Workplace inspection RLGM

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Daily Site Inspection

• Inspection carried out at the following time

  Date

• Add the Supervisor in charge of the area

Name

• Name

• Number

Safety System

• Add the The name(s) of employees at the mucking wedge.

Name

• Name

• Number

• Are all employees aware of the company's 5 point safety system?

  Yes

  No

  N/A

• Did the employees attend the morning crew line up meeting?<br>

  Yes

  No

  N/A

• Did the employee fill out the daily safety topic on his 5 point safety card?

  Yes

  No

  N/A

• Does the employee have the proper PPE for the job at hand?

  Yes

  No

  N/A

• Are all any permits required?

  Yes

  No

  N/A

PPE

• Is hard hat in good condition?

  Yes

  No

  N/A

• Are boots in good condition?

  Yes

  No

  N/A

• Is the employee wearing proper reflective material? (Must have reflective material on arms, legs and front and back of upper body?

  Yes

  No

  N/A

• Is belt in good order and within 5 years of expioary?

  Yes

  No

  N/A

Travelway

• Are there any hazards in the travel way?

  Yes

  No

  N/A

• Is the travel way in good condition?

  Yes

  No

  N/A

Site Specific Hazards - Slips/Trips/Falls

• Are there updated prints in the work heading?

  Yes

  No

  N/A

• Is ground conditions in good order?

  Yes

  No

  N/A

• Is there a scaling bar at the work heading?

  Yes

  No

  N/A

• Are barricades in place?

  Yes

  No

  N/A

• Does the work area have everything in place with good housekeeping?

  Yes

  No

  N/A

• Is the work area free of tripping hazards?

  Yes

  No

  N/A

• Is ground support up to standard and print followed?

  Yes

  No

  N/A

• Are employees working under supported ground?

  Yes

  No

  N/A

Ventilation

• Is the crew aware of the ventilation requirements for the heading

  Yes

  No

  N/A

• Is ventilation 50 feet from the working face?

  Yes

  No

  N/A

• Is the vent tubing in good order?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Fall arrest

• Is fall arrest required for the job site?

  Yes

  No

  N/A

• Are there proper anchor points?

  Yes

  No

  N/A

• Has the fall arrest been inspected?

  Yes

  No

  N/A

• Is fall arrest in good order?

  Yes

  No

  N/A

Acknowledgements

• Assessment carried out by

  Sign

• Name