Volume-II of IV - GAIL

5.0 MONTHLY Health, Safety & Environment (HSE) REPORT
(To be submitted by each Contractor)
Actual work start Date:________________ For the Month of:__________________
Project:_____________________________ Report No:________________________
Name of the Contractor:________________ Status as on:_______________________
Name of Work:_______________________ Name of Safety officer:_______________
Item
Total strength (Staff –Workmen)
Number of HSE meeting
organized at site
Number of HSE awareness
programmes conducted at site
This Month Cumulative
Whether workmen compensation
policy taken
Y/N
Whether workmen compensation
policy valid
Y/N
Whether workmen registered
Y/N
under ESI Act
Number of Fatal Accident
Number of Loss Time Accident
(Other than Fatal)
Other accident (Non Loss Time)
Total No. of Accident
Total man-hours worked
Man-hour loss due to fire and
accident
Compensation cases raised with
Insurance
Compensation cases resolved
and paid to workmen
Remark
Date: __/__/__ Safety Officer/RCM
(Signature and name)
To: OWNER…………………….. 1 COPY
RCM/SITE-IN-CHARGE MECON 1 COPY
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