Form IN-2006 "Blaster Shot Report" - Tennessee

What Is Form IN-2006?

This is a legal form that was released by the Tennessee Department of Commerce and Insurance - a government authority operating within Tennessee. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Tennessee Department of Commerce and Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form IN-2006 by clicking the link below or browse more documents and templates provided by the Tennessee Department of Commerce and Insurance.

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Download Form IN-2006 "Blaster Shot Report" - Tennessee

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DEPARTMENT OF COMMERCE AND INSURANCE
FIRE PREVENTION DIVISION
Blaster Shot Report
Date:
Time:
AM PM
Project Name: ______________________________
Blasting firm:
Exact Location of Blast:
Direction and distance of nearest structure:
Weather (check):
Cloudy
Rain
Clear
Windy
Temp.:
Type of materials blasted:
Type of shot:
Number of holes:
Hole diameter:
Hole depth:
Burden:
Spacing:
Stemming type:
Stemming depth:
Explosives used:
Explosives trade name:
Total amount of explosives used:
Total pounds per delay:
Type of caps used:
Delay used:
Delay trade name:
Type of mat or other form of protection
used (rubber, steel, mesh, clean dirt):
Method of firing with overhead diagram of delay (Use attached graph):
Location of each seismograph:
Name of seismograph firm:
Name of driller(s):
Anomalous or unusual conditions encountered during drilling:
Location of unloaded holes, or those requiring non-typical loading:
Documentation of measures taken to compensate for anomalous conditions:
Printed name of blaster:
Blaster ID#:
Signature of blaster:
Note: The use of this blast record form is not mandatory. See Tenn. Code Ann. § 68-105-107 for records required to be
kept by state law.
IN - 2006
1
RDA 2225
DEPARTMENT OF COMMERCE AND INSURANCE
FIRE PREVENTION DIVISION
Blaster Shot Report
Date:
Time:
AM PM
Project Name: ______________________________
Blasting firm:
Exact Location of Blast:
Direction and distance of nearest structure:
Weather (check):
Cloudy
Rain
Clear
Windy
Temp.:
Type of materials blasted:
Type of shot:
Number of holes:
Hole diameter:
Hole depth:
Burden:
Spacing:
Stemming type:
Stemming depth:
Explosives used:
Explosives trade name:
Total amount of explosives used:
Total pounds per delay:
Type of caps used:
Delay used:
Delay trade name:
Type of mat or other form of protection
used (rubber, steel, mesh, clean dirt):
Method of firing with overhead diagram of delay (Use attached graph):
Location of each seismograph:
Name of seismograph firm:
Name of driller(s):
Anomalous or unusual conditions encountered during drilling:
Location of unloaded holes, or those requiring non-typical loading:
Documentation of measures taken to compensate for anomalous conditions:
Printed name of blaster:
Blaster ID#:
Signature of blaster:
Note: The use of this blast record form is not mandatory. See Tenn. Code Ann. § 68-105-107 for records required to be
kept by state law.
IN - 2006
1
RDA 2225
DEPARTMENT OF COMMERCE AND INSURANCE
FIRE PREVENTION DIVISION
N
Blast Site Sketch: Show pattern layout, timing, and direction of shot. Be specific with the distance to
nearest structure(s), seismograph location(s), and the distance and direction(s) from the blast site.
Indicate address(es), station numbers or bench identification. Attach seismograph printout to this
record.
Comments:
Sample of Borehole Cross-Section
IN - 2006
2
RDA 2225
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