Surface Diamond Drill Safety Weekly Inspection Form

• Site conducted

  Select

• Inspection Date

  Date

• Contractor Name:

  Select Major Foraco Orbit Innu-Inuit Foraco Bagone'an Hy-Tech

  • Major
  • Foraco
  • Orbit
  • Innu-Inuit Foraco
  • Bagone'an
  • Hy-Tech

• Drill #

• BH #:

• Vale Inspector's Name(s):

• Supervisor's Name:

• Runner's Name:

• Helper's Name

• GPS
  Address

Dry

• Is there a Dry/Change Facility to inspect?

  Yes

  No

• Has the Dry already been inspected as part of another inspection today?

  Yes

  No

• Are pressurized cylinders properly stored and secured?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is there a tagged and current fire extinguisher?

  Yes

  No

• Please create an action item to address this failed response.

• Are there operational CO and smoke detectors?

  Yes

  No

• Please create an action item to address this failed response.

• Do all personal fans present at the drill site have full guards, front and back?

  Yes

  No

  N/A

• Please create an action item to address this failed reponse

• Rate the cleanliness of the Dry Facility. Are the concepts of 5S being adhered to? <br>SORT / SET IN ORDER / SHINE / STANDARDIZE / SUSTAIN

  Excellent (5S = 3 or 4)

  Good (5S = 2)

  Fair (5S = 1)

  Poor (5S = 0)

  N/A

• Please create an action item to address this failed response.

• Any Additional Comments or Actions Regarding the Dry?

  Yes

  No

• Upload image, create action Item(s), and/or add comments using the icons.

ACCESS

• Are there any dangerous trees along the access route?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are necessary signs present?<br>(Drill Rig # & Arrows, EMS, Steep Hill, No Trespassing, No Hunting, speed limit, etc.)

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are all areas where silting may occur being properly controlled? (silt fencing, hay bales, ditching, etc)

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• What is the Condition of the Access Trail:

  Excellent

  Good

  Fair

  Poor

• Please create an action item to address this failed response.

• Any Additional Comments or Actions Regarding the Access?

  Yes

  No

• Upload image, create action Item(s), and/or add comments using the icons.

Pump

• Is there an active pump shack at this site?

  Yes

  No

• Are there guards on all rotating pieces of equipment?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are steps and walkways in good condition?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is the work area clean and organized?

  Yes

  No

  N/A

• Do the lights work and are the bulbs guarded?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are extension cords in good condition/location?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is there a readily accessible striker present to light the propane?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is the pump shack and/or generators properly grounded? Only required if a source of electricity is present (e.g., generator).

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are proper pressure relief devices installed on the pump?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is all fuel in appropriately labeled (diesel/gasoline/oil) and stored in containers (110% capacity)?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Was the pre-op completed on the pump shack?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is there a fire extinguisher with a current tag?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is there a complete spill kits at the pump?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is there a first aid kit present at the pump?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is there an eye wash container present (N/A in winter)?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is there separate refuse containers for household and flammable waste?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is the pump shack in a safe location? (not on an incline or near an edge)

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are all pressurized cylinders (propane) properly stored, secured, and their inspection up to date?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are PFD and rescue ropes available for access to pump and supply line on ice?

  Yes

  No

  N/A

• Any Additional Comments or Actions Regarding the Pump?

  Yes

  No

• Upload image, create action Item(s), and/or add comments using the icons.

DRILL

• If the drill was pulling rods upon arrival did it have the appropriate barriers and signage to prevent access?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is the proper signage posted at the drill site? (E.x. PPE, Parking, No smoking, etc.)

  Yes

  No

  N/A

• Is fuel sloop located at least 4m from the drill?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are there fire extinguishers with current tags at the fuel sloop and drill?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is the CO detector functional?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are spill kits present and complete?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• During fire season, is fire fighting equipment present (axe, pails, shovels, pump pack)?<br>Ontario - Apr 1 to Oct 31<br>Newfoundland and Labrador - May 15 to Sept 30<br>Manitoba - Apr 1 to Nov 15

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Does the drill engine, generators, and pumps have drip pans & oil absorbent matting?

  Yes

  No

• Please create an action item to address this failed response.

• Are all fuel containers appropriately labeled (diesel, gas, oil) and stored (110% capacity)?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are pressurized cylinders (propane/methane) properly stored, secured, with inspection date current?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are extension cords in good condition (not frayed/tangled/stored/tagged)?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is there separate refuse containers for household and flammable waste?

  Yes

  No

• Please create an action item to address this failed response.

• Is the fall prevention (railing) in good condition? Is the roof access ladder secure? Brackets intact and pins in place?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are steps and walkways in good condition?

  Yes

  No

• Please create an action item to address this failed response.

• Is the drill on 8" X 8" timbers and do the drill skids make complete contact with the timbers? Shims Must be at least as wide as the timbers (E.g. 8")

  Yes

  No

  N/A

• Please create an action item to address this failed response.

  Yes

  No

  N/A

• Do the lights work and are the bulbs guarded (non-LED)?

  Yes

  No

• Please create an action item to address this failed response.

• Are there guards on all rotating pieces of equipment? Are they in good condition?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Do personal fans present at the drill have a full guard, front and back?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are Emergency Shut Down devices (E-Stops) present and functional?

  Yes

  No

• Shut down drill immediately, contact site supervisor

• Please create an action item to address this failed response.

• Is there a need for methane detection at the drill?

  Yes

  No

• Is the methane detector working and calibrated as designed? (test, log book) *Support brace must be in place to block the suspended drill head from dropping if a worker must enter the cage to perform the detector test*

  Yes

  No

• Shut down the drill immediately and contact site supervisor.

• Is the methane detection procedure posted at the drill in appropriate places?

  Yes

  No

• Is the crew trained and competent in the methane procedure? Ask.

  Yes

  No

• Is this a drill program on mine footprint that requires an approved mine drill print?

  Yes

  No

• Is the drill print valid for the current drill hole and posted at the drill rig

  Yes

  No

• Shut down the drill immediately.

• Is the Drill's interlock functioning properly?

  Yes

  No

• Shut down the drill immediately and contact site supervisor

• Is emergency preparedness information posted at the work site? Are personnel aware?

  Yes

  No

• Please create an action item to address this failed response.

• Is the Spill Reporting procedure posted at the work site?

  Yes

  No

• Please create an action item to address this failed response.

• Is the Drill's Green Tag posted and current?

  Yes

  No

• Are there at least 2 reliable communication sources on site, i.e. cellular, radio, satellite phone, etc.?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is there a sealed, stocked, and inspected First Aid Kit on site?

  Yes

  No

• Please create an action item to address this failed response.

• Is an AED readily accessible, in good condition, inspected, and located within a response time of 4 minutes or less to the patient?

  Yes

  No

• Please create an action item to address this failed response.

• Is there a stretcher and emergency gear readily available?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Is the pre-op inspection for the drill complete and satisfactory?

  Yes

  No

• Please create an action item to address this failed response.

• Is there a gyro currently located at the rig?

  Yes

  No

  N/A

• Is the gyro stored in its proper case and in a safe location?

  Yes

  No

  N/A

• Create action to correct deficiency.

• Is there any visible damage to the gyro?

  Yes

  No

  N/A

• Create action to correct the deficiency of damaged gyro.

• Rate the housekeeping at the drill. Are the concepts of 5S being adhered to? <br>SORT / SET IN ORDER / SHINE / STANDARDIZE / SUSTAIN

  Excellent

  Good

  Fair

  Poor

• Please create an action item to address this failed response.

• Is there a presence of a lightning detection system (handheld device/App on phone/etc) on site?

  Yes

  No

  N/A

• Any Additional Comments or Actions Regarding the Drill?

  Yes

  No

• Upload image, create action Item(s), and/or add comments using the icons.

• Are open holes, sumps, and banks completely barricaded at least 5 feet in distance?

  Yes

  No

  N/A

• Are ladders present and secured in the sumps?

  Yes

  No

  N/A

• Is the return water from the drill running into the sump?

  Yes

  No

  N/A

• Is the sump in good condition (ex. no leak, soil erosion, overflowing)?

  Yes

  No

  N/A

• Is there an "Open Hole" sign present?

  Yes

  No

  N/A

• If applicable, is the drying pad capable of holding additional material?

  Yes

  No

  N/A

• If applicable, is the sump liner in good condition (ex. no drooping or tears)?

  Yes

  No

  N/A

• Has one boom been placed at the entrance from the trench into sump 1?

  Yes

  No

  N/A

• Does sump 1 flow into sump 2

  Yes

  No

  N/A

• If applicable, does sump 2 flow into sump 3?

  Yes

  No

  N/A

• Are there any additional comments about the sump?

VEHICLES AND EQUIPMENT

• Has the pre-op been completed for the Evac Vehicle? (Truck/UTV/Snow Machine)

  Yes

  No

  N/A

• Is the vehicle in good condition? (look for damage/hazards, operational seat belts, PPE present/condition)

  Yes

  No

  N/A

• Is the fire extinguisher present and the tag current?

  Yes

  No

  N/A

• Are the appropriate (seasonal and terrain) tires on the vehicle and in good condition? (ex. winter or winter-rated tires in snow/ice conditions)

  Yes

  No

  N/A

• Is the cabin clean and free of hazards?

  Yes

  No

  N/A

• Additional Comments/Concerns:

• Is there a bulldozer present?

  Yes

  No

• Is the bulldozer in good condition? (look for damage/hazards, operational seat belts)

  Yes

  No

• If the bulldozer was used, was a pre-op completed?

  Yes

  No

  N/A

• Is the fire extinguisher present and are the inspection tags (monthly/yearly) current?

  Yes

  No

• Is the cabin clean and free of hazards?

  Yes

  No

• Additional Comments/Concerns:

• Is there a Skidder at the work site?

  Yes

  No

• Is the skidder in good condition? (inspect winch cable and clevis, look for damage/hazards, operational seat belts)

  Yes

  No

• If the Skidder was used, was a pre-op completed?

  Yes

  No

  N/A

• Is the fire extinguisher present and are the inspection tags (monthly/yearly) current?

  Yes

  No

• Is the cabin clean and free of hazards?

  Yes

  No

• Is a method being used to prevent unintended movement of the Skidder? Example: The blade/bucket/basket/wheel chocks.

  Yes

  No

• Additional Comments/Concerns:

• Is there any other equipment or vehicles being used on site?

  Yes

  No

• Is the vehicle or equipment in good operating condition?

  Yes

  No

• Have pre-ops been completed and are fire extinguishers present/current and cabin free of hazards?

  Yes

  No

  N/A

• Is the fire extinguisher present and are the inspection tags (monthly/yearly) current?

  Yes

  No

• Is the cabin clean and free of hazards?

  Yes

  No

• In Ontario, do UTV/RTV's on active drill/mine sites have a manual emergency brake and is it in use?

  Yes

  No

  N/A

• Additional Comments/Concerns:

• Any Additional Comments or Actions Regarding Support Equipment?

  Yes

  No

• Upload image, create action Item(s), and/or add comments using the icons.

PERSONNEL

Are Workers Wearing Appropriate Approved PPE?

• Are Workers Wearing Boots with Metatarsal Guards? Are They in Good Condition?

  Yes

  No

• look for these safety symbols

  

• Are Workers Coveralls Approved High Visibility? Is it in Good Condition?

  Yes

  No

• Please create an action item to address this failed response.

• Are Workers Wearing Approved Hard Hats? Are They in Good Condition?

  Yes

  No

• Please create an action item to address this failed response.

• Do Workers Have Long Sleeves?

  Yes

  No

• Are Workers Wearing Loose Items/Hoodies?

  Yes

  No

  N/A

• Are Workers Wearing or Do They Have Access to Appropriate Gloves in Good Condition?

  Yes

  No

• Please create an action item to address this failed response.

Crew Knowledge of Emergency Response

• Does The Crew Know Their EMS Number And Where To Find This Information?

  Yes

  No

• Does the Crew Know the Location of Their EMS Muster Site?

  Yes

  No

  N/A

• Please create an action item to address this failed response.

• Are Workers Aware of Evacuation Procedures?

  Yes

  No

• Please create an action item to address this failed response.

• Are Workers Aware of Emergency Supplies?<br>Eg. First Aid Kits, Stretcher Kit and its Contents, Eye Wash, etc.

  Yes

  No

• If applicable, is the drilling crew syncing their tablet regularly?

  Yes

  No

  N/A

• Any Additional Comments or Actions Regarding Personnel?

  Yes

  No

• Upload image, create action Item(s), and/or add comments using the icons.

• Have the crew members been involved in (and documented) a Tool Box Talk prior to beginning their shift that INCLUDED discussions about the expected weather for the shift?

  Yes

  No

• Are you Inspecting an Ice Drill Program?

  Yes

  No

• Is the current status of the road posted (ex. open, closed)?

  Yes

  No

• Is the minimum ice thickness in effect for the road posted?

  Yes

  No

• Is the maximum allowable Gross Vehicle Weight (GVW) permitted on ice posted?

  Yes

  No

• Are wooden pickets in place to demarcate boundaries of ice cover bearing reflective material that is visible at night? 100m intervals within 250m from shoreline and then 200m intervals thereafter.

  Yes

  No

• Is the speed limit posted throughout (ex. entry, exit, travel, passing)?

  Yes

  No

• Is the spacing signage in place? Spacing signage assists drivers in maintaining appropriate spacing such as 500m.

  Yes

  No

• Is the site layout established and demarcated?

  Yes

  No

• Is the drill and sludge recovery shack mounted over wood beams or timbers?

  Yes

  No

• Are beams or timbers frozen to ice?

  Yes

  No

• Are crew members aware of pullback duration limits?

  Yes

  No

• Are vehicles and crew members remaining within marked boundaries?

  Yes

  No

• Has the snow fence and signage been erected to restrict public access?

  Yes

  No

• Has one catch basin been installed around the casing at the ice surface to retain any oil leaks and run off drilling fluids?

  Yes

  No

• Are workers aware of the Working Alone Policy/Procedure?

  Yes

  No

• Is an Ice Safety Plan available and current?

  Yes

  No

• Are directional arrows to drills and EMS site present?

  Yes

  No

• Have workers reviewed the Orientation plan for Working On Ice including the Ice Safety Plan?

  Yes

  No

• Are workers wearing standard PPE as well as ice awl, boot cleats, whistle, sunglasses, snowmobile helmet (if required), and warm clothing such as waterproof gloves and boots?

  Yes

  No

• Are personnel aware of signs and symptoms of cold stress in addition to self-rescue techniques?

  Yes

  No

• Are personal aware of parking limitations including only two vehicle lengths from another vehicle and remaining stationary for less that two hours in a designated parking area?

  Yes

  No

• Are daily high/low temperatures being documented?

  Yes

  No

• Is a daily ice cover inspection report being conducted and documented?

  Yes

  No

• Is a full inspection of the ice drill pad being conducted and documented each day?

  Yes

  No

• Are ice monitoring stations in place along with ice thickness and freeboard checking being conducted and documented?

  Yes

  No

• Was a behavioural or safety dialogue conducted with the worker(s) at site?

  Yes

  No

• Please add one or two sentences about the safety dialogue held between yourself and the drilling crew.

• Remarks and/or Suggestions:

• Upload any supporting media (pictures/videos)

  Media

• Inspector Signature

Signature

• Inspector Signature

  Sign

• Driller/Helper/Supervisor Signature

Signature

• Driller/Supervisor Signature

  Sign