Information

  • Equipment Type and Name

  • DDMI Equipment Designation #

  • Client / Site

  • Conducted on

  • Audit team led by:

  • Add signature

  • Location

Audit Details

Assessment Team

  • Team Member

  • Audit Team Member
  • Name

  • Company or Organization

  • Contact email or phone number

  • Signature

Equipment Details

  • Vehicle Type (year, make, model)

  • Gross Vehicle Weight

  • Primary Use (purpose, location(s), etc.)

  • Secondary Uses

  • Class of Equipment (if applicable)

Licensing

  • Does this equipment require a statutory license or training certification to operate?

  • License Class

  • License Type

  • Statutory Body

Servicing Checklist

  • Is there a copy of the manufacturer's operating manual available

  • Where is this kept?

  • Who has access to this information?

  • An appropriate action must be added in Section N: "General Comments & Notes"

Maintenance Scheduling

  • Have the service/maintenance requirements been obtained from the supplier?

  • An appropriate action must be added in Section N: "General Comments & Notes"

  • Has the information been set up in Ellipse for this piece of equipment?

  • An appropriate action must be added in Section N: "General Comments & Notes"

  • Have parts been uploaded in Ellipse for warehousing?

  • An appropriate action must be added in Section N: "General Comments & Notes"

  • Has a critical spares list including maximum/minimum inventory requirements been provided by the supplier?

  • An appropriate action must be added in Section N: "General Comments & Notes"

  • Does this equipment require servicing from an outside service provider?

  • Is a service contract in place?

  • An appropriate action must be added in Section N: "General Comments & Notes"

Supporting Documentation

  • List any documents from JHAs, SOPs, studies or similar equipment audits that were used to support this risk assessment

  • Document
  • Document Title

  • Document Type

  • Document Location

Section A - Operator Access

Operator Access

  • A1 - Steps, rungs and hand holds highly visible and allow 3 points of contact at all times

  • Minimize damage

  • A2 - If bottom step/rung below lowest extremity of the machine, flexible step installed.

  • A3 - Steps, rungs, ladders and platforms provide with non-slip surface and minimize rock/soil retention

  • A4 - If powered extension steps or ladders fitted is there a lock out provided to prevent steps or ladders moving or operating while extended

  • A5 - Adequate provision made for operator regular access (pre-start inspection and general operation) and maintenance regular access (greasing, servicing). Review:

  • Engine oil level check and refill points

  • Hydraulic oil level check and refill points

  • Transmission oil level check and refill points

  • Radiator fluid level check and refill points

  • Fuel refill points

  • Grease point access

  • Access to cleaning windows

  • RTSS C4 – Working at heights

  • A6 - Areas above 1.8m from ground level to have Fall Prevention AND / OR Fall Protection systems in place (depending on application):

  • Fall Prevention (to stop a person falling) – For hand railing, require level floor, top rail (between 910mm and 1070mm from floor), mid rail and toe boards (min 100mm high) and safe access and egress. Hand railing to take force of 0.9kN in any direction.

  • Fall Protection (to protect a person if they do fall) – engineered anchor point(s) (to withstand 5000lbs (2300kg) of load) for connecting personnel safety harness and lanyard.

  • Look at frequency of access, how stable is footing or platform, hand holds, and so on)

  • A7 - Areas above ground level where people need to access must to be assessed for the risk of falling, regardless of the actual height. Preference should be given to fall prevention controls (e.g. hand rails).

  • A8 - Pinch points exposing personnel to risk of injury are to be identified, minimized (eliminated where possible) and controlled.

  • Look at access to machine, as well as any booms, articulation, scissor lift action, hydraulic cylinders.

Section B - Operator's Cab

Operator's Cab

  • SAE J-1040, Surface Vehicle Standard Performance Criteria for Rollover Protective Structures (ROPS)

  • CSA B352-M 1980, Rollover Protective Structures for Agricultural, Construction, Earthmoving, Forestry, Industrial and Mining Machines; or

  • NWT Regs 10.43

  • B1 - Roll Over Protection System (ROPS) to be fitted on mobile equipment

  • B2 - No damage, addition, modification, welding or cutting of a ROPS without engineer approval.

  • B3 - Each ROPS requires permanent stamping of the name of the manufacturer or certifying engineer, model and serial number, and machine type it is built for.

  • NWT Regs 10.45

  • B4 - Two means of exit should be provided from operator’s cabs. This may be achieved by a second door or a push out window or panel. Any push out window or panel should be suitably marked.  At least one exit should be useable in the event of a roll-over.

  • B5 - Cabins should seal from dust and noise; the maximum equivalent noise level of the running machine (With the doors and windows closed and the air conditioning system operating at maximum speed) should not exceed 83dB(A) for 12 hour shift.

  • Check blind spots and consider if cameras or other engineered controls are warranted for safe operation (i.e. to reduce or eliminate high risk blind spots).

  • B6 - The location of cabs and the fitting of windows should provide the operator with maximum visibility.

  • B7 - All windows shall be fitted with laminated safety glass or other shatterproof material.

  • Mine Reg 10.29

  • ANSI Z26.1-1977 Safety Code for Safety Glazing Materials for Glazing Motor Vehicles Operating on Land Highways.

  • B8 - Forward windscreen washing and wiping facilities should be provided.

  • NWT Regs 10.29

  • B9 - The operator’s seat should be well maintained and shock absorbing (adjustable for operator weight).

  • NWT Regs 10.29

  • B10 - The operator’s seat belt and seat belt anchorages are to be robust and conform to regulations. Assess adequacy of the belt (lap belt vs. 3pt or 5pt harness or other) for protecting the operator in the event of a collision, roll over or other vehicle incident

  • NWT Regs 10.48

  • SAE J386 Operator Restraint Systems for Off Road Work Machines.

  • B11 - Air conditioning / heating should be provided to control the cabin air. The mounting of the air conditioner or the accessories should not interfere with driver visibility.

  • ANSI Z21.40.2-19996 (ROZ) CGA 2.92-M96

  • B12 - The air conditioner air intake should be located to avoid engine exhaust emissions.

  • B13 - All cabin wiring systems are low voltage (less than 32 volt AC)

  • B14 - A hard wired and mounted 2-way radio that is programmed to Diavik frequencies is to be fitted in all equipment with an operators cabin.

  • B15 - The cabin should be free of sharp edges and protruding surfaces that could be struck by the operator.

  • Where these cannot be avoided or relocated, they must be adequately guarded, cushioned or otherwise protected.

Section C - Cabin Controls & Functions

Cabin Controls & Functions

  • C1 - Operator controls located within zone of comfort and reach

  • NIOSH Control Design

  • C2 - Operating controls clearly marked to show function and mode of operation

  • NIOSH Control Design

  • C3 - If equipment can exceed 30 km/h a speed indicating meter to be attached

  • C4 - A horn or similar device provided for use as a manually initiated audible warning device. If horn is air operated, an alternative warning device is required in case of failure in air delivery system

  • C5 - Unless machine designed for bi-directional use, audible backup alarm to be fitted, which is automatically activated when reverse selected

  • NWT regs 10.27

  • C6 - Emergency Stop or method of emergency shutdown provided in control cabin is clearly marked and identified

  • Intention for emergency stop circuit to connect directly to source of fuel, eg fuel pump solenoid

  • C7 - Emergency Stop/Shutdown when operated latches either electrically or mechanically such that the actuation can only be reversed by a deliberate action and the equipment does not restart automatically

  • C8 - Transmission interlock to be fitted, so that the vehicle cannot be started in gear

  • NWT regs 10.28

  • C9 - A service hour meter is fitted

Section D - Engine Compartment, Cooling & Fuel Systems

Engine Compartment, Cooling & Fuel Systems

  • D1 - All hydraulic oil, lubricating oil, and other oil circuit pipes and hoses within the engine compartment should:

  • Be constructed to OEM specification

  • Be routed away from hot engine surfaces

  • Be routed away from moving parts, supported and sleeved to give maximum protection

  • Be covered so oil from any leak can’t contact any exposed metal surface where temp exceeds 200°C under any condition of use

  • Be covered so that fuel from any leaks can’t contact any exposed metal surface that exceeds 80°C under any condition of use

  • If not possible to route out of the way, surface may require shrouding or heat shielding

  • D2 - All electrical wiring system are regulation and are protected / shielded from heat and damage

  • CSA M421-00 Use of Electricity in Mines with CSAC 22.1 Canadian Electrical Code, Mine Act & Regulations part 13

  • D3 - All engine exhaust systems installed so that no flames or glowing particles can be emitted within the engine compartment under any condition of use

  • D4 - Fire wall or barrier is installed to separate the engine compartment from hydraulics components and maintains engine ventilation and cooling effect

  • D5 - Radiator caps for cooling systems are fitted with a means of safely relieving pressure to prevent scalding personnel

  • D6 - Unit fitted with fuel devices requiring power to operate so that isolation of power will isolate fuel delivery. (ie - electric fuel pump)

  • D7 - All fuel lines double braid, heat resistant, corrosion resistant metal braided or metal. (OEM specifications)

  • D8 - Fuel filter elements enclosed and made of rugged construction with no glass componenents.

  • D9 - All high pressure fuel lines secured with approved clamps

  • D10 - All fuel tanks substantially constructed and protected against damage by collision

  • D11 - All fuel tanks fitted with non-leaking caps which are effective irrespective of the attitude of the equipment

  • D12 - All fuel caps are secured to the tank to stop chance of lost fuel caps and contaminated fuel / fire hazard

  • D13 - Where fuel overflow hoses are fitted, the hose extends so its lower than all engine components to minimize the chance of fire

  • D14 - If no automatic fast-fill filling system fitted, filler and vent must be located so that leaks or spillage during refuelling will not contact hot surface

  • D15 - Engine must run on low sulphur fuel (sulphur content less than 0.25% by weight)<br>Note: Only low sulphur fuel available on site.

  • D16 - Consider valves and overflow (e.g. bleeder valves, pressure relieve valves, fluid overflows, etc.) positions based on intended vehicle use and operating climate to:

  • Avoid debris or water from reaching the fluid system

  • Avoid blockage rendering them inoperable

Section E - Fluid Power and Pneumatic Systems

Fluid Power and Pneumatic Systems

  • E1 - Flexible hoses must be compatible with the hydraulic fluid used and maximum system pressure and temperature

  • OEM & CSA M423-M87 (R2000) Fire Resistant Hydraulic Fluids.

  • E2 - Where a hydraulic system incorporates an accumulator, the accumulator should be connected to the system using components of minimal length and adequate rating. Fittings should be located or otherwise guarded to provide mechanical protection.

  • E3 - A manual bleed valve should be fitted to allow pressure relief for maintenance. Fluid should return to tank. Self-draining accumulators are preferable. OEM requirements for bleed down of accumulators is required in maintenance manuals

  • RTS C1 - Isolation

  • E4 - Only properly specified hoses should be used with pneumatic systems. Care should be taken to ensure the clamps used are suitable for the job and have the pressure rating stamped on them.

  • E5 - Air compressors and pressure vessels should comply with the requirements of the Mines Act

  • NWT Regs 10.98

  • CSA B51-03 Boiler, Pressure Vessel and Pressure Piping code

Section F - Brakes & Steering

Brakes & Steering - Wheeled Equipment Only

  • F1 - Equipment to contain;

  • Service brake

  • Park brake (mechanically activated holding power)

  • Secondary or emergency brake (which can use the service break or park brake system)

  • A failure in one system not to affect the ability of one of the systems to stop the equipment safely

  • NWT Regs 10.30

  • F2 - All braking systems able to be tested from operator’s seat.

  • NWT Regs 10.30

  • F3 - fluid activated service braking systems to be dual circuit systems, each capable of stopping and holding equipment. A separate circuit for front wheels and a separate circuit for rear wheels. Both circuits should be operated by the same brake pedal.

  • Mine Reg 10.30

  • F4 - For fluid braking circuits, an alarm device and indicator lights should be provided on the control panel of equipment to warn of failure in fluid circuit or dangerous drop in brake pressure

  • NWT Regs 10.30

  • F5 - Either brake system pressure gauges should be provided, or points for measuring brake system pressure to be provided.

  • F6 - Pneumatic or hydraulic energy storage systems, if required for brake systems, must be provided solely for brake applications (eg not steering).

  • F7 - For power assisted brakes, an emergency energy source capable of applying the braking system must be provided

  • NWT Regs 10.30

  • F8 - Manufacturer recommendation required on testing of each braking system. An external method to monitor brake wear and brake reservoir fluid levels to be provided.

  • NWT Regs 10.31

  • F9 - Brake linings or pads not contain asbestos.

  • F10 - The original equipment manufacturer of the equipment to which the rims and wheels are fitted should recommend and advise :

  • The maximum wheel loads, speeds and operating temperature etc.

  • Procedures for servicing wheel rims, including in particular, multi-piece wheel rims.

  • Clear limits of tolerances, permissible wear and other permissible defects of wheel and rim components.

  • Recommended tire pressures and tire wear.

  • F11 - Where equipment depends on power to steer (and loss of power would result in loss of steering) and has a maximum speed greater than 20km/h, an auxiliary steering device is to be fitted to allow enough time to steer the vehicle to a stop

  • NWT Regs 10.38

  • SAE J1511/ISO 5051, Steering for Off Road Rubber Tired Machines

  • F12 - Hydraulic pump used for auxiliary steering to use a separate fluid reservoir from main reservoir.

  • NWT Regs 10.38

  • F13 - For equipment exceeding 45,000Kg with maximum speed greater than 20Km/h, non-destructive testing required on front wheel spindles, in accordance with manufacturer.

  • NWT Regs 10.39

  • F14 - Equipment with automatic engine shutdown devices must have audible and visual alarms warning operator of imminent shutdown.

  • NWT Regs 10.41

  • F15 - Auxiliary steering must automatically be activated on such an engine shutdown.

  • NWT Regs 10.41

  • F16 - An override system shall be fitted so that the operator can temporarily suspend automatic engine shutdown (to bring equipment to a safe stop)

  • NWT Regs 10.41

Section G - Electrical

Electrical

  • G1 - A single electrical isolation lockout point to be provided, which when activated disables all electrical power supply to the vehicle.

  • NWT Regs 10.21

  • G2 - Isolation of energy sources other than electricity (eg air, water, fluid under pressure, steam) to be identified in operating manuals, and be able to be locked out and isolated

  • NWT Regs 10.21

  • G3 - All electrical wiring is to be protected from personnel contact. Electrical distribution boxes are to be lockable to restrict unauthorised entry.

  • RTSS C2 Electrical safety

  • G4 - Electrical safety devices such as earth leakage and overload protection should be installed on equipment

  • RTSS C2 Electrical safety

  • G5 - Where accessible, electrical wiring should be inspected for proper routing, pinch points, friction/rub points, proper connections, etc.

  • G6 - Battery must be adequately secured to prevent movement during operation

  • G7 - Vehicle must be equipped with a remote receptacle for attaching charging or boosting connections

  • G8 - Battery fusing must be configured as close to the battery as is practical.

  • Equipment with multiple battery (auxiliary or ‘house’ battery) systems must be checked/verified for proper configuration. The vehicle master switch must remove voltage from each power supply system.

Section H - Guarding & Shielding

Guarding & Shielding

  • H1 - Suitable devices must be available to support and block equipment components in a raised position for operation or maintenance (eg truck box, loader arm), which should be attached to, or carried with the vehicle

  • NWT Regs 10.55

  • H2 - Articulated vehicles should be fitted with a steering frame lock attached to the vehicle.

  • H3 - Guards required on moving components which personnel can contact (drive belts, pulleys, sprockets, flywheels, pistons, tail shafts, conveyor belting). Guards must be sufficient to minimize chance of personnel contact.

  • NWT Regs 10.16

  • H4 - Guard or shields fitted in the vicinity of the exhaust, turbocharger and other hot surfaces to prevent both personnel contact, and fuel or oil spraying on hot surfaces (provided they don't trap fuel or oil around the exhaust or turbocharger).

  • NWT Regs 10.16

  • H5 - Guards required around every tail shaft to prevent a damaged or broken shaft from whipping around in a compartment or digging into the ground.

  • H6 - Guards should be designed so that operation and servicing can occur with the guards in place. Guards which need to be removed should be hinged to the machine. Guards should be easy to lift and hold without risk of finger injury

  • H7 - Any covers, shields or guards, if not constructed from steel, shall be constructed from fire resistant material if the failure of the material may place an operator at risk.

  • H8 - No modification has occurred to guards or shielding OR modifications have been signed off by an engineer and constructed/installed to that specification

Section I - Lighting

Lighting

  • I1 - All lights should be easily cleanable from ground level or otherwise safely accessible for cleaning by the operator

  • I2 - All mobile equipment designed to travel on a roadway should be provided with the following :

  • Dual indication lights readily visible from the rear of the equipment to show service brake operation.

  • Where retarder braking is provided by other than service brakes, dual indication lights visible from the rear of the equipment.

  • Indicator lights should be fitted front and rear to warn other traffic of an intention to turn.

  • Minimum 2 headlights to illuminate roadway

  • NWT regs 9.49, CSA-M424.2-M90

  • I3 - Equipment should display a Unit number visible from all directions.

  • I4 - Adequate reflectors and / or reflective tape should be provided on equipment to make it readily visible from any direction.

  • I5 - With the exception of mining production equipment, a flashing light is required to be mounted above the cab or clearly visible in all directions (Orange = light vehicle or service vehicle; Blue = heavy vehicle; Red = explosive or emergency vehicle)

  • NWT Regs 10.51

Section J - Maintenance

Maintenance

  • J1 - Shift safety and maintenance checklist to be provided (from manufacturer or supplier), for use as prestart inspection

  • NWT Regs 10.04

  • J2 - Manufacturer / supplier recommended ongoing inspection and maintenance program to be provided.

  • NWT Regs 10.04

  • J3 - For previously used equipment, a written record of past tests, inspections and maintenance work carried out.

  • NWT Regs 10.04

  • J4 - Are confined spaces marked with appropriate signage? Are there confined spaces which could be minimized or eliminated by design?

  • RTSS C5 – Confined spaces

Section K - Labelling & Instruction

Labelling & Instruction

  • K1 - Compliance plate, displayed in a prominent position, should show:

  • The serial number, manufacturer, model, date of manufacture

  • The maximum number of personnel for whom seating is provided.

  • K2 - A list of all limits of equipment operation applying to the equipment should be available to the operator. Such limits should include, but not necessarily be limited to:

  • Maximum grade (%) - Loaded and Unloaded

  • Maximum cross grade (%) - Loaded and Unloaded

  • Maximum load (tonnes) - Level conditions and with a range of grades

  • Maximum speed (km/hr) - Under all above conditions

  • K3 - Labels displaying warning at all accumulators that pressure must be safely released before work commences.

  • K4 - Labels displaying warning that "hearing protection must be worn" if noise level exceeds 83dB(A) at any location on the equipment.

  • K5 - Labels identify all high risk pinch points (including articulation areas) and coloured red

  • K6 - Labels identifying unauthorized access in areas above 110v AC or 32v DC

  • RTSS C2 Electrical safety

  • K7 - Towing instructions to be provided by the manufacturer, with towing points clearly identified.

  • K8 - Equipment constructed in separate sub-assemblies for transport should have;

  • The weight of The sub assembly and The attachment points for lifting permanently marked on it.

  • The lifting attachment points should have a minimum safety factor of 4 on the ultimate breaking load in relation to the weight of the sub-assembly.

  • K9 - Labeling of all controls including direction of movement where applicable

  • K10 - Labels should be made of non-corroding material and be attached with non-corroding screws, rivets, adhesive, etc.

Section L - Fire Control

Fire Control

  • L1 - Diesel-powered equipment and/or equipment with more than 100 litres of flammable fluid (including hydraulic fluid) must be fitted with an AFFF or equivalently effective multi nozzle fire suppression system in the engine compartment and in other likely combustion compartments. Manual fire suppression methods (fire extinguishers) are acceptable if a risk assessment determines that the potential impact or loss from a fire is low enough to warrant it.

  • Mine Reg 10.42, RTSS D1.3 Fire precautions

  • L2 - The system should not allow the engine to start, or to keep running, if system pressure falls below the manufacturers recommended minimum pressure (ie discharged, faulty or disconnected). The interlock may be able to be over-ridden by an over-ride switch that requires constant hand operation. This applies to allow the plant to be moved to a safer location.

  • L3 - When any in-built fire suppression system is actuated by any means, the engine must automatically shut down.

  • Mine Reg 10.42(3)

  • L4 - All units should be fitted with at least two manually operated fire suppression system actuators; one in the cabin and the other(s) at an external position(s) where it (they) can be readily reached from the ground level. There must be easy access to an actuator from either side of the machine.

  • Mine Reg 10.42(2)

  • L5 - Visible indication should be provided for the operator to show the operational readiness of the system. This indication should be visible to the operator from the normal operating position. (This does not apply to remote control panels).

  • L6 - There should be a separate electrical supply to each fire suppression system, where the loss of electrical power does not effect the operation of the system. The switch should be clearly marked ‘IN THE EVENT OF FIRE DO NOT SWITCH OFF’.

  • L7 - Wiring system should be constructed and protected so that it is capable of maintaining an adequate supply to the suppression equipment when exposed to fire.

  • L8 - Adequate size and type of portable external pressure fire extinguishers should be fitted and maintained on each vehicle. Fire extinguishers should be inspected daily and thoroughly cleaned, serviced, and maintained monthly. Extinguishers should also be compliant with yearly certifications and periodic hydrostatic testing requirements.

  • Mine Reg 10.42 (4)(5)

Section M - Towing

Towing

  • M1 - if applicable, a means of towing must be recommended by the manufacturer including each item noted below.

  • M2 - If applicable, towing attachment(s) must be designed to a minimum safety factor of 2.5 times the maximum rated towing capacity of the towed equipment.

  • M3 - if applicable,pProvision should be made for crossed slings to be fitted for towing.

Section N - General Coments & Notes

General Coments & Notes

  • Insert Notes, coments and actions required along with agreed responsible person or organization

  • Note 1

  • Note 2

  • Note 3

  • Note 4

  • Note 5

  • Note 6

  • Note 7

  • Note 8

  • Note 9

  • Note 10

Section O - Action Items

  • Action / Non-Conformance including section and reference #

  • Proposed Controls

  • Responsible Person

  • Action / Non-Conformance including section and reference #

  • Proposed Controls

  • Responsible Person

  • Action / Non-Conformance including section and reference #

  • Proposed Controls

  • Responsible Person

  • Action / Non-Conformance including section and reference #

  • Proposed Controls

  • Responsible Person

  • Action / Non-Conformance including section and reference #

  • Proposed Controls

  • Responsible Person

  • Action / Non-Conformance including section and reference #

  • Proposed Controls

  • Responsible Person

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.