IPLOCA HSE Statistics Return

Date
Type*
- New submission
- Replace previous submission
Company Name*
Is your company a Regular member?*
- Yes
- No
Note that this form is only for Regular members.

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Total number of hours worked (inclusive of overtime)

Number of hours worked during which the employee is present in the work environment (pipeline activities and associated facilities) as a condition of his or her employment, plus the extra hours put in as overtime.
Your company
Subcontractor
Total

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Total number of First Aid Cases (FAC)

Number of work-related injuries (scratches, cuts, burns, etc.) that did not result in a Medical Treatment Case (MTC)
Your company
Subcontractor
Total

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Total number of Medical Treatment Cases (MTC)

Number of work related injuries requiring medical treatment beyond first aid by a physician or other licensed health care professional; or illnesses diagnosed as work related by a Physician or other licensed health care professional; exclusive of any resulting in a Fatality or those meeting the definitions of an LWI or RWC.
Your company
Subcontractor
Total

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Total number of Restricted Work Cases (RWC)

Number of Restricted Work Case resulting from any work injury, which results in a work assignment, after the incident occurred, that does not include all the normal duties of the person’s regular job.
Your company
Subcontractor
Total

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Total reported number of Lost Workday Injuries (LWI)

Number of Lost Workday Injuries resulting from the sum of fatalities, permanent total disabilities, permanent partial disabilities and lost workday injuries. Note: if in a single incident 20 personnel receive Lost Time Injuries, then it is accounted for corporate reporting purposes as 20 LWIs (not 1 LWI).
Your company
Subcontractor
Total

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Total number of Workdays Lost (LWD)

Number of calendar days lost as a result of a work-related accident.
Your company
Subcontractor
Total

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Split of LWI

hould add up to the total LTI shown in item 5: {Total reported number of Lost Workday Injuries:47}
Transportation / vehicle-equipment accident / traffic

Accidents involving one or more moving vehicles which results in death or injury.
Your company
Subcontractor
Total
Lifting operations

Accidents resulting of the use of a lifting machine, including but not limited to falling object, collision with obstacles, breaking of machinery, etc.
Your company
Subcontractor
Total
Work at height / scaffolding

Accidents as a direct result of working at height (higher than waist level above the surrounding grade level or surface), on cranes, scaffolding, ladders etc.
Your company
Subcontractor
Total
Hand tools

Accidents as a direct result of the use of hand tools and portable hand held equipment including but not limited to the use of all powered or non-powered hand held tools, e.g. screw driver, wrench, grinder, hammer, chisel, welding tools, saw, drill machine, blow torch, etc.
Your company
Subcontractor
Total
Involving slips, trips and falls

Accidents as a direct result of a fall due to a slip or loss of stability.
Your company
Subcontractor
Total
Excavation / earth collapse

Accidents as a direct result of any kind of earth moving operation, be it by hand or with machines or explosives.
Your company
Subcontractor
Total
Confined spaces

Accidents resulting of a limited working space.
Your company
Subcontractor
Total
Impact with construction equipment

Accidents as a direct result of operating a piece of construction equipment or machinery including, but not limited to, pumps, compressors, mixers, turbines, boilers, cranes, earth moving equipment, etc.
Your company
Subcontractor
Total
Welding operations

Accidents occurring as a consequence of welding operations, including but not limited to arc burns.
Your company
Subcontractor
Total
Hazardous substances

Accidents occurring when processing, handling, storage or transportation of a hazardous or toxic substance.
Your company
Subcontractor
Total
Other

Accidents that cannot be logically classified under any category above.
Your company
Subcontractor
Total
Please briefly describe the "Other" incident(s)

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Total number of fatalities included in LWI

A fatality is a death resulting from a work injury or occupational illness, regardless of the time intervening between injury or illness and death. Provide an investigation report as detailed as possible, for each incident involving a fatality as to the root cause(s) to hse@iploca.com.
Transportation / vehicle-equipment accident / traffic

Accidents involving one or more moving vehicles which results in death or injury.
Your company
Subcontractor
Total
Lifting operations

Accidents resulting of the use of a lifting machine, including but not limited to falling object, collision with obstacles, breaking of machinery, etc.
Your company
Subcontractor
Total
Work at height / scaffolding

Accidents as a direct result of working at height (higher than waist level above the surrounding grade level or surface), on cranes, scaffolding, ladders etc.
Your company
Subcontractor
Total
Hand tools

Accidents as a direct result of the use of hand tools and portable hand held equipment including but not limited to the use of all powered or non-powered hand held tools, e.g. screw driver, wrench, grinder, hammer, chisel, welding tools, saw, drill machine, blow torch, etc.
Your company
Subcontractor
Total
Involving slips, trips and falls

Accidents as a direct result of a fall due to a slip or loss of stability.
Your company
Subcontractor
Total
Excavation / earth collapse

Accidents as a direct result of any kind of earth moving operation, be it by hand or with machines or explosives.
Your company
Subcontractor
Total
Confined spaces

Accidents resulting of a limited working space.
Your company
Subcontractor
Total
Impact with construction equipment

Accidents as a direct result of operating a piece of construction equipment or machinery including, but not limited to, pumps, compressors, mixers, turbines, boilers, cranes, earth moving equipment, etc.
Your company
Subcontractor
Total
Welding operations

Accidents occurring as a consequence of welding operations, including but not limited to arc burns.
Your company
Subcontractor
Total
Hazardous substances

Accidents occurring when processing, handling, storage or transportation of a hazardous or toxic substance.
Your company
Subcontractor
Total
Other

Accidents that cannot be logically classified under any category above.
Your company
Subcontractor
Total
TOTAL NUMBER OF FATALITIES
Fatality reports*
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Max. file size: 256 MB.

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Total number of Road Traffic Accidents

Number of road traffic incidents or accidents involving one or more moving vehicles which result in injuries and/or damage to property, vehicle(s) or loads being moved or carried by vehicles.
Your company
Subcontractor
Total

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Total number of kilometres driven
Total work-related kilometres driven in assigned vehicles (owned, leased, fleeted, or rented) during work related activities.
Your company
Subcontractor
Total

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Total number of near misses

A Near Miss is an unplanned event that did not result in injury or damage but had the potential to do so. Only a fortunate break in the chain of events prevented an injury, fatality or damage. Note: An incident where no ill health, injury, damage or other loss occurs is also referred to as a "near-miss.
Your company
Subcontractor
Total

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High Potential incidents

Incidents which could have resulted in severe injury or fatality.
Do you identify High Potential incidents (HIPO)?
- Yes
- No
Your company*
Subcontractor
Total*

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Occupational illnesses

Occupational illness is defined as a condition that results from exposure in a workplace to a physical, chemical or biological agent to the extent that the normal physiological mechanisms are affected and the health of the worker is impaired.
Do you identify occupational illnesses?*
- Yes
- No
Your company*
Subcontractor
Total

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Details of environmental incidents

Please refer to the threshold guidelines for Major & Minor Incidents
Accidental releases of liquids to water/ground
Major incidents in your company
Minor incidents in your company
Major incidents sub-contrators
Minor incidents sub-contrators
Accidental waste disposal
Major incidents in your company
Minor incidents in your company
Major incidents sub-contrators
Minor incidents sub-contrators
Accidental releases to air
Major incidents in your company
Minor incidents in your company
Major incidents sub-contrators
Minor incidents sub-contrators
Other environmental incidents

Noise, dust, visual impact.
Major incidents in your company
Minor incidents in your company
Major incidents sub-contrators
Minor incidents sub-contrators
Please briefly describe the "Other" incident(s)

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Total Fuel consumption (in thousand litres)

Quantity of fuel, both diesel and gasoline, consumed by owned and rented equipment, all engines and vehicles used during the year.
Your company
Subcontractor
Total

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Time spent on Health & Safety training staff (in person-hours)

Number of hours spent by personnel to get trained to Health & Safety standards (includes all the hours spent by all the personnel to get trained).
Your company
Subcontractor
Total

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Time spent on Environmental training staff (in person-hours)

Number of hours spent by personnel to get trained to Environmental standards (includes all the hours spent by all the personnel to get trained).
Your company
Subcontractor
Total

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Corporate Social Responsibility (CSR) report
Does your company produce an annual Corporate Social Responsibility (CSR) report?
- Yes
- No

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Certificated Management System
Detail of ISO, OHSAS and any other HSE certified accreditations obtained or in process.
Do you have a certificated Management System?
- Yes
- No
Certificates
- ISO 9001
- ISO 14001
- ISO 45001
- Other
Name of the certificate(s)

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Approval
This form must be approved by all parties.
Health & Safety Manager
Environmental Manager

fill out if different
CSR Manager

fill out if different
CEO
Your name
Your Email
Approval
- I submit the form with the approval of all parties named above

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Pre submission preview

Please review the form before final submission

Date: {Date:5}
Company name: {Company Name:2}
Submission type: {Type:3}

1. Total number of hours worked

Company	Subcontractor	Total
{Total number of hours worked company:17}	{Total number of hours worked subcontractor:21}	{Total number of hours worked company:22}

2. Total number of First Aid Cases

Company	Subcontractor	Total
{Total number of First Aid Cases company:25}	{Total number of First Aid Cases subcontractor:26}	{Total number of First Aid Cases:27}

3. Total number of Medical Treatment Cases

Company	Subcontractor	Total
{Total number of Medical Treatment Cases company:33}	{Total number of Medical Treatment Cases subcontractor:34}	{Total number of Medical Treatment Cases:35}

4. Total number of Restricted Work Cases

Company	Subcontractor	Total
{Total number of Restricted Work Cases company:42}	{Total number of Restricted Work Cases subcontractor:43}	{Total number of Restricted Work Cases:44}

5. Total reported number of Lost Workday Injuries

Company	Subcontractor	Total
{Total reported number of Lost Workday Injuries company:45}	{Total reported number of Lost Workday Injuries subcontractor:46}	{Total reported number of Lost Workday Injuries:47}

6. Total number of Workdays Lost

Company	Subcontractor	Total
{Total number of Workdays Lost company:48}	{Total number of Workdays Lost subcontractor:49}	{Total number of Workdays Lost:50}

7. Split of LWI

7a. Transportation / vehicle-equipment accident

Company	Subcontractor	Total
{LWI transportation / vehicle-equipment accident / traffic company:53}	{LWI transportation / vehicle-equipment accident / traffic subcontractor:56}	{LWI transportation / vehicle-equipment accident / traffic total:167}

7b. Lifting operations

Company	Subcontractor	Total
{LWI lifting operations company:111}	{LWI lifting operations subcontractor:112}	{LWI lifting operations total:169}

7c. Work at height / scaffolding

Company	Subcontractor	Total
{LWI work at height / scaffolding company:114}	{LWI work at height / scaffolding subcontractor:115}	{LWI work at height / scaffolding total:170}

7d. Hand tools

Company	Subcontractor	Total
{LWI hand tools company:117}	{LWI hand tools subcontractor:118}	{LWI hand tools total:171}

7e. Involving slips, trips and falls

Company	Subcontractor	Total
{LWI involving slips, trips and falls company:120}	{LWI involving slips, trips and falls subcontractor:121}	{LWI involving slips, trips and falls total:172}

7f. Excavation / earth collapse

Company	Subcontractor	Total
{LWI excavation / earth collapse company:123}	{LWI excavation / earth collapse subcontractor:124}	{LWI excavation / earth collapse total:173}

7g. Confined spaces

Company	Subcontractor	Total
{LWI confined spaces company:126}	{LWI confined spaces subcontractor:127}	{LWI confined spaces total:174}

7h. Impact with construction equipment

Company	Subcontractor	Total
{LWI impact with construction equipment company:129}	{LWI impact with construction equipment subcontractor:130}	{LWI impact with construction equipment total:175}

7i. Welding operations

Company	Subcontractor	Total
{LWI welding operations company:132}	{LWI welding operations subcontractor:133}	{LWI welding operations total:176}

7j. Hazardous substances

Company	Subcontractor	Total
{LWI hazardous substances company:135}	{LWI hazardous substances subcontractor:136}	{LWI hazardous substances total:177}

7k. Other accidents

Company	Subcontractor	Total
{LWI other accidents company:138}	{LWI other accidents subcontractor:139}	{LWI other accidents total:178}

{LWI other accidents description:140}

8. Total number of fatalities included in LWI

Company	Subcontractor	Total
{Total number of fatalities included in LWI company:58}	{Total number of fatalities included in LWI subcontractor:59}	{Total number of fatalities included in LWI:57}

9. Total number of Road Traffic Accidents

Company	Subcontractor	Total
{Total number of Road Traffic Accidents company:62}	{Total number of Road Traffic Accidents subcontractor:63}	{Total number of Road Traffic Accidents:108}

9b. Total number of kilometres driven

Company	Subcontractor	Total
{Total number of kilometres driven companyy:65}	{Total number of kilometres driven subcontractor:66}	{Total number of kilometres driven:162}

10. Total number of near misses

Company	Subcontractor	Total
{Total number of near misses company:70}	{Total number of near misses subcontractor:71}	{Total number of near misses:163}

10b. High Potential incidents

Do you identify High Potential incidents (HIPO)?

{High Potential incidents Y/N:69}

Company	Subcontractor	Total
{Total number of High Potential incidents company:180}	{Total number of High Potential incidents subcontractor:181}	{Total number of High Potential incidents:185}

11. Occupational illnesses

Do you identify occupational illnesses?

{Occupational illnesses Y/N:73}

Company	Subcontractor	Total
{Total number of occupational illnesses company:186}	{Total number of occupational illnesses subcontractor:187}	{Total number of occupational illnesses:188}

12. Details of environmental incidents

12a. Accidental releases of liquids to water/ground

Major company	Minor company	Major subcontractor	Minor subcontractor
{Major incidents accidental releases of liquids to water/ground company:142}	{Minor incidents accidental releases of liquids to water/ground company:144}	{Major incidents accidental releases of liquids to water/ground subcontrators:143}	{Minor incidents accidental releases of liquids to water/ground subcontrators:145}

12b. Accidental waste disposal

Major company	Minor company	Major subcontractor	Minor subcontractor
{Major incidents accidental waste disposal company:147}	{Minor incidents accidental waste disposal company:148}	{Major incidents accidental waste disposal subcontrators:149}	{Minor incidents accidental waste disposal subcontrators:150}

12c. Accidental releases to air

Major company	Minor company	Major subcontractor	Minor subcontractor
{Major incidents accidental releases to air company:152}	{Minor incidents accidental releases to air company:153}	{Major incidents accidental releases to air subcontrators:154}	{Minor incidents accidental releases to air subcontrators:155}

12d. Other environmental incidents

Major company	Minor company	Major subcontractor	Minor subcontractor
{Other major environmental incidents company:157}	{Other minor environmental incidents company:158}	{Other major environmental incidents subcontrators:159}	{Other minor environmental incidents subcontrators:160}

{Other environmental accidents description:161}

13. Total Fuel consumption (in thousand litres)

Company	Subcontractor	Total
{Total Fuel consumption company:80}	{Total Fuel consumption subcontractor:81}	{Total Fuel consumption:164}

14a. Health & Safety training staff (in person-hours)

Company	Subcontractor	Total
{Health & Safety training hours company:100}	{Health & Safety training hours subcontractor:101}	{Health & Safety training hours:165}

14b. Environmental training staff (in person-hours)

Company	Subcontractor	Total
{Environmental training hours company:104}	{Environmental training hours subcontractor:105}	{Environmental training hours:166}

15. Company HSE policy

Does your company have a carbon emission / energy reduction policy?	{Carbon emission/energy reduction policy:96}
Does your company calculate its greenhouse gas emissions?	{Calculation of greenhouse gas emissions:98}
Does your company have a water management policy?	{Water management policy:97}
Does your company have a waste reduction policy?	{Waste reduction policy:99}

16. Corporate Social Responsibility (CSR) report

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

{Annual Corporate Social Responsibility (CSR) report:88}

17. Certificated Management System

Do you have a certificated Management System?	{Certificated Management System:91}
Certificates	{Certificates:189}
Other Certificates	{Other Certificates:190}

18. Approval

Health & Safety Manager: {Health & Safety Manager:7}
Environmental Manager: {Environmental Manager:8}
CSR Manager: {CSR Manager:9}
CEO: {CEO:10}
Your Name: {Your name:12}
Your Email: {Your Email:13}

{I submit the form with the approval of all parties named above:15.1}

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IPLOCA HSE Statistics Return

for the period from January to December 2023

Step 1 of 23 - Submission information

Total number of hours worked (inclusive of overtime)

Total number of First Aid Cases (FAC)

Total number of Medical Treatment Cases (MTC)

Total number of Restricted Work Cases (RWC)

Total reported number of Lost Workday Injuries (LWI)

Total number of Workdays Lost (LWD)

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

Total number of fatalities included in 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

Total number of Road Traffic Accidents

Total number of kilometres driven

Total number of near misses

High Potential incidents

Occupational illnesses

Details of environmental incidents

Accidental releases of liquids to water/ground

Accidental waste disposal

Accidental releases to air

Other environmental incidents

Total Fuel consumption (in thousand litres)

Time spent on Health & Safety training staff (in person-hours)

Time spent on Environmental training staff (in person-hours)

Company HSE Programme

Corporate Social Responsibility (CSR) report

Certificated Management System

Approval

Pre submission preview

1. Total number of hours worked

2. Total number of First Aid Cases

3. Total number of Medical Treatment Cases

4. Total number of Restricted Work Cases

5. Total reported number of Lost Workday Injuries

6. Total number of Workdays Lost

7. Split of LWI

8. Total number of fatalities included in LWI

9. Total number of Road Traffic Accidents

9b. Total number of kilometres driven

10. Total number of near misses

10b. High Potential incidents

11. Occupational illnesses

12. Details of environmental incidents

13. Total Fuel consumption (in thousand litres)

14a. Health & Safety training staff (in person-hours)

14b. Environmental training staff (in person-hours)

15. Company HSE policy

16. Corporate Social Responsibility (CSR) report

17. Certificated Management System

18. Approval

HSE Statistics

HSE Statistics