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Subchapter 20. Tunnel Safety Orders
Article 24. Licensing of Blasters

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Appendix E

TUNNEL PREJOB SAFETY CONFERENCE CHECK LIST

This form outlines the subjects the Division will discuss at the Prejob Safety Conference.

1. PROJECT INFORMATION:
Starting date _____________________	Project Duration: ______________
a. Project Name ________________________________________________________________
Project Location________________________________________________________________
b. Name of Owner _______________________________________________________________
Owner's Address ________________________________________________________________
__________________________________________________    Phone ____________________
c. Contractor __________________________________________________________________
Contractor's Address ___________________________________________________________
________________________________________________________________________________
Employee's representative _______________________________  Phone _______________
________________________________________________________________________________

2. TUNNEL CLASSIFICATION:
Classification Type __________________________________   Date Issued ___________
Special Provisions _____________________________________________________________
General Geology ________________________________________________________________

3. TUNNEL SPECIFICATION:
a. Tunnel Diameter _________________________________	Tunnel Length __________
    Shaft Diameter __________________________________	Shaft Depth ____________
b. Excavation Method and Support and Additional Details ________________________
    ____________________________________________________________________________
c. Jacking Pit: Length _______ Width __________ Depth _____ Soil Type___________
Pit Shoring Type/Slope ____________________________ Access/Egress ______________
	Permit # and Competent Person ______________________________________________
	Additional Details _________________________________________________________
	____________________________________________________________________________

4. MANPOWER/TESTING EQUIPMENT
a. Total Manpower _____________ Max/shift UG ________ Statewide Employment ______
       b. Supervisors ___________________________________________________________
       c. Safety Rep. and No. ___________________________________________________
d. Gas Tester and No. ___________________________________________________________
e. Blaster and No. ______________________________________________________________
f. Gas Testing Equipment ________________________________________________________

5. EQUIPMENT
a. Mining Equipment _____________________________________________________________
    Haulage _____________________________________________________________________
b. Cranes - Model/Capacity ______________________________________________________
c. Certification # _____________________  	Date ____________
	Crane and Rigging Inspection and Records ____________________________________
	Hoisting Equipment __________________________________________________________
	Cages and Work Platforms ____________________________________________________
	Signals and Communication ___________________________________________________
d. Ventilation: Fan Model/HP/RPM ________________________________________________
	Vent Line Size ________________ Length __________________ Material __________
	Calculated CFM _________________________Reversible @surface?  Yes ____ No_____
	Auxiliary Fan_________________________________________________________________
e. Diesel Equipment: Diesel Permit Number ____________________________
	List Other Equipment _____________________	___________________	______________
	_________________  _____________________	___________________	______________
	Scrubber Installation, inspection, and maintenance reviewed? _________________

6. REQUIRED POSTINGS:
a. Cal/OSHA_______ Emergency Plan ______ Telephone Nos. ______ Classification_____
b. Code of Safe Practices ______ Citations ________ Diesel and Other Permits _____

7. SANITATION AND FIRST AID: 
First Aid Kit ___________ No. of Persons Trained in First-Aid _________ CPR_______

8. RELATED SAFETY ITEM DISCUSSION CHECKLIST:
a. State Mining and Tunnelling Program, including Inspections, procedures, citations,
training, and technical assistance.
b. Reporting accidents and incidents to DOSH in 24 hours.
c. Gas tests, calibration, records, frequency, notifying DOSH.
d. Required Occupational Injury and Illness record keeping.
e. Crane boom clearance, with overhead high voltage power lines, and set-up.  Daily and
other inspections, including quarterly.
f. Required Inspections, assignment, schedule, records.
g. Identification and location(s) of existing utilities.
h. Fire prevention, protection, and special provisions.
i. Hazardous material training and information.
j. Hearing Conservation Program requirements.
k. Dust Control, Sampling, Respiratory Protection Program elements.
l. Personal protective equipment: hard hats, steel-toe boots, self rescuers, welding goggles
and clothing, safety belts, and lines.
m. Traffic control, protection, warnings, reflective vests, etc.
n. Tunnel and shaft lighting, emergency and personnel lighting in case of power failure, and
laser safety if laser is used.
o. Tunnel communication system and underground utility lines.
p. Explosives-type, system, storage, transport, warning system.
q. Safety Meetings: Monthly ________ Weekly _____________ Records __________
r. Check-in system, primary and secondary exit protection/provision.
s. Underground Rescue Plan: Yes _____ No ________ Reviewed? Yes _______ No________
If IIPP is reviewed, attach Check List.
t. Employee and supervisory training requirements and programs.

9. NOTES AND DETAILS:
	
______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

10. SKETCH (IDENTIFY):








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