Dawson Mine SLT Preliminary Notification of Significant Incident - NOT FOR DISTRIBUTION

• Document No.

• Prepared by

Incident Details

• Anglo Classification

  HPI

  HPH

  N/A

  TBC

• DNRM Classification

  HPI

  NRI

  N/A

• CMSHR S198 type

  Select 1) an unplanned ignition of gas, dust, or a combination of gas and dust 2) the spontaneous combustion of coal or other material in an underground mine 3) the entrapment of a person 4) an electric shock to a person 5) an unplanned event causing the withdrawal of a person fromthe mine or part of the mine 6) an abnormal circumstances declaration 7) an unplanned event that causes only 1 escapeway from themine to be available for use 8) a fire on a vehicle or plant 9) an incident involving an explosive 10a) a fire 10b) a ventilation failure causing a dangerous accumulation of methane or other gas 10c) an inrush 10d) a coal or rock outburst 10e) damage to, or failure of, haulage equipment used to transport a person in a shaft or slope 10f) an unplanned movement of, or failure to stop, a vehicle or plant 10g) the failure in service of explosion protection of explosion-protected equipment 10h) a failure of electrical equipment or an electrical installation 10i) an unplanned ignition or explosion of a blasting agent or explosive 10j) a failure of strata control 10k) the exposure of a person to a hazardous substance 10l) an unforeseen hazard requiring a review of the mine’s safety and health management system 10m) the unplanned immersion of a person in liquid 10n) an unplanned movement of earth or coal 10o) a structural failure of equipment 10p) a collision involving a vehicle or plant

  • 1) an unplanned ignition of gas, dust, or a combination of gas and dust
  • 2) the spontaneous combustion of coal or other material in an underground mine
  • 3) the entrapment of a person
  • 4) an electric shock to a person
  • 5) an unplanned event causing the withdrawal of a person fromthe mine or part of the mine
  • 6) an abnormal circumstances declaration
  • 7) an unplanned event that causes only 1 escapeway from themine to be available for use
  • 8) a fire on a vehicle or plant
  • 9) an incident involving an explosive
  • 10a) a fire
  • 10b) a ventilation failure causing a dangerous accumulation of methane or other gas
  • 10c) an inrush
  • 10d) a coal or rock outburst
  • 10e) damage to, or failure of, haulage equipment used to transport a person in a shaft or slope
  • 10f) an unplanned movement of, or failure to stop, a vehicle or plant
  • 10g) the failure in service of explosion protection of explosion-protected equipment
  • 10h) a failure of electrical equipment or an electrical installation
  • 10i) an unplanned ignition or explosion of a blasting agent or explosive
  • 10j) a failure of strata control
  • 10k) the exposure of a person to a hazardous substance
  • 10l) an unforeseen hazard requiring a review of the mine’s safety and health management system
  • 10m) the unplanned immersion of a person in liquid
  • 10n) an unplanned movement of earth or coal
  • 10o) a structural failure of equipment
  • 10p) a collision involving a vehicle or plant

• Date and Time of incident

  Date
• Location
  Address

• Details

• Add drawing

  Drawing

• Photographs

  Media

• Persons involved

  Yes

  No

• Injuries

  Yes

  No

• Witnesses

  Yes

  No

• Equipment Involved

  Yes

  No

• Equipment Damage

  Yes

  No

• Environmental Condition

  Select Light Dark Sunny Wet Dry Windy

  • Light
  • Dark
  • Sunny
  • Wet
  • Dry
  • Windy

Reporting Details

• Reported Date

  Date

• Reported by

  Sign

• Enablon #

• Anglo American

• DNRM

• ISHR

• SSHR

• Scene Released?

  Yes

  No

  N/A

Additional Comments

• Comment