ENVIRONMENT, SAFETY AND HEALTH STATISTICS RECORDS FOR THE MONTH OF ……………..

PROJECT : Project Target

Man-hours worked 250,000
PROJECT COMMENCEMENT DATE : without LTI
Man-hours Worked
0
EXPECTED COMPLETION DATE : Without LTI
Date of Last LTI
MONTH ENDING :

Staff & Contractor

ITEM DESCRIPTION UNIT Project Total REMARKS
This month Cumulative Total
1 No. of Fatal Cases (FC) No 0 0 0 0
2 No. of Lost Time Accident No 0 0 0 0
3 Man hours worked Hrs 0 0 0 0
4 No. of Medical Treatment (MT) No. 0 0 0 0
5 No. of Lost Workdays (Days) (LW) Days 0 0 0 0
6 No. of First Aid Cases (Minor) (FAC) No 0 0 0 0
7 No. of Fire Incident (FI) No 0 0 0 0
8 No. of Vehicle Accident (VA) No 0 0 0 0
9 No. of Property Damage Accident (PDI) No 0 0 0 0

10 No. of Near Misses (NM) No 0 0 0 0

11 LTI Frequency LTI x 1000000 NIL NIL NIL NIL
Manhour Worked
LTI Severity LW x 1000000
12 Manhour Worked NIL NIL NIL NIL

13 Direct and Indirect Cost Incurred RM NIL NIL NIL NIL

14 NOP/NOI Issued by Relevant Authority 0 0 0 0

Prepared by: Approved by

____________________________ ______________________________
Name : Name :
Designation : ESH Officer Designation : Project Manager
Date: Date: