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MONTHLY SAFETY ACTIVITY REPORT

YEAR: ______

REPORTING LOCATION: _________

NUMBE MEDICAL / PROACTIVE MEASURES


LOST TIME #
R FIRST RESTRICTED
MONTH YTD AUTO
HOURS AID Near
TRIR ACCI % Safety % Safety Safety BBS % JSAs
WORKE CASES Loss
DAYS ACC DAY D Training Audits Meetings Observation Perform
D WO/R W/R Performed Performed Performed s Performed ed
Reports
RESTD ID. S
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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