301 - AS-F01 | Refuge Approved Work Package Hold & Release Record
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UNDER GRD MINE — ORIGINAL EDITABLE WORD | R12.95
AS-F01 — REFUGE APPROVED WORK PACKAGE HOLD & RELEASE RECORD
AS-F01 is the original five-gate approved work package hold and release record for contractors maintaining underground refuge chambers, escape routes and rescue equipment. The source places impairment decisions and emergency-area release under mine operator control.
WHERE THIS UNDERGROUND SOURCE IS USED
Use this form before isolating, handing back or transferring work on a mine refuge system. Enter MINE / AREA / LEVEL, WORK ORDER / MINE ZONE, DATE / SHIFT / PERMIT and CONTRACTOR SUPERVISOR, referring to the approved mine emergency plan for the affected district.
FIVE ACTUAL WORK PACKAGE HOLD GATES
1. Refuge chamber capacity, service interval and occupancy needs agreed with mine emergency team
2. Life-support oxygen, CO2 removal, water and communications services secured
3. Before isolation, alternative escape/refuge capability approved for affected district
4. Self-rescuer issue, condition and training interfaces verified with mine records
5. Refuge seals, pressure integrity, emergency lighting and gas monitors inspected
HOW TO COMPLETE THE SOURCE WORD RECORD
The actual HOLD TRIGGER / EVIDENCE GATE, REQUIRED EVIDENCE / VERIFICATION and RESULT / REFERENCE / WITNESS columns require five real evidence references and appropriate witnesses. Do not treat an incomplete or failed hold as PASS.
SOURCE-SPECIFIC SAFETY AND RELEASE CONTROL
The first hold addresses chamber capacity and district occupancy; the second checks life-support essentials, and the third requires an approved alternate refuge before isolation. The source's RELEASE CONDITION insists on witnessed correction and a valid mine-official decision.
OPERATOR CONTROL AND HANDOVER SIGNATURES
Operator-owned work release is recorded by reference only. Applicable hold gates must pass, defects be corrected and witnessed, and the named mine official must issue the actual release.
THE WORD SINGLE OR COMPLETE UNDERGROUND COLLECTIONS
This source-identical editable AS-F01 Word form is R12.95 and already included in the 371-document Underground Mining Checklist Package and complete 628-page Contractor H&S File. Owners of either complete product should avoid purchasing twice. Current mine emergency COPs, permits and written approval govern all work.
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