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CONSTRUCTION SITE HSE KEY Rev. No. 0

PERFORMANCE MEASURES Eff. Date

Page No. 1 of 1

Project Name: Location: Report Date :

Target Last Period Month of ___________________ This Period

Key Performance Measure Total to Date
Performance Performance Week 1 Week 2 Week 3 Week 4 Week 5 Performance

General Information:
Total Manpower At Maximum
Exposed Man-hour At Maximum
No. of Days w/o Lost Time Accident (LTA) At Maximum
Leading Indicators (Proactive Measures):
No. of Safety Meetings Held Once per week
No. of Safety Inspections Conducted Once per week
No. of Near-miss Incident Report Received At Max. Count
Lagging Indicators (Reactive Measures):
Fatality (FAT) Zero (0) Count
Lost Time Accident (LTA) Zero (0) Count
Restricted Work Accident (RWA) Zero (0) Count
First Aid Cases (FAC) Zero (0) Count
Medical Treatment Case (MTC) Zero (0) Count
Property Damage Accident (PDA) Zero (0) Count
Security Incident (SI) Zero (0) Count
Environmental Incident (EI) Zero (0) Count
Note: This Key Performance Measure (KPM) shall be signed and approved by the Project Manager. Forward this KPM to CHSE not later than the 7 th day of every month for ManCom reporting. HSE Manager to
furnish required report whenever deviation to Target Performance is obtained.

Prepared by: Reviewed and Approved by:

HSE Officer / HSE Manager Project Manager