Manual for Abandoned Underground Mine Inventory and Risk Assessment
Figure 2.2: Office Investigation of Field Report
| Ohio Department of Transportation Abandoned Underground Mine Inventory and Risk Assessment Office Investigation of Field Report |
Action Required: 1) 2) 3) |
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| Person Filing Original Field Report:__________________________Field Report No.__________ Location of Person Filing Original Field Report:_______________________________________ Telephone Number:_________________________Best time to call:________________________ Investigator's Name:_____________________________________ Date:___________________ |
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| Note to Investigator: Please contact the person providing the field report and make a record of the conditions which were observed or upon which work was performed either during maintenance or construction operations within the District. Use a new copy of this form for each separate roadway location. Be sure to make a record of any information, even if the condition/problem and related construction /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. |
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| Location of Condition/Problem (C-R-S)______________________________________________ Date(s) Observed:________________________________________________________________ |
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| Check Appropriate Box(es): _______Observed/encountered during Maintenance operations _______Observed/encountered during Construction operations _______Other__________________________________________________________________ |
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Surface Grade Problems:
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Drainage Problems/Irregularities (Check all appropriate items): 1.______Loss in volume of drainage at some midpoint of ditchline with smooth flowline 2.______Gain in volume of drainage at some midpoint of ditchline with smooth flowline 3.______Loss in volume of drainage in ditchline at some unexplainable low spot 4.______Gain in volume of drainage in ditchline at some unexplainable low spot |
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Are these drainage conditions seasonal or year-round:__________________________________ Construction/Maintenance action(s) taken to correct condition:___________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ |
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General Information: Is the person who completed the field report aware of any underground mines reported to exist in the vicinity of the roadway area? If so, please provide the name of the mine(s) here:___________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ |
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| Names of other contact person(s) (ODOT or private sector) which may be able to provide additional information regarding this site:_____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ |
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| Other information which may be pertinent:____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ |
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| PLEASE ATTACH A MAP OR SITE SKETCH OF THE FIELD REPORT AREA | |