UGRD-738-0614 R4 - Weekly Refuge Station Inspection Form

• Location

  Select C9290 A9160 A9035 A9080 Haulage C9065 9060 Shop D9050N D8990 D8935 N9175

  • C9290
  • A9160
  • A9035
  • A9080 Haulage
  • C9065
  • 9060 Shop
  • D9050N
  • D8990
  • D8935
  • N9175

• Prepared by

• Conducted on

  Date

• Other personnel attending the inspection

Access

• Proper signs posted and clearly identified "REFUGE STATION"?

  Yes

  No

  N/A

• Is access clearly illuminated?

  Yes

  No

  N/A

• Is the Green Light on?

  Yes

  No

  N/A

Fire Extinguishers

• Are fire extinguishers available and accessible?

  Yes

  No

  N/A

• Do the fire extinguishers have their monthly compliance stamp?

  Yes

  No

  N/A

Housekeeping

• Is approach to Refuge Station free of garbage and debris?

  Yes

  No

  N/A

• Is the air lock clean and orderly at the time of inspection?

  Yes

  No

  N/A

Safety Equipment

• Is mine air working?

  Yes

  No

  N/A

• General condition of the stretcher and accessories

  Safe

  At Risk

  N/A

• Is adequate door sealant available? (Required in C9290 and 9060 shop refuges)

  Yes

  No

  N/A

• Independent air supply (oxygen generator)

  Safe

  At Risk

  N/A

• Are the seals intact on the oxygen bottles

  Safe

  At Risk

  N/A

• Is the first aid kit sealed?

  Yes

  No

  N/A

• Enough Emergency water (Permanent - 8 flats of 24, 96 litres, Portable - 7 flats of 24, 84 litres)

  Safe

  At Risk

  N/A

• Emergency food supply

  Safe

  At Risk

  N/A

• Temperature control equipment

  Safe

  At Risk

  N/A

• Gas testing equipment

• Is the BM25 functioning correctly?

  Yes

  No

  N/A

• Drager pump and tubes available?

  Yes

  No

  N/A

• AED

• Expiration date on AED - specify date

  Safe

  At Risk

  N/A

• Expiration date on AED pads - specify date

  Yes

  No

  N/A

Communications

• Are sign off sheets in case of emergency available

  Yes

  No

  N/A

• Is the telephone working?

  Yes

  No

  N/A

• Is the radio working?

  Yes

  No

  N/A

• Is the PED working?

  Yes

  No

  N/A

• Is the Code of Conduct for Persons Occupying the Refuge Station posted inside?

  Yes

  No

  N/A

• Is a copy of fire fighting procedures available?

  Yes

  No

  N/A

• Is there an up to date copy of the Mine Ventilation Plan and escape routes posted?

  Yes

  No

  N/A

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