Mining Form

Free Fillable Ventilation Survey

Fill out this ventilation survey online and download as PDF - free, no signup required.

MI-0321 fieldsmonitoring

Project Information

Mine / Project Name*

MSHA Mine ID*

Survey Title / Description*

Surveyor Name*

Survey Date*

Survey Start Time

Survey End Time

Main Fan ID / Location

Survey Frequency

Fan Pressure Readings

Main Fan Static Pressure (in. w.g.)

Main Fan Quantity (CFM)

Auxiliary / Booster Fans in UseAuxiliary / Booster Fans in Use

Fan Pressure Notes

Air Velocity & Quantity Measurements

Record measurements at each designated ventilation station.

Methane & Gas Readings

Survey Summary

Ventilation Plan Current and PostedVentilation Plan Current and Posted

All Ventilation Controls Properly InstalledAll Ventilation Controls Properly Installed

Deficiencies Found

Corrective Actions Required

General Survey Notes

Photos

Location

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Dust Sampling Record

MI-04