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ARMY FORM W4030

(03/04)
(STANAG 2485)

MINE CLEARANCE RECORD

This record is intended to detail mine clearance activity wherever it is carried out. The record is to be
completed in as much detail as possible at the end of a clearance operation, or when a unit leaves the
mined area for another task, including when the task is not complete. The minimum required copies
are as follows:
Distribution:
• Copy 1 – Unit carrying out the operation: ………………………………………………………
• Copy 2 – Unit or civilian (eg Mayor) taking responsibility for an area: ……………………….
• Copy 3 – Engineer staff at formation HQ: ………………………………………………………

PART 1 - DETAILS OF MINED AREA

1. Mine clearance 2. Name of cleared
record number 1 area and map
grid reference
3. Map name 4. Map edition

5. Map sheet number 6. Scale of map

LIST OF ATTACHED DOCUMENTS

Serial Title of document Description
(eg map, sketch, photograph)
7.
8.
9.
10.
11.
12.
13.

DECLARATION
DECLARATION BY OFFICER OR NCO IN CHARGE OF CLEARANCE OPERATION
I declare that the area has been cleared of landmines and unexploded ordnance as described in this report.
Rank and Name Unit

Signature Date (DTG) 2

ACCEPTANCE BY THE RESPONSIBLE AUTHORITY

Name and details of organisation taking over the cleared area
Grade or Rank and Name Organisation
or Unit

Signature Date (DTG)2

1
Numbering system as designated by the theatre HQ.
2
DTG: Date Time Group DDTTTT Month YY (eg 310730A OCT 03).
1
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PART 2 - DETAILS OF MINE CLEARANCE ACTIVITY

14. Mine clearance record number (repeat number in No: ……………………
Serial 1)
15. Unit carrying out clearance

16. Rank and name of clearance party commander

17. Date & time of start of operation (DTG)

18. Date & time of end of operation ((DTG)

19. Methods, type of equipment and technologies used

for detection 3

20. Depth of detection (metres) 4

21. Description of methods, equipment and technologies

used for removing mines and ordnance5

22. Depth of removal (metres) 5

23. Description of methods, equipment and

technologies used for proofing

24. Depth of proofing (metres) 5

25. Is the area now metal free? YES/NO

26. Ground conditions at start and end of the operation.

(dry, wet, snow, frozen, etc)

27. Weather conditions at start and end of the operation

(dry, rain, snow, etc)

3
Examples are: manual/prodding, magnetic, electrical, nuclear resonance, anomaly detector, seismic, thermal imagery, radar,
photography, satellite, dogs, etc.
4
Record the depth to which the equipment is effective.
5
Include details of techniques and equipment (eg flail, plough, dozer, screening, mechanical, explosive, fire, chemical, high
pressure water.
2
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PART 3 - RECORD OF MINES AND ORDNANCE CLEARED

28. Mine clearance record number (repeat number No: ………..
in Serial 1)
LANDMARKS
(To identify the cleared area. Include these in sketch at Part 4)
Serial Map grid reference (UTM) Description

29.
30.
31.
32.
33.
MINED AREA BOUNDARY
(Details of boundary corners and changes of direction of boundaries)
Serial Map grid reference (UTM) Description of marker (including location if marker is buried)

34.
35.
36.
37.
38.
39.
40.
MINES AND ORDNANCE

41. State type of mined area (eg scatterable,

patterned/ single, anti-tank, anti-personnel or
mixed minefield)
Serial Type and designation of mine, booby trap, Total Description of any special features Disposal
IED and UXO including detail of anti-handling
devices if fitted
42.
43.
44.

3
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PART 4 - SKETCH MAP OF CLEARED AREA/ROUTE

Mine clearance record number (repeat No: ………..
number in Serial 1)

(Refer to STANAG 2036 Annex C for directions)

4
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