Mining Site Field Assessment Form
Complete this form to document your on-site mining site assessment. Please rate and comment on each aspect based on your observations.
Site Name
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall Site Condition
*
1
2
3
4
5
Safety Compliance Level
*
Rows
Not at all
Somewhat
Mostly
Fully
PPE Usage
1
2
3
4
Signage/Markings
5
6
7
8
Emergency Procedures
9
10
11
12
Environmental Controls in Place?
*
Yes
Partially
No
Equipment Status
*
All operational
Some issues
Major issues
Housekeeping & Cleanliness
1
2
3
4
5
Risk Level Assessment
*
Low Risk
1
2
3
4
High Risk
5
1 is Low Risk, 5 is High Risk
Please provide any additional comments or observations
Submit Assessment
Should be Empty: