IPLOCA HSE Statistics Return

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.

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)

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.

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.

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).

Total number of Workdays Lost (LWD)

Number of calendar days lost as a result of a work-related accident.

Split of LWI

hould add up to the total LTI shown in item 5: {Total reported number of Lost Workday Injuries:47}

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.

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.

Total number of kilometres driven

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

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.

High Potential incidents

Incidents which could have resulted in severe injury or fatality.

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.

Details of environmental incidents

Please refer to the threshold guidelines for Major & Minor Incidents

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.

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).

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).

Company HSE Programme

Corporate Social Responsibility (CSR) report

Certificated Management System

Detail of ISO, OHSAS and any other HSE certified accreditations obtained or in process.

Approval

This form must be approved by all parties.

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

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

{LWI other accidents description:140}

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

{Other environmental accidents description:161}

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

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}