Complete all metadata fields accurately to ensure proper traceability and accountability for this atmospheric inspection. All fields marked as mandatory must be completed before submission.
Mine Shaft Identification Code
Specific Zone/Level Being Inspected
Inspection Date and Start Time
Shift Period
Day Shift (06:00-14:00)
Afternoon Shift (14:00-22:00)
Night Shift (22:00-06:00)
Extended/Overlap Shift
Safety Officer Conducting Inspection
Shift Supervisor On Duty
Mine Operations Director
Gas Detection Equipment Model and Serial Number
Last Equipment Calibration Date
Is the detection equipment within calibration validity period?
Calibration due date
CRITICAL: Equipment out of calibration. Inspection cannot proceed. Immediately tag out equipment and request calibrated replacement before continuing.
Ambient Temperature at Inspection Point (°C)
Relative Humidity (%)
Barometric Pressure (kPa)
Number of Personnel Currently in Zone
Record all gas concentration measurements in parts per million (ppm) or percentage (%) as indicated. Take readings at multiple points for accurate zone assessment. Any reading outside safe parameters requires immediate follow-up actions.
Multi-Point Gas Concentration Measurements
Measurement Location | O2 Concentration (%) | CO Concentration (ppm) | Methane CH4 (%) LEL | NO2 Concentration (ppm) | Airflow Velocity (m/s) | Time of Reading (hh:mm) | ||
|---|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | G | ||
1 | Face Area - Primary | 20.8 | 5 | 0.5 | 0.3 | 0.25 | 08:15 | |
2 | Return Airway - Mid Zone | 20.5 | 8 | 0.8 | 0.5 | 0.4 | 08:22 | |
3 | Last Through Road | 20.9 | 3 | 0.3 | 0.2 | 0.6 | 08:30 | |
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Time-Weighted Average CO over 8-hour period (ppm)
Are all O2 readings above 19.5%?
Specify locations with deficient O2 and exact readings
Are any CO readings exceeding 50 ppm (immediate danger)?
CO Alert Level Classification
Level 1: 50-100 ppm (Warning)
Level 2: 100-200 ppm (Danger)
Level 3: 200+ ppm (Critical Evacuation)
Is methane concentration below 1.25% of Lower Explosive Limit (LEL)?
Document methane levels and immediate actions taken
Are NO2 levels within 3 ppm short-term exposure limit?
Document NO2 exceedance details and affected areas
Total Air Volume Flow Rate (m³/min)
Air Changes Per Hour (ACH) in Active Zone
Does airflow direction match ventilation plan?
Explain airflow anomaly and potential causes
Overall Air Quality Index Rating (1=Poor, 5=Excellent)
Thoroughly inspect all ventilation infrastructure including auxiliary fans, ducting, supports, and power systems. Any deficiency may compromise atmospheric safety and requires immediate attention.
Auxiliary Fan System Status
Fan Unit ID | Operational Status | Fan Speed (RPM) | Vibration Level (1=Normal, 5=Severe) | Noise Level (1=Quiet, 5=Excessive) | Power Supply Voltage (V) | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | AUX-FAN-03 | Yes | 1450 | 480 | |||
2 | AUX-FAN-07 | Yes | 1480 | 480 | |||
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Are all auxiliary fans operational and running at designed capacity?
Identify failed fans and impact on ventilation
Select all ducting integrity issues observed
No issues - all ducts intact
Holes or tears in flexible ducting
Disconnected joints
Crushed or flattened sections
Accumulated dust/debris inside ducts
Corrosion in metal ducting
Missing hanging supports
Other integrity concerns
Are ventilation ducts properly sealed at all connection points?
Describe leak locations and estimated air loss percentage
Are all duct hanging supports secure and properly spaced?
Document support failures or spacing violations
Is there any visible dust accumulation in ductwork that could affect airflow?
Specify location and estimated blockage percentage
Distance from Fan to Active Face (meters)
Is backup ventilation system available and tested functional?
Explain backup system status and contingency plans
Are fan maintenance records current and within recommended service intervals?
Document maintenance overdue items
Overall Ventilation Infrastructure Condition (1-5 stars)
This section addresses critical safety thresholds and immediate response actions. Any breach of safe atmospheric parameters must trigger appropriate alert protocols and corrective measures.
Have any atmospheric parameters exceeded critical safety thresholds?
Select all parameters requiring immediate action
O2 deficiency (<19.5%)
CO exceedance (>50 ppm)
Methane LEL (>1.25%)
NO2 exceedance (>3 ppm)
Airflow velocity insufficient (<0.15 m/s)
Multiple parameter failure
Alert Level Classification
Level 0: Normal Operations
Level 1: Advisory - Monitor Closely
Level 2: Warning - Enhanced Surveillance
Level 3: Danger - Prepare for Evacuation
Level 4: Critical - Immediate Evacuation Required
Has an evacuation alert been issued to personnel in the affected zone?
Evacuation Order Time
Are all personnel accounted for in the affected zone?
List missing personnel and last known locations
Select all immediate corrective actions implemented
Increased fan speed/added fans
Redirected airflow pathways
Sealed leaking duct joints
Activated backup ventilation
Restricted access to zone
Deployed additional gas monitoring
Initiated emergency communication protocol
Suspended mining operations in zone
No action required - parameters normal
Detailed Description of Air Delivery Adjustments Made
Estimated Time to Restore Safe Atmospheric Conditions (minutes)
Has the emergency communication system been tested and confirmed functional?
Document communication system failures and backup methods
Are refuge chambers accessible and stocked in this zone?
Explain refuge chamber status and alternative safe havens
Additional Safety Measures or Precautions Implemented
Final authorization section requiring executive review of all atmospheric data, inspection findings, and corrective actions. Clearance is required before resuming or continuing normal mining operations in the inspected zone.
Has the Mine Operations Director reviewed all atmospheric data and inspection findings?
Explain review status and pending items
Final Operational Clearance Decision
Full Clearance - Resume Normal Operations
Conditional Clearance - Operations with Restrictions
Temporary Suspension - Await Further Monitoring
Immediate Shutdown - Evacuate and Remediate
Extended Shutdown - Engineering Review Required
Specific Operational Restrictions or Conditions (if applicable)
Required Re-Inspection Interval (hours)
Has the EHS Lead independently verified critical gas readings?
Document EHS verification status and concerns
EHS Lead Risk Assessment Comments
Mine Operations Director Digital Signature
Director Sign-Off Timestamp
EHS Lead Digital Signature
EHS Lead Sign-Off Timestamp
Follow-Up Actions Required Before Next Shift
Upload Supporting Documentation (Photos, Calibration Certificates, Additional Reports)
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