ATTACHMENT 1

GOSHU KOHSAN CO., LTD.

WEEKLY SAFETY STATISTIC REPORT ( SHEET 1 OF 3 )
REPORTING PERIOD FROM:
TYPE OF ACCIDENT 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16, 17. 18 . 19 , 20. 21. FALL TO DIFFERENT LEVEL FALL ON SAME LEVEL STRUCK AGAINST OBJECT STRUCK BY FLYING OR FALLING OBJECT COLLAPSE STRUCK BY MOVING OBJECT CAUGHT IN OR BETWEEN OBJECT CUT/RUB STEPPING ON NAILS. ETC. DROWNING CONTACT WITH EXTREME TEMPERATURES CONTACT WITH POISONOUS SUBSTANCES CONTACT WITH ELECTRICAL CURRENT EXPLOSlON RUPTURE FIRE TRAFFIC ACCIDENT (PUBLIC ROAD) TRAFFIC ACCIDENT (OTHES.) REACTION OR OVER EXERTION OTHERS NOT CLASSIFIED

DOCUMENT No. JOB STUATTON

START

12 APR

TO:

19 APR

YEAR: 2012
NATURE OF INJURY

CONTINUE

INTERRUPT COMPLETE

EYE DISEASE

BURN

CUT

BRUISE

CONTUSION

SPRAIN

FRACTURE

OTHER

FATAL

FIRST AID
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL

TOTAL
DISTRIBUTION : JOB CODE PROJECT CLIENT

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
AST3 TPAC

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
APPROVED BY
CHECKED BY PREFARED BY

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

ATTACHMENT 1
GOSHU KOHSAN CO., LTD.
WEEKLY SAFETY STATATISTIC REPORT ( SHEET 2 OF 3 )
REPORTING PERIOD : FROM : 12 APR TO : 19 APR YEAR : 2012 RECORDABLE WORK INJURIES RECORDABLE LOST TIME INJURIES RESTRICTED MEDICAL INJURIES PERMANENT PERMANENT LOST WORKDAY TREATMENT LOST TIME (RECORDABLE TOTAL PATIAL WORKDAY CASES CASES INJURIES CASES) DISABILITIES DISABILITIES CASES (6) (7) (1)+(2)+(3)+(4)=(5) (5)+(6)+(7)=(8) (2) (3) (4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

CONTRACTOR

WORK CATEGORY

FATALITIES (1) 0 0 0

FIRST AID CASE 0 0 0

1 GKC 2 MEC 3 SSK

MAIN CONTRACTOR Construction of civil Construction of mechanical

THIS WEEKLY REPORT ACCUMULATION UP TO LAST WEEK ACCUMULATION UP TO THIS WEEK

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

Note : (5) Include fatalitics, permanent total disabilities, permanent partial disabilities. (8) Include lost time injuries (5) plus restriced workday cases and medical treatment cases.

ATTACHMENT 1
GOSHU KOHSAN CO., LTD.
WEEKLY SAFETY STATISTIC REPORT ( SHEET 3 OF 3 )
REPORTING PERIOD : FROM : 12 APR-19 APR YEAR : 2012 RECORDABLE WORK INJURIES FREQUENCY RATE OF RECORD CASE (ii) 0 0 0 NO OF LOST TIME INJURIES (LOST WORKDAY CASES) (iii) 0 0 0 LOST TIME INJURIES FREQUEUCY RATE OF LOST WORKDAY CASES (vi) 0 0 0 RATE OF LOST WORKDAY (vi) 0 0 0

WORK CATEGORY

TOTAL MANDAY WORKED

TOTAL MANHOURS WORKED

OSHA RECORD CASE (i)

LOST WORKDAYS (V)

SEVERITY RATE (vii)

1 2 3

GKC MEC SSK

MAIN CONTRACTOR Construction Construction

141 141 14

1128 1128 112

0 0 0

0 0 0

0 0 0

THE MONTH TOTAL ACCUMULATION UP TO LAST MONTH ACCUMULATION UP TO THIS MONTH

(i) Transfer the figures calculated in column 8 in sheet 2 of 3

296 62 358

2368 496 2864

0 0 0

0 0 0

############# ############# #############

0 0 0

0 0 0

############# ############# #############

0 0 0

Note:

(ii) Frequency Rate of Recordable injuries = No. of Total Recordable Injuries x 200,000 Total Manhour Worked (iii) Transfer the figure calculated in column 5 in sheet 2 of 3 (iv) Frequency Rate of Lost Time injuries = No. of Total Lost Time Injuries x 200,000 Total Manhour Worked

(vi) Rate of Lost Workdays = Total Lost Workdays x 200,000 Total Manhour Worked

(vii) Seroity Rate = Total Lost Workdays x 200,000 Total No. of Last Workday Cases and Permanent Partial Disabilities