Monthly HSE Report

Contract No. CMW-13036-C001 Project Title: CONSTRUCTION OF ROADS IN ZMC ABU DHABI
MONTHLY ACCIDENT RETURNS

Property or other
Month : ……………………

>3 day injuries

Total days lost

Environmental

Hours worked
Major injuries

Minor injuries

Occurrence
Dangerous

employees
Number of
Near Miss
Date of Reporting: ……………………

treatment

damaged
Fatalities

Incidents
First aid
Industrial Employee
Office Employee
Subcontractor
Total
ACCIDENT FREQUENCY RATE, FR =
ACCIDENT CLASSIFICATION
Total Total

A Treading on nails etc K Handling materials

B Falls from height L Foreign bodies in eye
C Falls into excavation M Burns or scalds
D Falls on level ground N Strains or sprains
E Collapse of excavation O Electric shock
F Falling objects P Heat exhaustion
G Striking fixed object Q Welding flash
H Struck by moving plant R Road accident
I Trapped by machinery S Horse play suspected
J Use of hand tools T Other unclassified
SITE RETURNS Number of No. of Total Training Hours ( Ref AS-F-HSE 002 & 065)
trainings atten. Total Training hr. (T1) Total man hr. spent for training (T2)
(No. of training X training duration) (No. of attendees X T1)

Induction training
Tool Box Talks
Other Internal Trainings e.g. (MSTU) (List of Training)

Number of Inspection during the month

Number of Safety Weekly Tours during the month
Workplace Visits or Inspections by Statutory Authority / Senior Management? Yes No (if yes, please give date
and brief summary).
Date(s) of safety meeting(s):
Manager’s Comments;

Signature: ....................................................................................
Date: ....................................................................
Note: All accident(s) mentioned above to be described as per below table and no first aid case will be considered if form
AS-F-HSE 009 is not filled and also enclosed filled AS-F-HSE 025 & 026.
Distribution:
Original Copy: Project Manager Copy to: Group HSE & Quality Manager

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 Monthly HSE Report

Type of
Accident Actions Taken to Prevent
Date Description of Accident Cause Of Accident
Recurrence
i.e. Major

Signature: ___________________________
Distribution:
Original Copy: Project Manager Copy to: Group HSE & Quality Manager

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 Monthly HSE Report

REPORTABLE DANGEROUS OCCURRENCES

MONTHLY INFORMATION

Previous
Category Total No. Months’ Current
This Month Ytd Total Ytd Total

Lifting Machinery
Pressure Systems
Freight Containers
Overhead Electric Lines
Electrical Short Circuit
Explosives
Biological Agents
Malfunction of Radiation Generators, etc.
Breathing Apparatus
Diving Apparatus
Collapse of Scaffolding
Train Collision
Wells
Pipelines or Pipeline Works
Carriage of Dangerous Substances by Road:
Tankers and Tank Containers
Carriage of Dangerous Substances by Road other
than by Tankers and Tank Containers
Collapse of Building or Structure
Explosion or Fire
Escape of Flammable Substances
Escape of Substances
Please detail significant new items:

Refer to (RIDDOR) Reporting of Injuries, Diseases and Dangerous Occurrences Regulation

Signature: ____________________________
Distribution:
Original Copy: Project Manager Copy to: Group HSE & Quality Manager

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