"Cms-7 Contractor Monthly WHS Performance Report Template" - Australia

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Download "Cms-7 Contractor Monthly WHS Performance Report Template" - Australia

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CMS-7 Contractor Monthly WHS Performance Report
Version 1 | March 2014
Purpose: This form is to be provided to the Contract Manager to report incident management statistics, status of implementation of
corrective actions and information on current WHS inspection reports and risk assessments.
This form is to be completed on a monthly basis.
This form is to be completed by the contractor.
Project:.................................................................................
Report for the month of:..............................................................
Contractor:............................................................................
Prepared by:...............................................................................
Contractor Reference No:.....................................................
Date:...........................................................................................
Performance Indicators
Indicator
Current Month
Mthly Average
Total
Number of lost time injuries
Working days lost due to injury
Number of hazard inspections conducted
Number of toolbox talks/consultation meetings
Status of Injured Personnel and/or Property Damage
Date of
Days Lost
Return to Work
Name/Item
Injury/Damage
Incident
Current
Total
Forecast
Actual
Month
WHS Corrective Actions
Status
Nature of Corrective Action
Open
Closed
Comments
Outcomes of WHS audits/inspections
Comments/Outcomes:
.............................................................................................................................................................................................................
.....................................................................................................
Comments on WHS Performance
Contractor: ...........................................................................................................................................................................................
.............................................................................................................................................................................................................
Council Representative: ......................................................................................................................................................................
.............................................................................................................................................................................................................
Contractor Sign off:
Council Representative Sign off:
REGISTERED
Sent to Safety@wagga: __________________
DWS Document No:
__________________
Date Registered:
__________________
Signed: ______________________________
CMS-7 Contractor Monthly WHS Performance Report
Version 1 | March 2014
Purpose: This form is to be provided to the Contract Manager to report incident management statistics, status of implementation of
corrective actions and information on current WHS inspection reports and risk assessments.
This form is to be completed on a monthly basis.
This form is to be completed by the contractor.
Project:.................................................................................
Report for the month of:..............................................................
Contractor:............................................................................
Prepared by:...............................................................................
Contractor Reference No:.....................................................
Date:...........................................................................................
Performance Indicators
Indicator
Current Month
Mthly Average
Total
Number of lost time injuries
Working days lost due to injury
Number of hazard inspections conducted
Number of toolbox talks/consultation meetings
Status of Injured Personnel and/or Property Damage
Date of
Days Lost
Return to Work
Name/Item
Injury/Damage
Incident
Current
Total
Forecast
Actual
Month
WHS Corrective Actions
Status
Nature of Corrective Action
Open
Closed
Comments
Outcomes of WHS audits/inspections
Comments/Outcomes:
.............................................................................................................................................................................................................
.....................................................................................................
Comments on WHS Performance
Contractor: ...........................................................................................................................................................................................
.............................................................................................................................................................................................................
Council Representative: ......................................................................................................................................................................
.............................................................................................................................................................................................................
Contractor Sign off:
Council Representative Sign off:
REGISTERED
Sent to Safety@wagga: __________________
DWS Document No:
__________________
Date Registered:
__________________
Signed: ______________________________