EHS: Annual Injury & Lost Time Reporting

Incident Alert Reporting

The Incident Alert is intended to provide information regarding a recent injury, process safety incident, or near miss. The purpose is to share learnings from these incidents.

First Name *			Last Name *
Date of Incident (DD/MM/YYYY) *
Nature of Incident *
Description of Incident *
Company Site (optional)
Site Complete Contact Information (Optional)

Annual Injury & Lost Time Reporting

This form is for ANNUAL safety reporting by COMPANY (not by plant). Please submit full company data only, not data by individual plant location.

The data should be reported in aggregate, and no data from any one company will be shared. Please note also that if your statistics include non-pine chemicals entities, it is not necessary to go to the trouble of separating these entities. The focus is on making reporting as simple as possible to encourage participation.

Year *
Total Manhours Worked this Year *
Total Injuries/Illnesses this Year *Total Injuries/Illnesses this Year
Number of COVID-19 Cases included in total *
Total Lost Workday Cases this Year *
Form Submitted By *
Organization *
Organization NAICS CodeNCAIS: North American Industry Classification System
Email Address *

EHS: Annual Injury & Lost Time Reporting

Incident Alert Reporting

Annual Injury & Lost Time Reporting

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