General Safety survey

• Name of the mine

• Operator of the mine
  Address

• Date of inspection

  Date
• Location of the mine
  Address

• Inspection by

• Summary of the inspection
  Address

Personal Protective Equipment (PPE)

• Is the PPE adequate for the work and health risks encountered?

  Yes

  No

• Is the PPE provided to all workers at no cost?

  Yes

  No

• Is there an adequate SOP for the use of PPE?

  Yes

  No

• What kind of PPE is used in the mine?

• Is the PPE in good condition?

  Yes

  No

• Is the PPE used correctly by all workers?

  Yes

  No

Firefighting equipment

• Are fire hazards present?

  Media

• Is there sufficient firefighting equipment?

  Yes

  No

• Fotos/Videos of firefighting equipment

  Media

Alarms and emergency signals

• Are alarms available and functioning?

  Yes

  No

• Do signals that show in direction of the nearest safe exit exist?

  Yes

  No

• Fotos/Videos of alarms

  Media

• Fotos/Videos of emergency signals

  Media

Electric installations and lighting

• Are electric installations in good condition?

  Yes

  No

• Is the lighting adequate?

  Yes

  No

• Fotos/Videos of electric installations

  Media

• Fotos/Videos of lighting

  Media

General safety

• Is regular risk assessment done before work?

  Yes

  No

• Are safety meetings held

  Yes

  No

• Is there a system of regular health surveillance for prevention of health hazards used?

  Yes

  No

• How does the system of regular health surveillance work?

  Yes

  No

  N/A

• Is there a catalogue of appropriate measures concerning the mine safety?

  Yes

  No

• Is trained health and safety personnel available?

  Yes

  No

• Is there a First Aid Room

  Yes

  No

• Is the First Aid Room adequately equipped?

  Yes

  No

• Do emergency preventive plans exist

  Yes

  No

• Are the emergency preventive plans sufficient and prevent all hazards in case of emergency?

  Yes

  No

• Are there trained first aid helpers and a good organized and equipped mine rescue team

  Yes

  No

• Are the workers informed about the involved risks and hazards of their workings?

  Yes

  No

Accident reporting and investigation

• Is there a system or SOP for accident reporting and accident investigation?

  Yes

  No

• Description of the SOP or system

Supervisory personnel

• Does the supervisory personnel have the adequate certificates for their respective responsibilities?

  Yes

  No

• Is there a person in charge in case of emergency?

  Yes

  No

• What is the line of responsibility in case of emergency?

SOPs for assigned tasks

• Does SOPs for all the assigned tasks exist?

  Yes

  No

• Are the SOPs safe and secure to follow?

  Yes

  No

• Do workers know about the relevant SOPs for thei jobs?

  Yes

  No

• If SOPs are missing: could this cause a risk?

  Yes

  No

Site information

• Is defective equipment removed off site?

  Yes

  No

• Doe the tunnels/shafts/adits have an adequate size?

  Yes

  No

• Is there illegal mining in the area of the mine?

  Yes

  No

Noise pollution

• Are the noise levels monitored?

  Yes

  No

• Are there specific PPE for noise?

  Yes

  No