿ Offloading Facilities (e.g. FPSO) ppm
 This Month
No. Data Required Units Sub-
PESB TOTAL
contractor
C
39 Spills
H

39.1 ME Number of Chemical spill incidents NO.

I
39.2 C Volume Litres
39.3 O
A
L Number of oil spill incidents No.
I
39.4 L Volume Litres
40 Hydrocarbons released* m3
LEGISLATIVE COMPLIANCE
41 HSE Legal Compliance Status %
42.1 Fines & Summonses (from authorities) NO.
42.2 - Amount (estimated cost) MYR
OTHERS
43 Security Audits NO.
44 Piracy/Security Drills NO.
45 HSE Plan & Programs (please indicate) :
NO.

46 HSE Non-compliance NO.

47 Consequence Management Cases NO.
48 Management Review NO.

*Please indicate Not Applicable (NA) for non relevant column.

Submitted by

Signature :

Name :

Position :
E

Date :
Reporting
From :
Date
To :
Year to Date (YTD)
Sub- Remarks
PESB TOTAL
contractor
 Year to Date
Sub- Remarks
PESB TOTAL
contractor

Approved by (HSE Manager)

Signature :

Name :