HEALTH, SAFETY & ENVIRONMENT REPORT FOR THE MONTH of May, 2023

PROJECT:

Contractor Name :

Project to
HSE PERFORMANCE 30-Apr 31-May Year to Date Current Year to Project to
Date HS & E PERFORMANCE
Previous Current Month Date Date
2023
MANPOWER & TIME
Average Number o f Workers on site Accident incidence rate (AIR) #REF! #DIV/0! #DIV/0!
Average Number o f Staff on site (Client/ PMC/CSC/Contractor)
Man hours worked
Man hours worked since last LTI
RIDDOR CATEGORIES Dates of LTIs: Man-hours to LTI
Category 1 -Number of Fatality 1-
Category 2-Number of Major Injuries 2-
Category 3-Number of Lost Time accidents (over 3 days) 3-
Category 4-Number of Dangerous Occurrence 4-
Category 5-Number of Specified Diseases (COVID-19) 5-
Category 6-Number of Injury Member of the Public FORMULAS TO CALCULATE HS & E PERFORMANCE STATISTICS
MEDICAL TREATMENT INCIDENT CATEGORIES ( RESULTING IN "LOST TIME")
Category 7 -Number of Lost Time Incident /Restricted Work Case
OTHER INCIDENT CATEGORIES
Number of Medical Treatment Case
Number of First Aid Cases
Number of Incident Involving Verbal or Physical Abuse at the Workplace
Number of Ill Health (occupational/work related)
Number of Cable Strikes Cases
Number of Fire Incident Cases
Number of Traffic Incident Cases
Number of Property Damage Cases
Number of Significant Pollution Incident
Number of Environmental Incident Cases
Number of Near Miss Cases
NUMBER of LEADING SAFETY & HEALTH INDICATORS Accident Incident rate (AIR)
Number of Internal & External HSE Management Audits Number of injuries in a period x 100,000
Number of HSE Drills Number of hours worked in that period
Number of HSE Staff on Site
Number of HSE Meetings
Number of Site HSE Management Inspections Accident/Incident Severity rate (SR)
Number of HSE Leadership Tours Number of days away from work x 100,000
Number of Positive Observations/ Good Practices Reported by (PMC/CSC) Number of hours worked in that period
Number of HSE Incentive Awards Issued
Number of HSE Campaigns Conducted
Number of Workers Attending Toolbox Talks

Number of Staff imparted HSE Skills Training

NUMBER Of LAGGING - SAFETY & HEALTH INDICATORS
Number of SVR: Safety Violation Reports
Number of NCR: Non-Conformance Reports
Number of Environmental Observations
Number of Unsafe Acts / Conditions (OHS Observations)

Contractor Project Manager Name: Signature:

Contracor HSE Engr Sign: Signature:

Rev 00 05/16/2023
 Leading Indicators
Current Previou

Number of Number of Number of Number of Number of Number of Number of Number of Number of Number of Number of
Internal & HSE Drills HSE Staff on HSE Meet - Site HSE HSE Lead- Positive HSE Incen- HSE Cam- Workers At - Staff im-
External HSE Site ings Manage- ership Observa- tive Awards paigns tending parted HSE
Manage- ment In- Tours tions/ Good Issued Conducted Toolbox Skills Train
ment Audits spections Practices Talks ing
Reported by
(PMC/CSC)

Lagging Indicators
12
8
4
0

Current Previous
 Current Previous

ber of Number of Number of

Cam- Workers At - Staff im-
gns tending parted HSE
ucted Toolbox Skills Train-
Talks ing
PURPOSE OF REPORTING The purpose of creating monthly reports is to provide monthly and ongoing leading and lagging information on the HSE performance for the
projects . As the information accumulates, statistical analysis can identify trends on the projects; identify lessons learned opportunities; which in
turn can help to prevent future loss events.

DEFINITIONS
MANPOWER & TIME
The average number of personnel present on site from Contractor, Sub-contractor, suppliers per reporting cycle.
Average Number o f Workers on site

The average number of personnel present on site from consultants and client representatives organziations per reporting cycle.
Average Number o f Staff on site (Client/ PMO/CSC/Contractor)

Man hours worked The total number of hours worked by personnel on site from Contractor, Sub-contractor, suppliers, consultants and client representatives
organziations per reporting cycle.
Man hours worked since last LTI The total number of hours worked by personnel on site from Contractor, Sub-contractor, suppliers, consultants and client representatives
organziations since last LTI.
LOST TIME INCIDENT CATEGORIES
Category 1 -Fatality The death of any person, whether or not they are at work, if it results from an accident arising out of or in connection with work.
Category 2-Major Injuries Defined injury, which requires immediate notification to Enforcing Authority under the Reporting of Injuries, Disease or Dangerous
Occurrence (RIDDOR). Specifically:
(a) Any fracture, other than to the finger, thumb or toe
(b) Any amputation
(c) Dislocation of the shoulder, hip, knee, or spine
(d) Loss of sight (whether temporary or permanent)
(e) A chemical or hot metal burn to the eye or penetrating injury to the eye
(f) Any injury resulting from an electric shock or electric burn, leading to unconsciousness or requiring resuscitation, or admittance to hospital for
more than 24 hours

Category 3- Lost Time accidents (over 3 days) Injury that results in a person missing 4 or more consecutive days (not counting the day of the accident) from work, or injury that results in a
person remaining at work but being unable to discharge their normal duties for one to three days.

Category 4-Dangerous Occurrence An occurrence, which arises out of or in connection with work and contained in RIDDOR, specifically for construction works, this would include:
(a) The collapse of overturning of, or the failure of any load bearing part of any lift, hoist, crane, derrick, MEWP, access cradle, excavator, pile-
driving frame or rig (over 7m in height) or fork lift truck.
(b) Any unintentional incident in which plant or equipment comes into contact with or causes an electrical discharge by coming into near proximity
of an overhead electrical line exceeding 200 volts
(c) Electrical short circuit or overload attended by fire or explosion and stops the plant for more than 24 hours or has the potential for death.
(d) Collapse of:
(i) Scaffolding over 5m in height
(ii) Scaffolding erected near to water, which could have resulted in a drowning incident
(iii) The suspension arrangements of any slung scaffold
(e) Incidents involving pipelines or pipeline works including unintentional escapes, damage, etc.
(f) Collapse of:
(i) A building or structure under construction, alteration, demolition etc that involves the fall of more than 5 tonnes of material.
(ii) Any floor or wall of a building used as a work place
(iii) Any false work
(g) The escape of flammable substances, including specific quantities of liquids or gas
(h) The escape of any substances in sufficient quantities to death or major injury or damage to health.
Category 5-Specified Diseases

Chemical and metal poisoning-Any work activity

Chrome ulceration, acne, skin cancer, folliculitis
Work with chrome compounds, minerals, oil, tar, pitch, radiation
Occupational asthma-W ork with epoxy resin, soldering flux, silica, sand, wood dust
Mesothelioma, lung cancer, asbestosis
Work with asbestos
Leptospirosis- W here there are rats, field mice, voles or other small mammals
Hepatitis- Exposure to blood or human waste products
Nasal or sinus cancer- W orking in a dusty building
Hand-arm vibration syndrome - Hand-held rotary or percussive tools, chainsaws and handheld circular saws
Pneumoconiosis -W ork with silica, sand, grinding wheels, boiler descaling
Occupational dermatitis / W ork with epoxy resin, oil, cement, solvents, hardwoods, plaster, concrete, bleach, acids, alkalis, wood preservatives
and anything else which causes dermatitis

Category 6-Injury Member of the Public

Category 7 -Lost Time Incident /Restricted Work Case
LOST TIME INCIDENT (LTI)
Injury that results in a person missing between one and three workdays (not counting the day of the accident) from work, or injury that results in a
person remaining at work but being unable to discharge their normal duties for one to three days.
RESTRICTED WORK CASE
Injury not being a major injury that results in a person either missing 4 or more consecutive days from work (not counting the day of the accident)
or being unable to fulfil his/her normal duties for 4 or more consecutive days, including non-working days i.e.- weekends.

MEDICAL TREATMENT INCIDENT CATEGORIES (NOT RESULTING IN "LOST TIME")

Medical Treatment Case Injury that results in a person being taken to hospital or given medical treatment by a Doctor or other Health Care Professional. Medical
Treatment means the management and care of a patient to combat disease or disorder including;
(a) Closing wounds using sutures or staples,
(b) Immobilisation of parts of the body using rigid stays plaster casts etc.

Medical Treatment does not include;

(a) Visits to a doctor or health care professional solely for observation or counselling;
(b) The conducting of diagnostic procedures such as x-rays and blood tests, including the administration of prescription medications used solely for
diagnostic purposes (e.g., eye drops to dilate pupils)

First Aid Cases First aid is defined as the follows:

(a)Injury that is given First Aid treatment by a First Aider, site medical centre or hospital;
(b) treatment of minor injuries which would otherwise receive no treatment or which do not
need treatment by a doctor or nurse.

Ill Health (occupational/work related) Where any person suffers from any of the occupational diseases specified in RIDDOR and their work involves one of the activities noted. All
instances where it is suspected that it may be necessary to report an Occupational Disease should be referred to the SHE dept.

NON-INJURY
Property INCIDENTS
Damage Cases CATEGORIES Any incident, not defined as a Dangerous Occurrance, that results in damage to tools & equipment, machinery, installations, plant, motor vehicles
or any other property located on site that did not result in personal injury
Environmental Incident Cases
HAZARDS / NEAR MISS CATEGORIES
Near Miss
Unsafe Acts / Conditions (Safety Observations)
H & S MANAGEMENT
SVR: Safety Violation Reports
NCR: Non-Conformance Reports
H & S COMMUNICATION & INITIATIVES
HSE Meetings
Site HSE Management Inspections
Number of Staff imparted Safety Skills Training
Toolbox Talks
Staff imparted HSE Skills Training
HSE Campaigns Conducted
Lost Time Incident Frequency Rate (LTIFR)
Recordable Injury Rate (RIR)
GUIDANCE FOR REPORTING
REPORTING TIME FRAMES
An Environmental Incident is one that has caused, or has the potential for causing, one or more of the following:
• Adverse impact on the quality of air, land or water, wildlife, aquatic species or species at risk.
• Exceedance of permit or external reporting requirement.
• Notification of external agencies due to emergency/beyond normal circumstances.
• Adverse publicity with respect to environment.
• Legal or regulatory action with respect to violation of statutes or environmental damage.
• Alteration of, or damage to, heritage or archaeological resources
Examples of Environmental Incidents include, but are not limited to:
• Spills of oil, fuel, PCB or chemicals.
• Visible damage to equipment where the public may believe there is an environmental effect.
• Sudden and uncontrolled emission or discharge of air pollutants (e.g. NOx) or sudden and uncontrolled gaseous releases (e.g. SF6, H2S, propane,
compressed CO2, natural gas).
• Discharge of deleterious substances into water.
• High or low flows, or flow changes, that adversely affect fish or fish habitat, wildlife or recreation.
• Adverse impacts on notable fish or wildlife species (e.g. sturgeon, eagles).
• Any ground disturbance (i.e. setting a new pole) where an archaeological site is encountered.
• Work and/or removal of vegetation in or near water bodies without regulatory approval.
• Violation of pesticide use, storage or application regulations and approvals.
• Violation of other environmental regulations, permits or approvals.
An incident which had the potential to result in personal injury and/or damage to the structure under construction, plant and equipment or the
environment
An unsatisfactory behaviour or site condition that could cause an incident if left unattended.
Total number of formal dedicated H&S meetings chaired by contractor
Total number of formal and recorded site safety inspections
Total number of site personnel attending safety training other than toolbox talks
Total number of toolbox talks conducted
Total number of site personnel attending toolbox talks
Total number of campaigns/initiatives during the period that positively promote H&S
The Total Number of Lost Time Incidents for the prescribed period divided by the Total Number of Man-hours worked for the same period
multiplied by 100,000
The Total Number of Recordable Injuries for the prescribed period divided by the Total Number of Man-hours worked for the same period
multiplied by 100,000
Please report to relevent PMC and CSC reporting requirement
This information shall be provided for the reporting month as defined by the contract (typically caledar month, unless otherwise specified). It shall
be made available within the first 4 days of the month.
week Manpower Manhours
Week 01 199 9552
week 02 199 9552
week 03 350 16800
Week 04 400 19200
Week 05 0
Total 1148 55104
Avg 287