Doc ID: PP701-HSE-F04

Consolidated Contractors International Company

Issue Date:

Weekly HSE Statistics Report Rev. No. B Rev.Date: 04-11-08

Page No. 1 of 1
Project Name: Project Number:
Area: Project Start Date: Segment:
Location: Project Finish Date:
Project Manager Report Number:
HSE Manager: Period Ending:

LAST THIS TOTAL First Aid Recordable

NO. DESCRIPTION TYPE
PERIOD PERIOD TO-DATE This period To-date This period To-date
EMPLOYE

1 No. of Employees (overall) 0 Abrasion

E

2 No. of Employees (HSE) 0 Arc Eye

3 No. of Lost Time Incidents (LTIs) 0 Asphyxiation
RECORDABLE CASES

4 No. of Restricted Work Cases 0 Blister

5 No. Occupational Illnesses 0 Burns

NATURE OF INJURY
6 No. of Occupational Fatalities 0 Contusion
7 No. of Medical Treatment Cases 0 Cut / wound
8 No. of Loss Consciousness Case 0 Dislocation
No. of First Aid Cases 0 Electric shock
RECORDABLE

9
NON-

10 No. of Near Misses 0 Foreign Body

11 No. of Non-Occupational Fatalities 0 Fracture
No. of HSE Staff inducted 0 Laceration
INDUCTION / TRAINING

12

13 No. of Project Personnel inducted 0 Puncture

14 No. of Employees Trained (other than Induction) 0 Sprain / Strain
15 Total Man-hours for HSE Induction 0 Others
16 Total Man-hours for Training 0
INSPECTI

17 No. of HSE Meetings 0 TOTAL 0 0 0 0

ON

18 No. of HSE Inspections 0 Ankle

19 No. of Fires 0 Arm / Forearm
ENVIRONMENT & SECURITY

20 No. of Thefts 0 Back

21 No. of Property Damage 0 Chest
22 No. of Alcohol Intoxication Cases 0 Ear
23 No. of Drugs Abuse Cases 0 Eye
24 No. of Spills / Leaks 0 Face
25 No. of Chemical Rleases 0 Finger
BODY PART AFFECTED

26 No. of Vehicles (Group 5 & 9) 0 Foot

VEHICLES

27 Total Kms. Driven (Group 5 & 9) 0 Groin

28 No. of Vehicle Accidents (Group 5 & 9) 0 Hand
29 Total Man-hours Worked (Direct & Indirect) 0 Head / Forehead
MAN-HOURS

30 Total Lost Man Days due to LTIs 0 Internal Organs

31 Total Man-hours from Last LTI / Fatality 0 Knee
32 LTI Frequency Rate (LTI FR) 0.00 0.00 Leg (Thigh / Calf)
33 Total Recordable Injury Rate (TRIR) 0.00 0.00 Mouth
RATES

34 Severity Rate 0.00 0.00 Neck

35 Mean Duration 0.00 0.00 Shoulder
Prepared by: Skin
Name & Signature Date Torso
Checked by: Wrist
HSE Manager (Name & Signature) Date Others
Approved by: TOTAL 0 0 0 0

Project Manager Name & Signature Date Allergy

INCIDENT RATE CALCULATIONS: Avian Flu
32 LTI Frequency Rate (LTI FR): Dermatitis
No. of Lost Time Injury x 200,000 (Item 3) Frost Bite
NATURE OF ILLNESS

Total Man-hours Worked Hearing Loss

33 Total Recordable Injury Rate (TRIR): Heat Stress
Total Number of Recordable Cases x 200,000 (Items 3+4+5+6+7+8) Malaria
Total Man-hours Worked Poisoning
34 Severity Rates: Respiratory
Total Lost Man Days x 200,000 (Item 30) Skin inflammation
Total Man-hours Worked Others
34 Mean Duration:
Total Lost Man Days (Item 30)
No. of Lost Time Injury TOTAL 0 0 0 0

Distribution: SCD MOA Form: PP701-HSE-F04 Rev. B