Mock MSHA Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Plant Area Inspected

• Current operating conditions, site activities, etc....

Finding #1

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #2

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #3

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #4

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #5

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #6

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #7

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #8

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #9

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #10

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #11

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #12

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #13

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #15

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #14

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #16

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #17

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #18

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #19

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

Finding #20

• Add media

  Media

• CFR Reference (30 CFR 46, 47, 48, 50, 56, 57, 62......)

• Estimated Penalty ($)

• Termination/Abatement Strategy

• Summary/General Observations

• Good Practices/Conditions Observed

• Add signature

  Sign