DAILY HSE PERFORMANCE REPORT

The contractor shall supply details of the HSE Performance as appropriate not later than
the end of working day.

REPORTING DAY/MONTH AND YEAR

Day 05 Month 03 Year 2020

CONTRACTOR DETAILS

Contractor Registered MMEAL Description of the Lifting

Name: work undertaken:

Mobile No. of Contact 0725-638-220 Specific site Terminal, Valley and Mound Area
Safety officer/Site location:
Supervisor:
Number of Employees: 22 Work Permit No: N/A

HSE PERFORMANCE & COMPLIANCE STATUS (Tick appropriately)

Do all your employees have YES / NO Any injury recorded (If yes YES / NO
PPE give details as per incident
reporting procedure)
Any new employee brought YES / NO Any unsafe acts / condition YES / NO
on site noted around your site? (if
yes describe)
All employees have done YES / NO Near Misses recorded? (if YES / NO
HSE & Security Induction yes describe)
Did you participate in the YES / NO
tool box talk
Topic of tool box talk Lift plan
discussed
Daily safety checks done YES / NO
Daily Safety Task YES / NO
Instruction done

DETAILS OF INCIDENTS / NEARMISS / UNSAFE CONDITIONS WHICH HAVE OCCURED

Damaged roller machine shade roller

Faulty swing lock brake for Zoom lion 55T -02

PERSON FILLING THE FORM

Contractor Shem Agesa Signature: SA Date: 05.03.2020

Safety
representative:
Contractor site Signature Date:
Engineer

Cc: Project Manager /HSE/F/20