Step 1: General Info

Required fields are marked with an asterisk (*).

Step 2: Stakeholder Info

Required fields are marked with an asterisk (*).

Contract Representative (i.e. Project Manager)

Contractor HSE or designate

EPCOR Owner's Representative & Coordinator

EPCOR HS&E Advisor

Step 3: Contract Companies

Required fields are marked with an asterisk (*).

Contract Company

(include overtime hours, capture subcontractor hours in separate line item below)

Is the Contract Company listed above Prime Contractor for this report?

Sub - Contractor Companies

Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Monthly Hours Worked

(including overtime hours)


Total Exposure Hours

(based on monthly hours inputted)

Step 4: Lagging Indicators

Required fields are marked with an asterisk (*).

Monthly HSE Performance



Step 5: Lagging Indicators

Required fields are marked with as astrisk (*).

Monthly HSE Performance






Step 6: Leading Indicators

Required fields are marked with an astrisk (*).

Monthly HSE Performance

Step 7: Regulatory Actions / Inspections

Required fields are marked with as asterisk (*).

Did your company experience any regulatory stop work orders, actions, demands, or inspections (that required your company to take action as directed by the regulator) this month?