• Prepared by:

  • Date

  • Select shift

  • Is this inspection being performed at the Maintenance area /

  • Additional comments

  • All of the following should be checked during the inspections (if applicable)<br>*Eyewash/Showers (w/cards) *Guards *Electrical Hazards *PPE *Slip, Trip & Fall Hazards<br>*Lighting *House Keeping *Trash cans *Fire Extinguishers *First Aid. <br> Any adverse conditions found?

  • Take picture of the adverse condition(s)

  • Notification to Miner’s Working in the Area?

  • Notification to Supervisor or Manager?

  • Is there a WO submitted? if so, enter the WO number

  • Enter WO number

Corrective Actions (if any)

  • Enter the Date when adverse conditions were corrected. Add any comment (if needed)

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.