Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Job No
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Contact on site
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Date & Time on site
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Risk Assessment provided
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Customer Signature
Belt Feeder - KIV14-08-4409
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Belt condition
- Good
- Fair
- Poor
- N/A
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Steel hopper sides / Extensions / Support leg condition
- Good
- Fair
- Poor
- N/A
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Belt alignment
- Good
- Fair
- Poor
- N/A
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Hopper skirting rubbers
- Good
- Fair
- Poor
- N/A
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Load rollers / Impact bars / Impact plates / Return rollers
- Good
- Fair
- Poor
- N/A
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Belt scraper (Where fitted)
- Good
- Fair
- Poor
- N/A
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Drive / Tail drum bearing condition
- Good
- Fair
- Poor
- N/A
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Auto greasers (Drive & Tail drum)
- Good
- Fair
- Poor
- N/A
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Plough condition
- Good
- Fair
- Poor
- N/A
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Motor / Gearboxes
- Good
- Fair
- Poor
- N/A
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Gearbox oil levels / Oil change required
- Good
- Fair
- Poor
- N/A
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Run conveyor empty (Check running amps at control panel)
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E-stop
- Pass
- Fail
- N/A
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Additional Notes
Conveyor - KIV14-02-4418
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Belt Condition
- Good
- Fair
- Poor
- N/A
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Belt alignment
- Good
- Fair
- Poor
- N/A
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Feed boot skirting rubbers
- Good
- Fair
- Poor
- N/A
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Main skirting rubbers
- Good
- Fair
- Poor
- N/A
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Feed boot impact section
- Good
- Fair
- Poor
- N/A
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Load rollers / return rollers
- Good
- Fair
- Poor
- N/A
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Belt scraper (Where fitted)
- Good
- Fair
- Poor
- N/A
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Drive / Tail / Knee joint bearing condition
- Good
- Fair
- Poor
- N/A
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Auto greasers (Drive & Tail drum)
- Good
- Fair
- Poor
- N/A
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Plough condition
- Good
- Fair
- Poor
- N/A
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Motor / Gearbox
- Good
- Fair
- Poor
- N/A
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Gearbox oil level / Oil change required
- Good
- Fair
- Poor
- N/A
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Run conveyor empty (Check running amps at control panel)
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E-stop
- Pass
- Fail
- N/A
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Additional Notes
Trommel - KIV14-07-4427<br>
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Steel side panel general condition
- Good
- Fair
- Poor
- N/A
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Mesh / Bolt / Washer condition
- Good
- Fair
- Poor
- N/A
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Sealing rubber condition (In-feed)
- Good
- Fair
- Poor
- N/A
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Brushes adjusted correctly into meshes
- Good
- Fair
- Poor
- N/A
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Drive Wheel Bearing condition
- Good
- Fair
- Poor
- N/A
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Retaining Wheels / Bearings
- Good
- Fair
- Poor
- N/A
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Auto Greasers (Drive & Retaining Wheels)
- Good
- Fair
- Poor
- N/A
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Drive wheel condition (Signs of heat / Blistering)
- Good
- Fair
- Poor
- N/A
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Motor / Gearboxes (Check for movement)
- Good
- Fair
- Poor
- N/A
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Gearbox oil levels / Oil change required
- Good
- Fair
- Poor
- N/A
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E-stop
- Pass
- Fail
- N/A
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Run trommel empty (Check running amps at control panel)
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Additional Notes
Conveyor - KIV14-02-4436<br>
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Belt Condition
- Good
- Fair
- Poor
- N/A
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Belt alignment
- Good
- Fair
- Poor
- N/A
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Feed boot skirting rubbers
- Good
- Fair
- Poor
- N/A
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Main skirting rubbers
- Good
- Fair
- Poor
- N/A
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Feed boot impact section
- Good
- Fair
- Poor
- N/A
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Load rollers / Return rollers
- Good
- Fair
- Poor
- N/A
-
Belt scraper (Where fitted)
- Good
- Fair
- Poor
- N/A
-
Drive / Tail / Knee joint bearing condition
- Good
- Fair
- Poor
- N/A
-
Auto greasers (Drive & Tail drum)
- Good
- Fair
- Poor
- N/A
-
Plough condition
- Good
- Fair
- Poor
- N/A
-
Motor / Gearbox
- Good
- Fair
- Poor
- N/A
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Gearbox oil level / Oil change required
- Good
- Fair
- Poor
- N/A
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Run conveyor empty (Check running amps at control panel)
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E-stop
- Pass
- Fail
- N/A
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Additional Notes
Over band magnet CBM305/1200-R (300mm above belt)
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Belt condition
- Good
- Fair
- Poor
- N/A
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Belt alignment
- Good
- Fair
- Poor
- N/A
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Drive / Tail drum bearing condition
- Good
- Fair
- Poor
- N/A
-
Auto greasers (Drive & Tail drum)
- Good
- Fair
- Poor
- N/A
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Motor / Gearbox
- Good
- Fair
- Poor
- N/A
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Gearbox oil level / Oil change required
- Good
- Fair
- Poor
- N/A
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Ferrous build up around magnet
- Good
- Fair
- Poor
- N/A
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Height over belt
- Good
- Fair
- Poor
- N/A
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Threaded bar / Chains / Curtains
- Good
- Fair
- Poor
- N/A
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Run overband magnet (Check running amps at control panel)
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E-stop
- Pass
- Fail
- N/A
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Additional Notes
Site Notes
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Special Notes
Completion Signature
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Customer
