CRM - Vehicle Collision or Rollover

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Task

• Location

Fit for Work and Fatigue Management

• Is the employee fit for work and able to stay focused on the task? E.g. physical/mental wellbeing, free from the effects of fatigue and/or medication

  Yes

  No

  N/A

Vehicle Pre-operational Inspection

• Are ROPs/FOPs in place for loading and hauling equipment? inspect tag.

  Yes

  No

  N/A

• Is the vehicle appropriate for the task? E.g. load/carrying capacity, size, working conditions

  Yes

  No

  N/A

• Has the operator documented a vehicle specific pre operational inspection ?

  Yes

  No

  N/A

• Has a proper braking system check/inspection been completed?

  Yes

  No

  N/A

• Have any critical safety items identified in the pre operational inspection been corrected ? E.g. seatbelts, braking systems. Are all items in the cab, cargo area and bed secured ?

  Yes

  No

  N/A

Operator Competency

• Is the employee authorized and competent to operate this vehicle for this task?

  Yes

  No

  N/A

• Is the seatbelt being worn?

  Yes

  No

  N/A

Access Control

• Has permission to enter the controlled area been granted?

  Yes

  No

  N/A

Positive Communication System

• Is your communication device working and appropriate for the task? E.g. adequate coverage and quantity

  Yes

  No

  N/A

• Do you understand the required positive communication protocols for this task?

  Yes

  No

  N/A

Road Conditions

• Have you confirmed if road and/or work area conditions are safe for operation ? E.g. consider weather, blasting activity

  Yes

  No

  N/A

• Are berms correct height for the largest piece of equipment traveling the road in areas with a drop off?

  Yes

  No

  N/A

Segregation

• Are segregation controls in place, secure and appropriate for the task? E.g. LV and HV separation, windrows, parking locations

  Yes

  No

  N/A

• Have you confirmed that segregation controls don’t create new risks ?

  Yes

  No

  N/A

Signage and Demarcation

• Are signage and/or demarcation controls visible, secure and appropriate for the task? E.g. restricted areas, poor road conditions, reduced speeds, roads closed, river crossings

  Yes

  No

  N/A

Downhill Haulage Management

• Are loads correct weight and size for equipment and grade?

  Yes

  No

  N/A

• Does the operator know the maximum payload for the vehicle you are operating?

  Yes

  No

  N/A

• In the event of overload/brake failure/overspeed/emergency , does the operator you know what to do?

  Yes

  No

  N/A

• Does the operator know the maximum speed when cresting and hauling downhill ?

  Yes

  No

  N/A