Canadian Mineral Exploration Environment, Health & Safety Survey Step 1 of 4 25% In completing this form please note the following: The form should be completed by junior companies, major companies, government geological surveys, diamond drilling contractors, geophysical contractors, and any other companies or contractors carrying out exploration related activities in Canada. The information collected will be used to produce the Canadian Mineral Exploration Environment Health & Safety Annual Report - click here for the 2016 report. It will also be used to develop tools such as the new Helicopter Slinging Training presentation jointly developed by AME and PDAC. We ask companies to submit in the spaces below a close estimate of the number of person days worked by company employees and contractors for the following: Surface exploration and geological field work which includes line-cutting, geophysical, geochemical, trenching, etc. Surface drilling Underground exploration including underground drilling, mining, and geological work Please include the names of contractors so that we do not duplicate information. These names will not be published. If you have any questions about the form please contact Jonathan Buchanan at 604-630-3923 or [email protected]. All information will be kept confidential, and Personal Information Protection and Electronic Documents Act mandates will be maintained. Name of Person & Company Responsible for Environment, Health, & SafetyName* First Last TitleCompany Name*Email* Address InformationPhoneAddress* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province / Territory Postal Code Does your organization have a Health and Safety Policy?YesNoDoes your organization have a Health and Safety Program?*AlwaysSometimesNeverDoes your organization have a Health and Safety Management Plan?*YesNoDoes your organization conduct health and safety simulation exercises at every field site?*AlwaysSometimesNeverDoes your organization conduct task risk analyses and identify hazards at each field site?*AlwaysSometimesNeverDoes your organization have a return to work program for workplace injuries?*AlwaysSometimesNeverDuring worker meetings (staff, worksite, office meetings) safety is discussed...*At the start of every meetingAs an agenda item at every meetingAs an agenda item occasionally at meetingsNeverFor Board of Directors meetings, safety is discussed...*As an agenda itemOnly when there is an incidentNeverDoes your organization have an environment policy?*YesNoDoes your organization have an environmental program?*AlwaysSometimesNeverDoes your organization have an environment management plan?*YesNoNames of Contractors/Companies Estimated mineral exploration expenditures in Canada 2018 ($) Total number of person–hours worked in 2018 by company employees in Canada:*Estimated total of person-hours worked in 2018 by company contractors in Canada*Did you experience any incidents (either lost-time or without lost-time)?*YesNoPlease complete the incident reporting spreadsheet and attach hereDownload spreadsheet templateAccepted file types: pdf, xlsx.