The 2019 IPLOCA Health, Safety and Environmental Statistics Return

    (For the period from January to December 2019)

    Notes
    The Heath & Safety and the Environmental Statistics forms have been combined into one single form.
    Please read carefully the relevant guidelines before filling in this form. Specific guidelines are also available through the help button next to most of the questions.
    The pdf form can be used as a draft, to collect data before submitting them online.
     

     Engineering / project management  Main contractor  Sub-contractor

     

    MEMBER COMPANY NAME: 

     

     

    Your Company Only

    Your
    Sub-contractors
    (if any)

    1.

    Total number of hours worked (inclusive of overtime)

    2.

    Total number of First Aid Cases (FAC)

    3.

    Total number of Medical Treatment Cases (MTC)

    4.

    Total number of Restricted Work Cases (RWC)

    5.

    Total reported number of Lost Workday Injuries (LTI)

    6.

    Total number of Workdays Lost (LWD)


    7.

    Split of LWI:

     

     

     

    - Transportation / vehicle-equipment accident / traffic

     

    - Lifting operations

     

    - Work at height / scaffolding

     

    - Hand tools

     

    - Involving slips, trips and falls

     

    - Excavation / earth collapse

     

    - Confined spaces

     

    - Impact with construction equipment

     

    - Welding operations

     

    - Hazardous substances

     

    - Other

     

    Please briefly describe the "Other" incident(s)

       

    8.

    Total number of fatalities included in LWI (questions 5 and 7)

     

    Split of fatalities:

     

     

     

    - Transportation / vehicle-equipment accident / traffic

     

    - Lifting operations

     

    - Work at height / scaffolding

     

    - Hand tools

     

    - Involving slips, trips and falls

     

    - Excavation / earth collapse

     

    - Confined spaces

     

    - Impact with construction equipment

     

    - Welding operations

     

    - Hazardous substances

     

    - Other

     

    Please provide an investigation report as detailed as possible, for each incident involving a fatality as to the root cause(s) to hse@iploca.com

     

    Do you authorise IPLOCA to publish the report(s) on the IPLOCA Health, Safety and Environment Shared Experiences platform?

     YES

     NO


    9.

    Total number of Road Traffic Accidents (On and off-public road)

     

    Total number of kilometres driven


    10.

    Total number of near misses

     

    Do you identify High Potential near misses (HIPO)?

     YES

     NO

     

    If yes, total number of HIPOs


    11.

    Do you identify occupational illnesses?

     YES

     NO

     

    If yes, total number of occupational illnesses


    12.

    Details of environmental incidents
    Threshold guidelines

    Your Company
    Only

    Your
    Sub-contractors

     

    # of major incidents

    # of minor incidents

    # of major incidents

    # of minor incidents

    · Accidental releases of liquids to water/ground

    · Accidental waste disposal

    · Accidental releases to air

    · Other environmental incidents (Noise, dust, visual impact)

    Please briefly describe the "Other" incident(s)
     

     


     

     

    Your Company Only

    Your
    Sub-contractors

    13.

    Total Fuel consumption (in thousand litres)


    14.

    Time spent training staff (in person-hours)

       

     

    Health & Safety Training

     

    Environmental Training


    15.

    a) Does your company have a carbon emission / energy reduction policy?

     YES

     NO

     

    b) Does your company calculate its greenhouse gas emissions?

     YES

     NO

      c) Does your company have a water management policy?

     YES

     NO

      d) Does your company have a waste reduction policy?

     YES

     NO


    16. Does your company produce an annual Corporate Social Responsibility (CSR) report?

     YES

     NO

      If yes, is it in line with a recognised standard?

     YES

     NO

      If yes, which one?

    17.

    Do you have a certificated Management System?

     YES

     NO

     

    a) If no, is it planned to certificate the following systems in the future?

     YES

     NO

     

    b) If yes, which of the following certificates do you have?

     ISO 9001

     OHSAS 18001

     ISO 14001

     ISO 45001

     OTHER (provide name) 



    Form must be approved by all parties:

     

    Name of Health & Safety Manager:

    Name of Environmental Manager (if different):

    Name of CSR Manager (if different):
     

    Name of CEO:

    Name of the person submitting the form:

    E-mail address of the person submitting the form:

    I submit the form with the approval of all parties named above