Whsmp · OPW16/0021

                                                                                                                                                                                         Site Weekly Data Collection Form
                                                                                                                                                                                                                                                 HB-HSEQ-F-049-A
                                                                                                                                                                                                                                                       Version: 9




                                                                        Site HSE Statistics                                       Week Ending:                                                            JOB #:
                                                                                                                       Mon              Tues              Wed                Thurs              Fri             Sat           Sun
                                                                         Audit Criteria                                                                                                                                                    TOTAL        AVERAGE
                                                                                                                        /    /           /     /          /   /              /   /              /     /         /     /           /   /

                                                               No of HB Employees on site
                                                               No. of Labour Hire/Indirect on site
                      PEOPLE




                                                               No. Of Subcontractor workers on site.
                                                               Average hours per day
                                                               Inductions completed
                                                               No. New SWMS/JSA/JHA's Developed.
                                                               No of Subbie SWMS received & reviewed.
                     HS




                                                               Emergency drills conducted

                                                               No. New Plant & Equipment Pre-start’s/ RA's
                   &
                   P

                   E    Removed/




                                                               Waste Type
                         Recycled




                                                               Waste Qty (m3/Lt)
                        Waste




                                                               Waste Type
                                                               Waste Qty (m3/Lt)
 ENV




                                                               Fauna Injured
                                       Objectives




                                                               Flora Inadvertently Removed
                                                               Sediment Control Failures
                                                               Sewer Overflow
 be entered on




                                                               Corrective Actions raised (HB-HESQ-F-029-A)
 (all notices to


 spreadsheet)
   Systems &
     Notices


     project




                                                               Corrective Actions CLOSED OUT
                                                               Safety Alerts, m e m o’s & Bl it z circulated
                                                               Enforcement action, regulator notices received
                                                               Foreman Daily Diary Completed

                                                               Engineer / Certifier Inspections carried out
                      Quality




                                                               Engineer / Certifier Inspections carried passed

                                                               Defects Identified
                                                               Defects rectified & Closed Out

                                                               Pre start Meetings (HB-HESQ-F-054)
                                                               Toolbox Meetings (HB-HESQ-F-055)
                                       Objective and Targets




                                                               Internal Audits (HB-HSEQ-F-046 or 047)
 Lead Indicators




                                                               Task Observations (HB-HESQ-F-052)
                                                               Weekly Inspections (HB-HESQ-F-048)
                                                               Committee Meetings (HB-HESQ-F-058)
                                                               Public/Neighbour complaints (HB-HESQ-F-041)
                                                               Project HSE Monthly R e view M eeting ((HB-
                                                               HESQ-F-057)
                                                               First Aid Injuries (FAI)
                                                               Medically Treated Injuries (MTI)
                      Lag Indicators




                                                               Restricted Work Injuries (RWI)
                                                               Lost Time Injuries (LTI)
                                                               Lost Time Hours (LTH)
                                                               Other Incidents (P&E, Near Miss, Env)


                     FIRST AID INJURY SUMMARY
                                                                          BAC              HAND                  ARM             HEAD              NECK           LEG/FEET           SHOULDER             EYE             CHEST           FACE         TOTAL
                           CUTS

                       BURNS
                    SPLINTERS

                       BRUISE

                   FOREIGN BODY

                   MUSCLE PAIN

                    PUNCTURE

                        OTHER

                        OTHER
                        TOTAL


COMMENTS:




Name:                                                                                                             Signed:                                                                   Date: