366 - AW-R04 | Mine Cleaning Material, Test & Return-to-Service Register
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UNDER GRD MINE — EDITABLE WORD ORIGINAL R12.95
AW-R04 — Material, Test & Return-to-Service Register
An underground cleaning area can look finished while its waste manifest, cleaning permit or dust/gas result remains missing. AW-R04 is the editable source-original material, test and return-to-service register for industrial-cleaning and waste contractors to expose these gaps before the mine accepts the work.
When and where this original is used
Use AW-R04 at close-out of an underground wash-down, pressure-jetting, dust-control or waste-services work order. Record MINE / AREA / LEVEL, WORK ORDER / MINE ZONE, DATE / SHIFT / PERMIT and CONTRACTOR SUPERVISOR, tying each test or manifest to the actual mine level, controlled activity and shift.
The seven technical checks printed in the document
1. Mine area owner accepts clean condition, remaining waste and restored equipment
2. High-pressure jetting requires dedicated line isolation, hose integrity and exclusion zones
3. Waste categories, containers and transfer records traceable to surface disposal
4. Wash water and sludge managed to avoid dewatering or water-quality impairment
5. Cleaning does not damage support tags, sensors, cable protection or fire barriers
6. No use of solvents, polishers or water methods outside approved material procedure
7. Dust, silica, diesel particulate and chemical exposure control defined
How to complete the source evidence table
The actual columns are #, MINING-SPECIFIC ITEM / EVIDENCE TO TRACK, DOCUMENT / RESULT / MEASURED VALUE and DATE / AUTHORITY / STATUS. Enter source revisions, inspection results or measured values and responsible authorities for each row. The original requires retaining certificates, test sheets and approvals, with no unexplained blanks. Do not substitute an unsupported yes/no answer for missing monitoring or disposal evidence.
Defects, close-out and who may release the area
AW-R04 provides OUTSTANDING DEFECT / NCR / REINSPECTION / RETENTION FILE REF and REVIEW / CLOSE-OUT AND EVIDENCE REFERENCES. Contractor supervisor and Host mine authority name/signature fields where required, plus Date / release reference, record an accountable handover. Only an authorised mine official may grant operational return-to-service approval; this record never issues the permit itself.
Editable Word Single and the two complete collections
This R12.95 Single is the original editable AW-R04 Word file. It is also in the 371-form Underground Mining Checklist Package and 628-page full Contractor H&S File. Existing owners need not buy twice; valid mine permits remain essential.
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