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
Details
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Company name
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Project title
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Contract no.
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Equipment type and model
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Unique identification no.
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Plant owner’s name
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Plant user’s name
General
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1. Is there any obvious visual damage (distressed welds) or missing parts?
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Give details
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2. Is the operator’s manual provided securely with the item of plant?
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Give details
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3. Are items such as linkages, props, struts, cables and hoses in good order?
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Give details
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4. Does the plant clearly display all appropriate rated capacity (safe working loads), pressures or speeds?
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Give details
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5. Are all moving parts protected by fully operating and suitable guards?
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Give details
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6. Are suitable warning notices fitted where necessary?
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Give details
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7. Are all controls, including emergency stops, clearly identified and marked?
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Give details
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8. Is the plant generating excessive noise, fumes or other exhaust gases?
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Give details
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9. Are edge protection and handrails suitable and secure?
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Give details
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10. Are the brakes and steering fully functional?
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Give details
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11. Is the plant fitted with headlights, indicators, number plates and a horn?
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Give details
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12. Are the wheels/nuts, tyres or tracks intact and securely in place?
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Give details
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13. Is the plant fitted with working driver/passenger seating and restraints?
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Give details
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14. Is a falling object protective structure (FOPS) fitted where necessary?
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Give details
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15. Is a roll-over protective structure (ROPS) fitted?
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Give details
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16. Are fuel, engine/hydraulic oils and coolant levels adequate, with no leakage?
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Give details
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17. Is the item provided with secured special gas cylinders if LPG powered?
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Give details
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18. Is the item provided with the correct drawbar or tow hitch?
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Give details
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19. Other (please state if none)
Lifting equipment
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20. Is the plant fitted with hydraulic check valves where necessary?
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Give details
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21. Are slewing or elevation restrictors fitted and working as necessary?
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Give details
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22. Are ancillary items (such as the chains, rope, hook and block) in good order?
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Give details
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23. Is the plant provided with sufficient working outriggers?
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Give details
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24. Is certificate of thorough examination in date (6 or 12 months as appropriate)?
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Give details
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25. Is the automatic safe load indicator (ASLI) fitted and operational?
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Give details
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26. Other (please state if none)
Safety critical items
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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.)
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Give details
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28. Is plant fitted with working reversing cameras or convex mirrors?
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Give details
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29. Is plant fitted with working reversing alarm, clearly audible at 10 m?
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Give details
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30. Is the maximum gradient displayed or inclinometer provided where required?
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Give details
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31. Is plant fitted with a quick hitch/coupler?
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Give details
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32. Is plant fitted with amber beacon or light bar as necessary?
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Give details
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33. Does plant have a suitable fire extinguisher in a convenient location?
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Give details
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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
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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).
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Give details
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Name
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Position
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Signature
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Date