Form E1 - Sector Quarterly Performance Report

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ADOSH-SF – Forms
Form E1 – Sector Quarterly Performance Report - Version 4.0 – 15th July 2024 Page 1 of 4
Form E1
General Information
Classification Code: Sector Regulatory Authority:
Reporting Period:
Year: ____  Q1 (Jan-Mar)  Q2 (Apr-Jun)  Q3 (Jul-Sep)  Q4 (Oct-Dec)
Reporting Timeframe: End of April End of July End of October End of January
Sector Summary:
Number of
Entities
Reporting:
Total
Number of
Employees:
Total Working
Hours Performed
This Quarter:
Occupational Health and Safety Performance - Compulsory Reporting to Competent Authority
KPI 1-01 - Cumulative
Number of Entities Nominated (High Risk)
Total Number of “High Risk” Entities Nominated to develop full
OSHMS:
Total Number of Entities approved (full OSHMS):
KPI 1-02 – Cumulative
Number of Entities Notified (Medium/Low
Risk Entities)
Total Number of “Medium Risk” Entities Notified to comply with
Mechanism 5:
Total Number of “Low Risk” Entities Notified:
KPI 1-03 –This Quarter
Number of entities with an approved OSHMS
complying with quarterly OSH performance
reporting requirements
Total number of entities with an approved OSHMS who should
submit their OSH Performance Report:
Percentage of entities with an approved OSHMS complying:
KPI 1-04 – This Quarter
Number of SRA investigations of incidents
Number of serious incidents notified or reported by entities with
an approved OSHMS:
Number of serious incidents notifications/reports received by the
SRAs involving entities without an approved OSHMS:
Number of investigations performed by SRA:
Percentage of investigations performed by SRA (out of total
incidents notified or reported this quarter):
KPI 1-05 –This Quarter
Number of SRA inspections of entities
Number of nominated/notified entities inspected (excluding those
with approved OSHSMS):
Number of entities with an approved OSHMS inspected:
Percentage of entities with an approved OSHMS inspected (out of
total entities inspected this quarter):
KPI 1-06 – Cumulative
Number of SRA Audits of entities
Number of entities with approved OSHMS audited by SRA:
Percentage of entities with approved OSHMS audited by SRA:
*KPI 1-07 – This Quarter
Number of OSHMS Workshops / Seminars or
Similar Training Conducted by the
SRA
Total Number of workshops/Seminars:
Total Number of Participants:
Total Training hours (for all participants in all workshops) :
No. of Participants Title Training Level Training Provider Training Hours
KPI 1-08– This Quarter
Number of Awareness Activities conducted by
the SRA
Total Number of Awareness Notifications (workshops,
publications, press releases, etc.) sent to the Center:
Percentage of Awareness Notifications approved by the Center
(out of total submitted this quarter):
*Note: Additional information can be attached on a separate sheet if required

ADOSH-SF – Forms
Form E1 – Sector Quarterly Performance Report - Version 4.0 – 15th July 2024 Page 2 of 4
Form E1
Occupational Health & Safety Performance Summary for Sector Entities, Contractors & Other
Persons
S-KPI 2-01 Total Incidents (From Sector Entities and Non- Nominated Contractor working
with Sector Entities) (sum of S-KPI 2-02 &3-01)
Occupational Health & Safety Performance Summary for Sector Entities
S-KPI 2-02 Total incidents (From Sector Entities)
Entity (s) Employees Injuries & Illness
Consequences No. Lost
Workdays Other Consequences No.
Lost Time
Injuries
Fatality Serious Dangerous Occurrence
Permanent Total Disability Equipment / Property Damage
Permanent Partial
Disability
Lost Workdays Cases
a) Lost Workdays Injuries
b) Lost Workdays
Occupational Illness
Restricted Workday Case
Medical Treatment Case
Total Consequences (Summation of Injuries, illnesses and other Consequences)
S-KPI 2-03
Total Reported Case Frequency (TRCF)
[Total Injuries & illness reported in KPI 2-02
(Lost Time Injuries, Restricted Workdays and
Medical Treatment Cases)]
Number of Total Injuries
& Illness Reported in the
Reporting Period
Number of
Working Hours
in Reporting
Period
TRC x 1,000,000
Working Hours
S-KPI 2-04
Lost Time Injury Severity Rate (LTISR)
[Total Lost Workdays reported in KPI 2-02]
Zero LWDs for Fatality & Permanent Total
Disability
Number of Workdays
lost due to Injuries &
illness in the Reporting
Period
Number of
Working Hours
in Reporting
Period
No. of Days Lost x 1,000,000
Working Hours
S-KPI 2-05
Lost Time Injury Frequency Rate (LTIFR)
[Total Lost Time Injuries reported in KPI 2-02
(Fatality, Permanent Total Disability,
Permanent Partial Disability & Lost Workdays
Cases)]
Number of Lost Time
Injuries in the Reporting
Period
Number of
Working Hours
in Reporting
Period
No. of LTI’s x 1,000,000
Working Hours
S-KPI 2-06
Number of Near Miss & First Aid Cases for
Sector Entities:
Near Miss First Aid Cases

ADOSH-SF – Forms
Form E1 – Sector Quarterly Performance Report - Version 4.0 – 15th July 2024 Page 3 of 4
Form E1
Occupational Health & Safety Performance Summary for Contractors (hired by or working for Sector
Entities but not Nominated currently with any concerned SRA/does not fall under any current Sector).
S-KPI 3-01
Total Incidents (From Non-Nominated Contractor
working with sector entities)
(total No. of incidents that occurred during the reporting
quarter)
Contractor (s) Employees Injuries & Illness
Consequences No. Other Consequences No.
Lost Time Injuries
Fatality Serious Dangerous Occurrence
Permanent Total
Disability Equipment / Property Damage
Permanent Partial
Disability
Lost Workdays
Cases
a) Lost Workdays
Injuries
b) Lost Workdays
Occupational
Illness
Restricted Workday Case
Medical Treatment Case
Total Consequences (Summation of Injuries, illnesses and other Consequences)
S-KPI 3-02
Number of Near Miss & First Aid Cases for
Contractors:
Near Miss First Aid Cases
S-KPI 3-03
Number of
Monitoring
Activities
Performed on
Contractor(s) /
Supply Chain by
Sector
Entities(nominated/
non-nominated):
Total No. of Contractors Inspections Performed on Contractors
Review / Approval of Contractor OSH
Procedures.
Contractor Incidents Investigated by
Entity.
Specific Requirement / Part System Audit
Performed on Contractors Corrective Notices Issued to Contractors:
Full OSHMS Audit Performed on Contractor Breach Notices Issued to Contractors:
Summary for Other Persons (Visitors, Students, Hotel Guests, Passengers, etc in Sector
Entities.)
S-KPI 4-01
Number of Fatalities & Injuries for other Persons:
Total consequences (Summation of Fatalities &
Injuries)
Fatality Other Injuries
S-KPI 4-02
Number of Near-Miss & First Aid Cases for other
Persons:
Near Miss First Aid Cases
OSH Resources, OSHMS Development & Implementation Cost and Enforcement Summary for
the Sector
S-KPI 5-01-
OSH Resources in
entities within
Sector
(Cumulative)
Number of OSH Employees Number of OSH
Nationals Employees
No. of OSH Nationals Employees x 100
Number of OSH Employees
Number of OSH Employees that
passed the OSHAD-SF
Practitioner Course
Number of OSH Employees Registered at Qudorat till date

ADOSH-SF – Forms
Form E1 – Sector Quarterly Performance Report - Version 4.0 – 15th July 2024 Page 4 of 4
Form E1
S-KPI 5-02
Average Number
of Training Hours
per Employee
Number of OSH Training
Hours Undertaken
No. of OSH Training Hours undertaken by Employees
Total No. of Employees
S-KPI 5-03
Number of Sector Entities with approved
OSHMS completed annual 3rd Party OSHMS
Compliance Audit and report approved by SRA
Total number of entities with approved OSHMS
completed annual 3rd Party compliance Audit and
submitted report and approved by SRA during this
quarter.
Percentage of entities with approved OSHMS
completed annual 3rd Party compliance Audit.
S-KPI 5-04
Number of Corrective Notices (warning notices,
improvement notices) issued by the SRA as a
result of non-compliance to OSHMS
requirements within its Sector
Number of warning notices issued:
Number of improvement notices issued
Number of prohibition notices issued:
S-KPI 5-05
Number of Breach Notices (fines / penalties /
enforceable undertakings) issued by the SRA
as a result of non-compliance to OSHMS
requirements within its Sector
Number of fines / penalties issued:
Number of enforceable undertakings (entity’s
commitment to spend money to rectify OSHMS non-
compliance):
Total value of all fines / penalties/ enforceable
undertakings enforced (AED):
Declaration
I declare that all information provided in this document is true, correct and complete.
Signature of the
Authorised
Contact Person :
Regulatory
Authority
Official
Stamp:
Date :
(DD/MM/YYYY) _____ / _____ / _____
Official Use
Remarks :
Competent Authority Stamp Entered into Database by:
Name:
Signature:
Date: (DD/MM/YYYY) _____ / _____ / _____
Reviewed by:
Name:
Signature:
Date: (DD/MM/YYYY) _____ / _____ / _____