TABLE 2

SITE(S) INJURIES DATA REPORT (see note (a)), Month of , 200X

 

INTERFIELD

SUB-CONTRACTORS

TOTAL

 

Last Month

Total to Date

Last Month

Total to Date

Last Month

Total to Date

NUMBER OF RECORDABLE WORK HOURS

 

 

 

 

 

 

Death Cases (b)

 

 

 

 

 

 

Lost Work-day (away) cases (c)

 

 

 

 

 

 

Restricted Work-day cases (c)

 

 

 

 

 

 

More than First Aid cases (requiring medical treatment)

 

 

 

 

 

 

Total recordable cases, number

 

 

 

 

 

 

Total Work-hours (d)

 

 

 

 

 

 

 

 

 

 

 

 

 

INJURY FREQUENCY RATES(g)

 

 

 

 

 

 

Death Cases (b)

 

 

 

 

 

 

Lost Workday (Away) Cases, Rate (e)

 

 

 

 

 

 

Restricted Workday Cases Rate (e)

 

 

 

 

 

 

More than First Aid Cases Rate

 

 

 

 

 

 

Total Recordable Injury Cases, Rate

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER INCIDENTS

 

 

 

 

 

 

First Aid Cases (f)

 

 

 

 

 

 

Vehicle Accidents

 

 

 

 

 

 

Damage Incidents

 

 

 

 

 

 

Security Incidents

 

 

 

 

 

 

Fires

 

 

 

 

 

 

Spills and other environmental

 

 

 

 

 

 

Near misses

 

 

 

 

 

 

Note: Data required for all personnel working full time or part time on Client’s Projects.

Notes for Completing "Injuries Data Report"

  1. All data, definitions of injury classification and rates shall be reported in accordance with the Recording and Reporting Occupational and Health Administration (OSHA) as codified at 29 CFR Part 1904, ANSI 216.4 and Client's Safety Management Manual.

  2. Do not include deaths as lost work day(s) cases. Deaths count as zero number of lost work days (away) and as zero lost work days cases.

  3. For non-fatal Number Lost Work Days (Away) or Number Restricted Work Days, count only the work days actually lost or restricted. Do not include the day of injury or illness or any days (weekends, normal days off, holidays, vacation) on which the employee would not have worked even though able to work.

  4. Include manual, non-manual, engineering and administrative work-hours expended at the Work Site(s) including shops and fabrication yards at this location.

  5. In case an injury results in both Lost Work Days (Away) and Restricted Duty Work Days count the injury as a Lost Work Day (Away) case only, but show the Lost and Restricted Work Days on their respective lines.

  6. First aid cases are not considered as recordable injuries for this report.

  7. The typical calculation of injury incidence rate is on 200,000 employee-hours worked.