Inspection
Daily 5-Point Card Completed
Work Area Scaled-2 scaling Bars
Work Area Clean and Organized
PPE Worn
1 Meter clearance around PowerPack
Roadways clean
Wire in Good Shape, No Eye Catchers
No Protruding Rock Bolts
Rods secured in rack
Face Plate Properly Anchored
Station well lit
Barricades and Signs in Place
Refuge location known
Guards in Place
Drinking Water Available?
Walkways clear 36" or greater
Mine Phone Operational in Work Area
Utilites Hung Properly
Whip Checks in Place
Ventilation Sweeping Face
No Holes in Ventilation
Flammables and oil cans properly labeled?
Mobile Equipment in Good Shape
Platform stable and well constructed
Wheel Chocks Available on Equipment
No Visible Leaks on Equipment
Hand Tools in Good Shape
Fire Extinguishers in Good Shape
First Aid Kits Current
Emergency shutdowns operational
Cable & Attachments in good shape
Vehicles Chocked and Park Brake Set
Employee current on Task Training
Hydraulic Hoses in good condition
Hose Wrap in good shape
Electrical cables properly hung clear walkway to First aid supplies
Trash Cans used with Lids
Lock-Out Tag-Out available
ACKNOWLEDGEMENT
By signing below, you are acknowledging that the following PGI has been reviewed by all parties involved in this audit. All answered marked; NO, AT RISK, or NEEDS WORK have been addressed and will be fixed or corrected before the end of the shift on the date this audit was conducted on. All CORRECTED answers must be signed by the person correcting the issue at the time of the inspection.
SUPERVISOR NAME
