NCI-Mock MSHA Audit (H&S Detail Version)

Location Information

• Site conducted

  Select

• Operating Division

  Select

• Areas Inspected

  Select

• What Business Partners Were Audited?

• Areas Inspected

  Select

• Areas Inspected

  Select

• What Areas Were Inspected?

• Date Completed

  Date

• Lead Auditor

• Audit Participants

• Event Number

Observation

• Hazard Type

  Select Unsafe Act Unsafe Condition Policy Violation

  • Unsafe Act
  • Unsafe Condition
  • Policy Violation

• Priority

  High

  Medium

  Low

• Description

• Critical Risk Prevention Violation?

  Yes

  No

• Which CRP Was Violated?

  Select Fitness For Duty Confined Space Entry Working At Heights Hazard & Risk Assessment Lifting & Hoisting Mobile Equipment Operations Chemicals & Hazardous Materials Equipment Safeguards & Protective Devices Hazardous Energy Control Ground Control & Slope Stability

  • Fitness For Duty
  • Confined Space Entry
  • Working At Heights
  • Hazard & Risk Assessment
  • Lifting & Hoisting
  • Mobile Equipment Operations
  • Chemicals & Hazardous Materials
  • Equipment Safeguards & Protective Devices
  • Hazardous Energy Control
  • Ground Control & Slope Stability

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

• 30CFR - Part 47 - Hazard Communication

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

• 30CFR - Part 48 - Training Of Miners

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

• 30CFR - Part 49 - Mine Rescue

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart B - Ground Control

• 30CFR - Part 56/57 - Subpart B Ground Control

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart C - Fire Prevention & Control

• 30CFR - Part 56/57 - Subpart C Fire Prevention

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart D - Air Quality & DPM

• 30CFR - Part 56/57 - Subpart D Air Quality & DPM

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart E - Explosives

• 30CFR - Part 56/57 - Subpart E Explosives

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart F - Drilling & Rotary Jet Piercing

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart G - Ventilation

• 30CFR - Part 56/57 - Subpart G Ventilation

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart H - Loading, Hauling, & Dumping

• 30CFR - Part 56/57 - Subpart H Loading, Hauling, Dumping

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart J - Travelways & Escapeways

• 30CFR - Part 56/57 - Subpart J Travelways & Escapeways

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart K - Electricity

• 30CFR - Part 56/57 - Subpart K Electricity

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart L - Compressed Air & Boilers

• 30CFR - Part 56/57 - Subpart L Compressed Air & Boilers

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart M - Machinery & Equipment

• 30CFR - Part 56/57 - Subpart M Machinery & Equipment

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart N - Personal Protection

• 30CFR - Part 56/57 - Subpart N Personal Protection

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart O - Materials Storage & Handling

• 30CFR - Part 56/57 - Subpart Materials Storage & Handling

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart P - Illumination

• 30CFR - Part 56/57 - Subpart P Illumination

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart Q - Safety Programs

• 30CFR - Part 56/57 - Subpart Q Safety Programs

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart R - Personnel Hoisting

• 30CFR - Part 56/57 - Subpart R Personnel Hoisting

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

Subpart S - Miscellaneous

• 30CFR - Part 56/57 - Subpart S Miscellaneous

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media

• 30CFR - Part 62 - Occupational Noise Exposure

Observation

• Hazard Type

  Unsafe Act

  Unsafe Condition

  Policy Violation

• Priority

  High

  Medium

  Low

• Description

• 30 CFR Reference Part/Section

• Cited Regulation Text

• Likelihood

  No Liklihood

  Unlikely

  Reasonably Likely

  Highly Likely

  Occurred

• Expected Injury

  Select No Lost Workdays Lost Workday or Restricted Duty Permanently Disabling Fatal

  • No Lost Workdays
  • Lost Workday or Restricted Duty
  • Permanently Disabling
  • Fatal

• Significant & Substantial

  Yes

  No

• Number Of Persons Affected

• Negligence

  None

  Low

  Moderate

  High

  Reckless Disregard

• Has The Hazard Been Corrected

  Yes

  No

• Steps Taken To Mitigate The Hazard

• Photographs

  Media