7/23/2019 Copy of SOP1App04

http://slidepdf.com/reader/full/copy-of-sop1app04 1/2

SOP 001 App. 4 Rev. 2 08 Jan. 2014 Page 1 of 2

HEISCO

HEALTH & SAFETY STATISTICS REPORT FOR THE MONTH OF - / YEAR -

Project/ Cost Center No. : Date :

Project/ Cost Center Nae :

Project Start Date : E!"ecte# Date o$ Project Co"%eton :

N'(er O$ : )"to Last Mont* T*s Mont* Acc''%at+e Tota%

   M  a  n   H  o  '  r  s   ,

HEISCO Man*o'rs ore#

S'(-Contractor Man*o'rs ore#

   0  e   *   &  c   %  e

Tota% 1%oeters #r+en

   I  n  c   &   #  e  n

   t  s

Lost Te Inc#ents 2LTI3

Lost Da4s #'e to LTI

Frst A# Cases

Me#ca% Treatent Cases

Restrcte# or D't4 Cases

Fata% Case

Near Msses

Fre Inc#ents

Roa# Tra$$c Inc#ents 2RTI3

   S  a   $  e   t  4   T  r  a   &  n   &  n  5

No o$ Too% 6o! Meetn5s Con#'cte#.

   I  n  s  "

   0   &  o   %  a   t   &  o  n arnn5 7+en

Pena%tes Iss'e#

Prepared By : Concurred By :

Safety Engneer! Offcer  Pro"ect #anager 

Sgnature: Sgnature:

Tota% Man*o'rs ore# nc%'#n5S'(-Contractors

Tota% sa$e Man Ho'rs ore# snceLast LTI

Pro"ert4 Daa5e$Ot%er t%an &re ncdent'(

Ot*ers$'pecfy(

No o$ E"%o4ees Atten#e# Sa$et4

In#'cton Trann5.

No o$ E"%o4ees Atten#e# Sa$et4Aarness Trann5.

No o$ P%anne# Ins"ectons Carre#o't

) Pro"ect' *++ ca+cu+ate ,an%our' fro, t%e -egnnng of t%e pro"ect *%erea' Co't Center' *++ ca+cu+ate on year to year -a''.

7/23/2019 Copy of SOP1App04

http://slidepdf.com/reader/full/copy-of-sop1app04 2/2

SOP 001 App. 4 Rev. 2 08 Jan. 2014 Page 2 of 2

Distribution: Original: HSE Department Copies: PM and Safety Engineer/ Officer/ Representative