Format for First Aid Analysis Report

Name of the Project: TPSP Month: APRIL

Year: 2019
Sr. No. Causative wise First Aid cases Number of cases

1 Fall of material 0
2 Slip & fall on level 0
3 Hit by objects 0
4 Pressed between objects 0
5 Fall into pit/ depth 0
6 Contact with moving parts 0
7 Soil collapse 0
8 Road accidents (Vehicle/ Equipment) 0
9 Foreign body into eye 0
10 Welding flash in eye 0
11 Gas poisoning 0
12 Using of defective tools/ tackles 0
13 Electrocution 0
14 Burn injury due to electrical 0
15 Burn injury due to gas cutting/ welding 0
16 Chemical burns 0
17 Suffocation 0
18 Breaking of grinding wheel 0
19 Blasting of detonator 0
20 Drowning 0
21 Contact with hot objects 0
22 Rock fall 0
23 Material handling 0
24 Ill health(Occupational diseases only) 0
25 Others (Specify) 0

Total

First Aid Incidence Rate = Number of First Aid cases X 1000

Average number of workers

= ____________________
_______________ _______________
Project HSE Engineer Project Manager

Format No.: HCC F 001 15 091, Rev.01, Rev date: 06.09.11 Page 1of 1