Project Name: Design & Construction of Abdali Clemenceau Hospital (ACH)

Construction Start Date:

Data for Month of:

EMPLOYMENT INFORMATION

Average Daily Number of Employees

Total Hours Worked by Employees

NOTES: COMPLETION OF AFR/AIR WORKBOOK

1. Complete the Site/ Office Region at the top left of the Worksheet
2. With the exception of the above, the summary sheet and statistics sheet needs no input.

Monthly Sheets

1. List all Contractors working on your Project in the left column including Consolidated Consultants Group and the Client if
2. Complete 'CC Staff Numbers', Contractor's Labour Numbers', General Visitors Numbers in the unprotected cells
3.Visitor hours', using the attached monthly workbook. The hours for each will calculate automatically X10 hours per perso
4. Complete all the other sections 'highlighted in blue' within the workbook.

Summary

1. This will automatically show the hours worked on your Project for that Month and will provide a monthly AIR and AIR re
2. With this information, CC will be able to benchmark our performances across each region in a master KPI workbook
3. All calculations to this workbook are compliant to the RIDDOR regulations 2012 and OSHA classification of injury types
4. Any Alterations or amendments to this workbook can only be completed by the Senior CMC HSE Manager

Definitions
1. Lost Workday Case (LWC): A work related injury that renders the injured person unable to perform their normal
2. Restricted Work Case (RWC) Injured or sick person who cannot fulfil their normal duties following an incident but
3. Medical Treatment Case (MTC) Injured or sick person that requires more than first aid treatment from a doctor or ph
4. First Aid Treatment Case (FAC) A work related incident or illness that can be treated by a first aider or equivalent
 Construction End Date:

Date Submitted:

0
0

tants Group and the Client if applicable

e unprotected cells
atically X10 hours per person - visitors will be inputted manually

de a monthly AIR and AIR respectively

a master KPI workbook
assification of injury types
HSE Manager

able to perform their normal work activities for more than one work day
es following an incident but can perform other duties not full time
eatment from a doctor or physician
a first aider or equivalent
Annual KPI Report
Period: Jan 16- Dec 16

REPORTED ACCIDENTS MINOR

CATEGORY
FATALITY LWC RWC MTC FAC
Slips Trips Falls - - - - -
Electric Shock - - - - -
Cuts / Abrasions - - - - -
Falling Objects - - - - -
Eye Injuries - - - - -
Ingestion / Swallowed - - - - -
Inhalation / Breathing - - - - -
Manual Handling - - - - -
Assault by Human - - - - -
Burns / Scolds - - - - -
Contact Injuries - - - - -
Vehicle Accidents - - - - -
Others - - - - -
TOTAL - - - - -
Reported Accidents (FT-LWC-MTC-RWC) -
Minor Accidents (FAC) -
No. of Unsafe Act / Conditions -
No. of Traffic Incidents -
No. of Emergency Drills Conducted -
No. of Initiative Awards -
Inspections by Contractor's HSE Team -
Inspections by DAR HSE Team -
Inductions Completed -
Tool Box Talks Delivered -
Average Annual No. of Personnel -
Total Annual Manhours -
Annual Accident Incident Rate (AAIR) #DIV/0!
Annual Accident Frequency Rate (AAFR) #DIV/0!

AAIR = x100,000

AAFR = x100,000
Annual Minor Accidents

Category Jan.16 Feb.16 Mar.16 Apr.16 May.16 Jun.16 Jul.16 Aug.16 Sep.16

Slips Trips Falls - - - - - - - - -

Electric Shock - - - - - - - - -

Cuts / Abrasions - - - - - - - - -

Falling Objects - - - - - - - - -

Eye Injuries - - - - - - - - -

Ingestion / Swallowed - - - - - - - - -

Inhalation / Breathing - - - - - - - - -

Manual Handling - - - - - - - - -

Assault by Human - - - - - - - - -

Burns / Scolds - - - - - - - - -

Contact Injuries - - - - - - - - -

Vehicle Accidents - - - - - - - - -

Others - - - - - - - - -

Total Minor Accidents - - - - - - - - -

1
Total Monthly Minor Accidents
1

1
f Unsafe Acts / Conditions

0
 1

No. of Unsafe Acts / Conditions

1

-
-
Jan.16 -
Feb.16 -
Mar.16 -
Apr.16 -
May.16 -
Jun.16 -
Jul.16 -
Aug.16 -
Sep.16 -
Oct.16
 1

Oct.16 Nov.16 Dec.16 Total 1 Total Annual Minor Accidents by Type

1
- - - - 1

No. of Unsafe Acts / Conditions

- - - - 1

1
- - - -
0
- - - -
0
- - - - 0

- - - - 0

-
- - - - - - - - -s - - - - -s
alls o ck n s cts
r ie e d in g
lin g an ld
sF Sh sio bj
e ju llo
w th d
Hu
m Sc
o
- - - - Trip r ic bra O In a rea Han y s /
g e w
ps ct A in Ey /S /B ua
l
lt
b
ur
n ta
Sli Ele t s/ Fall o n on an a u B on
u ti s C
- - - - C sti la M As
In
ge ha
In
- - - -
Category
- - - -

- - - -

- - - -

- - - -
 -
Sep.16 -
Oct.16 -
Nov.16 -
Dec.16
cidents by Type

- - - - -s - -
in
g
lin
g an lds r ie nt s e rs
d m co ju e th
Han y Hu /S t In ccid O
l s
ua tb ur
n ac A
ul nt cle
an sa B Co h i
As Ve

ory
Annual Unsafe Acts / Conditions

Category Jan-16 Feb-16 Mar-16 Apr-16 May.16 Jun-16 Jul-16

Equipment And Plant Damage - - - - - - -

Conflict with Moving Vehicles /
Plant
- - - - - - -

Contact with Moving Machinery - - - - - - -

Exposure to Harmful Substance - - - - - - -

Contact - Striking of Utility
Service
- - - - - - -

Housekeeping Standards - - - - - - -

Something Falling / Collapsing - - - - - - -

Breach of Security - - - - - - -

Incorrect Protective Equipment - - - - - - -

Confined Working Spaces - - - - - - -

Inadequate Warning Signs - - - - - - -

Defective Tools / Equipment - - - - - - -

Inadequate Lighting - - - - - - -

Inadequate Training - - - - - - -

Improper Lifting / Handling - - - - - - -

Behavioural Safety / Horseplay - - - - - - -

Substandard Working
Conditions
- - - - - - -

Protruding Object - - - - - - -

Others - - - - - - -

Total Unsafe Acts / Conditions - - - - - - -

1 Total Annual Unsafe Acts / Conditions by Type

1

1
 1

1 Total Annual Unsafe Acts / Conditions by Type

1

1
No. of Unsafe Acts / Conditions

-
- -t - - - -s - - - - - - - -
ag
e
lan er
y
n ce vice rd sin
g
r ity e nt ces ig ns e nt
ti ng in
g
n a r a cu a in
Da
m
s/
P hi st Se nd lap Se pm gS
p gS pm Lig
h
Tra
t le ac Sub t y Sta Col f q ui in nin qui e te
an i t
Pl
ic gM fu
l
Uti
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o
ve
E
or
k ar
s/
E
qu
a
qu
a
d eh vin m f pi in a ti W l e e in
A n n g V
M
o
H a r
g o ke e
Fall
Bre
te c
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W
ua te
Too
ad
n ad
r Lif
t ov
i
to in se g ro n q e In I e
en M ith re rik ou h in tP nfi de ctiv rop
m w t H t c o a e p
p ith ct su -S e re C In f
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Eq t n x a S In
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C

Category
 Aug.16 Sep.16 Oct-16 Nov-16 Dec.16 Total
Tota
- - - - - - 1

- - - - - -
1
- - - - - -
1
- - - - - -

- - - - - - 1

No. of Unsafe Acts / Conditions

- - - - - - 1
- - - - - -
1
- - - - - -

- - - - - - 0

- - - - - - 0

- - - - - -
0
- - - - - -
0
- - - - - -

- - - - - - -
-
Jan-16 -
Feb-16 -
Mar-16 -
Apr-1
- - - - - -

- - - - - -

- - - - - -

- - - - - -

- - - - - -

- - - - - -

nditions by Type
 nditions by Type

-s -s -t - - - - - - -s
iS gn en ti ng in
g
l in
g
p lay ons je ct er
in h
g pm Lig
h
Tra nd se iti b t
n in qui e e Ha H or ond n gO O
ar t t / i
/E qu
a
qu
a
in
g
ty
/ gC ru
d
W
o ls e e if fe kin o t
To ad ad L Sa or Pr
ve In In
per ral d
W
cti o u ar
fe pr av
io
nd
Im h ta
Be bs
Su
 Total Annual Unsafe Acts / Conditions

-
b-16 -
Mar-16 -
Apr-16 -
May.16 -
Jun-16 -
Jul-16 -
Aug.16 -
Sep.16 -
Oct-16 -
Nov-16 -
Dec.16
 -
Nov-16 -
Dec.16
Annual Near Miss Reports

Category Jan.16 Feb.16 Mar.16 Apr.16 May.16 Jun.16 Jul-16 Aug.16 Sep.16
Mobile Plant / Equipment - - - - - - - - -

Access / Egress - - - - - - - - -

Chemical / Substances - - - - - - - - -

Compressed Gasses - - - - - - - - -

Demolition - - - - - - - - -

Dewatering - - - - - - - - -

Dust / Fumes - - - - - - - - -
Edge Protection /
Guarding
- - - - - - - - -

Electrical - - - - - - - - -

Excavations - - - - - - - - -

Falling Objects - - - - - - - - -

Fire - - - - - - - - -

Hot Works - - - - - - - - -

Ladders / Stepladders - - - - - - - - -

Housekeeping - - - - - - - - -

Lifting Operations - - - - - - - - -

Lighting - - - - - - - - -

Machinery - - - - - - - - -

Portable Tools - - - - - - - - -

Riser / Lift Shaft Protection - - - - - - - - -

Traffic Management - - - - - - - - -

Manual Handling - - - - - - - - -

MEWP / Scissor Lift - - - - - - - - -

Mobile Scaffold Tower - - - - - - - - -

Noise - - - - - - - - -
Documentation - - - - - - - - -

Piling Operations - - - - - - - - -

Pollution - - - - - - - - -

PPE - - - - - - - - -

Roadworks - - - - - - - - -

Roof Works - - - - - - - - -

Scaffolds - - - - - - - - -

Signage - - - - - - - - -

Storage of Materials - - - - - - - - -

Temporary Works - - - - - - - - -

Vibration - - - - - - - - -

Waste Management - - - - - - - - -

Welding - - - - - - - - -

Welfare Facilities - - - - - - - - -

Work At Height - - - - - - - - -

Undergound Services - - - - - - - - -

OTHER - - - - - - - - -
Total Near Miss
Reports
- - - - - - - - -
Oct.16 Nov.16 Dec.16 Total
- - - - 1
Total Monthly
- - - - 1
- - - -
1
- - - -
1

No. of Near Miss Reportss

- - - -
- - - - 1

- - - - 1

- - - - 0
- - - -
0
- - - -
0
- - - -
- - - - 0

- - - - -
-
Jan.16 -
Feb.16 -
Mar.16 -
Apr.16 -
May.16
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - 1

- - - -
1
Total Annual Nea
- - - -
1
- - - -
- - - - 1

- - - - 1
ar Miss reports

- - - - 1

0
 1

No. of Near Miss reports

1
- - - -
0
- - - -
0
- - - -
- - - - 0

- - - - 0

- - - -
-
-t -s -s -s - - -s - -l -s -s - -s -s - -s -
n g g e g g
- - - - en gres nce sse itio rin me rdin trica tion ject Fir ork der pin tion htin
m a a l e u c d e
ip / E st G o at F ua le ava Ob W a e ra ig h
ot tepl sek pe L ac
- - - - Equ ess Sub sed Dem Dew st / / G E Exc ing H u O M o
nt / Acc cal / pre
s Du on Fall s / S Ho ing P
a i m cti r if
- - - - Pl m
e C o te de L if
b ile Ch Pr
o
L ad /L
o ge r
se
- - - - M Ed Ri

- - - - TYP
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -

- - - -
 Total Monthly Near Miss Reports

-
Apr.16 -
May.16 -
Jun.16 -
Jul-16 -
Aug.16 -
Sep.16 -
Oct.16 -
Nov.16 -
Dec.16

Total Annual Near Miss Reports by Type

 -l -s -s - -s -s - -s - - -s - -t - - -r - - -s - - -s -s -s - -s -s - -t - -s -t -s -
g g g E g
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t ati b d e ti h in T c m d To N ta ti u w f g e ra m l
e cil e rv T
cav g O ot W pla eke pera Lig ach ble rote age Han cisso ld a l
en per Pol
W a i t W
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x e s a n l o o o n re k nd
E llin H St u O M ort f P a ua / S caf um O R R of r a
lfa or gou
Fa o g
s / H ifin P ha c M an P e S Doc ling ge m po e
M e
r S W il i a
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t W W der
dde L
L if Traf M ME ob P
Sto T
La r/ M W Un
se
Ri

TYPE / OBSERVATION
 -
Dec.16
 - - - - -
g s t s
d in itie igh ice HER
el acil He erv OT
F t S
re rk A und
o
W ergo
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Annual HSE Inspection Reports

Category Jan.16 Feb.16 Mar.16 Apr.16 May.16 Jun.16 Jul-16 Aug.16 Sep.16
Mobile Plant / Equipment - - - - - - - -

Access / Egress - - - - - - - -

Chemical / Substances - - - - - - - - -

Compressed Gasses - - - - - - - -

Demolition - - - - - - - - -

Dewatering - - - - - - - - -

Dust / Fumes - - - - - - - -
Edge Protection /
Guarding
- - - - - - - -

Electrical - - - - - - - - -

Excavations - - - - - - - -

Falling Objects - - - - - - - - -

Fire - - - - - - - -

Hot Works - - - - - - - -

Ladders / Stepladders - - - - - - - - -

Housekeeping - - - - - - - -

Lifting Operations - - - - - - - -

Lighting - - - - - - - -

Machinery - - - - - - - - -

Portable Tools - - - - - - - - -
Riser / Lift Shaft
Protection
- - - - - - - - -

Traffic Management - - - - - - - - -

Manual Handling - - - - - - - -

MEWP / Scissor Lift - - - - - - - - -

Mobile Scaffold Tower - - - - - - - - -

Noise - - - - - - - - -
Documentation - - - - - - - - -

Piling Operations - - - - - - - -

Pollution - - - - - - - -

PPE - - - - - - - - -

Roadworks - - - - - - - -

Roof Works - - - - - - - -

Scaffolds - - - - - - - -

Signage - - - - - - - - -

Storage of Materials - - - - - - - - -

Temporary Works - - - - - - - -

Vibration - - - - - - - - -

Waste Management - - - - - - - -

Welding - - - - - - - - -

Welfare Facilities - - - - - - - - -

Work At Height - - - - - - - - -

Undergound Services - - - - - - - - -

OTHER - - - - - - - - -
Total HSE Inspection
Hazards (HSEO) - - - - - - - - -
Oct.16 Nov.16 Dec.16 Total
1
Total Monthly HSE I
- - - -
- - - - 1

- - - - 1
- - - -
1
- - - -
1
No. of issues Raised
- - - -
- - - - 1

- - - - 0

- - - -
0
- - - -
0
- - - -
0
- - - -
- - - - -
-
Jan.16 -
Feb.16 -
Mar.16 -
Apr.16 -
May.16
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - 1

- - - -
1
Total Annual HSE Inspe
- - - -
1
- - - -
1
- - - -
- - - - 1

- - - - 1
issues Raised

0
 1

No. of issues Raised

- - - -
0
- - - -
0
- - - -
0
- - - -
- - - - 0

- - - - -
-t -s -s -s - - -s - -l -s -s - -s -s - -s
n g g e g
- - - - en gres nce sse itio rin me rdin trica tion ject Fir ork der pin tion htin
p m E ta Ga o l te Fu a c a b W d e
a e ra ig
qui ss / ubs ed em ewa t / Gu Ele xcav g O ot tepl sek pe L a
E e S ss D D Du n s / E n H S ou g O M
- - - - t / Acc cal / pre lli
n i ti o Fa rs / H ifin P
a c
Pl e m om
C ote
dd e L
L
- - - - ile Ch Pr La r/
ob ge se
M Ed Ri
- - - -
- - - - TY

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -

- - - -
Total Monthly HSE Inspections Hazards (HSEO)

6 -
Apr.16 -
May.16 -
Jun.16 -
Jul-16 -
Aug.16 -
Sep.16 -
Oct.16 -
Nov.16 -
Dec.16

al Annual HSE Inspections Hazards (HSEO) by Type

 - -l - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ng rica ons ects Fire orks ers ing ons ting ery ools tion ent ling L if wer oise tion ons tion PPE orks orks olds age rials orks tion ent ing ties ight ices HER
t ti j dd ep ti h in T c m d r To N nta rati llu n a ld li e v T
ec cava Ob t W pla eke pera Lig ach ble rote age Han cisso ld e e o adw of W Scaf Sig ate ry W ibr agem We Faci t H Ser O
g o p P M V
Ex llin H Ste us O
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a an fare rk A und
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P h c a P eS e M e Wo rgo
l
F
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if S f M EW il Do Pilin rag Tem ste W e
L a o a
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La r / M U
se
Ri

TYPE / OBSERVATION
 -
Dec.16
 - - - - -
ing ties ight ices HER
d i
el acil He erv OT
F At d S
e
ar ork un
W ergo
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Un
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: JAN-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Confined Working Spaces Reported Accidents (FT-LWC-MTC- -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 0.9 Injure
0.8
12 0.7
0.6
10 0.5
No. of njuries

8 0.4
0.3
6 0.2
No. of Accidents

0.1
4 0
2 ad ders ck es
t
Column L He l Ba Ch
- ou
Sh
lls ck s ts es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the
p a b n ll a n H / S n id O
ri ric br O I a re Ha I cc
ips T ect / A lling Eye / Sw / B ual lt by rns tact e A
Sl l n u n l
E ts Fa
u ti on atio Man ssau B Co ehic
C s al A V
ge
In Inh
 4 0

No. o
No. of Accide
2 ad ders ck t
es
Column L He l Ba Ch
- ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

1
0.9
0.8
Injured Body Part by Type
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
ad ders ck es
t s
er
s gs et es se rs th Column Q
He l Ba Ch
m
Ar F ing Le Fe Ey No Ea ou Column P
ou M
Sh /
nds Column O
Ha

Body Part
0
ad ders ck es
t s
er
s gs et es se rs th Column Q
He l Ba Ch
m
Ar F ing Le Fe Ey No Ea ou Column P
ou M
Sh /
nds Column O
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: FEB-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Confined Working Spaces Reported Accidents (FT-LWC-MTC- -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 1 Injure
1
1 1
1 1
1 1
No. of njuries

1 0
1 0
1 0
No. of Accidents

0 0
0 -
0 t
0 Column N ad ders ck es
He l Ba Ch
- Column L ou
Sh
lls ck s t s es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the H
p a b n ll a n H / S n id O
ri ric br O I a re Ha I cc
ips T ect / A lling Eye / Sw / B ual lt by rns tact e A
Sl l
E ts Fa n u n l
u ti on atio Man ssau B Co ehic
C s al A V
ge
In Inh
 0
0 -

No. o
No. of Accide
0 t
0 Column N ad ders ck es
He l Ba Ch
- Column L ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her H
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

1
1
1
Injured Body Part by Type
1
1
1
0
0
0
0
-
ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou F M
Column P
Sh s/
n d
Ha

Body Part
-
ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
n ds
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: MAR-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Confined Working Spaces Reported Accidents (FT-LWC-MTC- -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 1 Injure
1
1 1
1 1
1 1
No. of njuries

1 0
1 0
1 0
No. of Accidents

0 0
0 -
0 t
0 Column O ad ders ck es
He l Ba Ch
- Column L ou
Sh
lls ck s t s es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the H
p a b n ll a
a re Ha n S n id O
ri ric br O I H / I cc
ips T ect / A lling Eye / Sw / B ual lt by rns tact e A
Sl l
E ts Fa n u n l
u ti on atio Man ssau B Co ehic
C s al A V
ge
In Inh
 0
0 -

No. o
No. of Accide
0 t
0 Column O ad ders ck es
He l Ba Ch
- Column L ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her H
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

1
1
1
Injured Body Part by Type
1
1
1
0
0
0
0
-
ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou F M
Column P
Sh s/
n d
Ha

Body Part
-
ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
n ds
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: APR-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS REPORTED ACCIDENTS

PROJECT PARTIES CATEGORY
No. Hours No. Hours No. Hours FATAL (FT) LWC RWC MTC
- - Slips Trips Falls - - - -
- - Electric Shock - - - -
- - Cuts / Abrasions - - - -
- - Falling Objects - - - -
- - Eye Injuries - - - -
- - Ingestion / Swallowed - - - -
- - Inhalation / Breathing - - - -
- - Manual Handling - - - -
- - Assault by Human - - - -
- - Burns / Scolds - - - -
- - Contact Injuries - - - -
- - Vehicle Accidents - - - -
- - Other (Specify Below) - - - -
- - -
- - TOTAL - - - -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR = x100,000 REPORTED
INJURED BODY PARTS
TOTAL MANHOURS WORKED - (Non Fatal)
Head -
* Number where Amber or Red has been scored in the HSE Inspection
MAFR = x100,000 Shoulders -
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO) Back -
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION Chest -
Mobile Plant / Equipment - Manual Handling - UNSAFE ACTS / CONDITIONS Arms -
Access / Egress - MEWP / Scissor Lift - Equipment And Plant Damage - Hands / Fingers -
Chemical / Substances - Mobile Scaffold Tower - Conflict with Moving Vehicles / Plant - Legs -
Compressed Gasses - Noise - Contact with Moving Machinery - Feet -
Demolition - Documentation - Exposure to Harmful Substance - Eyes -
Dewatering - Piling Operations - Contact - Striking of Utility Service - Nose -
Dust / Fumes - Pollution - Housekeeping Standards - Ears -
Edge Protection / Guarding - PPE - Something Falling / Collapsing - Mouth -
Electrical - Roadworks - Breach of Security -
Excavations - Roof Works - Incorrect Protective Equipment - HSE STATISTICS
 Reported Accidents (FT-LWC-MTC-
Falling Objects - Scaffolds - Confined Working Spaces - RWC)
Fire - Signage - Inadequate Warning Signs - Minor Accidents (FAC)
Hot Works - Storage of Materials - Defective Tools / Equipment - No. of Unsafe Act / Conditions
Ladders / Stepladders - Temporary Works - Inadequate Lighting - No. of Traffic Incidents
Housekeeping - Vibration - Inadequate Training - No. of Emergency Drills Conducted
Lifting Operations - Waste Management - Improper Lifting / Handling - No. of Initiative Awards
Lighting - Welding - Behavioural Safety / Horseplay - Inspections by Contractor's HSE Team
Machinery - Welfare Facilities - Substandard Working Conditions - Inspections by DAR HSE Team
Portable Tools - Work At Height - Protruding Object - Inductions Completed
Riser / Lift Shaft Protection - Undergound Services - Other (Specify Below) - Tool Box Talks Delivered
Traffic Management - OTHER - - Monthly Accident Incident Rate (MAIR)
TOTAL - - TOTAL - Monthly Accident Frequency Rate (MAF
 INJURED BODY PARTS BY ACCIDENT CATEGORY

MINOR HEAD SHOULDERS BACK CHEST ARMS HANDS / FIN

CATEGORY
FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
- Slips Trips Falls - - - - - - - - - - - - - - - - - - - - - -
- Electric Shock - - - - - - - - - - - - - - - - - - - - - -
- Cuts / Abrasions - - - - - - - - - - - - - - - - - - - - - -
- Falling Objects - - - - - - - - - - - - - - - - - - - - - -
- Eye Injuries - - - - - - - - - - - - - - - - - - - - - -
- Ingestion / Swallowed - - - - - - - - - - - - - - - - - - - - - -
- Inhalation / Breathing - - - - - - - - - - - - - - - - - - - - - -
- Manual Handling - - - - - - - - - - - - - - - - - - - - - -
- Assault by Human - - - - - - - - - - - - - - - - - - - - - -
- Burns / Scolds - - - - - - - - - - - - - - - - - - - - - -
- Contact Injuries - - - - - - - - - - - - - - - - - - - - - -
- Vehicle Accidents - - - - - - - - - - - - - - - - - - - - - -
- Other - - - - - - - - - - - - - - - - - - - - - -

- LEGS FEET EYES NOSE EARS MOUTH

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls - - - - - - - - - - - - - - - - - - - - - -
MINOR
Electric Shock - - - - - - - - - - - - - - - - - - - - - -
- Cuts / Abrasions - - - - - - - - - - - - - - - - - - - - - -
- Falling Objects - - - - - - - - - - - - - - - - - - - - - -
- Eye Injuries - - - - - - - - - - - - - - - - - - - - - -
- Ingestion / Swallowed - - - - - - - - - - - - - - - - - - - - - -
- Inhalation / Breathing - - - - - - - - - - - - - - - - - - - - - -
- Manual Handling - - - - - - - - - - - - - - - - - - - - - -
- Assault by Human - - - - - - - - - - - - - - - - - - - - - -
- Burns / Scolds - - - - - - - - - - - - - - - - - - - - - -
- Contact Injuries - - - - - - - - - - - - - - - - - - - - - -
- Vehicle Accidents - - - - - - - - - - - - - - - - - - - - - -
- Other - - - - - - - - - - - - - - - - - - - - - -
-
Accidents / Incidents 1 Injured Body Part by Type
1
1
1 1
1
s
 Accidents / Incidents 1 Injured Body Part by Type
1
1
- 1 1
1 1

No. of njuries
- 1
1 1
- 1 1
No. of Accidents

0 0
0
0 0
0 0 C
- Column L
0 C
lls ck s ts es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the -
ip c a b n ll a an H S n id O
Tr ctri Abr ng O ye I Swa Bre l H by ns / ct I Acc
1 2 3 4 5 6 7 8 9 10 11 12
ps e / li E / / a t r ta e
Sli El uts Fal n on anu aul Bu Con hicl Body Part
C stio lati M Ass Ve
ge a
#DIV/0! In Inh
#DIV/0!
Category
PARTS BY ACCIDENT CATEGORY

HANDS / FINGERS
MTC FAC
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

MOUTH
MTC FAC
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

1 Injured Body Part by Type

1
1
s
 1 Injured Body Part by Type
1
1
1
No. of njuries

1
1
0
0
0 Column Q
0 Column P
-
1 2 3 4 5 6 7 8 9 10 11 12

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: MAY-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling -
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management - OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - - -
Electric Shock - - - - -
Cuts / Abrasions - - - - -
Falling Objects - - - - -
Eye Injuries - - - - -
Ingestion / Swallowed - - - - -
Inhalation / Breathing - - - - -
Manual Handling - - - - -
Assault by Human - - - - -
Burns / Scolds - - - - -
Contact Injuries - - - - -
Vehicle Accidents - - - - -
Other (Specify Below) - - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Confined Working Spaces Reported Accidents (FT-LWC-MTC- -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls - - - - - - - - - - - - - -
Electric Shock - - - - - - - - - - - - - -
Cuts / Abrasions - - - - - - - - - - - - - -
Falling Objects - - - - - - - - - - - - - -
Eye Injuries - - - - - - - - - - - - - -
Ingestion / Swallowed - - - - - - - - - - - - - -
Inhalation / Breathing - - - - - - - - - - - - - -
Manual Handling - - - - - - - - - - - - - -
Assault by Human - - - - - - - - - - - - - -
Burns / Scolds - - - - - - - - - - - - - -
Contact Injuries - - - - - - - - - - - - - -
Vehicle Accidents - - - - - - - - - - - - - -
Other - - - - - - - - - - - - - -

ANKLE FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls - - - - - - - - - - - - - -
Electric Shock - - - - - - - - - - - - - -
Cuts / Abrasions - - - - - - - - - - - - - -
Falling Objects - - - - - - - - - - - - - -
Eye Injuries - - - - - - - - - - - - - -
Ingestion / Swallowed - - - - - - - - - - - - - -
Inhalation / Breathing - - - - - - - - - - - - - -
Manual Handling - - - - - - - - - - - - - -
Assault by Human - - - - - - - - - - - - - -
Burns / Scolds - - - - - - - - - - - - - -
Contact Injuries - - - - - - - - - - - - - -
Vehicle Accidents - - - - - - - - - - - - - -
Other - - - - - - - - - - - - - -

1
Accidents / Incidents 1 Injure
1
1 1
1 1
1 1
No. of njuries

1 0
1 0
1 0
No. of Accidents

0 0
0 -
0 t
0 ad ders ck es
Column L He l Ba Ch
- ou
Sh
lls ck s ts es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the H
p a b n ll a
a re Ha n H / S n id O
ri ric br O I I cc
ips T ect / A lling Eye / Sw / B ual lt by rns tact e A
Sl l
E ts Fa n u n l
u ti on atio Man ssau B Co ehic
C s al A V
ge
In Inh
 0
0 -

No. o
No. of Accide
0 t
0 ad ders ck es
Column L He l Ba Ch
- ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her H
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -

1
1
1
Injured Body Part by Type
1
1
1
0
0
0
0
-
ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou F M
Column P
Sh s/
n d
Ha

Body Part
-
ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
n ds
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: JUN-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Confined Working Spaces Reported Accidents (FT-LWC-MTC- -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 1 Injure
1
12 1
1
10 1
No. of njuries

8 0
0
6 0
No. of Accidents

0
4 -
2 ad ders ck es
t
Column L He l Ba Ch
- ou
Sh
lls ck s ts es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the H
p a b n ll a n H / S n id O
ri ric br O I a re Ha I cc
ips T ect / A lling Eye / Sw / B ual lt by rns tact e A
Sl l n u n l
E ts Fa
u ti on atio Man ssau B Co ehic
C s al A V
ge
In Inh
 4 -

No. o
No. of Accide
2 ad ders ck t
es
Column L He l Ba Ch
- ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her H
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

1
1
1
Injured Body Part by Type
1
1
1
0
0
0
0
-
ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou F M
Column P
Sh s/
n d
Ha

Body Part
-
ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
n ds
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: JUL-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Confined Working Spaces Reported Accidents (FT-LWC-MTC- -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds -
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 1 Injure
1
1 1
1 1
1 1
No. of njuries

1 0
1 0
1 0
No. of Accidents

0 0
0 -
0 t
0 Column Q ad ders ck es
He l Ba Ch
- Column L ou
Sh
lls ck s t s es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the H
p a b n ll a
a re Ha n S n id O
ri ric br O I H / I cc
ips T ect / A lling Eye / Sw / B ual lt by rns tact e A
Sl l
E ts Fa n u n l
u ti on atio Man ssau B Co ehic
C s al A V
ge
In Inh
 0
0 -

No. o
No. of Accide
0 t
0 Column Q ad ders ck es
He l Ba Ch
- Column L ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her H
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

1
1
1
Injured Body Part by Type
1
1
1
0
0
0
0
-
ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou F M
Column P
Sh s/
n d
Ha

Body Part
-
ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
n ds
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: AUG-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- - - -
- - - -
- - - -
- - - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Confined Working Spaces Reported Accidents (FT-LWC-MTC- -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 1 Injure
1
12 1
1
10 1
No. of njuries

8 0
0
6 0
No. of Accidents

0
4 -
2 ad ders ck es
t
Column L He l Ba Ch
- ou
Sh
lls ck s ts es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the H
p a b n ll a n H / S n id O
ri ric br O I a re Ha I cc
ips T ect / A lling Eye / Sw / B ual lt by rns tact e A
Sl l n u n l
E ts Fa
u ti on atio Man ssau B Co ehic
C s al A V
ge
In Inh
 4 -

No. o
No. of Accide
2 ad ders ck t
es
Column L He l Ba Ch
- ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her H
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

1
1
1
Injured Body Part by Type
1
1
1
0
0
0
0
-
ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou F M
Column P
Sh s/
n d
Ha

Body Part
-
ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
n ds
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: SEP-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- - - -
- - - -
- - - -
- - - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Confined Working Spaces Reported Accidents (FT-LWC-MTC- -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 1 Injure
1
12 1
1
10 1
No. of njuries

8 0
0
6 0
No. of Accidents

0
4 -
2 ad ders ck es
t
Column L He l Ba Ch A
- ou
Sh
lls ck s ts es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the Ha
p a b n ll a n H / S n id O
ri ric br O I a re Ha I cc
ips T ect / A lling Eye / Sw / B ual lt by rns tact e A
Sl l n u n l
E ts Fa
u ti on atio Man ssau B Co ehic
C s al A V
ge
In Inh
 4 -

No. o
No. of Accide
2 ad ders ck t
es
Column L He l Ba Ch A
- ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her Ha
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

Injured Body Part by Type

ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou F M
Column P
Sh s/
nd
Ha

Body Part
 ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
nds
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: OCT-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- - - - -
- - - -
- - - -
- - - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Reported Accidents (FT-LWC-MTC-
Confined Working Spaces -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 1 Injure
1
12 1
1
10 1
No. of njuries

8 0
0
6 0
No. of Accidents

0
4 -
2 ad ders ck t
es
Column L He l Ba Ch
- ou
Sh
lls ck s ts es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the H
ip c a b n ll a an H S n id O
s Tr ctri Abr ng O ye I Swa Bre l H by ns / ct I Acc
p e / li E / / a t r ta e
Sli El uts Fal n on anu aul Bu Con hicl
C stio lati M Ass Ve
ge a
In Inh
 4 -

No. o
No. of Accide
2 ad ders ck t
es
Column L He l Ba Ch
- ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her H
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

1
1
1
Injured Body Part by Type
1
1
1
0
0
0
0
-
ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou /F
M
Column P
Sh
n ds
Ha

Body Part
-
ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
n ds
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: NOV-16 CC CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL - MAIR =
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection
MAFR =
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
MC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Reported Accidents (FT-LWC-MTC-
Confined Working Spaces -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 1 Injure
1
12 1
1
10 1
No. of njuries

8 0
0
6 0
No. of Accidents

0
4 -
2 ad ders ck t
es
Column L He l Ba Ch
- ou
Sh
lls ck s ts es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the H
ip c a b n ll a an H S n id O
s Tr ctri Abr ng O ye I Swa Bre l H by ns / ct I Acc
p e / li E / / a t r ta e
Sli El uts Fal n on anu aul Bu Con hicl
C stio lati M Ass Ve
ge a
In Inh
 4 -

No. o
No. of Accide
2 ad ders ck t
es
Column L He l Ba Ch
- ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her H
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

1
1
1
Injured Body Part by Type
1
1
1
0
0
0
0
-
ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou /F
M
Column P
Sh
n ds
Ha

Body Part
-
ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
n ds
Ha

Body Part
 ACCIDENT WORKBOOK / KPI REPORT
MONTH: DEC-16 CC - CMC WORKBOOK:

PROJECT STAFF PROJECT LABOR VISITORS

PROJECT PARTIES
No. Hours No. Hours No. Hours
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTAL - - - - - -
TOTAL NO. OF PERSONNEL -
TOTAL MANHOURS WORKED -

* Number where Amber or Red has been scored in the HSE Inspection Report
MONTHLY NEAR MISS REPORTS (NMR) VS. HSE INSPECTION HAZARDS (HSEO)
TYPE / OBSERVATION NEAR MISS INSPECTION TYPE / OBSERVATION NEAR MISS INSPECTION
Mobile Plant / Equipment Manual Handling
Access / Egress MEWP / Scissor Lift
Chemical / Substances Mobile Scaffold Tower
Compressed Gasses Noise
Demolition Documentation
Dewatering Piling Operations
Dust / Fumes Pollution
Edge Protection / Guarding PPE
Electrical Roadworks
Excavations Roof Works
Falling Objects Scaffolds
Fire Signage
Hot Works Storage of Materials
Ladders / Stepladders Temporary Works
Housekeeping Vibration
Lifting Operations Waste Management
Lighting Welding
Machinery Welfare Facilities
Portable Tools Work At Height
Riser / Lift Shaft Protection Undergound Services
Traffic Management OTHER
TOTAL - -
WORKBOOK / KPI REPORT
CMC WORKBOOK:

REPORTED ACCIDENTS MINOR

CATEGORY
FATAL (FT) LWC RWC MTC FAC
Slips Trips Falls - - - -
Electric Shock - - - -
Cuts / Abrasions - - - -
Falling Objects - - - -
Eye Injuries - - - -
Ingestion / Swallowed - - - -
Inhalation / Breathing - - - -
Manual Handling - - - -
Assault by Human - - - -
Burns / Scolds - - - -
Contact Injuries - - - -
Vehicle Accidents - - - -
Other (Specify Below) - - - -

TOTAL - - - - -

MAIR = x100,000 REPORTED

INJURED BODY PARTS MINOR
(Non Fatal)
Head - -
MAFR = x100,000 Shoulders - -
Back - -
Chest - -
UNSAFE ACTS / CONDITIONS Arms - -
Equipment And Plant Damage Hands / Fingers - -
Conflict with Moving Vehicles / Plant Legs - -
Contact with Moving Machinery Feet - -
Exposure to Harmful Substance Eyes - -
Contact - Striking of Utility Service Nose - -
Housekeeping Standards Ears - -
Something Falling / Collapsing Mouth - -
Breach of Security
Incorrect Protective Equipment HSE STATISTICS
Reported Accidents (FT-LWC-MTC-
Confined Working Spaces -
RWC)
Inadequate Warning Signs Minor Accidents (FAC) -
Defective Tools / Equipment No. of Unsafe Act / Conditions -
Inadequate Lighting No. of Traffic Incidents
Inadequate Training No. of Emergency Drills Conducted
Improper Lifting / Handling No. of Initiative Awards
Behavioural Safety / Horseplay Inspections by Contractor's HSE Team
Substandard Working Conditions Inspections by DAR HSE Team
Protruding Object Inductions Completed
Other (Specify Below) Tool Box Talks Delivered
Monthly Accident Incident Rate (MAIR) #DIV/0!
TOTAL - Monthly Accident Frequency Rate (MAF #DIV/0!
 INJURED BODY PARTS BY ACCIDENT CATEGORY

HEAD SHOULDERS BACK CHEST

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

LEGS FEET EYES NOSE

CATEGORY
LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC LWC RWC
Slips Trips Falls
Electric Shock
Cuts / Abrasions
Falling Objects
Eye Injuries
Ingestion / Swallowed
Inhalation / Breathing
Manual Handling
Assault by Human
Burns / Scolds
Contact Injuries
Vehicle Accidents
Other

1
Accidents / Incidents 1 Injure
1
12 1
1
10 1
No. of njuries

8 0
0
6 0
No. of Accidents

0
4 -
2 ad ders ck t
es
Column L He l Ba Ch
- ou
Sh
lls ck s ts es d g g n ds es s r
s Fa Sho sion jec juri owe thin dlin uma col juri ent the H
ip c a b n ll a an H S n id O
s Tr ctri Abr ng O ye I Swa Bre l H by ns / ct I Acc
p e / li E / / a t r ta e
Sli El uts Fal n on anu aul Bu Con hicl
C stio lati M Ass Ve
ge a
In Inh
 4 -

No. o
No. of Accide
2 ad ders ck t
es
Column L He l Ba Ch
- ou
Sh
s k s s d g g n s s
Fall hoc ions ject rie we hin dlin ma cold rie ents her H
s S s b ju lo at n u S ju d Ot
Trip tric bra g O e In wal Bre l Ha y H s / ct In cci
ps ec / A lin Ey / S n / ua ult b urn nta cle A
Sli El uts Fal n o an a B Co hi
C stio lati M Ass Ve
ge a
In Inh

Category
T CATEGORY

CHEST ARMS HANDS / FINGERS

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

NOSE EARS MOUTH

MTC FAC LWC RWC MTC FAC LWC RWC MTC FAC

1
1
1
Injured Body Part by Type
1
1
1
0
0
0
0
-
ad ders ck t s s gs et es se rs th
es m er Le Fe Ey Ea ou Column Q
He l Ba Ch Ar ing No
ou /F
M
Column P
Sh
n ds
Ha

Body Part
-
ad ders ck t s rs gs et es se rs th
es m ge Fe Ey Ea ou Column Q
He l Ba Ch Ar in Le No
ou F M
Column P
Sh /
n ds
Ha

Body Part