CNC - Mutua Universal

Contact details

Name *

Surnames *

Address

Postcode *

Town / City

Email *

Telephone *

Complete phone number (country code+area code of the subscriber), if the user wishes to be contacted if necessary

Company *

Details of accident rate of the company

Number of workers *

Annual average number of workers in the company included in the report, in the period corresponding to the same

Annual hours worked *

Enter the real number of hours worked during the period corresponding to the report

Tendering country *

Year of the report *

Name of the project *

Number of Death and Disability cases

Fatalities (Deaths due to work-related injury) *

Do NOT count the cases when travelling to and from work or not traumatic (for example, cardiovascular events)

Permanent Total Disabilities *

Enter the number of cases during the period classified as Severe Disability, Absolute Disability or Total Disability. Do NOT count the cases when travelling to and from work or not traumatic (for example, cardiovascular events)

Permanent Partial Disabilities *

Enter the number of cases during the period classified as Permanent Partial Disability. Do NOT count the cases when travelling to and from work or not traumatic (for example, cardiovascular events), nor non-disabling permanent injuries

Accidents resulting in sick leave, without sick leave and other recordable cases

Lost Time Accidents (Accidents resulting in sick leave, does not include disabilities) *

These are accidents that happened DURING THE WORK DAY that have resulted in sick leave, but have not been already counted in the chart of disabilities

Other recordable cases. Medical Treatment cases (Accidents not requiring sick leave. Medical care) *

Accidents DURING THE WORK DAY without sick leave that have required medical care

Other recordable cases. First Aid cases (Accidents not requiring sick leave. Medicine cabinet treatment) *

Enter the cases DURING THE WORK DAY that have been treated using the medicine cabinet and do not need medical treatment, although they would have received the medicine cabinet treatment

Number of cases of disease

Occupational Diseases (Occupational diseases declared) *

Enter only the cases that the Mutual Society has declared and that have been officially accepted

Special cases

Multiple accidents *

Accidents DURING THE WORK DAY when more than one worker has been injured

Days Lost

Days Lost by Job Accident (Days lost due to work-related accident, totals) *

Number of days of sick leave due to work-related injuries that TOOK PLACE DURING THE WORK DAY. Relapses will be included with the accident that caused them

Days lost due to occupational diseases *

Number of days of sick leave due to occupational disease. Relapses will be included with the case that caused them

Days Lost by Permanent Disability *

Number of days of sick leave due to cases of Permanent Disability that TOOK PLACE DURING THE WORK DAY. Relapses will be included with the accident that caused them

Please tick the rates that have to be mentioned in the report
Please tick the rates that have to be mentioned in the report

FATALITY RATES

Fatal Injury Rate (No. of fatalities per 100,000 full-swindles workers) v

Fatal Accident Rate (No. of deaths for 100,000 full-time workers)

LOST TIME INJURIES RATESNumber of cases with with sick leave

ANSI - Lost Time Injury Frequency Rate (LTIFR) (Not. Cases with days away from work /Total hours worked in period) x 1,000,000

Frequency rate of accidents resulting in sick leave

OSHA - Lost Time Incident (LTI) Frequency Rate (per 100 full-time workers) (No. Lost Time Incidents /hours worked in period x 200,000)

Frequency rate of accidents resulting in sick leave for 100 full-time workers (No. accidents resulting in sick leave /hours worked in period x 200,000)

LTIncident Rate (No. Lost Time Incidents /Average workers in period x 100)

Incidence rate of accidents resulting in sick leave (No. Accidents resulting in sick leave /Average No. of workers in period x 100)

SEVERITY OR SERIOUSNESS RATES Severity rates

Total Injury Severity Rate (per 1,000,000 hours worked) (No. of lost working days /Total hours worked in period x 1,000,000)

Severity Rate (No. of lost working days /total hours worked in period x 1,000,000)

Severity Rate (SEVERITY) (Days lost x 200,000) / Total Hours (Exposure)

Severity rate (No. of lost working days /Total hours worked in period x 200,000)

LTI Severity Rate (No. of lost working days / Total hours worked in period x 100,000)

Severity rate (No. of lost working days /Hours worked in period x 100,000)

Accident at work seriousness index (No. of lost working days /total hours worked in period x 1,000)

Severity Rate (No. of lost working days /Hours worked in period x 1,000)

SR - Severity rate = (No. of lost working days per year x 1000) / No. hours worked per year)

Severity rate (No. of lost working days / Total annual working hours x 1,000)

Mean Lost Time (Total Days Lost/No. of cases)

Average duration of cases (Total lost working days /No. of cases)

COMBINED RATES Combined rates

Reportable injuries with lost working days or fatalities

Fatal cases or with sick leave

Recordable Injury Frequency (RIF) (MAs + LTIs) / Total Hours (Exposure) x 200,000

Frequency rate of cases with sick leave or with medical treatment (No. cases with sick leave+No. cases medical treatment)/hours exposure x 200,000)

TOTAL INJURIES AND ILLNESS RATES Total injuries and illness rates

OSHA - DART incidence rate (LTIs+JTRWs) / Total Hours (Exposure) x 200,000

OSHA-DART incidence rate (cases with sick leave or with restricted or repositioning work) ((No. cases sick leave + No. cases with repositioning + No. cases work with restrictions) / Total hours worked in period x 200,000)

OSHA - Total Incident Recordable Frequency Rate (TIRFR) (per 1,000,000 hours worked) (F+LTI+MWI+MAI)/Total hours exposure x 1,000,000

OSHA - Total Incident Recordable Frequency Rate (TIRFR) for 1,000,000 hours worked ((No. deaths + No. cases with sick leave + No. of cases with repositioning or restriction at work + No. of cases just with medical care) / Hours worked in period x 1,000,000)

TRIF (Total Recordable Incident Frequency) (MAI + MWI + LTI + F)/Hours exposure x 200,000

Accidents Total frequency rate registrables ((No. deaths + No. cases with cancellation + No. of cases with outplacement or constraint at work +
No. of cases just with medical care) / Hours worked in the period x 200,000)

Incident Rate of Injury and Illness Cases per 100 Full-Time Workers [(No. Injuries+ No. Illness)]/Average annual workers x 100

Accident and Illness incidence rate for 100 full-time workers ((No. Accidents + No. Illnesses) / Average annual number of workers x 100

OTHERS

Other

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The information provided will be saved in a record with the sole objective of issuing the certificates and to improve the study that will serve as the methodological basis. The database custodians will be the CNC and Mutua Universal. Details will not be transfered to third parties or used for promotional purposes, except for sending information regarding the object of the project

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