Oversight Inspection (KINROSS)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Shift

  Days

  Nights

• Crew

  Select Crew 1 Crew 2 Crew 3 Crew 4 Straight days Crew A Crew B Other (please comment)

  • Crew 1
  • Crew 2
  • Crew 3
  • Crew 4
  • Straight days
  • Crew A
  • Crew B
  • Other (please comment)

• Department

  Select Ore Process Mine Admin/Tech service Mill Fixed Maint Mobile Maint Contractor

  • Ore Process
  • Mine
  • Admin/Tech service
  • Mill
  • Fixed Maint
  • Mobile Maint
  • Contractor

• Location of Inspection

• Area Supervisor

• What items were discussed with the supervisor to help mentor, support and improve culture

• Were there any corrective action due to this interaction

  Yes

  No

• Add a comment or create an action

• What level of workplace exam are you doing an oversight on

  FLRA

  Paper form

  iauditor

• Is the form filled out correctly

  Yes

  No

  N/A

• Has the person conducting the FLRA been trained and has a 5000-23

  Yes

  No

  N/A

• Are there any improvement ideas or suggestions for the FLRA

  Yes

  No

• Please explain

Click add to add more conditions or practices requiring Correction.

Conditions or Practices Requiring Correction

• Conditions or Practices Requiring Correction

  Select Housekeeping Safe Access Electrical Guarding Chemical IH-OH (Noise, dust, eyewash station, PPE, etc.) Environmental Damaged tools/Equipment Slip/trip/fall hazard Flammable, Combustible, disposal/storage Accumulation of Trash or missing lid Travel ways/roadways Poor or inadequate safety behavior Poor or inadequate safety procedure Inadequate Berms/Barriers Stored Energy

  • Housekeeping
  • Safe Access
  • Electrical
  • Guarding
  • Chemical
  • IH-OH (Noise, dust, eyewash station, PPE, etc.)
  • Environmental
  • Damaged tools/Equipment
  • Slip/trip/fall hazard
  • Flammable, Combustible, disposal/storage
  • Accumulation of Trash or missing lid
  • Travel ways/roadways
  • Poor or inadequate safety behavior
  • Poor or inadequate safety procedure
  • Inadequate Berms/Barriers
  • Stored Energy

• Location of Condition or Practice

• Equipment Number

• Photos

  Media

Ranking

• Risk Assessment

  Low

  Moderate

  Major

  Critical

• Accountability Requirement

  Low

  Moderate

  High

  Unwarrantable

• Priority Ranking: A = Initiate immediate corrective action, B = Complete corrective action within 48 hours, C = Complete corrective action within 30 days, OFI- Opportunity for Improvement; No completion date assigned.

  A

  B

  C

  OFI