Title Page

  • Site conducted

  • Supervisor

  • Coordinator

  • Conducted on

  • Location
  • Team onsite

Light Vehicles

LIGHT VEHICLES & ROADS

    Light Vehicles Inspected
  • Asset Number

  • Vehicle condition matched prestart

  • Photos

Vehicles

  • Ongoing LV issues requiring follow up?

Light Vehicle Roads

  • Are vehicles using LV roads where required?

  • Are observed vehicles complying with site traffic rules?

  • Notes

  • Photos

Infrastructure

INFRASTRUCTURE

    Parkups & Tie Down Areas
  • Area Name

  • Area is clean and tidy

  • Details

  • Adequate lighting is present

  • Details

  • Comments

  • Laydowns, Fuel Bays, Misc.
  • Area Name

  • Area is clean and tidy

  • Details

  • Adequate lighting is present

  • Details

  • Comments

  • Waterstands
  • Waterstand Name

  • Area is free from ponding water

  • Details

  • Ground is safe and level for pedestrians

  • Details

  • Comments

  • Photos

Jobs

JOBS

    Development & Other Pit Hygiene Jobs
  • Job Name

  • What Hazards & Issues Are Present?

  • Estimated timeframe for completion

  • Photo

Dig Areas

DIG AREAS

    Dig Area
  • Area & Dig Unit

  • Material Types

  • Material?

  • Is The Running Track & Floor In Good Condition?

  • What Is The Face Condition?

  • Face description

  • Are There Factors Resulting In Slow Digging?

  • Are There Specific Hazards/Obstacles Present? Misfires? Bores? Major Oversize? etc.

  • Is The Dig Unit Pulling Their Batters On The Fly?

  • Additional Comments

  • Photos

Dumps

DUMPS & STOCKPILES

    Dump/Stockpile
  • Dump Name

  • Are Windrows Built To Correct Height, Thickness, and out of Competent Material?

  • Is There Visible Cracking, Slumping, or Water Pooling?

  • Are Dump Markers Appropriately Placed?

  • Is There A Positive Gradient To The Tip Face?

  • Are Lighting Plants Suitably Placed To Provide Appropriate Illumination For Night Shift?

  • Are Trucks Approaching Tip Head In A Clockwise Direction & Not Using The Windrow To Stop?

  • Additional Comments

  • Photos

Roads

ROADS

Road Condition

  • Are Roads & Intersections Designed To Standard?

  • Are Road Suitably Watered?

  • Is Delineation & Demarcation Clean & Appropriately Placed?

  • Is Visibility At Intersections Obstructed by Windrows, Vegetation, or Other Obstacles?

  • Are Bunds And Windrows Built To Correct Height?

  • Are There Any Hazards In The Road Surface?

  • Details

  • Notes

  • Photos

General

GENERAL

Hazards

  • Are Work Areas Safe From Potential Hazards Above?

  • Are Mining Activities Posing Any Risk To Areas Below?

  • Are Work Areas Clear Of Spillage?

  • Is Effective Dust Control In Place?

  • Is Lighting of Active Work Areas Appropriate For Night Shift?

  • Areas Not Being Used Windrowed Off As Appropriate?

  • All Open Edges Are Appropriately Controlled

  • Restricted Areas Demarcated and Access Restricted

  • Equipment & Vehicles Parked Fundamentally Stable and In Appropriate Locations (obeying exclusion zones from other equipment, highwalls, etc)

  • Clear & Positive Communication Being Used At All Times

  • All Delineation, Demarcation, Cones Appropriately Placed & Clean

  • Have Any Geotechnical Hazards Been Identified?

  • What Are The Geotechnical Hazards?

  • Report Geotechnical Hazards To Geotech Engineers

  • Additional notes

  • Photos

Signoff

SUMMARY AND SIGN OFF

  • Additional Comments

  • Outgoing Supervisor Signature

  • Incoming Supervisor Signature

  • Send to Superintendent for approval.

  • Superintendent Signature

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.