Cms-7 Contractor Monthly Whs Performance Report

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: ______________________________