Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Is a contractor being audited?

  • Which contractor company?

Prework Aspects

  • Foundational aspects applicable to all Fatal Risks that address: housekeeping, workplace exams, FLRA, training confirmation, and emergency protocols.

  • Is the work area housekeeping in good order? (i.e., clear walkways and organized tools/materials)

  • Has a workplace exam been conducted?

  • Have all hazards been identified, corrected, or communicated?

  • Has the employee conducted a Field Level Risk Assessment (FLRA) or Team Risk Assessment (TRA)?

  • Has the employee received training? (i.e., task training, procedure or guidelines)

  • Can the employee explain the proper emergency shut down, summoning for help and evacuation procedures? 

Critical Control Verification

  • Critical Controls: Actions and conditions that must be in place and functioning 100% of the time, without fail, to protect people when working in potentially significant risk situations.

    Instructions: For each critical control, select Controlled, AtRisk, or NA (Not Applicable or not observed). See Assessment below for definitions. If something is marked AtRisk, immediately Pause the work until the missing protections are put in place. Write the corrective action taken in the notes box below

Competency

  • Has the worker been trained and authorized, and does the worker understand the components of Fall of Ground activity?

  • Is the worker familiar with the FRA and critical controls?

Ground Control

  • Have identified ground control hazards and mitigations been communicated from geotechnical to supervisors and frontline operations in between shifts?

  • Are the highwalls scaled and free of debris, and are the catch benches adequate?

  • Are team members maintaining loading faces at a safe working height/angle and are not positioning themselves between mining equipment and the face?

  • Is there a barrier (e.g., berm or jersey barriers) in place to stop people and mobile equipment from entering areas where material can fall from a high wall/excavation?

  • Is the highwall/stockpile built and maintained to plan design?

  • Are team members entering restricted areas without permission? (e.g., base and crest of highwalls/stockpiles, benches, mining faces, dumps and blasting areas)

  • Is the surface water control installed and maintained according to design and clear of obstructions? (e.g., storm water drains)

Barriers/Barricades and Exclusion Zones

  • Are restricted areas demarcated and signed?

  • Is employee entry prohibited without authorization?

  • Are employees not entering equipment swing radius or blind spots unless positive communication is established, equipment is shut down and any blades/buckets/rippers/etc. are lowered to the ground?

  • Are barriers/barricades and exclusion zones being communicated and maintained?

Engineered Support System

  • Do installed trenching controls meet or exceed Excavation and Trenching Standard requirements? (e.g., shoring, sloping, benching designs, or hydro excavating)

  • Is a ground disturbance/dig permit at the work site and filled out correctly?

Geotechnical Inspection and Monitoring Systems

  • Is there functioning ground displacement detection equipment in place for all areas of the pit wall where there is a risk of failure?

Uncontrolled Ground Movement Procedures

  • Do the employees understand the emergency procedures? (e.g., seismic, primary/secondary escape)

  • CONTROLLED The presence of this control is verified and effective

  • ATRISK This control is missing or ineffective

  • NA / NO Not Applicable to this exposure situation or Not Observed

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.