This form is used to determine the rating of the Member Company for the AWRF HSE Safety Award. 

It will also help the AWRF to better understand and measure the effectiveness of our industry’s HSE programs. All information gathered shall be held in the strictest confidence and used only to improve our industry’s workplaces. 

The formulas below were developed by OSHA and take into account a correction factor for small to large companies.  These formulas help present your company with a quantifiable and qualifiable result to your company’s safety program.

LTIR (Lost Time Incident Rate)  = # of Lost Time Incidents x 200,000 Hours / # of Hours Worked in 2025

TRIR (Total Recordable Incident Rate) = # of Incidents x 200,000 Hours / # of Hours Worked in 2025  

Ratings: 0.00 – 0.99 Green    

1.00 – 3.99 Yellow  

4.00 – UP Red

In order to achieve an AWRF HSE Safety Award, the company shall have a Green rating in the LTIR. Award levels are based on consecutive years of a Green rating. 

Award Levels:  

Standard 1 to 2 years consecutively Green   

Silver  3 to 4 years consecutively Green   

Gold  5 to 6 years consecutively Green   

Platinum 7 to 10 years consecutively Green   

Diamond 10 years and greater consecutively Green

Please attach your Company’s OSHA 300 log with description to verify your numbers. 

**Please do not show employee names on the injury section of the OSHA form. 

The HSE Committee is actively working to improve our Industry’s workplace. Please assist in this effort by returning this form and your applicable Provincial and/or Government lost time forms by Thursday, September 10th. The higher the participation in this program, the better we can serve the membership.

Provincial and Territorial Government Forms 

Federal 

Employer’s Annual Hazardous Occurrence Report (EAHOR)

 Alberta 

Employer’s Report of Injury Form (C-040) 

British Columbia 

Employer’s Report of Injury or Occupational Disease Form 

Manitoba

Employer’s Incident Report Form 

New Brunswick 

Report of Accident or Occupational Disease (Form 67) 

Newfoundland 

Employer’s Report of Injury (Form 7)

 Northwest Territories and Nunavut

 Employer’s Report of Accident (CS002 0603) 

Nova Scotia 

WCB Accident Report

 Ontario

 Employer’s Report of Injury / Disease (Form 016-0007A) 

Prince Edward Island

 Employer’s Report of Accident (Form 7) 

Quebec

 (All information on web is in French, we need a translation) 

Saskatchewan

 (Cannot find a form on the WCB website) 

Yukon

 Employer’s Report of Injury/Illness (WCB1275 Rev.07/98)