Title Page
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Conducted on
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Prepared by
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Location
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Hearing Protection (earmuff)
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Head Protection ( bump cap)
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Safety glasses
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Safety glooves
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Safety shoes
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Safety vest
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Uniform (seragam kerja)
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Driving speed limit (mengendarai tidak melampaui batas kecepatan)
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Seatbelt worn (penggunaan seat belt)
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Safe approach to aircraft (mendekati pesawat dengan aman)
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Parking in safety position with exit clear (posisi parkir aman jalur evakuasi tak terhalang)
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Safe entry/exit from cab (masuk dan keluar kabin dengan aman, mengetahui letak ESB jika ada)
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Sequence of bonding and lanyard ( urutan bonding dan lanyard)
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Fueling operation/monitoring/deadman (pengamatan pdg, deadman dipegang, pengamatan receiptacle)
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Correct use of platform/ladders (penggunaan tangga yg aman)
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Quality control/cwd/visual (visual test dengan cwd dilakukan setelah 1000 l )
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Storage of equipment (penempatan peralatan)
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Position of cone (penempatan cone/bendera 4 arah)
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Look up, look down, walk aroun (pengamatan atas, bawah, keliling)
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House keeping (kebersihan kendaraan pengisian)
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Dispenser/refueller checklist (checklist kendaraan pengisian)
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Morning draining of dispenser/refueler (draining harian kendaraan pengisian)
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Correct lifting/pulling/pushing (ergonomis dan benar dalam mengangkat, menarik dan mendorong)
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Risk area/safe positioning (operator bergerak dalam posisi aman)
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Comment (catatan,issue)
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Area to improve (kekurangan yg perlu diperbaiki)
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Area to praise (hal baik yg perlu dihargai)
