Monthly Safety Indicators
Directorate/Region
Contractor Name
(if applicable)
Please fill out all applicable sections
1. Incidents - Injury
No. Reported this period
No. Closed out this period
No. Outstanding over 30 days
No. Serious incidents reported this period
No. Serious incidents reported to SHW within 24hrs
Contract No.
(if applicable)
Month
Lost Time Injury (LTI)
(One full shift or longer missed)
MRWA
ISP
Contractor
Incidents – No Injury
No. Reported this period
No. Closed out this period
No. Outstanding over 30 days
No. Serious incidents reported this period
No. Serious incidents reported to SHW within 24hrs
Incident Comments
MRWA
Damage
ISP
Contractor
2. Hours Worked – (see definition page)
No. Office hours worked
No. Project site hours worked (if applicable)
MRWA
ISP
Contractor
3. Hazards
No. Reported this period
No. Closed out this period
No. Outstanding over 30 days
MRWA
ISP
Contractor
4. Safety Committee
No. Committee members
No. Committee members present at meeting
MRWA
ISP
Contractor
5. Audits (formal – completed by qualified auditor)
No. Scheduled this period
No. Completed this period
No. Corrective actions raised this period
No. Corrective actions outstanding after 30 days
MRWA
ISP
Contractor
6. Workplace Inspections (formal)
No. Worksites (see definition page)
No. Inspections of worksites planned/scheduled
No. Inspections actually undertaken
MRWA
ISP
Contractor
7. Inductions
No. New starters requiring an OSH induction
No. New starters OSH inducted on their first day
MRWA
ISP
Contractor
8. OSH Training - TNA
No. Scheduled participants for key OSH training
sessions occurring this period (identified in TNA)
No. Actual training session participants this period
MRWA
ISP
Contractor
9. Toolbox Meeting (if applicable)
No. Held this period
No. Scheduled attendees this period
No. Actual attendees this period
MRWA
ISP
Contractor
MRWA
ISP
Contractor
10. Safe Observation Conversation (SOC)
No. SOCs planned/scheduled
No. SOCs actually undertaken
Year
Safety Mgmt.
Plan Revision No.
Non Lost Time Injury (NLTI)
(Less than one full shift missed)
MRWA
ISP
Contractor
MRWA
Near Miss
ISP
Comments
Contractor
11. Vehicle Monthly Checklists (VMC’s)
MRWA
ISP
Contractor
No. VMC’s planned/scheduled
No. VMC’s actually undertaken
Declaration: I hereby declare that the answers given in this document describe our business entity’s performance in respect to Safety, Health and Wellbeing for the
Contract and contract period prescribed above. I acknowledge the right of Main Roads Western Australia to further verify our stated performance by audit.
Name
Main Roads Western Australia
Document Number: D13#717549
Signature
Date
TRIM Ref No.
Definitions
MRWA = Staff employed directly by Main Roads Western Australia.
ISP = Staff employed by an Integrated Service Provider, including sub-contractors via the ISA and Minor Contract Works (MCW).
Contractor = All construction contractors: All workers who are operating on our sites/premises and we have some control due to this
i.e. this includes agency contractors, consultants who meet the above statement.
1.
Incidents
Injury
Lost Time Injury (LTI): One full shift of work or longer missed
Non Lost Time Injury (NLTI): Less than one full shift missed from work duties
No Injury
Damage: High potential for injury avoided, however property damage has occurred.
Near Miss/Hit (no injury or property damage): Injury or property damage was avoided, but high potential for it to occur.
No. Reported: Number of incidents that were reported and recorded
No. Closed: Number of incidents that were deemed to be fully investigated and requiring no further action
No. Outstanding after 30 days: Incidents that have not had their investigation completed and signed off
Serious incidents: All Lost Time Injuries (LTI) are classified as serious incidents. Serious Non Lost Time Injuries (NLTI) are
deemed to be any that have or were very likely to result in serious injury (missing more than one full shift of work), but
through chance did not. The Serious Incident flowchart can be located on iRoads.
Serious incidents reported to SHW within 24hrs: All LTIs and serious NLTIs reported are required to be reported to the
Safety, Health and Wellbeing (SHW) Branch within 24hours of the incident occurring via email or phone.
2.
Hours Worked
- Total hours worked during the reporting month by personnel. If an employee splits their time, they would be classified
dependent on where they spend the majority of their time e.g. 60% of time on site, all hours of employee listed as site.
- Contractors: All staff employed to undertake Main Roads activities are to have their hours listed, except for Main Roads staff.
3.
Hazards
- Number of hazards identified through workplace inspections this reporting month.
- Number of workplace inspection hazards closed out this reporting month.
- Number of workplace inspection hazards outstanding at the end of the month, which were reported more than 30 days ago.
4.
Safety Committee
- Number of safety committee members that are nominated to attend committee meetings.
- Number of committee members to attended the safety committee in this reporting month.
5.
Audits (Formal – completed by qualified auditor)
- Number of project or site audits scheduled this reporting period. This includes, but is not limited to, audits of safety
compliance and sub-contractor audits.
- Number of completed audits during this reporting period.
- Number of corrective actions raised during the reporting period.
- Number of corrective actions outstanding after 30 days from reporting date.
6.
Workplace Inspections (Formal)
- Number of unique offices or worksites (project and depots etc.) that are to be inspected.
- Number of formal inspections (involving a formal record of inspection produced and signed, improvements noted) planned to
take place during the reporting period (based on risk, some sites may be inspected more frequently than others).
- Number of inspections that were completed in the period.
7.
Inductions
- Number of staff that commenced work this period and had not visited the site before. This includes, but is not limited to, new
office staff, agency staff and temporary contractors such as electricians and plumbers that are new to the workplace site.
- Number of these new starters which completed an OSH induction on their first day.
8.
OSH Training – Training Needs Analysis (TNA)
- Number of scheduled participants to attend key OSH training sessions this reporting period as identified in the TNA matrix.
This is OSH training deemed necessary to conduct your work whilst fulfilling your OSH obligations.
- Number of actual participants who attended the key OSH training sessions.
9.
Toolbox
- Number of toolbox meetings held this period.
- Number of scheduled participants who were expected to attend the meeting.
- Number of actual participants who attended the toolbox.
10.
Safe Observation Conversation (SOC)
Number of Safe Observation Conversations that were planned/scheduled to take place during the reporting period
(information should be retrieved from the respective local SOC registers)
Number of Safe Observation Conversations completed in the reporting period
11.
Vehicle Monthly Checklists (VMC’s)
Number of VMCs that were planned/scheduled to take place on MRWA fleet vehicles during the reporting period
Number of VMC’s that were actually performed on MRWA fleet vehicles