Project Name
/ Site No
Monthly Site HSE Performance Report Client
Consultant
Total HSE
HSE Performance Report for the Month of - Staff at Site
Manpower & Manhours Details -
Avg
Cumulative
Mandatory Manpower Man hours
Trade/Desgn Nos Trade/Desgn Nos Nos Man hours till
Certified Personnel for the Current Month
Last Month
Month
Engineers Labourers Rigger
Remarks :
Sr Foreman
Electirician Scaffolder
/foreman
Asst Foreman Pipe Fitter First Aider
Confined Space
Ganger Operators
Workers
Carpenter Drivers Fire Wardens
Mason Sub Contractors Male Nurse
Steel Fixers Others
Induction Training (All Employees absent above 14 days from site to be reinducted)
H-F-07
Revision 01
24-01-2016
No of Persons Newly Joined No. of person joined after 14 days No. Induction sessions conducted
Initial Induction Re-Induction
continous absence during the month
Tool Box Training Total Number of tool box conducted across the Project during the mon
Average time of Total Persons
Areas Activity Name of the Person conducted No. of sessions
each session covered
HSE Training (Internal & External)
Date Sessions / Hours Venue FACULTY TARGET PARTICIPANTS
Total Hours Taken For Induction Total Hours Taken For TBT Total Hours Taken For Internal Trainings
Total Training Hours For Induction, TBT & Trainings for the Month 0
Accident (LTI) / Near Miss Incident (NM) / First Aid (FA)/ Vehicular accident (VA)/ Property Damage(PD)Service DamageDetails(SD
H-F-07
Revision 01
24-01-2016
Description
S/No Date Incident Type Part of the body Injured / damage incase of Causative Factor
vehicle
Risk Assessment:
Risk Assessments Carried out this
Total Number of Risk Assessments Carried Out For The Project Total Number of Risk Assessments Reviewed (Date)
Month
Sub Contractor Details :
Total No. of Sub-Contractors No. of Inspections Performed On Sub-Contractors No. of Review/Approval of Sub-Contractor EH
No. of Site Audits Performed on Sub-Contractor
No. of Full EHSMS Audit Performed on Sub
Sub-Contractor Incidents investigated by Entity
Corrective Notices Issued to Sub-Contr
Breach Notices issued to Sub-Contractors
H-F-07
Revision 01
24-01-2016
Client / Consultant Inspection or Audit :
Date Inspected By Number of Observations Specify the Open / Pending Ob
Other Information: Date Remarks
Safety committee meeting :
Site Safety Walk:
HSE Awards/Appreciation
NOC'S - No Objection Certificate
Description ( Authority / Agency ) Date Of Issue Date Of Expiry
Date of compilation: Singature of HSEA Singature of P.M
Main copy will be submitted to P.M before 4th of each month with a copy to HSEM, Sr. HSEA , HSE CO-OD , HSE SECRETARY & Site safety committee members
H-F-07
Revision 01
24-01-2016
Cumulative Man Hrs from the start of Year 2015
m site to be reinducted)
H-F-07
Revision 01
24-01-2016
Number of People Inducted from the start of Project
Initial Reinduction
cross the Project during the month
Main Topics covered
No. of person
Training Topic covered
Attended
Total Hours Taken For External Trainings
D)Service DamageDetails(SD)
H-F-07
Revision 01
24-01-2016
Learning
Corrective & Preventive Action Taken
Points
Remarks
iew/Approval of Sub-Contractor EHS Procedures
ull EHSMS Audit Performed on Sub-contractor
rrective Notices Issued to Sub-Contractors
H-F-07
Revision 01
24-01-2016
Specify the Open / Pending Observations
Remarks
Date Of Expiry
Singature of P.M
e safety committee members
H-F-07
Revision 01
24-01-2016
PROJECT ENVIRONMENTAL REPORT -
Site Number & Name.: Client Name:
Report prepared
Consultant Name: by:
1. Environmental Training
Description of Environmental Tool Box Talk / Regular Trainings
Sl No Date Subject Time No. Of Attendees
2. Monitoring
Date of
Nature of Monitoring (Air/Water/Noise, etc) Monitoring
Monitoring Done by Remarks
3. Audits/Inspections
No. of Environmental Non-Conformances Ra
Nature of Inspection No of Open
No. of Inspections Major NCR's Minor NCR's NCR's
4. Solid Waste Management
No of Skips
Waste Contractor assigned for the project
present
Disposal
Volume of Each Skip
Frequency
Loading Type of Unloading
Quantity RSP
Date Waste Date
Food
Concrete
Metal
Wood
Nails
Waste Oil
Used
Batteries
Paper
Toners
Plastic
Bitustick
Hazardous
Waste
Asphalt
Other -
specify
5. Effluent Waste Management
Waste Contractor assigned for the project or Self
Disposal Frequency
Type of Waste Quantity Removed this Month Disposed as per CWM Norms (Loca
Liquid Effluent
Liquid - Other
Other - specify
6. Consumption
Quantity of fuel used on site: Litres
Quantity of potable water used on site: Litres
Electricity : kWH
7.Environmental Rewards/Fines
Env. Awards/ Appreciation
Fines
8. Other
Status of
Status of CEMP with Status of Env. Aspects & Env. Concrete
No of Drip Trays
Rev No Impacts Objectives & Washout Area
Targets
I hereby confirm that all details furnished above are true and can be verified
Name Signature
RT -
rainings
Attendees Remarks
al Non-Conformances Raised
Remarks
Recycling
Company Landfill-
Facility-
Truck No. Location
Location
ed as per CWM Norms (Location)
No of Spill
No of Drip Trays
kits/Arrangements
can be verified
Date
Month
Year
MONTHLY HSE STATISTICS REPORT - HILALCO
S.NO SUBJECT NO'S
1 No. of unsafe acts & condtions
2 No. of closed unsafe acts & conditions
3 No. of outstanding Unsafe Acts & Conditions
4 No. of LTI'S (Lost Time Incidents)
5 No. of Fatalities
6 No. of Occupational Illness
7 No. of Medical Treatment Cases
8 No. of on-site First Aid Cases
9 No. of Equipment & Property Damage
10 No. of Near Misses
11 No. of Inductions
12 No. of Re-Inductions
13 No. of TBT'S (Tool Box Talk)
14 No. of Internal Trainings
15 No. of External Trainings
16 No. of Empowerment to Stop Work
17 No. of HSE Walks
18 No. of HSE Committee Meetings
19 No. of HSE Awards
20 No. of Good Practices
21 No. of Fines & Penalties
22 No. of NCR'S
23 No. of HSE Inspections (Consultant & Client)
24 No. of HSE Audits
Date
Month
Year
MONTHLY HSE STATISTICS REPORT -
SUB CONTRACTORS
S.No SUBJECT NO'S
1 No. of unsafe acts & condtions
2 No. of closed unsafe acts & conditions
3 No. of outstanding Unsafe Acts & Conditions
4 No. of LTI'S (Lost Time Incidents)
5 No. of Fatalities
6 No. of Occupational Illness
7 No. of Medical Treatment Cases
8 No. of on-site First Aid Cases
9 No. of Equipment & Property Damage
10 No. of Near Misses
11 No. of Inductions
12 No. of Re-Inductions
13 No. of TBT'S (Tool Box Talk)
14 No. of Internal Trainings
15 No. of External Trainings
16 No. of Empowerment to Stop Work
17 No. of HSE Walks
18 No. of HSE Committee Meetings
19 No. of HSE Awards
20 No. of Good Practices
21 No. of Fines & Penalties
22 No. of NCR'S
23 No. of HSE Inspections (Consultant & Client)
24 No. of HSE Audits
Monthly Site Inspection Checklists / Permits
S.No Check List Yes No No. of Inspections Date of Inspection Conducted
1 Machinaries & Eqiupment Inspection
2 Portable Power Tools
3 Lifting Tools & Tackles
4 Electrical DB/ELCB Inspection
5 Housekeeping
6 Environmental Inspection
7 Excavation Checklist
8 Fire Extinguisher Inspection
9 Gas Cutting Works Inspection
10 Hand Tools Inspection
11 Scaffolding Inspection
12 Welding Inspection Checklist
13 Hot Work Permits
14 Confined Space Entry Permit
15 Excavation Permit
16 Spill Prevention Control
17 Training Need Analysis
18 Risk Register Updated
SITE HSEA:- HSEA SIGNATURE DATE:-
PROJECT -
Fire Extinguishers Internal Monthly Inspection Report -
Inspection Carried Out By: Date & Time:
Fire Extinguisher Date of Condition of Extinguisher
SL No. Location Weight of
Last External Inspection Discharge
Type Capacity ID No. Purchase Last Refill CO2 Ext.in
Inspection tag/sticker Hose/nozzle
Kg
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
TOTAL NO OF CO2 =
TOTAL NO OF DCP =
TOTAL NO OF FOAM =
GRAND TOTAL =
Special Remarks : HSEA SIGNATURE :
Report -
Date & Time:
ition of Extinguisher
Pressure of Remarks
DCP/Foam type Visual Seal
Ext. in Bar
=
=
=
=
Project -
Site HSE Assest Report For the Month of -
Working & Well Calibration Due Date
S.NO HSE ASSEST Location Remarks
Maintained (Yes/No) ( If Applicable)
Note : HSE assets = Camera (HSEA), Cable detector
(SK), Gas detector (SK), B.A. Set (SK), Air Line
Respirator (SK).
To be send to HSE secretary every month along with
Monthly HSE report.
HSEA SIGNATURE :
10
12
0
2
4
6
8
No. of unsafe acts & condtions
f closed unsafe acts & conditions
tanding Unsafe Acts & Conditions
No. of LTI'S (Lost Time Incidents)
No. of Fatalities
No. of Occupational Illness
No. of Medical Treatment Cases
No. of on-site First Aid Cases
f Equipment & Property Damage
No. of Near Misses
No. of Inductions
No. of Re-Inductions
No. of TBT'S (Tool Box Talk)
No. of Internal Trainings
No. of External Trainings
o. of Empowerment to Stop Work
No. of HSE Walks
No. of HSE Committee Meetings
MONTHLY HSE PERFORMANCE REPORT - HILALCO
No. of HSE Awards
No. of Good Practices
No. of Fines & Penalties
No. of NCR'S
No. of unsafe acts
No. of closed unsafe acts
No. of outstanding Unsafe Acts
No. of LTI'S (Lost Tim
No.
No. of Occupati
No. of Medical Treat
No. of on-site Fir
No. of Equipment & Proper
No. of
No. o
No. of R
No. of TBT'S (To
No. of Intern
No. of Extern
No. of Empowerment t
No. o
No. of HSE Committ
No. of
No. of Go
No. of Fines
O
No. of HSE Awards
No. of Good Practices
No. of Fines & Penalties
No. of NCR'S
Inspections (Consultant & Client)
No. of HSE Audits
No. of
No. of Go
No. of Fines
No. of HSE Inspections (Consulta
No. of
0
2
4
6
8
10
12
No. of unsafe acts & condtions
No. of closed unsafe acts & conditions
o. of outstanding Unsafe Acts & Conditions
No. of LTI'S (Lost Time Incidents)
No. of Fatalities
No. of Occupational Illness
No. of Medical Treatment Cases
No. of on-site First Aid Cases
No. of Equipment & Property Damage
No. of Near Misses
No. of Inductions
No. of Re-Inductions
No. of TBT'S (Tool Box Talk)
No. of Internal Trainings
No. of External Trainings
No. of Empowerment to Stop Work
No. of HSE Walks
No. of HSE Committee Meetings
No. of HSE Awards
MONTHLY HSE PERFORMANCE REPORT - SUB CONTRACTORS
No. of Good Practices
No. of Fines & Penalties
No. of NCR'S
o. of HSE Inspections (Consultant & Client)
No. of HSE Audits
No. of u
No. of closed u
No. of outstanding Un
No. of LTI'
No.
No. of M
No. of
No. of Equipme
No.
No. of Empo
No. of HS
No. of HSE Inspection
No. of NCR'S
o. of HSE Inspections (Consultant & Client)
No. of HSE Audits
No. of HSE Inspection
