WORKPLACE EXAM RECORD [Requirements Only]
Date:
*
-
Month
-
Day
Year
Date
Competent person(s):***
*
WORKING AREA(S) EXAMINED
*
Despacho
Extraccion
Planta de Arena #1 & 2
Taller
Quijada
Cono
Quimico
Rows
Conditions Not Promptly Corrected
Date Corrected
1
2
3
**"Location" is meant to indicate the overall site—this could be "Mine" or "Plant" or "Unit," as appropriate.
**The rule only requires that the date of the exam be noted. However, because the rule also requires that an exam be performed for each shift, unless the shift is indicated it would be difficult to determine which shift the examination covered.
***The competent person who performed the examination must be identified, but no signature is required.
Submit
Should be Empty: