Contractors' Questionnaire - Construction Owners Association of ...

6.2.1. Your Direct-Hire Employees
Please provide the Total Number of Fatalities from:
________ Workplace occupational injuries or illnesses
◘Unknown
________ Travel-related
◘Unknown
Please provide the Total Number of Lost
Time Cases, Medical Aid Cases and First
Aid Cases:
Please provide the Total Workdays for
Lost Time, Medical Aid and First Aid
incidents:
________ Lost Time Cases ◘ Unknown
________ Medical Aid Cases ◘ Unknown
________ First Aid Cases ◘ Unknown
________ Lost Time Days
________ Medical Aid Days
________ First Aid Days
◘ Unknown
◘ Unknown
◘ Unknown
Please provide the Total Number of
Restricted Work Cases, Restricted
Medical Aid Cases and Restricted First Aid
Cases:
________ Total Restricted Work Cases
◘ Unknown
Please provide the Total Workdays for
Restricted Work, Restricted Medical Aid and
Restricted First Aid incidents:
________ Total Restricted Workdays
◘ Unknown
Near Misses
Near Misses are common at many worksites. They do not result in injury-but they may cause
property damage. If, say, an employee had been in a slightly different position or place, or the
equipment or product placement had been to the left or right, serious injury and/or damages could
have resulted. A lot depends on sheer luck and circumstance (Heberle, 1998).
How many near misses occurred?
____________ ◘Unknown
Total Site Work-hours of Direct-Hire Employees (Exposure Hours): _________ ◘Unknown
Peak Workforce Number of Direct-Hire Employees: _______________◘Unknown
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