HSG Statistics Questionnaire

sender

reply

Legal name of the company that you are completing these stats for?*

Your First & Last Name:*

First NameLast Name

Your Email Address:*

example@example.com

I am completing stats for:*

Q1=Jan/Feb/MarQ2=Apr/May/JunQ3=Jul/Aug/SepQ4=Oct/Nov/Dec

Quick Help Guide - Company Statistics Chart:

What are Exposure Hours? Provide the total hours worked by all persons on your company payroll (T4 employees only). Include overtime and training but exclude leave, sickness and other absences. Time spent on a site such as a camp, an offshore rig or a boat, but not working, is not to be included in this estimate. Do not include hours worked by contractors and subcontractors.

What do I include for KM's driven? Please list the total amount of kilometres driven in the period by company owned vehicles

Who is included in my Avg # of Employees? Include all persons on your company payroll. Do not include subcontractors.

Company Statistics:*

	Average # of Employees	Number of Exposure Hours (Shop/Office)	Number of Exposure Hours (Field)	Total Number of Exposure Work Hours (Employees)	Total KM's Driven
Q1
Q2
Q3
Q4

Did you use contractors or subcontractors in the period you are reporting for?*

YesNo

Contractor and Subcontractor Statistics (Please enter any/all information you have):

	Average # of Contractors and Subcontractors	Number of Contractor/Subcontractor Exposure Hours (Shop/Office)	Number of Contractor/Subcontractor Exposure Hours (Field)	Total Number of Exposure Work Hours (Contractors/Subcontractors)
Q1
Q2
Q3
Q4

Signature of Individual That Completed This Form:*