Manual for Abandoned Underground Mine Inventory and Risk Assessment
Figure 2.1: Field Report
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Name:________________________________________________Date:___________________ Office Location:_______________________________________________________________ Telephone Number:_________________________Best time to call:______________________ |
As a part of establishing a listing of sites to be evaluated by the abandoned underground mine inventory, the District is gathering information regarding past or present maintenance or construction problems which may have been, or are, related to the presence of mines beneath the roadway.
Please report any unusual grade settlements or drainage conditions which you observed or upon which you have performed work either during maintenance or construction operations with the District. Please report any information, even if the condition/problem and related construction or maintenance occurred years ago. All known conditions/problems within the right of way should be reported. Significant conditions immediately beyond the right of way may also be indicators of conditions evolving beneath the roadway.
| Location ( C-R-S) |
Condition/Problem/Maintenance | Approximate Date |
|---|---|---|
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_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ | ||
Please return this completed form to____________ at the District ____________ Office. If you have any questions about the completion of this form, or wish to discuss information you are reporting on this form, please contact (District Contact Person) at (Telephone number).
For District Office Use: Field Report No.__________