Employee Information: Calendar Employee Employee Total # of Employee Employee Employee Year Hours # of recordables # of lost TRIR DART Worked fatalities workday Rate cases Contractor involving days Information: away from work 2016 2015 2014 2013 2012 Calendar Contractor Contractor Total # of Contractor Contractor Contractor Year # of recordables # of lost TRIR DART Hours fatalities workday Rate Worked cases involving days away from work 2016 2015 2014 2013 2012 3. Combined employee and contractor TRIR ______ and DART rate ________ Combined TRIR = (Total # of Employee recordables + Total # of Contractor recordables)* (200000) / (Total Employee Hours Worked + Total Contractor Hours Worked) Combined DART = (Total # of Employee DART cases + Total # of Contractor DART cases)* (200000) / (Total Employee Hours Worked + Total Contractor Hours Worked) 4. Date of last fatality: _______
Employee Information: Calendar Year Employee Hours Worked Employee # of fatalities Total # of recordables Employee # of lost workday cases involving days away from work Employee TRIR Employee DART Rate 2016 2015 2014 2013 2012 Contractor Information: Calendar Year Contractor Hours Worked Contractor # of fatalities Total # of recordables Contractor # of lost workday cases involving days away from work Contractor TRIR Contractor DART Rate 2016 2015 2014 2013 2012 3. Combined employee and contractor TRIR ______ and DART rate ________ Combined TRIR = (Total # of Employee recordables + Total # of Contractor recordables)* (200000) / (Total Employee Hours Worked + Total Contractor Hours Worked) Combined DART = (Total # of Employee DART cases + Total # of Contractor DART cases)* (200000) / (Total Employee Hours Worked + Total Contractor Hours Worked) 4. Date of last fatality: _______
DSA%202016.docx