PR1171-Part II
PR1171-Part II
DOCUMENT ID - PR 1171
REVISION - 4.0
DATE - 01/01/02
HSE – PROCEDURE
Embedding HSE into our Business
Document Authorisation
Document Authority Document Custodian Document Author
‘dapo Oguntoyinbo Gordon Muirhead Trevor Ford
Ref. Ind: CSM Ref. Ind: CSM/1 Ref Ind: UEG/1D
Date: 01/01/02 Date: 01/01/02 Date: 01/01/02
The following is a brief summary of the four most recent revisions to this document. Details of all revisions prior
to these are held on file by the Document Custodian.
User Notes:
The requirements of this document are mandatory. Non-compliance shall only be authorised by CSM through
STEP-OUT approval.
A controlled copy of the current version of this document is on PDO's EDMS. Before making reference to this
document, it is the user's responsibility to ensure that any hard copy, or electronic copy, is current. For
assistance, contact the Document Custodian.
This document is the property of Petroleum Development Oman, LLC. Neither the whole nor any part of this
document may be disclosed to others or reproduced, stored in a retrieval system, or transmitted in any form by
any means (electronic, mechanical, reprographic recording or otherwise) without prior written consent of the
owner.
Contents
1. Introduction.......................................................................................................................1
1.1 Purpose..................................................................................................................................1
1.2 Distribution/Target Audience...................................................................................................1
2.1 Scope.....................................................................................................................................2
2.2 Definition...............................................................................................................................2
2.3 Deliverables............................................................................................................................2
2.3.1 Records........................................................................................................................2
2.4 Responsibilities.......................................................................................................................2
2.5 Performance Requirements......................................................................................................3
2.6 Contractor’s HSE Management Plan.........................................................................................3
2.6.1 Preamble......................................................................................................................3
2.6.2 Contract-Specific HSE Management Plan........................................................................3
2.6.3 Leadership and Commitment.........................................................................................4
2.6.4 Policy and Strategic Objectives......................................................................................4
2.6.5 Organization, Responsibilities, Resources, Standards and Documents...............................4
2.6.6 Hazards and Effects Management Process......................................................................5
2.6.7 Planning and Procedures...............................................................................................6
2.6.8 Implementation, Monitoring and Corrective Action..........................................................6
2.6.9 Audit............................................................................................................................7
2.6.10 Review.........................................................................................................................7
2.7 Contractor's HSE Key Personnel...............................................................................................7
2.7.1 Requirements for HSE Advisers......................................................................................7
2.7.2 Minimum Competence for HSE Advisers.........................................................................8
2.7.2.1 Professional HSE Adviser...........................................................................................8
2.7.2.2 HSE Adviser seconded from Line Management............................................................9
2.8 Site Restoration......................................................................................................................9
2.9 DuPont Safety Training Observation Program (STOP)................................................................9
2.9.1 Key points in the DuPont STOP Program.......................................................................10
2.9.2 Summary of the Du Pont Supervisor’s Safety................................................................11
2.10 HSE Penalties and Defaults.................................................................................................12
1. Introduction
1.1 Purpose
Part II of PR-1171 is intended to be included, as an reference, in document GU-140,
C-09 HSE Requirements, to enable Contractors, together with Contract Holders, to carry
out PDO prescribed HSE activities in the manner and at the level required by PDO. Of
particular importance is the detail given for the preparation of the Contractor’s HSE
Management Plan.
It is mandatory that in any contract the HSE requirements of Part II of PR-1171 are
fulfilled by both Contractors and PDO Contract Holders. This entire part of PR-1171
shall be given to Contractors to enable them to carry out the requirements detailed
below, in addition to all other contractual requirements.
Part I of this Procedure is targeted at Contract Owners, Contract Holders and other
PDO personnel tasked with the HSE aspects of contract planning, tender preparation,
evaluation and subsequent contract HSE management.
Part II of this Procedure contains HSE instructions for Contractors. It is the obligation
of Contract Holders to ensure that Part II is supplied to Contractors and that the
instructions in it are followed.
2.2 Definition
Contractors and Contract Holders shall adhere to Part II of PR-1171 in the preparation
and use of documents to meet the HSE requirements of both the Tender
documentation and the Post-Award HSE management requirements of a Contract.
Other mandatory contractual requirements not given in this document remain
obligatory on both Contractors and Contract Holders.
2.3 Deliverables
2.3.1 Records
Contractor(s) shall provide the following deliverables, as stated in Contract Document C-09
HSE Requirements.
PDO staff: Any non-compliances with Part II of PR-1171 shall be notified, investigated
and reported as per document CP-122, HSE Management System Manual.
2.4 Responsibilities
Contract Holders shall ensure that Contractors have copy of Part II of PR-1171, further
ensuring that the requirements of Part II of PR-1171 are adhered to within the scope of
a Contract. In the event that circumstances prevent compliance with Part II of PR-
1171, Contract Holders shall seek step-out approval (CP-122, HSE Management System
Manual).
Contractor(s) shall be responsible for ensuring that activities undertaken within the
scope of their contracts are managed in accordance with the requirements of Part II of
PR-1171, and all other Contract documentation.
Contractor(s) shall satisfy the HSE requirements of Part II of PR-1171 as well as all
other obligations arising from the documentation and the execution of a contract.
Except for mobilization, no other contract specific activities on PDO concession area or
at Site may be commenced until PDO has issued an HSE Certificate (refer Appendix 1).
2.6.1 Preamble
This entire Section 2.6 of Part II of PR-1171 provides basic assistance to Contractors
and Contract Holders in the development and application of HSE Management Plans.
HSE Management Plans are mandatory, shall be specific to each individual contract,
and shall reflect the nature of the work to be performed and the specific hazards
presented by the work.
Contract Holders shall use this information when evaluating the adequacy of a
Contractor’s HSE Management Plan.
As part of the tendering process, each Contractor is obliged to conduct a Hazards and
Effects Management Process (HEMP) which is used to develop the information required
for document C-09 HSE Requirements:
Contractor(s) shall detail all HSE issues discovered, including those advised by PDO in
C-09, and detail how these risks will be controlled, mitigated and managed. Details
provided shall fully describe the manpower, equipment and broad details of the
Contractor’s HSE policies that will be applied to the management of HSE risk for the
Contract. The Contractor will fully describe the manpower that will be applied to the
HSE management of the Contract, including names, qualifications and experience.
Copies of each individuals’ CV will be included in the Tender documentation for C-09.
Contractor(s) shall, following the contract award, kick-off meeting and subsequent on-
site HSE workshop, revise the HEMP as necessary to develop the HSE Management
Plan, following the information in the rest of document.
Contractor(s) shall clearly indicate the policy, procedures and standards to be adopted
during each phase of the Contract.
Contractor(s) shall cover all Contract Phases from mobilization through execution,
demobilization and site restoration.
Contractor(s) shall describe how the HSE Management Plan will apply its established,
generic programs to manage its activities in the specific contract.
Contractor(s) shall identify the contract-specific work activities it will perform and the
anticipated HSE hazards associated with the work.
Contractor(s) shall clearly describe its plan (controls) for minimizing the potential
effects of these anticipated hazards. The plan shall identify specific deliverables,
targets, performance measures, monitoring programs, etc. When possible,
responsibilities should be clearly assigned and completion dates specified.
Contractor(s) shall submit the completed HSE Management Plan to the Contract Holder
for approval.
The approved HSE Management Plan shall become part of the contract documents.
Contractor(s) shall obtain formal approval from the Contract Holder for any proposed
deviations from or amendments to its HSE Management Plan.
The HSE Management Plan should contain only measurable, quantifiable, contract-
specific actions that will be taken during the life of the contract. The following outline is
suggested:
Provide a list of Contractor senior management and describe their typical participation
in HSE activities related to contracts (meetings, inspections, audits, etc.).
Provide a written copy of the HSE Policy. The Contractor’s HSE Policy shall be
produced in an easy to read format in the working languages of staff and the
workforce, endorsed and dated by the Contractor’s senior executive, and communicated
to all employees and other relevant parties.
Contractor(s) shall:
Prepare a contract-specific organization chart showing personnel responsible for the
implementation of HSE objectives.
Provide the number of HSE Advisers to be employed on the Contract, describe their
roles, responsibilities and deployment.
Describe a typical schedule for contract specific HSE meetings to review and
communicate HSE issues to all levels of the contract-specific organization and between
PDO, the Contractor and Subcontractors, including (as appropriate):
PDO/Contractor HSE meetings (refer HSE Monitoring Program, Appendix 2);
Contractor/Subcontractor HSE meetings;
craft specific HSE meetings;
toolbox meetings
Provide a statement indicating the typical involvement of HSE support functions within
the Contractor organization (if applicable) in:
preparing and monitoring departmental action plans;
Contractor(s) shall allocate sufficient resources at all levels to effectively manage HSE.
Contractor(s) shall ensure that all employees (including sub-contractors) are competent
to perform their work tasks, that relevant HSE training is provided, and that HSE
requirements are incorporated into competency assessment and assurance programs.
Contractor(s) shall ensure that all employees (including sub-contractors) are competently
supervised.
Contractor(s) shall provide a matrix describing required training for contract activities
(including refresher training) and maintain training records of staff employed on the
contract.
Contract Holder shall, for both PDO and Contractor personnel, prepare a contract-
specific HSE training plan based on the matrix in Appendix 3.
Contract Holder shall advise Contractors of compulsory training required for contract
activities. Required training might include, but shall not be limited to:
HSE induction;
job procedures (e.g. Permit to Work, fire fighting, scaffolding);
road safety;
health (e.g. first aid, use of PPE);
incident investigation and reporting; auditing;
HSE meetings;
environmental protection/awareness;
supervisory training; specialized training as necessary; on the job training;
emergency planning.
Contractor(s) shall:
Provide a register of anticipated contract-specific hazards and effects identified by the
detailed HEMP.
From the assessment of hazards, identify risk reduction measures to control and
recover, including:
work methods and work site procedures
emergency response plans
exposure reduction methods
Contractor(s) shall:
Provide contract-specific HSE objectives and targets.
Provide a list of contract-specific work procedures and other procedures to address HSE
hazards identified in the HEMP.
Identify potential emergency scenarios that might arise during the contract and
procedures typically used in such scenarios. Examples include:
road traffic accident;
fire;
H2S evacuation;
first aid;
radiation leak;
man lost;
storm;
blow-out;
Medevac;
environmental spill (oil, chemicals).
Contractor(s) shall:
List the typical communication techniques used to make contract personnel aware of
HSE issues. Examples include:
Meetings (refer paragraph 2.6.7)
personal contact;
notice boards (indicate locations)
newsletters (indicate frequency of issue)
Describe typical methods of HSE promotion during contracts, e.g.:
small ‘give aways’ with HSE message;
competitions
Prepare an inspection schedule for the above, indicating the frequency of inspection,
responsible party and the location of the inspection.
Using the template in Appendix 4, report monthly HSE information to the Contract
Holder.
Nominate the person responsible for preparing the monthly HSE report.
Prepare a program for monitoring contract-specific HSE data, describing what will be
measured, where the measurement will occur, who will perform the measurement and
the method used to take the measurement.
2.6.9 Audit
Contractor(s) shall provide a contract-specific matrix showing the schedule for HSE
audit and inspections. Appendix 2 might be of assistance to Contractors as well as
Contract Holders.
2.6.10 Review
Contractor(s) shall propose the appointment of the HSE Key Personnel given in
document C-09 HSE Requirements for Contract Holders review and approval.
Individuals to fill the positions of Contractor HSE Adviser(s), Contractor
Representative(s) and Contractor Site Representative(s) shall be classified as HSE Key
Personnel under the contract.
HSE Advisers shall not be responsible for line management and supervision; the role of
HSE Advisers shall be facilitatory/advisory in nature.
Contractor(s) shall define the role and responsibilities of the HSE Advisers in the HSE
Management Plan.
Unless otherwise specified in the C-09 HSE Requirements, a minimum of one HSE
Adviser shall be provided per geographical area in which the contract is operating.
Geographical area is defined as a PDO operating area (e.g. Bahja, Marmul, Lekhwair,
etc.). The HSE Adviser(s) shall visit each location on a regular basis and remain a
sufficient length of time to fulfil the duties defined in the HSE Management Plan.
The total number of HSE Adviser(s) employed by the Contractor and deployment of
them for any individual contract shall be defined in the HSE Management Plan.
Contractor Management shall, at all times throughout the duration of the contract, be
able to demonstrate that line managers and supervisors have ready access to sufficient
numbers of professionally qualified HSE Advisers.
In the case of a Lump-Sum contract (also including EPC, turnkey, etc.), one HSE
Adviser might provide support for a maximum of two contracts in a geographical area,
subject to written authorization from the Contract Owners.
HSE Advisers shall be knowledgeable in specific relevant safety techniques and have a
working knowledge of the legal and contractual health, safety and environmental
requirements that must be met. They must have the ability to communicate effectively
at all levels of the Contractor’s organization.
Contractor(s) shall confirm in the Tender document C-09 HSE Requirements that they
will provide HSE Advisers that satisfy the minimum competence requirements.
Attendance at the following PDO courses or approved equivalent is mandatory for all
HSE Advisers:
Permit to Work – Signatories LXE015
Road Safety Management LXE042
Light Vehicle Daily Checks LXE960
Heavy Goods Vehicle Daily Checks LXE955
Incident Investigation and Reporting LXE032
Managing HSE Workshop LXE008
Refer to PDO document SP-1157, Specification for HSE Training, for information on
these courses. An HSE Adviser holding higher qualifications not currently recognized by
PDO, might be exempted from some of the above requirements subject to the
exemption provisions of SP-1157.
Contractor’s HSE Advisers shall be qualified in accordance with either of the following
requirements:
Professional HSE Advisers shall have a minimum of five years work experience, of which
at least two years shall have been as an HSE Adviser. Work experience must be related
to the activities to be carried out under the terms of the contract.
HSE Adviser shall, as an alternative, have a minimum of two years work experience and
be a member of an independent internationally recognized Professional Institution per
the list below:
IOSH: Member of the Institute of Occupational Safety and Health.
DIPSM: Diploma in Safety Management, or Member of International
Institute of Safety Management.
RSP: Registered Safety Professional.
Other per Approved List held by PDO’s CFDH for HSE (CSM)
Line Managers who are seconded to HSE might be acceptable as HSE Advisers provided
that the proposed individuals have a minimum of three years experience on PDO
contracts at site supervisory level. Work experience must be related to the activities to
be carried out under the terms of the contract.
Proposed individuals who do not satisfy the criteria of three years experience on PDO
contracts at site supervisory level shall be subject to review and approval by PDO’s
CFDH for HSE (CSM) to determine acceptability to PDO.
Upon completion of the Work or Services, the Contractor(s) shall satisfactorily restore
the Site, including any areas of PDO concession area and any premises thereon, used
by the Contractor to perform the Work or Services as per the requirements of SP-1012
Specification for Land Management. Upon completion of the restoration of the Site, the
Contractor(s) shall apply for certification of such restoration. PDO shall certify
satisfactory completion by the issuance of a Site Restoration Certificate (refer Appendix 5).
To fully implement this policy in Contract management, PDO has made mandatory the
DuPont Safety Training Observation Program (STOP) for all Contractors:
Contractor(s) shall fully implement Dupont’s STOP for Supervision TM program. Progress,
implementation and analysis shall be reported monthly in the monthly report (refer
Appendix 4). All management and supervisory staff, from the Contract Manager to
Foreman, shall be trained and shall implement the system.
Contract Owner shall decide whether STOP shall be implemented in a contract or not.
As guideline: STOP shall be implemented in all contracts except those that are of a non-
operational nature (e.g.: an insurance contract). Formal deviation not to implement
STOP or an equivalent program shall be given by the Service Group Custodian for the
type of work covered in the contract.
STOP for Supervision™ sets up the framework upon which the entire STOP Series is
built. The basic principle of STOP is that all injuries and occupational illnesses can be
prevented. The main objective of the STOP for Supervision™ program is to train each
member of the line organization to eliminate incidents and injuries by skillfully
observing people as they work, talking with them to correct their unsafe acts, and
encouraging them to follow safe work practices.
The responsibility for safety is placed solidly within the line organization, from the top
manager on down to the first-line supervisor. Each individual learns the program with
their immediate supervisor and is accountable to that person for the safety effort and
performance of their area of responsibility. This cascading teaching approach builds a
common understanding and commitment throughout the organization.
STOP is not just filling out and sending in an observation card. It requires you to follow
the observation cycle, Decide – Stop – Observe – Act – Report. One of the most
important aspects is the communication with the personnel during the STOP
audit/observation. This is when the supervisor can encourage good behavior/practice
and with the individual identify and discuss unsafe acts and hazards. Also he must
make sure the individual understands the unsafe acts and hazards.
STOP does not recommend establishing a quota system for the number of cards filled in
as it can lead to a ‘safety competition’ environment.
There should be an audit system for Safety Observation Cards submitted. An example
is given in Appendix 5 of the STOP Administrator’s and Leaders Guide.
Submitted Safety Observation Cards should be used at the worksite during HSE or
toolbox meetings.
1. Objective
To eliminate incidents and injuries. The key to eliminating incidents and injuries is
to modify behavior by observing people as they work and talking with them to
encourage safe working practices and eliminate at-risk behavior.
2. Principles
3. Main Concepts
4. Techniques
STOP follows the Safety Observation Cycle; Decide –Stop –Observe – Act –Report
Decide that safety auditing is an important priority. Allocate time to audit people’s
work practices and behavior on the job.
Stop near enough to the person so that you can clearly see what they are doing. Be
alert for unsafe acts in the first 10 to 30 seconds.
Observe everything the person is doing in a careful systematic way as you review the
audit categories in your mind; i.e. reactions of people, personal protective equipment,
positions of people, tools and equipment, procedures and house keeping.
ACT by talking with the person to reinforce safe work practices and address at-risk
behavior.
Report your observations and actions on a STOP safety observation card.
HSE Penalties and Defaults shall be determined from the PDO HSE Monitoring Program
(Appendix 2) and its related inspections and audits, as well as any Contract
Performance Reports detailing unauthorized deviations.
Vehicle/Plant Accepted
Notes:
On behalf of the Contractor I confirm that the activities stated above have been carried out and we
are capable of performing the work in a healthy, safe and environmentally responsible manner.
Name Ref. Ind. Responsibility Signature
Contract Manager
We hereby agree that the HSE status of this Contract allows work to proceed, subject to the above
exceptions.
Name Ref. Ind. Responsibility Signature
PDO Representative*
PDO Contract Holder
* At Contract Holder's discretion
Inspections
Management
Walkabouts
Audits
Emergency
Exercises / Drills
Follow-up
Contract Holder shall complete the column “Required for this Contract” depending on the hazards of the Work or Services.
Course Title Course Code Target Population Require Required Contract Holder
d for this Comments on Contract
Contract Requirements.
Level 1 Staff HSE Induction LXE300, LXA300, LXH300 Contractor junior Staff C YES/NO
Level 2 Staff HSE Induction LXE003,LXA003,LXH003 Contractor senior Staff C YES/NO
H2S Awareness & Escape LXE002,LXA002, LXH002 Contractor staff who will enter H2S designated areas C YES/NO
Gas Testing - Basic LXE017 Contractor personnel who are designated as Authorized Gas Testers C YES/NO
Contractor personnel who are required to use SCBA for entry to
Self Contained Breathing
Apparatus
LXE001,LXA001, LXH001 confined spaces or as standby during confined space entry operations. C YES/NO
Designated Rescue Personnel.
Defensive Driving – Bus Module Contractor personnel who are required to drive light or heavy buses on
(Light and Heavy)
DD05A, DD05E
blacktop or graded roads in Oman as part of performing their job.
C YES/NO
Defensive Driving – Annual Contractor personnel who are required to drive light or heavy vehicles
Assessment
DD06E, DD06A, DD06H
on blacktop or graded roads in Oman as part of performing their job.
C YES/NO
Contractor personnel who are responsible for the operational
Safe-Journey Management LXE970, LXA970, LXH970
management of driving activities, and Contractor HSE Advisors.
C YES/NO
Contractor personnel responsible for the operational management of
Road Safety Management LXE042, LXA042, LXH042 On hold YES/NO
driving activities, and Contractor HSE Advisors.
Defensive Driving in Oman, Light Contractor personnel who are required to drive light vehicles in the
Vehicles, Blacktop Roads
DD01E, DD01A, DD01H
performance of their work duties.
C YES/NO
Defensive Driving in Oman, Heavy Contractor personnel who are required to drive heavy vehicles (Heavy
Vehicles, Blacktop Roads
DD02A, DD02H
Goods or Heavy Buses) in the performance of their work duties.
C YES/NO
Defensive Driving, Graded Roads,
Contractor personnel who are required to drive light or heavy vehicles
for both Heavy and Light Vehicle DD03E, DD03A, DD03H
on graded roads in Oman as part of performing their job.
C YES/NO
Drivers
Contractor personnel who are required to drive light or heavy bulk
Defensive Driving, Bulk Tanker
Module (Light and Heavy)
DD04A, DD04H liquid tankers, including vacuum tankers, on blacktop or graded roads C YES/NO
in Oman as part of performing their job.
LXE401, LXA401, LXH401
Basic Life Support (Foundation)
LMCE006, LMCA006, LMCH006
Contractor personnel who have been designated as First Aiders. C YES/NO
Practical First Aid LMCE006, LMCA006, LMCH006
(Refresher) LXE401, LXA401, LXH401
Contractor Drivers and refresher for Basic Life Support (Foundation) C YES/NO
Appendix 3 continued
Course Title Codes Target Pop Required Required Contract Holder
for this Comments on
Contract Contract
Requirements.
Fire Wardens LXE037, LXA037, LXH037 Contractor personnel who are designated as Fire Wardens. C YES/NO
Contractor Permit Holders, all cooks and catering personnel, and
Basic Fire Extinguisher LXE005, LXA005, LXH005
designated Fire Wardens.
C YES/NO
Contractor personnel who are required to supervise activities that
Scaffolding Appreciation LXE044
includes the use of scaffolding and access platforms. HSE Advisors.
C YES/NO
As
M for Contractor HSE Advisors. / R for Contractor Supervisors and
required
Incident Investigation and Managers, including as a minimum Contract Holders and Contractor
LXE032 in Target YES/NO
Reporting Contract Managers, who may be required as part of their job function
Populatio
to lead incident investigations. n
Contractor personnel nominated as Tripod BETA analysts for accident
Tripod BETA LXE801
and incident investigations M YES/NO
Job Hazard Analysis LXE101, LXA101, LXH101 Contractor Foreman level personnel C YES/NO
Hazard Awareness &
Communication
LXE052, LXA052, LXH052 Contractor Supervisory staff C YES/NO
Contractor Supervisor level personnel involved in receipt and dispatch
of chemicals, transportation (drivers) and handling of chemicals,
Chemical Hazard Awareness LXE440, LXA440, LXH440 M YES/NO
working in chemical storage areas, and handling chemicals in
operational areas
HSE Management of Contracts LXE041 Contractor Managers C YES/NO
all Contractor HSE Key Personnel identified as HSE Key Personnel in
Managing HSE Workshop LXE008
Contract Document. M YES/NO
Drilling HSE Workshop LXE012 Senior Contractor Drilling engineers and personnel M YES/NO
Contractor personnel who will directly supervise a work party (i.e. first
Permit to Work Holders LXE510 line supervisor, leading hand or charge hand). A technician may also C YES/NO
be a Permit Holder.
Contractor personnel who will fulfil a role within the Permit to Work
Permit to Work Signatories LXE015
System of permit applicant, area authority or responsible supervisor
C YES/NO
Contractor personnel who may fulfil a role within the Permit to Work
Permit to Work Auditing LXE046
Audit Team as the nominated Auditor.
R YES/NO
Contractor Super. level personnel before allocation of direct
Supervising Safety LXE006, LXA006, LXH006 responsibility for operational activities and Contractor/Sub-contractor C YES/NO
supervision
Vehicle Mounted Crane Operators LXE053, LXA053, LXH053 Contractor vehicle mounted crane operators and their helpers C YES/NO
Upon completion, this document must be faxed to CSM/423 Fax # 67-3145 (for database).
CONTRACT NUMBER:
NAME OF Company:
RETURN FOR THE MONTH OF:
Number of EMPLOYEES WORKING ON CONTRACT:
Number of MAN-HOURS worked (including any overtime) in the month:
Number of FATALITIES & PERMANENT DISABILITIES in the month:
Number of LOST WORKDAY CASES in the month: (LWC)
Number of RESTRICTED WORK CASES in the month: (RWC)
Number of MEDICAL TREATMENT CASES in the month: (MTC)
Number of FIRST AID CASES in the month: (FAC)
Number of NEAR MISSES in the month: (SEVERITY 0)
Number of OCCUPATIONAL ILLNESSES in the month: (TROI)
Number of CALENDAR MAN-DAYS LOST due to SICKNESS ABSENCE
Number of NON-INJURIOUS (SEVERITY 4 OR 5) INCIDENTS in the
month which are NOT included above:
Number of NON-ACCIDENTAL DEATHS in the month: (NAD)
Number of: ROAD TRAFFIC ACCIDENTS in the month: (RTA)
MONTHLY DRIVING NO. OF VEHICLES KM DRIVEN
STATISTICS
VEHICLES ABOVE 4,000kg GVW
OTHER VEHICLES
INJURED PERSONNEL ABSENT FROM WORK OR ON RESTRICTED WORK during the month:
NAME DATE
WAS CERTIFIED UNFIT ON
WAS CERTIFIED UNFIT ON
WAS CERTIFIED UNFIT ON
Names of previously injured people, CERTIFIED FIT TO RETURN TO WORK during the month,
following an LTI absence or a period of restricted work.
NAME DATE
RETURNED TO WORK ON
RETURNED TO WORK ON
RETURNED TO WORK ON
Signed by Contractor: Signed by Contract Holder:
Position in Company: Reference Indicator:
Date: Date:
NOTES:
All returns should relate to the previous calendar month only.
The average may be taken as the total number of employees when fluctuations occur.
In cases of doubt clarification should be sought from PDO’s CSM Department.