INSTRUCTIONS FOR COMPLETING THE CONTRACTOR INCIDENT REPORTING LOG

Kinder Morgan will utilize this form for tracking all incidents/accidents.

A. INCIDENT SUMMARY REPORT Information gathered from the CSM-001 report can be entered into this tab. This tab is a summary of the
incident. In addition it will track the number and types of injuries that a contractor and subcontractor have during a project. The general
contractor also must include incidents or injuries for any subcontractors being utilized.

1 Column A - Enter the date of the incident.

2 Column B - Enter the location of the incident.

3 Column C - Enter the name of the contractor or subcontractor

4 Column E - Enter the IMPACT Incident number for incident. This confirms incident has been uploaded into KM IMPACT Database.

5 Column F - Enter a brief description of the incident.

6 Column G - In "Incident Type," select from the drop down the type of incident that occurred.

7 Column H - If the type of incident was an injury and resulted in Days Away With Restricted Time or the injury has Lost Time associated (DART),
click on yes. Click NO if this does not apply.

B. CURRENT PROJECT TOTALS Total Recordable Incident Rate (TRIR) and "Days Away/Restricted/Transfer" (DART).

1 Column A Enter the contractor name, including any subcontractors utilized.

2 Columns B-C Enter the project status of the contractor and subcontractors. If a contractor or subcontractor has been dismissed or
released from the project, the contractor or subcontractor would be considered Inactive. The General/Prime Contractor will need to
supply this information for the project.
3 Column D - Enter the project start date when the accumulated man hours began for each contractor and subcontractor.
4 Column E - Enter the current project man hours for the report period. (Example: Report is March 5th ; Man hours accumulated would
be Feb 1 through Feb 29)
5 Column F Enter the the Project Man Hours to Date for each contractor and subcontractor. Subcontractors hours should be listed
separately from the General/Prime Contractor.
6 Column G - Select applicable Kinder Morgan Business Unit.

7 Column H Enter the current project total OSHA Recordable Incidents.

8 Columns I through K Column provides automatic formula function-no action required.
9 Column M Enter the current project total of incidents with Days Away or Restricted, Transfer.
10 Columns N through P - Column provides automatic formula function-no action required.

CSM-007
Instructions
01/13
Contractor Incident Reporting Log

Project Name:
Project Manager:
Chief Inspector:

IMPACT Days Away or

Contractor Company Name
Date of Incident Location of Incident (General/Prime/Sub)
Incident Description of Incident Incident Type Restricted Time
Number Case

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Contractor submit to KM Chief Inspector and upload into ISNetworld CSM-007

Incident Reporting Log
or submit to the KM Contractor Safety Group at: Contractor_safety@kindermorgan.com 01/13
Contractor MAN-HOUR / TRIR Log
Month of:
Project Name:
Project Manager: Page 1 of ______
Business Unit

Project Status Total Recordable Incident Rate (TRIR) Days Away/Restricted Time (DART)
Monthly Man Hours Project Total Man
Project START # OSHA
Contractor Company Name (General/Prime/Sub) (Current Month Hours Hours (Project Start
Date Recordable
Active Inactive ONLY) thru Project to Date) Select KM Business Incidents KM # Incidents with Days KM
Unit (Project to Date) Current TRIR Benchmark Difference Away or Restricted Time Current DART Benchmark Difference

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

CSM-007B
01/13
 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

TOTALS: 0 0 0 0.00 0.00 0 0.00 0.00

Total Project Monthly Total Project Man

Man Hours (All Hours (All
Contractors) Contractors)

CSM-007B
01/13