This form is used by mining companies to notify the Ministry of Labour of reportable incidents as identified in section 53 of the Occupational Health and Safety Act and section 21(5) of the Regulation for Mines and Mining Plants. It includes notification of groundfall or rockburst and vehicle incident or fire.

This form is used by the operator of a surface magazine or a mine using explosives to notify the Ministry of Labour and the joint health and safety committee or health and safety representative, if any, before first use of a surface magazine or explosives and annually after first use.

This form is completed by employers, as required by section 182 (1) of the Regulation for Mines and Mining Plants, before diesel equipment is first used in an underground mine The completed form must be kept readily available at the mine site.