Short Interval Work Place Inspection

• FMSO Mine Operations Work Place Inspection

• Client / Site

• Conducted on

  Date

• Supervisor:

• Select crew below.

• Crew 1

• Crew 2

• Crew 3

• Crew 4

• Select shift below.

• Day Shift

• Night Shift

Stockpile

• Illumination:

  Safe

  At Risk

  N/A

• Condition:

  Safe

  At Risk

  N/A

• Grade box:

  Safe

  At Risk

  N/A

• Berm:

  Safe

  At Risk

  N/A

Excavator loading areas

• Illumination:

  Safe

  At Risk

  N/A

• Condition:

  Safe

  At Risk

  N/A

• Berms:

  Safe

  At Risk

  N/A

• Grade box:

  Safe

  At Risk

  N/A

• HighWalls:

  Safe

  At Risk

  N/A

Main Haul Roads

• Condition:

  Safe

  At Risk

  N/A

• Width:

  Safe

  At Risk

  N/A

• Berms:

  Safe

  At Risk

  N/A

• Drainage:

  Safe

  At Risk

  N/A

• HighWalls:

  Safe

  At Risk

  N/A

• Supervisor(s) Signature

  Sign

• Revision 1.0 iCloud posted document is the controlled copy. 07/10/13