Title Page
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Site conducted
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Prepared by
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Conducted on
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Department
- Maintenance
- Mine
- Ore process
- Ancillary
- Mill
- Tech Services
- Security
- Dewatering
- Safety bonus contributions
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Which Maint group
- Fixed
- Electrical
- Mobile
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Which group
- Dispatch
- IT
- Mining
- Blasting
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Which group
- Met lab
- Pads
- Plants
- Refinery
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Which group
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Which group
- Accounting
- HR
- CI
- Management
- Safety
- Environmental
- Projects
- Clinic
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Which group
- Assay lab
- Survey
- Sampling
- Geotech
- Hydrology
- Geology
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Location
- Hazard report (1 point)
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Select Shift
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What part of shift was the hazard found
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How many days into the rotation was the hazard found (effected crew)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- Overtime
- Extra shift
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Was equipment involved
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Equipment type and numbers
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Is this a Critical risk report or Standard hazard report
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Which Critical Risk would this be classified under?
- Cable Handling
- Permit to work programs
- Working around Conveyor belts
- Haul truck and small vehicle interactions
- Fueling Equipment
- Chemical Handling
- Fatigue
- Braking systems on Mid duty vehicles
- Shovel swing radius
- Heavy equipment operation
- Working on pressurized systems
- Equipment fires
- Working around highwalls
- Energy isolation
- Other (please comment)
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Select the PTW program
- Working at heights
- Hot work
- Trenching and excavation
- Lifting/ Rigging/Towing
- Confined space
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Select type of energy
- Lock out, Tag out, Try out (LOTOTO)
- Live Testing
- Stored energy/pressure
- Other (please comment)
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Description of condition or practice
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Photo of condition
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Immediate action(s) taken
- Reported to supervisor/management
- Shut the area/task down
- Added controls
- Other (please comment)
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Reported to who
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What controls
- Elimination (Complete removal of hazard to worker)
- Substitution (Replace a hazard with something less hazardous)
- Engineering (Guards, alarms, reduce exposure, modify work)
- Administrative (Training, policies etc.)
- PPE (gloves, hearing protection etc. )
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Comment required
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Hazard Classification
- Housekeeping
- Safe Access
- Electrical
- Guarding
- Chemical
- IH-OH (Noise, dust, eyewash station, PPE, etc.)
- Environmental
- Damaged tools/Equipment
- Slip/trip/fall hazard
- Flammable, Combustible, disposal/storage
- Accumulation of Trash or missing lid
- Travel ways/roadways
- Poor or inadequate safety behavior
- Poor or inadequate safety procedure
- Inadequate Berms/Barriers
- Stored energy
- Other (please comment)
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Is this hazard cyanide related
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Description of condition or practice
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Photo of condition
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Immediate action(s) taken
- Reported to supervisor/management
- Shut the area/task down
- Added controls
- Other (please comment)
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Reported to who
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What controls
- Elimination (Complete removal of hazard to worker)
- Substitution (Replace a hazard with something less hazardous)
- Engineering (Guards, alarms, reduce exposure, modify work)
- Administrative (Training, policies etc.)
- PPE (gloves, hearing protection etc. )
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What controls were added
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Was work stopped to mitigate the hazard?
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Describe resolution
Establish a long term solution to eliminate a hazard (2 points)
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Please ensure the 1 point section is fully competed as well
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What steps have been established to sustain the corrective actions
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What measurement will be used to know the control is in place and effective (long term)
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Who is the control owner
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Notify Committee for review
New Critical risk topic (6 points)
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Complete description of condition or practice requiring a new CR topic
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Photo(s) of condition
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What department(s) would benefit the most from this CR topic
- Maintenance
- Mine
- Ancillary
- Mill
- Ore Process
- Tech Services
- Administration
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Submit Topic for review
