UNUSUAL OCCURRENCE REPORT
FOR GROUNDFALL/ROCKBURST
(UNDERGROUND MINE)
THIS REPORT IS FOR:
FALL OF GROUND
ROCKBURST
GENERAL
Internal Report
Company
incident code:
Company:
Reportable Incident
(see Sect. 21 of Ontario Regulation 854))
Mine:
Address:
Date:
Unknown
Damage sustained by mine
openings:
None
Time of occurrence:
AM
Single location
PM
Unknown
Multiple locations
General description of occurrence:
WORKERS
At time of incident workers were:
Underground
Were workers normally required in area:
Yes
Were workers in immediate area of damage:
Were there any injuries:
Yes
Surface
No
Yes
No
No one Working
Was access to the area restricted?
Unknown
Yes
No
To within what distance of the
incident were workers present:
No
m
ft
Nature of Injuries:
SEISMICITY (FOR ROCKBURSTS ONLY)
Seismic event that
most likely triggered
damage:
Magnitude scale:
Magnitude:
Coordinates:
Apparent seismic
source mechanism:
Nuttli
Richter
Other:
Event magnitudes:
Undetermined
The Rockburst:
Hanging wall
Visual Inspection
Estimated
Triggered a fall of ground
Depth
Pillar burst
m
ft
Fault slip
Magnitude of largest event:
2– 3
Unknown
Period of time over which events occurred (if more than one):
Location determined by:
Strain burst
1- 2
Unknown
Location of major events:
East
Magnitude of first event:
<1
Number of events:
North
>3
Unknown
Unknown
Footwall
Seismic Monitoring Equipment
Not Located
Displaced material violently
Unknown
Seconds
Minutes
Ore Zone
Hours
Not Located
Other Monitoring Equipment
Was contained by ground support
Revised November 28, 2013
DAMAGE LOCATION #1
DESCRIPTION OF OCCURRENCE
Mine level:
Location:
This area was:
Active
Inactive
Abandoned
Geological zone:
F/W
H/W
The incident occurred in:
Coordinates:
Ore
Damage sustained to:
Drift/XC
Nothing apparent
None
VRM
If pillar sustained damage:
Pillar dimensions
Type:
m
Blasting
ft
Back
Wall
ft
Bolting
Drilling
From unsupported
ground:
Scaling
Pillar or Secondary Recovery
Sill
Shoulder
m
Mucking
Undercut & Fill
Block Caving
Blasthole
Other:
Crown
Other:
Length:
Floor
Other:
Unknown
Post Pillar Cut & Fill
Sublevel Caving
Post
Stope
Span:
Equipment
Width:
From behind support
(uncontained):
Material displaced
tonnes
Rib
Face
Depth
Ore/waste pass
Primary Recovery
Cut & Fill
Uppers Retreat
Height:
Material displaced from:
Backfilling
None
Shrinkage
Slot & Slash
Shaft
Length:
Ground Support
Ore Recovery in Immediate Area:
Mining Method:
Pillar
Width:
Excavation
Associated mining activity:
East
Rock type:
Raise
Opening dimensions: Height:
North
m
Brow
Unknown
ft
Other:
Contained by support:
Total:
tons
Damage dimensions
Length:
Width:
Tabular
Blocky
Max. depth:
Thin/slabbing
Irregular
m
Displaced material
Wedge
Rockburst damage
mechanism
Rock bulking due to fracturing
Rock ejection due to seismic energy transfer
Rock fall due to seismic shaking
Unknown
ft
Shotcrete
Unknown
Not applicable
Comments:
Rock mass characteristics
(choose one only)
Bedded
Blocky/Chunks
Dyke
Fault/shear
Contacts
Joint alteration/infilling
Water
Orientation:
trend/plunge
dip/dip direction
Structural geology and water
Fault/dyke description
Massive
Fractured
Slabbing
Unknown
Steeply dipping joints
Thickness:
Flat lying joints
m
ft
Comments:
Revised November 28, 2013
DAMAGE LOCATION #1
ROCK SUPPORT SYSTEM
Backfill Type
Location or Opening Backfilled
Binder Type and
Content
Percentage Filled
Pattern
Performance
Location
Reinforcement
Type
Length
Back
Walls
Wide
Long
Failed
Beyond
Mechanical
bolts
Resin rebars
Friction
stabilizers
Expandable
bolts
Dynamic bolts
Cable bolts
Surface
support
Location
Type
Back
Walls
Dimension
or
thickness
Performance
Cracked or
bulged
Broken
Failed
Wire-mesh
Shotcrete
Straps
Used to support
Performance
Other system
Back
Walls
Deformed
Broken
Failed
Comments Regarding Effectiveness of Support Systems:
Follow-up Action:
Revised November 28, 2013
DAMAGE LOCATION #2
DESCRIPTION OF OCCURRENCE
Mine level:
Location:
This area was:
Active
Inactive
Abandoned
Geological zone:
F/W
H/W
The incident occurred in:
Coordinates:
Ore
Damage sustained to:
Drift/XC
Nothing apparent
None
VRM
If pillar sustained damage:
Pillar dimensions
Type:
m
Blasting
ft
Back
Wall
ft
Bolting
Drilling
From unsupported
ground:
Scaling
Pillar or Secondary Recovery
Sill
Shoulder
m
Mucking
Undercut & Fill
Block Caving
Blasthole
Other:
Crown
Other:
Length:
Floor
Other:
Unknown
Post Pillar Cut & Fill
Sublevel Caving
Post
Stope
Span:
Equipment
Width:
From behind support
(uncontained):
Material displaced
tonnes
Rib
Face
Depth
Ore/waste pass
Primary Recovery
Cut & Fill
Uppers Retreat
Height:
Material displaced from:
Backfilling
None
Shrinkage
Slot & Slash
Shaft
Length:
Ground Support
Ore Recovery in Immediate Area:
Mining Method:
Pillar
Width:
Excavation
Associated mining activity:
East
Rock type:
Raise
Opening dimensions: Height:
North
m
Brow
Unknown
ft
Other:
Contained by support:
Total:
tons
Damage dimensions
Length:
Width:
Tabular
Blocky
Max. depth:
Thin/slabbing
Irregular
m
Displaced material
Wedge
Rockburst damage
mechanism
Rock bulking due to fracturing
Rock ejection due to seismic energy transfer
Rock fall due to seismic shaking
Unknown
ft
Shotcrete
Unknown
Not applicable
Comments:
Rock mass characteristics
(choose one only)
Bedded
Blocky/Chunks
Dyke
Fault/shear
Contacts
Joint alteration/infilling
Water
Orientation:
trend/plunge
dip/dip direction
Structural geology and water
Fault/dyke description
Massive
Fractured
Slabbing
Unknown
Steeply dipping joints
Thickness:
Flat lying joints
m
ft
Comments:
Revised November 28, 2013
DAMAGE LOCATION #2
ROCK SUPPORT SYSTEM
Backfill Type
Location or Opening Backfilled
Binder Type and
Content
Percentage Filled
Pattern
Performance
Location
Reinforcement
Type
Length
Back
Walls
Wide
Long
Failed
Beyond
Mechanical
bolts
Resin rebars
Friction
stabilizers
Expandable
bolts
Dynamic bolts
Cable bolts
Surface
support
Location
Type
Back
Walls
Dimension
or
thickness
Performance
Cracked or
bulged
Broken
Failed
Wire-mesh
Shotcrete
Straps
Used to support
Performance
Other system
Back
Walls
Deformed
Broken
Failed
Comments Regarding Effectiveness of Support Systems:
Follow-up Action:
Revised November 28, 2013
DAMAGE LOCATION #3
DESCRIPTION OF OCCURRENCE
Mine level:
Location:
This area was:
Active
Inactive
Abandoned
Geological zone:
F/W
H/W
The incident occurred in:
Coordinates:
Ore
Damage sustained to:
Drift/XC
Nothing apparent
None
VRM
If pillar sustained damage:
Pillar dimensions
Type:
m
Blasting
ft
Back
Wall
ft
Bolting
Drilling
From unsupported
ground:
Scaling
Pillar or Secondary Recovery
Sill
Shoulder
m
Mucking
Undercut & Fill
Block Caving
Blasthole
Other:
Crown
Other:
Length:
Floor
Other:
Unknown
Post Pillar Cut & Fill
Sublevel Caving
Post
Stope
Span:
Equipment
Width:
From behind support
(uncontained):
Material displaced
tonnes
Rib
Face
Depth
Ore/waste pass
Primary Recovery
Cut & Fill
Uppers Retreat
Height:
Material displaced from:
Backfilling
None
Shrinkage
Slot & Slash
Shaft
Length:
Ground Support
Ore Recovery in Immediate Area:
Mining Method:
Pillar
Width:
Excavation
Associated mining activity:
East
Rock type:
Raise
Opening dimensions: Height:
North
m
Brow
Unknown
ft
Other:
Contained by support:
Total:
tons
Damage dimensions
Length:
Width:
Tabular
Blocky
Max. depth:
Thin/slabbing
Irregular
m
Displaced material
Wedge
Rockburst damage
mechanism
Rock bulking due to fracturing
Rock ejection due to seismic energy transfer
Rock fall due to seismic shaking
Unknown
ft
Shotcrete
Unknown
Not applicable
Comments:
Rock mass characteristics
(choose one only)
Bedded
Blocky/Chunks
Dyke
Fault/shear
Contacts
Joint alteration/infilling
Water
Orientation:
trend/plunge
dip/dip direction
Structural geology and water
Fault/dyke description
Massive
Fractured
Slabbing
Unknown
Steeply dipping joints
Thickness:
Flat lying joints
m
ft
Comments:
Revised November 28, 2013
DAMAGE LOCATION #3
ROCK SUPPORT SYSTEM
Backfill Type
Location or Opening Backfilled
Binder Type and
Content
Percentage Filled
Pattern
Performance
Location
Reinforcement
Type
Length
Back
Walls
Wide
Long
Failed
Beyond
Mechanical
bolts
Resin rebars
Friction
stabilizers
Expandable
bolts
Dynamic bolts
Cable bolts
Surface
support
Location
Type
Back
Walls
Dimension
or
thickness
Performance
Cracked or
bulged
Broken
Failed
Wire-mesh
Shotcrete
Straps
Used to support
Performance
Other system
Back
Walls
Deformed
Broken
Failed
Comments Regarding Effectiveness of Support Systems:
Follow-up Action:
Revised November 28, 2013
ATTACHEMENTS
Please, provide a list of attached documents (e.g. photos, mine plans, etc.) if applicable.
SIGN-OFF
Date Report Completed
Phone: (
)
Name of Person Completing Report
Fax: (
Title
)
Name
Title
E-Mail:
Signature
Date
If this is a reportable incident, please send report to:


District Office, Mining Health and Safety Program, Ontario Ministry of Labour Mike.Kat@ontario.ca
Ground Control Specialist, Workplace Safety North, 690 McKeown Avenue, PO Box 2050, North Bay, Ont. P1B 9P1
GCS@workplacesafetynorth.ca
To obtain a copy of the Guidelines for completing the Unusual Occurrence Report for Groundfall/Rockburst, or for additional information,
please contact WSN’s Ground Control Specialist, (705) 474-7233 GCS@workplacesafetynorth.ca
Revised November 28, 2013