MSHA HANDBOOK SERIES - PH13-V-1 - Mine Safety and Health ...

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GENERAL COAL MINE INSPECTION PROCEDURES AND INSPECTION TRACKING SYSTEM HANDBOOK CHAPTER 6 D. Forms and Information Needed in an E01 Inspection Report. E01 Inspection Report and Requested Order of Filing (all of the below forms may not be applicable for all inspection reports, which do not have to be maintained in any particular order in the files) _____ 2000-22 Mine Activity Data (if applicable with SCSR Plan, Cleanup Program, and Ground Control Plan statements, documented on line No. 17-Remarks). _____ Citations, Orders, and Safeguards (7000-3) with any photo mounting worksheets (4000-125), with all subsequent actions (7000-3a) including any vacated issuances and vacate memorandums if applicable, elevated enforcement actions paperwork (7000-32 SAR). Citations and orders organized by date with the last issuance being up front in the report. Previous issued citations, orders, and safeguard subsequent actions shall be maintained in the event that the original enforcement action was generated from. _____ General Inspection Cover Sheet (7000-10H), Daily Cover Sheets (7000-10I) if applicable with all notes including any preprinted listings documented as notes taken on the event. _____ 2000-204 Roof & Vent Plan Evaluation. _____ 2000-209 Mine Information Form (one copy must be submitted to health clerk or supervisor immediately upon completion and one copy maintained in report). _____ 2000-223 ERP Plan Review Form. _____ Air Bottle Results for Each Sample Taken (Analytical Report). _____ 2000-43 Mine Atmosphere Sampling Print Out (only if result not yet received, then a copy of the submitted form showing that analytical report not yet received). _____ 2000-156 Rock Dust Sample Submission Form(s), sample forms with analysis results (if results not yet received by close date of inspection a copy of the submitted 2000- 156 showing that analysis results not yet received. _____ 2000-86 Respirable Dust Form. Release 1 (February 2013) 6-9
GENERAL COAL MINE INSPECTION PROCEDURES AND INSPECTION TRACKING SYSTEM HANDBOOK CHAPTER 6 _____ MSN 014 Respirable Dust Results with Blue Cards Attached (not mandatory that they be signed, but must have a positive identifier of who conducted the sample). _____ 2000-84 Noise Survey Results. _____ Results of other samples taken (asbestos, etc.). _____ 2000-207 Independent Contractor Form (only if new or updated). _____ 2000-208 Independent Contractor Form (for contractors on mine site). _____ Impoundment Inspection Forms. (MSHA form number is currently being assigned) _____ 2000-34 Coal Refuse Pile Periodic Inspection Form. _____ ATF 5030.5 and/or ATF 5400.5 ATF Inspection Form. _____ Diesel Equipment Inventory Records (print out). _____ SCSRs Inventory Records (print out). Note: 2000-220 form is discontinued. _____ Part 49 Checklist (Mine Rescue Station). _____ ITS Tracking (print out). _____ Mine Tracking Map(s). _____First-Line Supervisors E01 Certification Sheet Release 1 (February 2013) 6-10
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MSHA HANDBOOK SERIES U. S. Departme
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TABLE OF CONTENTS Chapter 1 - INTRO
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19. Illumination of Work Areas ....
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V. Special Assessment .............
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COAL MINE SAFETY AND HEALTH GENERAL
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GENERAL COAL MINE INSPECTION PROCED
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