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    Monthly Report Form

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    Star Stream
    Report Form

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Monthly Report Form

    Uploaded by

    Star Stream
    18 views2 pages
    Report Form

    Copyright

    © © All Rights Reserved

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    DOC, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    18 views2 pages

    Monthly Report Form

    Uploaded by

    Star Stream
    Report Form

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    HEALTH & SAFETY REPORT FORM

    Consultant /
    Contractor
    Details:

    Date:

    Date of Last Site Inspection:


    Reporting (provide details where required)
    Number of First Aid Cases
    Number of Cases requiring more than First Aid Treatment
    Number of Lost Time Cases (3 consecutive shifts or work
    days lost including potential work days)
    Number of Fatalities
    Number of Environmental Incidents
    Have any major accidents been recorded (Provide
    copy of Notification of accident form )
    Are there any other accidents to report? (If so, provide
    details.)
    Cost Associated with each Incident detailed above
    Details of Property / Asset Damage
    Number & Type of Hazards reported
    Man Hours Worked (Average over Period)
    Number of employees
    Hours Worked (Day shift)
    Hours Worked (Night Shift)
    House Keeping
    Is the Site neat and orderly?
    Are all areas free from Rubbish and Debris?
    First Aid Management
    Does the number and type of first aid equipment provided comply with
    the First Aid regulations:
    Do first aid boxes include all items required by the regulations
    Safety Tours & Inspections
    Number of Safety Inspections carried out
    Number of Senior Management Safety Tours
    Attach copies of all safety inspections carried out since last report.
    Audit and Improvement
    Inspections By:
    Date:

    Report Form Issue 1

    PB Ltd

    Consultant

    Contractor

    Itemise Outstanding
    Corrective Actions

    Action & Other Items List all actions and any other issues

    Name

    Signed

    Position

    Prepared by:

    Safety Officer

    Approved by:

    Project Manager

    Date

    EMERGENCY CONTACT DETAILS


    Role
    Project Manager
    Health & Safety
    Officer
    Construction
    Manager
    First Aider(s) / Male
    Nurse

    Report Form Issue 1

    Name(s) of
    Appointed Person(s)

    Mobile Telephone Number:

    Office Ext Number:

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