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AGREEMENT between BROWARD COUNTY and Cummings ...

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Exhibit 2<br />

Page 205 of 379<br />

CONTRACTOR MONTHLY REPORT OF WORK<br />

INJURY AND ILLNESS STATISTICS<br />

Month 20_<br />

Name of Contractor:<br />

Name of Subcontractor:<br />

Location: Date of Report / /<br />

Prepared by:<br />

(Name, Title <strong>and</strong> Company)<br />

<br />

<br />

Single Contractor Report<br />

Contractor’s composite report; list names of subcontractors in Remarks <strong>and</strong> attach a copy of each<br />

subcontractor’s single monthly report.<br />

Total for Month<br />

Cumulative Total YTD<br />

First Aid Cases<br />

* OSHA Recordable Cases<br />

* OSHA Lost Workday Cases<br />

* Lost Workdays<br />

Fatalities<br />

Total Work Hours<br />

Remarks:<br />

(Check if continued on back of form)<br />

Notes: If you are a subcontractor, please identify your General Contractor.<br />

* As defined by Federal OSHA<br />

S

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