Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
TSF supervisor conducting this Safe Declaration Inspection
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Name
- Paul Mashiyi
- Frank Mnisi
- Israel Tiro
- David Moerane
- Tsepo Matabane
- Other
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Coy nr
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Date and time when inspection is conducted
Competancy
Training
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I am Appointed as a Supervisor At The TSF
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My Medical and induction is current
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I Have a valid Pit Licence
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I know what my Roles and Responsibilities are
Inspection
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Is the Entrance to TSF Baricaded according to Standard?
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
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Is the appropriate Signage in place?
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
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Speed Limit signage posted
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
Work Area Inspection
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Light Vehicle parking available and clearly Marked
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
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Roadway Conditions
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
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Safety Berms to Standard<br>
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
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Lighting plant in place and Barricaded to Standard
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
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Tipping Direction indicated as per SOP?
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
Tip head
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Centre berm to standard and 50m away from tip Head?
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
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Grade Box in position and set up correctly?
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
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Tip Head Demarcated?
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
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Dust Control in order?
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What have you done to rectify this Non Conformance?
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Did you inform your Direct Supervision that you are unable to rectify the Non Conformance by yourself
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Were you and your Direct Supervisor able to rectify the Non Conformance
Safe Declaration
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Based on my inspection that I conducted and by virtue of my training and Compatency I declare the Tailings Storage Facility Construction Site:
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