Bonus Program CRM Impact Form

Use this mining CRM Impact form to record critical risk incidents and injuries across departments such as maintenance, operations, processing, geology, and safety. Log site details, shift and rotation, equipment involved, permit to work program, energy isolation, and the specific critical risk category. Capture full incident descriptions, photos, immediate actions, notifications, and added controls following the hierarchy of controls. Classify event type and loss, including near miss, first aid, medical injury, or fatal, and select incident mechanisms like struck by, falls, caught in or between, contact with energy, equipment failure, or abnormal operation. Track corrective and potential long term actions to strengthen controls and improve safety performance.