UNDERGROUND WORKPLACE INSPECTION. ¥ - duplicate

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

TRAVEL WAY

• Is the travel way clean and in good order?

  Yes

  No

  N/A

• Ground Conditions?

  Yes

  No

  N/A

• Are proper barricades and signs in place?

  Yes

  No

  N/A

• Is ventilation in good order? ( doors working, reflective tape on doors, bulkheads)

  Yes

  No

  N/A

• Is there standing water in travelway?

  Yes

  No

  N/A

• Condition of Powder Mag

  Yes

  No

  N/A

• Condition of Cap Mag

  Yes

  No

  N/A

• Refuge station.

  Yes

  No

  N/A

WORKPLACE AND EQUIPMENT

• Housekeeping

  Yes

  No

  N/A

• Are proper signs and barricades in place? (Unsupported ground, rotating equipment electrical cable)

  Yes

  No

  N/A

• Are the proper length and number of scaling bars present?

  Yes

  No

  N/A

• Is ground support requirements being followed?

  Yes

  No

  N/A

• Pipe installation

  Yes

  No

  N/A

• Proper lockout procedures being followed

  Yes

  No

  N/A

• Is equipment chocked

  Yes

  No

  N/A

• Is there standing water in heading?

  Yes

  No

  N/A

• Is the equipment tagged in properly?

  Yes

  No

  N/A

• Is there sufficient ventilation in the heading for the equipment being used?

  Yes

  No

  N/A

• Is the vent tube on messenger cable and in good order?

  Yes

  No

  N/A

• Is the ventilation 50 feet from the face?

  Yes

  No

  N/A

• Is the crew aware of the ventilation requirements?

  Yes

  No

  N/A