Contractor Site Departure Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Health & Safety Documentation

• Are all the Contractor's Incidents closed out on CINTELLATE?

  Yes

  No

  N/A

• Are all the Contractor's Action Items Closed out on CINTELLATE?

  Yes

  No

  N/A

• Are all required Documents Code 1 on COREWORX?

  Yes

  No

  N/A

• Are all the Contractor's Hazard Reports closed out?

  Yes

  No

  N/A

Permits

• Are all Permits relinquished?

  Yes

  No

  N/A

• Are all Permits handed back to CPM?

  Yes

  No

  N/A

• Has the Contractor returned all Lock Boxes?

  Yes

  No

  N/A

• Is the Permit Register complete?

  Yes

  No

  N/A

Environmental

• Is the Environmental Audit complete?

  Yes

  No

  N/A

• Has the contractor left material in a cyclone prepared state?

  Yes

  No

  N/A

• Has the Contractor left the site in a clean state?

  Yes

  No

  N/A

Comments & Sign-off

• Comments.

• Contractor Representative

  Sign

• Citic Pacific Mining Health & Safety Auditor

  Sign

• Citic Pacific Mining Health & Safety Superintendent/ Manager

  Sign