Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Details

  • Company name

  • Project title

  • Contract no.

  • Equipment type and model

  • Unique identification no.

  • Plant owner’s name

  • Plant user’s name

General

  • 1. Is there any obvious visual damage (distressed welds) or missing parts?

  • Give details

  • 2. Is the operator’s manual provided securely with the item of plant?

  • Give details

  • 3. Are items such as linkages, props, struts, cables and hoses in good order?

  • Give details

  • 4. Does the plant clearly display all appropriate rated capacity (safe working loads), pressures or speeds?

  • Give details

  • 5. Are all moving parts protected by fully operating and suitable guards?

  • Give details

  • 6. Are suitable warning notices fitted where necessary?

  • Give details

  • 7. Are all controls, including emergency stops, clearly identified and marked?

  • Give details

  • 8. Is the plant generating excessive noise, fumes or other exhaust gases?

  • Give details

  • 9. Are edge protection and handrails suitable and secure?

  • Give details

  • 10. Are the brakes and steering fully functional?

  • Give details

  • 11. Is the plant fitted with headlights, indicators, number plates and a horn?

  • Give details

  • 12. Are the wheels/nuts, tyres or tracks intact and securely in place?

  • Give details

  • 13. Is the plant fitted with working driver/passenger seating and restraints?

  • Give details

  • 14. Is a falling object protective structure (FOPS) fitted where necessary?

  • Give details

  • 15. Is a roll-over protective structure (ROPS) fitted?

  • Give details

  • 16. Are fuel, engine/hydraulic oils and coolant levels adequate, with no leakage?

  • Give details

  • 17. Is the item provided with secured special gas cylinders if LPG powered?

  • Give details

  • 18. Is the item provided with the correct drawbar or tow hitch?

  • Give details

  • 19. Other (please state if none)

Lifting equipment

  • 20. Is the plant fitted with hydraulic check valves where necessary?

  • Give details

  • 21. Are slewing or elevation restrictors fitted and working as necessary?

  • Give details

  • 22. Are ancillary items (such as the chains, rope, hook and block) in good order?

  • Give details

  • 23. Is the plant provided with sufficient working outriggers?

  • Give details

  • 24. Is certificate of thorough examination in date (6 or 12 months as appropriate)?

  • Give details

  • 25. Is the automatic safe load indicator (ASLI) fitted and operational?

  • Give details

  • 26. Other (please state if none)

Safety critical items

  • 27. Does the operator have 360° visibility at a height and distance of 1 m all around? (This can be achieved by items listed below.)

  • Give details

  • 28. Is plant fitted with working reversing cameras or convex mirrors?

  • Give details

  • 29. Is plant fitted with working reversing alarm, clearly audible at 10 m?

  • Give details

  • 30. Is the maximum gradient displayed or inclinometer provided where required?

  • Give details

  • 31. Is plant fitted with a quick hitch/coupler?

  • Give details

  • 32. Is plant fitted with amber beacon or light bar as necessary?

  • Give details

  • 33. Does plant have a suitable fire extinguisher in a convenient location?

  • Give details

  • 34. Is plant fitted with fire or exhaust suppression systems for work in tunnels, etc.?

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Comments

    Comments
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Signatures

  • I have carried out the above checks where appropriate and have established to the best of my knowledge that this item is/is not* in safe working order (*Indicate as applicable).

  • Give details

  • Name

  • Position

  • Signature

  • Date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.