Monthly Project Health and Safety Report
Environmental ProgrammesMonthly Project Health and Safety Report(Submit by the 3rd day of the next month)Chief Directorate:Data for the Month (e.g. Oct): Region:Date Submitted: Agent (e.g. WfW, WoF): Project Name:Report compiled by:Name of AM / IMPL / PPM:Designation:Approved by AM / IMPL / PPM: YESNOSignature:Signature: INCIDENT SUMMARYNUMBER OF CASESRATESINCIDENT TYPES CURRENT MONTHYEAR TO DATEDisabling Incident Frequency Rate (DIFR) Calculation:Total # of disabling injuries, fatalities & illness X 200 000 / _______ # of hours worked by all employees & participants = DIFRNEARMISSESFIRST AID INJURY DISABLING INJURY FATALITYOCCUPATIONAL DISEASEENVIRONMENTAL IMPACTSEMPLOYMENT INFORMATION (for the month) TOLERANCE LIMITDIFR(year to date)AVERAGE NUMBER OF EMPLOYEES / PARTICIPANTSTOTAL HOURS WORKED BY EMPLOYEES / PARTICIPANTS NEARMISSESFIRST AID INJURYTYPE / TREND OF NEARMISSES (Only provide summary description e.g. almost slipping, snake sittings etc.)TOOLS / EQUIP USED(where applicable)CAUSESTYPE / TREND OF FIRST AID INJURIES (Only provide summary description e.g. slipping, cuts etc.)TOOLS / EQUIP USED (where applicable)CAUSESDETAILS OF DISABLING INCIDENTS (include all injuries, illnesses and incidents within the scope of the “incident classification” listed below)NONAME & SURNAMESEXPROJECTDATE OF INJURY (DD/MM/YY)INCIDENT CLASSIFICATION (refer to list below) PART OF BODY AFFECTED(refer to list below)TOOL / EQUIP USEDSHORT DESCRIPTION OF INJURYTYPE OF CONTACT(refer to list below)EXPECTED DAYS BOOKED OFF(refer to list below)1.2.3.4.5.6.7.8.9.10.INCIDENT CLASSIFICATIONFATALITY, SERIOUS, MINOR, VEHICLE ACC, VEHICLE / EQUIPMENT / PROPERTY (VEP) DAMAGE, EQUIPMENT / MACHINE (EM) FAILURE, ENVIRONMENT, THEFT. PART OF BODY AFFECTEDHEAD, NECK, EYE, EAR, TORSO, FINGER, HAND, UPPER ARM, ELBOW, LOWER ARM, UPPER LEG, KNEE, LOWER LEG, ANKLE, FOOT, TOE, INTERNAL, MULTIPLE, OTHERTYPE OF CONTACT /GENERAL AGENTSTRUCK BY, STRUCK AGAINST, CUT, SLIPPING/FALL, FALL AGAINST, HANDLING, LIFTING, LOADING, MACHINE, TRANSPORT, ELECTRICITY, HI – JACKING, STINGS / BITES, CHEMICAL, DUST, FUMES, NOISE, FIRE, WATER, VAPOUR, GAS, TEMPERATURE, ERGONOMICS, DEHYDRATION, ATTACK, LATEX, OTHER, NONE, UNKNOWNDAYS BOOKED OFF1 - 3 DAYS, 3 - 7 DAYS, 1 - 2 WEEKS, 2 -4 WEEKS, 1 - 2 MONTHS, 3 - 4 MONTHS, 5 - 6 MONTHS, FATALITY, NOT BOOKED OFF, UNKNOWNPS!!! Please submit required Incident Investigation reports to your Regional SHE Officer.HEALTH AND SAFETY COMMUNICATION / TRAININGCURRENT MONTH YEAR TO DATENO OF SESSIONSNO OF ATTENDEESNO OF SESSIONSNO OF ATTENDEESSafety Orientation / InductionTool box talks / Similar activitiesSHE Standards & Procedures training (internal)Safe Wok Procedures training (internal) Driver training / Advance Driver TrainingForklift / Bell loader / Crane trainingBoat Operator trainingChainsaw trainingClearing saw / Brush cutter trainingHerbicide Application trainingRehabilitationEco – Factory operational training (Dry & Wet mill machines)StackingSprayingRope Access trainingFire Fighting trainingTrades (Construction training)Scaffolding erection trainingHot workSnake Awareness / Wild animal Awareness trainingSHE Representative First AidVehicle Safety CampaignsOtherHEALTH AND SAFETY ACTIVITIES CURRENT MONTH YEAR TO DATELIST NUMBER LIST NUMBER Documented Safety Inspection / Observations completed Project SHE Meetings heldArea SHE meetings attendedRisk Assessments completedEmergency Evacuation practice drills completedRed card issuedYellow card issuedCorrective actions takenDisciplinary actions takenDocumented Second Party Assessments completedDocumented GAP Analysis completedDocumented External audits completed3.1 LIST ANY MAJOR NON-CONFORMANCES IDENTIFIED DURING INSPECTIONS / ASSESSMENTS / AUDITS. REASON FOR NON-CONFORMANCES CORRECTIVE ACTIONS / EP NATIONAL INTERVENTION REQUIRED1.2.3.4. ................
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