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
Assessment
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Name:
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Date:
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Position
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Experience rating:
Assessment
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Is the operator familiar with the Safe Operating Procedures for this machine
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Did the operator do a walk around prior to the pre start inspection
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Did the operator undertake a pre start inspection including checking oil and water
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Did the operator demonstrate proper procedures for starting the machine
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Did the operator demonstrate proper procedures for moving the machine
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Did the operator correctly assess the conditions before moving off
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Has the operator received any formal training on this machine
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Off Road Driving: Tar Seal
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Off Road Driving: Metal Road
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Chains
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Engage 4x4 and hubs
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Off Road Assessment: Flat
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Off Road Assessment: Medium
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Off Road Assessment: Steep
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Winch Training
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Is the operator wearing the correct PPE and is it in good condition
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Did the operator position the containers correctly to pour (e.g. to avoid slashing)
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Filling the tank with Venturi
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Filling the tank with a hose
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Did the operator use separate rubber gloves
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Triple rinse containers for recycling (only Dye and Meturon together)
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Was the machine being operated in a safe and controlled manner
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Did the operator demonstrate the correct shut down procedures
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Has the operator shown competence in identifying, recording and notifying hazards
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Is the operator aware of the requirement to record all accidents and incidents
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Does the operator understand the Emergency Procedures and Evacuation Area
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Comments
This is to certify that the operator named herein has been formally assessed and is considered to be competent and authorised to operate the machine specified above without supervision
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Junior (Supervised at all times)
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Assessor Sign
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Intermediate (Unsupervised in dry conditions)
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Assessor Signed
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Senior (Unsupervised)
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Assessor Signed
