CVM Mine Services Work Area Inspection & Handover

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date

  Date

• Shift

  Day

  Night

• Crew

  A

  B

  C

  D

Safety

• Please enter brief description in Notes or attach photo if there is an event

• Safe Shift?

  Safe

  Event

• Safety Focus

Dozer Task

• Time of Inspection

  Date

• Location

• Equipments

  Select TE09 TE50 TE58 DZ314 DZ315 EX02 EX05 TE06 TE07 BC12 BC93 BC395

  • TE09
  • TE50
  • TE58
  • DZ314
  • DZ315
  • EX02
  • EX05
  • TE06
  • TE07
  • BC12
  • BC93
  • BC395

• Task details

• Photo of task

  Media

• Hazards

• Severity Level (select AL and PL)

  Select AL0 PL0 PL1 PL2 PL3 PL4

  • AL0
  • PL0
  • PL1
  • PL2
  • PL3
  • PL4

• Photo of Hazards

  Media

• Controls

• Please add photos, notes or assign actions when required

• Access in good condition – graded, suitable for emergency access

  Yes

  No

  N/A

• Parking areas – clearly indicated and demarcated

  Yes

  No

  N/A

• Position of equipment - are equipment operate in safe position?

  Yes

  No

  N/A

• Bunding and stand off - appropriate heights and widths

  Yes

  No

  N/A

• Geotechnical hazards - stand off from walls

  Yes

  No

  N/A

• Risk assessment – suitable quality, appropriate for task

  Yes

  No

  N/A

Civil Task

• Time of Inspection

  Date

• Location

• Equipments

  Select GR352 GR459 TE10 TE16 TE18 TE39 BC29 WC106 WC475 WC476 WC477 WC482 WC241 WC242 BC503 TK263 BC81 Moxy 301 Moxy 701 Moxy 702 Moxy 743 LD93 TE80 LD604 LD605 TE40 BC601 TE15 TE82 CMB10 KBS01

  • GR352
  • GR459
  • TE10
  • TE16
  • TE18
  • TE39
  • BC29
  • WC106
  • WC475
  • WC476
  • WC477
  • WC482
  • WC241
  • WC242
  • BC503
  • TK263
  • BC81
  • Moxy 301
  • Moxy 701
  • Moxy 702
  • Moxy 743
  • LD93
  • TE80
  • LD604
  • LD605
  • TE40
  • BC601
  • TE15
  • TE82
  • CMB10
  • KBS01

• Task details

• Photo of task

  Media

• Hazards

• Severity Level (select AL and PL)

  Select AL0 PL0 PL1 PL2 PL3 PL4

  • AL0
  • PL0
  • PL1
  • PL2
  • PL3
  • PL4

• Photo of Hazards

  Media

• Controls

• Please add photos, notes or assign actions when required

• Access in good condition – graded, suitable for emergency access

  Yes

  No

  N/A

• 50m Active Mining Area in place, visible and functional

  Yes

  No

  N/A

• Parking areas – clearly indicated and demarcated

  Yes

  No

  N/A

• Position of equipment - are equipment operate in safe position?

  Yes

  No

  N/A

• Bunding and stand off - appropriate heights and widths

  Yes

  No

  N/A

• Risk assessment – suitable quality, appropriate for task

  Yes

  No

  N/A

• Loading and discharge – procedures followed

  Yes

  No

  N/A

Pump Crew

• Pump/s

  Select Pump 1 Pump 2 Pump 3 Pump 4 Pump 5 Pump 6 Pump 7 Pump 8 Pump 9 Pump 10

  • Pump 1
  • Pump 2
  • Pump 3
  • Pump 4
  • Pump 5
  • Pump 6
  • Pump 7
  • Pump 8
  • Pump 9
  • Pump 10

• Location (Ramp, Bench)

• Status

  Running

  Breakdown/Shutdown

  Standby

• Pump/s

  Select Pump 1 Pump 2 Pump 3 Pump 4 Pump 5 Pump 6 Pump 7 Pump 8 Pump 9 Pump 10

  • Pump 1
  • Pump 2
  • Pump 3
  • Pump 4
  • Pump 5
  • Pump 6
  • Pump 7
  • Pump 8
  • Pump 9
  • Pump 10

• Location (Ramp, Bench)

• Status

  Running

  Breakdown/Shutdown

  Standby

• Pump/s

  Select Pump 1 Pump 2 Pump 3 Pump 4 Pump 5 Pump 6 Pump 7 Pump 8 Pump 9 Pump 10

  • Pump 1
  • Pump 2
  • Pump 3
  • Pump 4
  • Pump 5
  • Pump 6
  • Pump 7
  • Pump 8
  • Pump 9
  • Pump 10

• Location (Ramp, Bench)

• Status

  Running

  Breakdown/Shutdown

  Standby

• Pump/s

  Select Pump 1 Pump 2 Pump 3 Pump 4 Pump 5 Pump 6 Pump 7 Pump 8 Pump 9 Pump 10

  • Pump 1
  • Pump 2
  • Pump 3
  • Pump 4
  • Pump 5
  • Pump 6
  • Pump 7
  • Pump 8
  • Pump 9
  • Pump 10

• Location (Ramp, Bench)

• Status

  Running

  Breakdown/Shutdown

  Standby

• Pump/s

  Select Pump 1 Pump 2 Pump 3 Pump 4 Pump 5 Pump 6 Pump 7 Pump 8 Pump 9 Pump 10

  • Pump 1
  • Pump 2
  • Pump 3
  • Pump 4
  • Pump 5
  • Pump 6
  • Pump 7
  • Pump 8
  • Pump 9
  • Pump 10

• Location (Ramp, Bench)

• Status

  Running

  Breakdown/Shutdown

  Standby

• Pump/s

  Select Pump 1 Pump 2 Pump 3 Pump 4 Pump 5 Pump 6 Pump 7 Pump 8 Pump 9 Pump 10

  • Pump 1
  • Pump 2
  • Pump 3
  • Pump 4
  • Pump 5
  • Pump 6
  • Pump 7
  • Pump 8
  • Pump 9
  • Pump 10

• Location (Ramp, Bench)

• Status

  Running

  Breakdown/Shutdown

  Standby

• Pump/s

  Select Pump 1 Pump 2 Pump 3 Pump 4 Pump 5 Pump 6 Pump 7 Pump 8 Pump 9 Pump 10

  • Pump 1
  • Pump 2
  • Pump 3
  • Pump 4
  • Pump 5
  • Pump 6
  • Pump 7
  • Pump 8
  • Pump 9
  • Pump 10

• Location (Ramp, Bench)

• Status

  Running

  Breakdown/Shutdown

  Standby

• Pump/s

  Select Pump 1 Pump 2 Pump 3 Pump 4 Pump 5 Pump 6 Pump 7 Pump 8 Pump 9 Pump 10

  • Pump 1
  • Pump 2
  • Pump 3
  • Pump 4
  • Pump 5
  • Pump 6
  • Pump 7
  • Pump 8
  • Pump 9
  • Pump 10

• Location (Ramp, Bench)

• Status

  Running

  Breakdown/Shutdown

  Standby

• Pump associated task (poly welding etc.)

HV Road Maintenance Task

• Time of Inspection

  Date

• Location

• Equipments

  Select GR352 GR459 TE10 TE16 TE18 TE39 BC29 WC106 WC475 WC476 WC477 WC482 WC241 WC242 BC503 TK263 BC81 Moxy 301 Moxy 701 Moxy 702 Moxy 743 LD93 TE80 LD604 LD605 TE40 BC601 TE15 TE82 CMB10 KBS01

  • GR352
  • GR459
  • TE10
  • TE16
  • TE18
  • TE39
  • BC29
  • WC106
  • WC475
  • WC476
  • WC477
  • WC482
  • WC241
  • WC242
  • BC503
  • TK263
  • BC81
  • Moxy 301
  • Moxy 701
  • Moxy 702
  • Moxy 743
  • LD93
  • TE80
  • LD604
  • LD605
  • TE40
  • BC601
  • TE15
  • TE82
  • CMB10
  • KBS01

• Task details

• Photo of task

  Media

• Hazards

• Severity Level (select AL and PL)

  Select AL0 PL0 PL1 PL2 PL3 PL4

  • AL0
  • PL0
  • PL1
  • PL2
  • PL3
  • PL4

• Photo of Hazards

  Media

• Controls

• Please add photos, notes or assign actions when required

• Signage – appropriate, in place, visible, mounted correctly

  Yes

  No

  N/A

• Positive Communication – when entering area and interacting work areas

  Yes

  No

  N/A

• Position of equipment - are equipment operate in safe position?

  Yes

  No

  N/A

• Risk assessment – suitable quality, appropriate for task

  Yes

  No

  N/A

LV Road Maintenance Task

• Time of Inspection

  Date

• Location

• Equipments

  Select GR352 GR459 TE10 TE16 TE18 TE39 BC29 WC106 WC475 WC476 WC477 WC482 WC241 WC242 BC503 TK263 BC81 Moxy 301 Moxy 701 Moxy 702 Moxy 743 LD93 TE80 LD604 LD605 TE40 BC601 TE15 TE82 CMB10 KBS01

  • GR352
  • GR459
  • TE10
  • TE16
  • TE18
  • TE39
  • BC29
  • WC106
  • WC475
  • WC476
  • WC477
  • WC482
  • WC241
  • WC242
  • BC503
  • TK263
  • BC81
  • Moxy 301
  • Moxy 701
  • Moxy 702
  • Moxy 743
  • LD93
  • TE80
  • LD604
  • LD605
  • TE40
  • BC601
  • TE15
  • TE82
  • CMB10
  • KBS01

• Task details

• Photo of task

  Media

• Hazards

• Severity Level (select AL and PL)

  Select AL0 PL0 PL1 PL2 PL3 PL4

  • AL0
  • PL0
  • PL1
  • PL2
  • PL3
  • PL4

• Photo of Hazards

  Media

• Controls

• Please add photos, notes or assign actions when required

• Signage – appropriate, in place, visible, mounted correctly

  Yes

  No

  N/A

• Positive Communication – when entering area and interacting work areas

  Yes

  No

  N/A

• Position of equipment - are equipment operate in safe position?

  Yes

  No

  N/A

• Risk assessment – suitable quality, appropriate for task

  Yes

  No

  N/A

Exposure to Environmental Harm

• Any uncontrolled water release?

  Yes

  No

  N/A

• Drains - free flowing?

  Yes

  No

  N/A

• Dams - water level checked?

  Yes

  No

  N/A

Sign off

• Name & Signature

  Sign