Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Incident Title
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Enter a SHORT description of the event as a title
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Entity
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Enter crew this event refers to
- Mining A Crew
- Mining B Crew
- Mining C Crew
- Maintenance A Crew
- Maintenance B Crew
- Maintenance C Crew
- Administration
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Timing of event
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Enter date and time of EVENT
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Enter date and time event was REPORTED
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Enter date and time event was reported to HSE Dept
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Event location
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Enter location of event
- Production crib area
- Dane Hill Pit
- Zabeel Pit Area
- ROM
- Production Admin Area
- Go Line
- Water Standpipe
- Fuel Farm
- Workshop
- Main Office Area (Roper Camp)
- Sawfish Camp
- Site Access Rd
- Other
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If other location enter here
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Event classification
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Enter event type
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Enter type of event
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Severity
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1A- Equipment damage of greater than $100k, death or permanent disability, high severity environmental impacts
2A- Equipment damage of between $15k- $100k , lost time - medical treatment or restricted work injury , moderate severity environmental impacts
3A- Equipment damage of less than $15k, first aid injury, low severity environmental impacts
No impact -
Enter correct rating<br>
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What happened
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Enter a detailed description of the event
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Enter reported by
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Enter reported to
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Add photos of the scene
