Data for a recent 12 month period

(e.g. 2016/17 end of June financial year or calendar year 2016)

* 1. Organisation name (will remain confidential):

* 2. Your name (will remain confidential):

* 3. Job title (will remain confidential):

* 4. Phone number (will remain confidential):

* 5. Email (will remain confidential):

* 6. Industry type (e.g. food manufacturer, mining, warehousing, healthcare, government regulator etc.):

* 7. Number of employees (EFT) covered by data:

No. Employees (EFT): Number of effective full time employees, including regular casuals or contracted regular workers

* 8. Number of LTI's

LTI: Lost time injury e.g. work injury resulting in inability to work for one shift (8 hours) or more, any time after the incident.

* 9. Number of MTI's

MTI: Medical treatment injuries e.g. treatment by qualified medical practitioner beyond first aid. Not an MTI if only first aid, even if first aid is given by a doctor

* 10. Number of First Aid Injuries (if known)

* 11. Number of Days Lost (due to work injuries - all year)

* 12. Number of Total Recordable Injuries

TRI: Total recordable injuries include: death, loss of consciousness, lost time causes, restricted work, job transfers, affected work routines, and medical treatment beyond first aid

* 13. Workers Compensation Premium (in dollars [$] if available)

Workers Compensation Cost: Workers Compensation premium costs only for a recent 12 month period e.g. last financial year

* 14. No. of Safety & Workers Compensation Personnel (EFT) (e.g. 25 people)

* 15. Inspections Conducted to Schedule (percentage)

* 16. Hazards Fixed < 60 days (percentage)

* 17. Safety Climate Survey (Percentage positive per annual Safety Climate survey)