Mining Operations Risk Mitigation Assessment Form
Use this form to evaluate mining operation hazards, document current controls, and assign mitigation actions for the assessed site or area.
Mine Site & Assessment Scope
Mine/Site Name
*
Location / Area Assessed
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessment Type / Operation Area
*
Open-Pit
Underground
Processing Plant
Haul Road
Maintenance Area
Stockpile
Other
Assessor Name / Role
*
Operational Risk Evaluation
Hazard Risk Evaluation
*
Rows
Likelihood
Severity
Current Control Adequacy
Ground instability
1
2
3
Equipment interaction
4
5
6
Blasting / explosives
7
8
9
Ventilation
10
11
12
Dust exposure
13
14
15
Traffic management
16
17
18
Electrical hazards
19
20
21
Confined spaces
22
23
24
Working at height
25
26
27
Emergency preparedness
28
29
30
Overall Risk Level
*
Low
Moderate
High
Critical
Mitigation Actions & Follow-Up
Prioritized Corrective Actions
*
Responsible Person or Team
*
Target Completion Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Required Resources / Equipment
Final Assessment Status
*
Please Select
Approved
Approved with Actions
Re-assessment Required
Submit
Should be Empty: