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Mandatory Reporting Fields Date:: R-001-REV.01-Montly Site HSE Performance Report Page 1 of 2

This document contains a monthly health, safety, and environment performance report template for a construction project. The template includes fields for reporting lagging and leading safety indicators such as near misses, first aids, lost time incidents, safety meetings, and inspections. It also captures exposure hours and headcounts for direct employees and subcontractors. The report requires signatures from the site construction manager and HSE officer for approval and must be submitted by the last business day of each month.

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Ravelle Jacquire
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141 views2 pages

Mandatory Reporting Fields Date:: R-001-REV.01-Montly Site HSE Performance Report Page 1 of 2

This document contains a monthly health, safety, and environment performance report template for a construction project. The template includes fields for reporting lagging and leading safety indicators such as near misses, first aids, lost time incidents, safety meetings, and inspections. It also captures exposure hours and headcounts for direct employees and subcontractors. The report requires signatures from the site construction manager and HSE officer for approval and must be submitted by the last business day of each month.

Uploaded by

Ravelle Jacquire
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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* Mandatory reporting fields Date:      

*Project Name/Number:

*Client:
*SUB – CONTRACTOR
COMPANIES:
Contacts: Name Contact Number

*Construction Manager

*Site HSE Officer

*Client HSE Representative

*Project Manager:

MONTHLY HS&E PERFORMANCE


LAGGING INDICATORS Monthly Year to
Total Date LEADING INDICATORS Monthly Year to
Total Date
*Near Misses (#)

*First Aids (#) Toolbox Talks

*Medical Treatments (#) Safety Meetings

*Lost Time (#) Orientations/Inductions

* Recordable (#) / Fire Inspections / Observations

*Damage to Property Corrective Actions completed


*Restricted / Modified Work            
Other:     
Days
*Reportable Environmental            
Other:     
Incidents (#)
*ET Hours Worked (Regular)

*ET Hours Worked (Overtime)


* Sub-Contractors Hours
Worked
*Total Exposure Hours Post
LTI
ET Regular HRS+ET OT + Contractors
HRS

Total HRS for the Project to


date
*ET Total Workforce Head
Count
*Total Sub-Contractor Head
Count
*Total Exposure Head Count
ET Head Count + Sub-Contractor

REPORT APPROVERS

*DESIGNATION *SIGNATURE

R-001-REV.01-Montly Site HSE Performance Report Page 1 of 2


*Report Completion Instructions
Reports to be approved by the Site Construction Manager & HSE Officer. All Reports must be submitted by 10h00 on the last business day of each
month.
*Please note – that for all accidents & incidents reported in above table– submit separate Incident Report and closed out Investigations Reports accordingly.

R-001-REV.01-Montly Site HSE Performance Report Page 2 of 2


*Report Completion Instructions
Reports to be approved by the Site Construction Manager & HSE Officer. All Reports must be submitted by 10h00 on the last business day of each
month.

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