Title Page
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Site conducted
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Conducted on
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Name
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Prepared by
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Registration
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Before commencing use, please check the following items:
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Brakes, Steering, gauges, lights, warning devices
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Reported by:
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Reported to:
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Date/time reported:
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Method reported:
- Telephone
- In Person
- Radio
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If unsafe, park machine, tag out and contact Supervisor to advise accordingly. Machine shall not be used until fault is rectified.
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Visibility - windscreen, wipers, washer, demister, mirrors, windows
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Reported by:
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Reported to:
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Date/time reported:
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Method reported:
- Telephone
- In Person
- Radio
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If unsafe, park machine, tag out and contact Supervisor to advise accordingly. Machine shall not be used until fault is rectified.
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Cabin - access/egress, seating, seatbelts, loose objects, control levers
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Reported by:
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Reported to:
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Date/time reported:
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Method reported:
- Telephone
- In Person
- Radio
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If unsafe, park machine, tag out and contact Supervisor to advise accordingly. Machine shall not be used until fault is rectified.
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Wheels, tyres, nuts, damage, wear, pressure (visual)
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Reported by:
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Reported to:
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Date/time reported:
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Method reported:
- Telephone
- In Person
- Radio
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If unsafe, park machine, tag out and contact Supervisor to advise accordingly. Machine shall not be used until fault is rectified.
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Guards - in place, secure, warning signs - lights, alarms
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Reported by:
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Reported to:
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Date/time reported:
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Method reported:
- Telephone
- In Person
- Radio
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If unsafe, park machine, tag out and contact Supervisor to advise accordingly. Machine shall not be used until fault is rectified.
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Hydraulics - rams, hoses, leaks, wear
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Reported by:
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Reported to:
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Date/time reported:
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Method reported:
- Telephone
- In Person
- Radio
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If unsafe, park machine, tag out and contact Supervisor to advise accordingly. Machine shall not be used until fault is rectified.
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Excessive wear - hooks, chains, pins, pivots, tracks, ground engagement tools
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Reported by:
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Reported to:
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Date/time reported:
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Method reported:
- Telephone
- In Person
- Radio
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If unsafe, park machine, tag out and contact Supervisor to advise accordingly. Machine shall not be used until fault is rectified.
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Oil and Coolant levels
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Reported by:
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Reported to:
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Date/time reported:
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Method reported:
- Telephone
- In Person
- Radio
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If unsafe, park machine, tag out and contact Supervisor to advise accordingly. Machine shall not be used until fault is rectified.
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Misc, electrical, fire extinguisher, communications
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Reported by:
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Reported to:
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Date/time reported:
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Method reported:
- Telephone
- In Person
- Radio
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If unsafe, park machine, tag out and contact Supervisor to advise accordingly. Machine shall not be used until fault is rectified.
