Fillable CEMENT FACILITY WORKPLACE EXAM RECORD Quarry or Mine (Mine Safety and Health Administration)

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CEMENT FACILITY WORKPLACE EXAM RECORD Quarry or Mine (Mine Safety and Health Administration)

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U.S.A. forms for Mine Safety and Health Administration (MSHA)

BROWSE MINE SAFETY AND HEALTH ADMINISTRATION (MSHA) (VA) FORMS

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Quarry or Mine Finish Mill (Milling) Operations
Raw Material Proportioning and Blending Laboratory
Raw Mill (Milling) Operations Packing, Shipping, and Distribution
Coal or Fuel Operations Baghouses and Precipitators
Preheater and Calciner Area Maintenance Area: ______________
Kiln Ar
ea Facility Grounds: _______________
Clinker Cooler Operations Other Area: ___________________
Adverse Conditions
Date Corrected
CEMENT FACILITY
WORKPLACE EXAM RECORD
Location*: ____________________________ Shift**: ______________ Date: ______________________
Competent Person(s) ***: ___________________________________________
WORKING AREA(S) EXAMINED:
* 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.
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CEMENT FACILITY WORKPLACE EXAM RECORD Quarry or Mine (Mine Safety and Health Administration)

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Completed 19 July 2020

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