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Batangas Business Office: BS-01 Dimatatac Road, San Pascual, Batangas, 2404, Philippines

Tel. No.: (043) 727-1026 / 727- 4926 / Tele-Fax No.: (043) 727-1964
Email Add: m4cmsi@yahoo.com / Website: www.m-4constructio.com
Republic of the Philippines
Department of Labor and Employment
BUREAU OF WORKING CONDITIONS
Manila

Date __________________


ANNUAL WORK ACCIDENTAL/ ILLNESS EXPOSURE DATA REPORT

Name of Establishement:____________________________________________________
Nature of Business:_________________________________________________________
Address:__________________________________________________________________

Exposure Data__________________________________ January to December 19_______
Numbers of Employees________________________________________________
Total Hours Worked by All ____________________________________________
Employees During the Year____________________________________________
Injury Summary ___________________________________________________________
Total - All Disabling Injuries / Illnesses___________________________________
Total - Non- Disabling_________________________________________________
Frequency Rate____________________________________________________________
Severity Rate______________________________________________________________


General Manager



This report shall be accomplished whether or not there were accident / illness during the period, covered
and submitted to the Regional Labor Office or local government having jurisdiction not later than the 30
th

day of the month following the end of each calendar year.



Frequency Rate is the total disabling injuries per million employee hours of exposure.


Number of disabling injuries x 1,000.000
Frequency Rate = --------------------------------------------------------
Employee hours of Exposure


Severity Rate is the total number of days lost or charged per million employee hours of exposure.


Number of days lost or charged x 1,000.00
Severity Rate = ----------------------------------------------------------
Employee hours of Exposure


Exposure is the total number of hours worked by all employees in each established including employees
or operating production, maintenance, transportation, clerical, administrative, sales and other departments.


Disabling Injuries- work injuries which result death permanent total disability, permanent partial
disability or temporary total disability.


Non- Disabling Injuries (Medical Treatment) - Injuries which do not result into disabling but require first
-aid medical attention of any kind.