MSHA Documentation Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.0 General (Documentation)

• 1.01 Legal Identification [MSHA Form 2000-7] - [Part 41]

  Yes

  No

  N/A

• 1.02 Organizational Chart [Line of Authority 48.25(b)(1)]

  Yes

  No

  N/A

• 1.03 Mine Map

  Yes

  No

  N/A

• 1.04 Training Plan [48.3]

  Yes

  No

  N/A

• 1.05 Mine Rescue Plan

  Yes

  No

  N/A

• 1.06 Training Records [48.9] [MSHA Form 5000-23]

  Yes

  No

  N/A

• 1.07 Record of Examination of Working Places [ 57.18002]

  Yes

  No

  N/A

• 1.08 Inventory of Hazardous Chemicals [Part 47] - HazCom

  Yes

  No

  N/A

• 1.09 Hazcom Training Plan

  Yes

  No

  N/A

• 1.10 Accident, Injury and Illness Reports [MSHA Form 7000-1] [50.20]

  Yes

  No

  N/A

• 1.11 Quarterly Employment Reports; [MSHA 7000-2][50.30]

  Yes

  No

  N/A

• 1.12 Mine Firefighting, Emergency, Evacuation Plan [57.11050 - .11059]

  Yes

  No

  N/A

• 1.13 Emergency Safety Telephone Numbers are Posted [57.18012]

  Yes

  No

  N/A

• 1.14 Continuity Tests (Electrical Grounding) [57.12025-.12028]

  Yes

  No

  N/A

• 1.15 Check In / Check Out System

  Yes

  No

  N/A

• 1.16 Contractor Information Forms

  Yes

  No

  N/A

• 1.17 Fire Extinguisher Inventory

  Yes

  No

  N/A

• 1.18 Plan of Operation

  Yes

  No

  N/A

• 1.19 Ventilation Plan

  Yes

  No

  N/A

• 1.20 Safety Meetings

  Yes

  No

  N/A

• 1.21 Vehicle & Equipment Inspection Forms

  Yes

  No

  N/A

• 1.22 Underground Ventilation Checks

  Yes

  No

  N/A

• 1.23 Ground Support Manufacturers Certification (ASTM 432-83) [57.3203]

  Yes

  No

  N/A

• 1.24 Ground Support Pull Tests

  Yes

  No

  N/A

• 1.24 Noise levels. [30 CFR Part 62]

  Yes

  No

  N/A

• 1.25 Dust and DPM Readings

  Yes

  No

  N/A

• 1.26 Records of Evacuation Tests

  Yes

  No

  N/A

• 1.28 Recent Citations Posted

  Yes

  No

  N/A

• 1.29 Review recent inspection

  Yes

  No

  N/A

• 1.30 SCSR Inspection Form

  Yes

  No

  N/A