Title: CONTRACTOR PERSONNEL AND SAFETY STATISTICS MONTHLY SUMMARY

Form: S2052
Version: 08/12

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT Page 1 of 1
CONTRACTOR PERSONNEL AND SAFETY STATISTICS MONTHLY
SUMMARY

The contractor shall suppl y details of the Personnel and Safety Statistics to the Principals Representative as appropriate
with copy to Site Health and Safety Staff no later than the second working day following the end of the month.
Site Health and Safety Staff will collate the statistics and forward same to Brisbane Health and Safety Support Officer by
the fourth working day following the end of the month
REPORTING MONTH AND YEAR:
Month: Year:

CONTRACTOR DETAILS:
Contractor Registered Name:
Contractor Address:
ABN or ACN:
Contractor or Site Working Hours:
Contract Number(s) Covered:

SITE / FACILITY (Please select as appropriate):

Callide A Station Kogan Creek A Station Wivenhoe Power Station
Callide B Station Other (Please Specify)
Callide C Station


PERSONNEL AND SAFETY STATISTICS:
Safety Statistic Type and Definition Total Number
Staff Numbers (FTE):

Total Full Time Equivalent (FTE) number of staff
Personnel Residing in the Local Area (FTE):

Contractor personnel that reside in homes for which they own or pay rent in the local area
Near Misses / Hazards:

An incident which has the potential to cause harm to the environment, property or personnel
First Aid Injuries:
A work related injury or illness requiring a one-time treatment and subsequent observations by a First Aider or Medical
Practitioner e.g. bandage on a cut, treatment of superficial burns, cold compress on a sprain, etc.
Medical Treatment Injuries (MTIs):
A work related injury or illness requiring more than first aid treatment by a medical practitioner but resulting in no lost time
e.g. stitches, strain requiring physiotherapy, fracture, etc.
Lost Time Injuries (LTIs):

A work related injury or illness that results in time lost from one full day / shift.
Total Recordable Case Frequency Rate (TRCFR):
TRCFR = Total Number of Lost Time Injuries +Medical Treatment Injuries
Total Hours Worked
X 1,000,000
Lost Time Injury Frequency Rate (LTIFR):
LTIFR = Total Number of Lost Time Injuries
Total Hours Worked
X 1,000,000
Number of Workers Compensation Claims:

CONTRACTOR SIGN-OFF:
Name:
Signature:
Contact Phone No: Date: