Documente Academic
Documente Profesional
Documente Cultură
FORM E
ENTITY QUARTERLY EHSMS PERFORMANCE REPORTING
General Information
Name of Entity:
KPI 2-01 Total Number of EHS Incidents Reported: EM: OP: Total:
Restricted Reportable
Near Miss:
Health and Safety Workday Case: Occupational
Summary: Illness /
First Aid Injury: Lost Time Injury: Disease:
(Consequences of Reportable
reported H&S Equipment /
Dangerous
incidents) Property Damage:
Occurrence:
Fatality:
Medical Reportable
Treatment Case: Serious Injury:
Number of EHS
KPI 2-03 No. of EHS Training Hours undertaken by Employees
Training Hours
No. of Employees
Undertaken
Average Number of
Training Hours per
Employee
Percentage Reduction
KPI 2-07 or Increase
This Reporting Quarter Previous Reporting Quarter
(Indicate reduction as a
Power Consumption negative figure eg 3.5 %)
kW h Per
Total kW h kW h Per Employee Total kW h kW h Per Employee
(Total Kilowatts Hours (kW h) and Employee
kW h per Employee)
Percentage Reduction
KPI 2-10 or Increase
This Reporting Quarter Previous Reporting Quarter
(Indicate reduction as a
Fuel Consumption negative figure eg 3.5 %)
Average fuel Number of Average fuel
Average fuel consumption of entity Number of vehicles consumption of vehicles owned consumption of
owned and /or operated vehicles. % Fleet Fuel Consumption
owned and/or vehicles and/or vehicles
operated by entity (Combined Cycle operated by (Combined Cycle Increase or Decrease
(Liters per 100 kilometers) L/100 klms) entity L/100 klms)
Percentage Reduction
KPI 2-11 or Increase
This Reporting Quarter Previous Reporting Quarter
Non-Hazardous Waste Disposal (Indicate reduction as a
negative figure eg 3.5 %)
Amount of non-hazardous (solid Solid (kg) Liquid (L) Solid (kg) Liquid (L) Solid Liquid
and liquid) waste collected by
Service Providers for disposal.
KPI 2-17 Review / Approval of EHS Procedures: Specific Requirement / Part System Audit:
Declaration
I declare that all information provided in this document is true, correct and complete.
Signature of the
Official
Authorised
Stamp:
Contact Person :
Official Use
Remarks :
Signature:
Reviewed by:
Name:
Signature: