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HSE Statistic

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21 views3 pages

HSE Statistic

Uploaded by

Angga
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Replace with your company letter head / address

FORM REF. NO. : Your reference no MONTHLY HSSE PERFORMANCE REVISION NO. : 1

Project / Location / Subcontractor : Reporting :


of Month

Reporting Period [Date] : To :

Reported by : Attn :

Reference Number : Cc :

LAST YEAR TARGET /


THIS ACTUAL
TYPE OF INCIDENT [20XX] LIMIT [Cur-
MONTH YTD [20XX]
rent Year]
NON-PROCESS RELATED INJURIOUS INCIDENT

Lost Time Injury

No. of Fatal Incident


No. of Fatality
1.1
Permanent Total/Partial Disability
Lost Workday Case
No. of Lost Workday [in days]
Non-Lost Time Injury
Restricted Work Case
1.2 No. of Restricted Workday [in days]
Medical Treatment Case
First Aid Injury
NON-PROCESS RELATED NON-INJURIOS INCIDENT
Occupational Illness
1.3 Fire/Explosion
Property/Equipment Damage
Property/Equipment Lost
Environmental Pollution Related Incident
Violation of Zeto Rules
Violation of 12 Life Saving Rules
Security Incident
Other incidents [Please specify in spread sheets]
1.4 Near Miss Incident
LAND TRANSPORTATION SAFETY
1.5.1 Total Travel Distance in Kilometers
1.5.2 No. Fatal Vehicle Accident
1.5.3 Total Vehicle Accident

TARGET /
LIMIT THIS ACTUAL
KEY PERFORMANCE INDICATORS LAST YEAR
[Current MONTH YTD [20XX]
Year]
Template by Andrew Lee Salin @ www.andrewsalin.com
Replace with your company letter head / address

FORM REF. NO. : Your reference no MONTHLY HSSE PERFORMANCE REVISION NO. : 1

LEADING KPI
1.6.1 HSSE Plan Progress
1.6.2 Management Facility Visit / SIV
1.6.3 HSSE Committee Meeting
1.6.4 Monthly HSSE / Operation Meeting
1.6.5 HSSE Inspection / Walkabout
1.6.7 Unsafe Act Unsafe Condition Reporting
LAGGING KPI
1.7.1 Lost Time Injury Frequency [LTIF]
1.7.2 Total Recordable Case Frequency [TRCF]

1.7.3 Total Recordable Occupational Illness Rate [TROIF]

1.7.4 Fatal Vehicle Accident Rate [FVAR]


1.7.5 Total Vehicle Accident Rate [TVAR]
1.7.6 Total Safe Manhours
Number of days since Last Time Injury / Goal Zero
1.7.7
Days

2 DESCRIPTION OF THE LOST TIME ACCIDENT(S)


[Please include: Oceancare/Sub-contractor, Job Title, Date, Location, Day Lost, Cause(s), Action(s) Taken Etc]

3 FIRE / PROPERTY DAMAGE / SIGNIFICANT NEAR MISSES


[Briefly state: Date, Location, Cause(s), Action(s) Taken and Cost]

4 HSE HIGHLIGHTS
[Briefly state: Significant Safety Achievement, Safety Training and Safety Awareness Programme undertaken during the
month]

5 AREA OF IMPROVEMENTS
[Highlight any improvements either propose by Oceancare’s personnel, client(s) or other third party]

NOTES

 Separate sheet of paper may be used for the Incident Description/Safety Highlight.

Template by Andrew Lee Salin @ www.andrewsalin.com


Example Workplace Inspection Report / Walkabout Report

Date of Inspection :

Site Name / Location :

Inspected by :

No Findings Picture Category Action Taken Action Party Target Date Picture
(UC / UA)

Conducted by: Acknowledged by:

Name: Name:
Position: Site Safety Supervisor Position: Project Manager

Date: Date

Template by Andrew Lee Salin @ www.andrewsalin.com

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