Serial

Daily EHS REPORT FOR CONTRACTOR Number

Project: Site Work Start: / / 0001
Date: / / Time in: Time out: Weather

(1) Contractor:
Company Description of work
Site Manager Tel: Safety officer Tel:
(2) Project Manpower
Number of Manpower Man Hours worked Lost time injury (LTI) New employees Visitors
Total hr.day
(3) EHS Info
Injury Accidents Safety Violations Inspection Checklist
Near Misses Toolbox Meeting Work Permit
(4) Site Activity
1. % 4. %
2. % 5. %
3. % 6. %
(5) EHS Activity
1. 4.
2. 5.
3. 6.
(6) Unsafe Conditions and Acts
1. 5.
2. 6.
3. 7.
4. 8.

DSR, Rev A1, Murtadha AlRuwaie 1

Done by: ……………………… Signature: Date: / /

DSR, Rev A1, Murtadha AlRuwaie 2