• Prepared by:

  • For third shift: Select the date when your shift start

  • Date

  • Select shift

  • All of the following should be checked during the inspections (if applicable) *Eyewash/Showers (w/cards) *Guards *Electrical Hazards *PPE *Slip, Trip & Fall Hazards *Lighting *House Keeping *Trash cans *Fire Extinguishers *First Aid. Any adverse conditions found?

  • Take picture of the adverse condition(s) or provide additional comments

  • Notification to Miner’s Working in the Area?

  • Notification to Supervisor or Manager?

  • Enter the Date when adverse conditions were corrected. Add any comment (if needed)

  • Briefly describe correction:

Additional Comments (if any)

  • Add any comment (if needed)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.