FIRST AID ANALYSIS REPORT

Project: Month: Year:

I Based on causes Number II Based on type of injury Number

1 Fall from height / stairs 1 Abrasion
2 Slip / trip / fall - same level 2 Amputation
3 Contact with electricity 3 Bruise
4 Struck by falling material 4 Burn / scald
5 Struck by flying material 5 Fracture / Dislocation
6 Hit / run-over by eqpt / machinery 6 Cut / Laceration
7 Hit by hand tool / object 7 Sprain / Strain
8 Contact with hot object / flame 8 Swelling
9 Equipment failure / misuse 9 Eye Injury
10 Cut with sharp object 10 Puncture
11 Use of defective equipment 11 Other
12 Caught in between Total 0
13 Others
Total 0

III Based on Area / Location Number IV Base on Body part injured Number
1 Building - Work place 1 Head
2 Reinforcement Yard 2 Eye
3 Store 3 Ear
4 Approach Road 4 Face
6 Stack Yard 6 Shoulder
7 Carpentry Yard 7 Chest
8 Cement Godown 8 Stomach
9 DG / Electrical Panel 9 Hand
10 Scrap yard 10 Fingers
11 Other (Specify) 11 Leg
12 Other (Specify) 12 Foot
13 Other (Specify) 13 Toe
14 Other (Specify) 14 Others
Total 0 Total 0

V Contractor-wise Name Number

Contractor 1
1 (Main Civil)
2 Contractor 2
3 Contractor 3
4 Contractor 4
5 Contractor 5
6 Contractor 6
7 Contractor 7
8 Contractor 8
9 Contractor 9
10 Contractor 10
11 Contractor 11
12 Contractor 12
Total 0

Inspected by: Signature:

SA06 v1706