Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • This form is provided to identify the minimum monthly reporting requirements of AWX Divisions to National Safety Manager.

DETAILS (To be completed and sent to National Safety Manager by the 3rd day of new month)

  • Month:

  • Year:

  • Division Manager:

  • Division: (please indicate your division with a cross)

WORKFORCE NUMBERS &MAN HOURS WORKED

  • Employee Category:
    AWX

  • Total No. of Employees

  • Total No. Of Hours Worked

  • Employee Category:
    subcontractors

  • Total No. of Employees

  • Total No. Of Hours Worked

  • Employee Category:
    Total (current month)

  • Total No. of Employees

  • Total No. Of Hours Worked

  • Employee Category:
    Total (year to date financial year)

  • Total No. of Employees

  • Total No. Of Hours Worked

INDIGENOUS WORKFORCE NUMBERS (included in the above)

  • No. Of AWX Indigenous Employees

  • Total No. Indigenous Employees

  • % of Indigenous Employees on site

  • What is indigenous target No. For this Division? (if measured)

  • % (a) / Total No. Of employees

GROUP REPORTING REQUIREMENTS

  • INCIDENTS REPORTED

  • Injury Incidents (i)

  • No. Of Lost Time Injuries (LTI)

  • No. Of Medical Treatment Injuries (MTI)

  • No. Of Alternative Duty Injuries (ALT)

  • No. Of First Aid Injuries (FAI)

  • Damage Incidents (d)

  • No. Of Plant Damage

  • No. Of Business Loss Incidents

  • No. Of Heavy Vehicle Incidents

  • No. Of Light Vehicle Incidents

  • No. Of Theft Incidents

  • Other Incidents (o)

  • No. Of Non-statical Incidents

  • No. Of near Misses

  • No. Of Environmental Incidents

  • No. Of Hazards

  • TOTAL NO. OF INCIDENTS (i) + (d) + (o) = Total incidents

  • TARGET TRIFR - Total Recordable Injury Frequency Rate

  • ACTUAL TRIFR

  • TARGET TEIFR - Total Environmental Incident Frequency Rate

  • ACTUAL TEIFR

OTHER INFORMATION

  • No. Of days lost due to LTI's

  • No. Of sig incident alerts generated

  • List new Jobs/Project for current month: 1. 2. 3. 4.

  • Have all SWMS been completed per Project

  • List Site inspection Locations completed: 1. 2. 3. 4.

AUDITS AND QUARTERLY RISK REVIEWS

  • Was a QRR completed this month?

  • Was a Q&E audit completed this month?

  • Was a H&S audit completed this month?

  • No of Inspections planned as per schedule

  • No of Inspection completed as per schedule

QUALITY AND ENVIRONMENT

DRUG TESTING

  • No. Of tests conducted

  • No. Of confirmed positive results received

ALCOHOL TESTING

  • No. Of tests conducted

  • No. Of confirmed positive results received

BUSINESS UNIT REPORTING REQUIREMENTS

  • Divisions positives for Month (Safety / Environment Related):

  • Divisions Areas of improvement (Safety/Environment Related):

Actions Required Safety & Environment Related:

  • Action

  • Person responsible

  • Date to be Completed

  • Closed out Date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.