DAILY HSE REPORT - Checklist And Inspection Template

[Pages:2]DATE

.......

PROJECT NAME

.......

08.00 - 12.00 12.00 - 15.00 15.00 - 20.00 20.00 - 24.00

TIME

Morning Afternoon

Evening Night

COMPANY/ POSITION .........

MAN POWER

DAILY HSE REPORT

Document No. ...

Effective Date ...

Version

...

Rev. Date

...

CLEAR

WEATHER RECORD CLOUDY

RAIN

HEAVY RAIN

NUMBER OF MANPOWER

MAN HOURS

TOTAL MH PREVIOUS

TOTAL MH TODAY

TOTAL MH TO DATE

REMARKS REMARKS

OVERTIME TOTAL

LAGGING INDICATOR Fatality

Lost Time Injury (LTI) Medical Treatment Injury (MTI)

First Aid Injury (FAI) Near Miss

Environmental Issue Property Damage

HSE KEY PERFORMANCE INDICATOR

TARGET 0

PREVIOUS 0

0

0

0

0

0

0

0

0

0

0

0

0

THIS PERIOD 0 0 0 0 0 0 0

LEADING INDICATOR Tool Box Meeting/ Safety Talk/ GSM Project HSE Induction/ Orientation Tool & Equipment Inspection Permit to Work Issued Safety Patrol HSE Joint Inspection ( Client & subcon ) HSE Meeting/ P2K3 Competency & Awareness Training Emergency Drill Exercise Management Visit HSE AUDIT HSE Reward & Recognition

NO 1 2 3 4 5 6 7 8 9 10 11 12

TARGET

Schedule New Emp/ Visitor

Monthly Daily Daily

Schedule Daily

Schedule Schedule Schedule Schedule Schedule

PREVIOUS

THIS PERIOD PROJECT TO DATE

HSE ACTIVITIES IMPLEMENTED DESCRIPTIONS

PROJECT TO DATE 0 0 0 0 0 0 0

REMARKS

ACTIVITY DOCUMENTATION

Prepared by,

Acknowledged by, Project Manager

 ................
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