Mining Site Drill Crew Safety Performance Sheet
Date:
Shift:
Location:
Drill Rig:
Supervisor:
Crew Members
#
Name
Role
Signature
1
2
3
4
Safety Checklist
Item
Yes
No
Comments
PPE Worn Correctly
Toolbox Meeting Conducted
Area Inspected
Equipment Pre-Start Check
Housekeeping Maintained
Incidents / Near Misses
Corrective Actions
Supervisor Remarks