Ground Support Observation Form*

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Conditions and Observations

• Ground Conditions:

  Select Massive Blocky Bedded Fractured

  • Massive
  • Blocky
  • Bedded
  • Fractured

• Structure:

  Select Faulting Jointing Potential Wedge

  • Faulting
  • Jointing
  • Potential Wedge

• Stress Conditions

  Select No Signs Spalling Excessive Loose Ground Working

  • No Signs
  • Spalling
  • Excessive Loose
  • Ground Working

• Heading Dimensions: (H X W)

Bolt Data:

• Bolt Type:

  Rebar

  Conebolt

  Rockbolt

  Split-Set

  Spiin Cable

• Bolt Length:

  Select 4' 5' 5'6" 7' 7'6" 8'3" 12' 16'

  • 4'
  • 5'
  • 5'6"
  • 7'
  • 7'6"
  • 8'3"
  • 12'
  • 16'

• Pattern:

  Select 4 X 4 Dice 5 6 X 6 Intersection support

  • 4 X 4
  • Dice 5
  • 6 X 6
  • Intersection support

• Plate Type:

  6" X 6" Flat

  6" X 6" Domed

  5" X 5" Domed

• Screen Type:

  #6 WWM

  #9 WWM

  Chainlink

  Shotcrete

• Has the Shotcrete been applied according to company shotcrete policy? (correct thickness,not covering back holes etc.)

  Yes

  No

  N/A

• Equipment used:

  Jackleg

  Stoper

  Robolter

Observations:

• What condition is the equipment/tool, ground support storage?

  Clean

  Housekeeping Required

• Has the area been well scaled?

  Yes

  No

  N/A

• Installation area:

  Back

  Wall

• Resin Expiry Date:

  Date

• Correct number of fast and slow resin installed?

  Yes

  No

• Spin Time (Seconds):

• Hold Time (Seconds):

• Resin Visible at collar?

  Yes

  No

• Length of thread showing (inches):

• Screen installed correctly?

  Yes

  No

  N/A

• Does bolting pattern meet the requirements of the driving print?

  Yes

  No

• Additional Comments:

• Media:

  Media

• Select date

  Date

• Add signature

  Sign