Dust Investigation Form

• Site

• Conducted on

  Date

• Prepared by

Details of non-conforming issue

• Visible Dust Emission from Stack?

  Off

  On

• Add media

  Media

• Outside Belt Dusting (BC-03/04)?

  Off

  On

• Add media

  Media

• Tailings Pond lift off?

  Off

  On

• Add media

  Media

• Haul Road lift off?

  Off

  On

• Add media

  Media

Weather Information

• Conditions

• Temperature

• Wind direction

• Wind speed

• Precipitation in last 24 hours?

  Off

  On

Corrective actions information

• State cause or possible cause of non-conformance. Complete immediate corrective action using attachment icon.

• State operational changes made to correct issue.

Status of Fugitive Dust Emissions and Sign Offs

• All fugitive Dust Emissions have been addressed, contained and clean up?

  Yes

  Contained, but not cleaned up

  No

• Signature of Environmental Supervisor Required

  Sign

• Signature of Operations Manager Required

  Sign

Auditor Sign off

• Signature of Auditer

  Sign