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MONTHLY SAFETY ACTIVITY REPORT

YEAR: ______

REPORTING LOCATION: _________

PROACTIVE MEASURES
NUMBER MEDICAL / RESTRICTED LOST TIME
MONTH FIRST AID # AUTO
HOURS YTD TRIR
CASES ACCID % Safety % Safety Safety BBS Near Loss
WORKED % JSAs
DAYS Training Audits Meetings Observations Reports
WO/R W/R ACCID. DAYS Performed
RESTD Performed Performed Performed Performed

JANUARY

FEBRUARY

MARCH

APRIL

MAY

JUNE

JULY

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

DECEMBER

NOTE: Periodically verify that OSHA 300 log information agrees with year-to date Safety Statistics and make corrections required.

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