WEEKLY HSE PERFORMANCE STATISTIC SUMMARY

Company :
Area :
Week-Year :
Period :
TOTAL UP
LAST THIS
NO DESCRIPTION TO THIS UNIT
WEEK WEEK
WEEK
1 Working day --- --- --- Day
2 Manpower --- /--- --- /--- Persons
(min/max)
Indirect =
Direct =
Local Batang =
3 Man-days --- --- --- MD
4 Man-hours --- --- --- MH
5 Safe Man-hours from last LTA --- --- --- MH
AFR (Accident Frequency Rate)

(Number of injury non

LTAx200,000)/Total of Manhours
from last LTA

6 Finding Joint Inspection --- --- --- Numbers

7 Status Inspection Follow-up … /… … /… … /… (Closed/Open)
8 Induction --- --- --- Persons
9 Training --- --- --- Topics
10 Work Permit --- --- --- Numbers
11 Lost Time Accident (LTA)
a. Fatality --- --- --- Case
b. --- --- --- Case
c. --- --- --- Case
d. Lost Workday Case (LWC) --- --- --- Case
12 Injurious Non-LTA
a. First Aid Case (FAC) --- --- --- Case
b. Medical Treatment Case (MTC) --- --- --- Case
13 Non-Injurious
a. Near Miss --- --- --- Case
b. Property Damage / Loss --- --- --- Case
c. Fire Incident --- --- --- Case
d. Road Accident --- --- --- Case
e. Environmental Incident --- --- --- Case
f. Occupational Illnesses and --- --- --- Case
Industrial Diseases
14 Concern / issue item (if any) Briefly explain
15 Tool Box Meeting (TBM) Evidence
(photos)
 16 Machinery / Heavy Equipment
1. Crane … … … unit
2. Excavator … … … unit
3. Bulldozer … … … unit
4. Vibro-roller … … … unit
5. Dump truck / DT … … … unit
6. Boring machine … … … unit
7. Ship-boat … … … unit
8. Generator … … … unit
9. … etc. … … … unit

TOOL BOX MEETING – EVIDENCE