MIN O BOT FOR 006 Cyanide PPE Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

ITEM

• Water Proof Sportsbag

  Yes

  No

• Chemical gloves full length x 3 pair

  Yes

  No

• Riggers gloves - Cow grain x 1 pair

  Yes

  No

• Safety glasses x 2 pair

  Yes

  No

• Safety goggles (Mono-goggles) x 1 pair

  Yes

  No

• Hearing protection x 1 pair

  Yes

  No

• Eye wash bottle (check date and record)

  Yes

  No

• Eye wash liquid refill bottle x 1 (check date and record)

  Yes

  No

• Full face mask x 1

  Yes

  No

• Respirator filter x 2 (P3 filters)

  Yes

  No

• Respirator storage bag x 1

  Yes

  No

• Cyanide Antidote Kit x 1 (Enter bag number)

  Yes

  No

• HCN Toxipro detector x 1 (record serial number)

  Yes

  No

• PPE alcohol wipes x 1 (packet)

  Yes

  No

• First aid kit x 1 (check contents and dates)

  Yes

  No

• Safety helmet x 1

  Yes

  No

• Full brim sun protection for safety helmet x 1

  Yes

  No

• Helmet mounted full face shield with chin guard x 1

  Yes

  No

• Hi visibility long sleeve shirt and long pants

  Yes

  No

• Chemical resistant disposable overalls x 1

  Yes

  No

• Full chemical suit or PVC pants and jacket (check condition)

  Yes

  No

• Steel cap gumboots x 1 pair

  Yes

  No

• Static free torch with batteries x 1

  Yes

  No

  N/A

• Insect repellant spray x 1

  Yes

  No

• Danger/caution demarcation tape x 1 roll

  Yes

  No

• Sunscreen 30 plus SBF x 1

  Yes

  No

• Escape respirator x 1 (check date)

  Yes

  No

• Driver Signature

  Sign

• Auditor Signature

  Sign