Laserfiche WebLink
Mine Safety and Health Adminisiratj `~~jj <br />Section I-Violation Data <br />1. Date Mo <br />S Da <br />~ L QYr <br />/ D 2. Time 124 Hr Clockl <br />D <br />~ 3. Citation <br />ONudmher <br />3630822 <br />f~/ServEd o r <br />/ 5 er for <br />' <br />6 <br />. Mipe ~ ~ <br />~~L) /~/rv/. `~_/_ 7. ine lD - D ~~ Z IContractorl <br />8. ondition r Practice Ba. Written Nonce 110381 ^ <br />Zd00- <br /> <br /> <br /> <br />S r f D <br /> <br />977 ~~ <br /> <br /> <br /> <br /> <br /> <br />See Continuation F rm IMSHA Form 7000-3a) ^ <br />9. Violation A. Health <br />Qt~ef ~ R. Section <br />of Act <br />/ <br />~ p <br />/ _ C. Part/Section of <br />Title 30 CFR <br />~ <br />~ <br />2 <br />Section II-I nspettor's Evaluation <br />10. Gravity: <br />A. Injury or Illness (has) fist: No Likelihood Unlikely ^ Reasonably Likely^ Highly Likely^ <br />Occurred ^ <br />B. Injury or Illness could rea- <br />sonably be expected to be~. No Lost Workdays Lost Workdays or Restricted Duty ^ Permanenllv <br />isabling^ Fatal ^ <br />C. Significant and Substantial (See Reverse) ~ Yes ^ No D. Number of Persons Affected Q Q <br />11. Negligence (check onel <br />A. None ^ B. Low ^ C Moderate D. High ^ <br />.Reckless Disregard ^ <br />12. Type of Action <br />/ <br />- <br />- <br />~ <br />- 13. Type of Issuance (check one) <br />Citation Order ^ <br />Safeguard ^ <br />14. Initial Action <br />D. Written <br />A. Citation^ 8. Order^ C. Safeguard ^ Notice ^ E. Citation/ <br />Order <br />Number F. D fed Mo Da Vr <br />1 S. Area or Equipment <br /> <br /> <br />16. Termination Due <br />A Date Mo <br />D ,j Da <br />D ~ Yr <br />~ 8 Time (24 <br />Hr Clockl <br />/ <br />/ <br />D <br />D <br />Section III-Termination Action <br />17. A i to Terminate <br />r <br /> <br />' , <br />18. Terminated <br />A. Date Mo <br />S Da <br />O Z Vr <br />[~ Q <br />R. Time 124 Hr. Clock) <br />/ <br />D <br />5 <br />Section IV-Automated System Data <br />19. Type of Inspection <br />lactivity Co 1 D i 20. Event Number O ~ ~ ~ 21. Primary or Mill <br />22. r 23 4R umber <br />v15HA Form 7000-3, Mar 85 IRevi 1 <br />V <br />