ADOPT-A-MINEFIELD^® CLEARANCE REPORT

TO BE READ WITH ATTACHED SITE PLAN, MAP OVERLAY AND MAP SHEET

1.        MAP NAME

6.             MAP REFERENCE & NAME OF CLEARED AREA.

2.        EDITION

Attach explanatory map(s) and/or sketch(es).

3.        SHEET NO.

4.        SCALE

5.        ID NO.

PART 1 - DETAILS OF MINE CLEARANCE

7. Name of mine clearing organisation.

8.        Start & finish dates.

9. Quantity and types of mines and UXO located.

10. Methods & technologies used.

11. Quantity and types of mines and UXO destroyed.

12. Depth of clearance.

13. Is area now metal free?

14. Type & location of cleared area marking.

(Show on attached sketch)

15. Quality Assurance carried out by: (name & organisation)

16. Quality Control checks used.

PART 2 - DECLARATION

A.  Declaration by senior representative of organisation responsible for mine clearance

B.       Declaration by Responsible Authority

I declare that the area described in this document has been cleared and that, to the best of my knowledge and belief, it is free of landmines and unexploded ordnance.

(1)     This Declaration of clearance is accepted.

(2)     The area described in this report is accepted as clear of landmines & unexploded ordnance.

Name.

Name.

Position in organisation.

Name of organisation.

Signature.

Signature.

Date.

Date.

THIS DOCUMENT HAS BEEN DISTRIBUTED AS SHOWN BELOW

a.        Original to:

c. Copy to:

b.        Copy to:

d. Copy to: