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Newmont„., CRIPPLE CREEK & VICTOR <br /> PO Box 191 <br /> CRIPPLE CREEK&VICTOR 100N.3rdStreet <br /> Victor CO 80860 <br /> Sisk Assessment ' <br /> What rate err l r:0itt? <br /> NEWMONT. <br /> NORTH AMERICA <br /> . fv'r„s <br /> What could Eh ange/gas wrong?(People or Planrl =err P!anWi Field Level Risk Assessment <br /> Dire: <br /> Name: <br /> Crew/Shift: <br /> Foreman: <br /> No Complacency:When rve done ataam ytimes before,Ia9 <br /> perladlokrevkvtlsestepsand compute a t6it assessment. <br /> No Assumpdons:I v Y not par chick work era I know and <br /> L1'oat can do about.?Iae weabetter waV2 SC?? .'I t::-ILo abort A. ewe atette:v:;:';^i; rmderdardthe Kent of e`eyonek.A.:land elmnethey knee, <br /> mpiehffi <br /> _.-- -- Ster Pomsed:When!recognize my trend isnotoa the task.IWB <br /> --- —, slop,take akremh,and re,any before retornig to walk <br /> IIIII♦ I— Ina oat dim mnuif to take the areoaVby <br /> shereantioC procedures <br /> Foreman Comments? f"r:tnte,Ct r,n entC ��� <br /> NEWMON T. <br /> A'ORia AMERICA <br /> • VITAL BEHAVIORS <br /> Notes/Sketch Pad Work Area is Cerrectit'e Acti,ns <br /> Work Area 1: <br /> Work Area 2: <br /> Work Area 3: <br /> Ws or No or N/A <br /> W/A1 W/A1 W/A3 <br /> Do I InveAe proper PPE? <br /> Vebkies NNuredkoo mmlekeu? <br /> safe acres to all areas? <br /> Eguipme lemeted? Work Notification: <br /> Eneyaay Master/Error.Poi*? Work Area 2 Corrective Actions <br /> flee Ex ingdshen&Iootian? <br /> Energy Isolated•EledMed/lpd? <br /> Ventilation? <br /> Guards and Barriers m Pia? <br /> Ground(minim Inspected? <br /> Elerbk al Cords and Ground Rda <br /> Area Ho;aekereN Good? <br /> Flammable Storage&libelee <br /> PmpoTods and Cm&Bae? Work Notification: <br /> PnOp lopectlom[mmetd ? Work Area 3:Corrective Actions <br /> Am I in the Noe of Are? <br /> Olin;Gear,Slop&Nods Gage <br /> Herds Corrected or Banfodd? <br /> Oil Spfk or lab Properly Contained? <br /> Adequate Nghdng load'? <br /> Work Place Exam Completed? <br /> Any WmIPemks Needed? <br /> (Ie_Not Work CondoelSprq <br /> EmvacanRreMwykkks1 ft) <br /> — <br /> Work Notification: <br /> • <br /> Department THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT Doc Id: <br /> Sir Date of This Issue--/--/-- Date of Next Review:--/--/-- Page 63 of 73 <br />