Information
-
Job Number
-
Customer
-
Job Description
-
Start Date
-
Finish Date
Pre-check questions
-
Checklist
Day
-
Date
-
We/I have read, understood and signed the method statement/risk assessment?
-
What Method Statement reference number are you using?
-
Generic Method Statement reference number
- MS1 - servicing & load test
- MS2 - breakdown
- MS3 - site survey
- MS4 - install anti-collision
- MS5 - install remote control
- MS6 - install downshop
-
We have obtained and completed all necessary permits that may be on this site
-
Isolation in place as per Method Statement?
-
Have isolations isolations been checked to ensure they are correct (using a known working voltmeter)?
-
Has all PPE been visually checked? If any defects are found please immediately remove from service and contact your senior manager for replacement. Please ensure that all PPE is worn at all times.
-
Are you aware of others working in the area?
-
Are the correct tools been used for the job?
-
Is all lifting equipment been used compliant with the correct colour code?
-
Is all electrical equipment PAT tested?
-
Have all tools been visually inspected and suitable for task?
-
Will your task harm the environment?
-
If yes to the above
Yes
-
Please describe what will harm the environment?
-
What actions have been taken?
-
Are you happy to proceed?
Access
-
Is the access / egress suitable?
-
If The Answer Is NO Then Please State What Measures Have Been Put Into Place?
-
Access Method
Access selected
-
Access Method Selected?
- cherry picker
- tower scaffolding
- scaffold
- scissor lift
- man ridding basket
- Crane Access Ladders / Platform
- ladders
- stairs and walkway
- platform with edge protection
- trailer mount cherry picker
- other (state in comments)
-
Using ladders / stepladders? if yes this section must be filled out?
Yes
-
Are you using ladders? (Theses are only to be used as a last resort)
-
Are the ladders static and unable to be moved by other equipment? (tied off and footed)
-
Do you need to be in the same position for a long period? (if yes please seek better access)
-
If the answer to the above is YES then answer the next question
-
Next decision?
Options
-
Can you share the task? (Please note if the job is going to take a long time then better access is to be arranged)
-
If the task is going to take a long time then better access must be sourced?
-
Different access used?
- cherry picker
- tower scaffolding
- scaffold
- scissor lift
- man ridding basket
- Crane Access Ladders / Platform
- ladders
- stairs and walkway
- platform with edge protection
- trailer mount cherry picker
- other (state in comments)
Collision
-
Is there a risk of collision?
-
If the answer is yes please answer the next question
-
Risk of collision
Yes
-
What are you at risk of colliding with?
-
Control measures put in place to reduce the risk enough to safely carry out the task?
- isolate other cranes either side
- isolate bay
- flag/lookout man
- temp stop blocks
- other method write in comments
- hospital section
-
Different Method Please State Here?
-
Is it safe to proceed with the task now that measures have been put I'm place? (If no seek advice)
Rescue Prevention / Rescue Plan (best practice is fall restraint)
-
Rescue Prevention / Rescue Plan
Selection
-
What is your rescue plan method?
- temp running line - with short lanyard
- fixed running line - with short lanyard
- fixed guarding / edge protection
- MEWP; battery emergency decent
- MEWP; man on floor
- ladder; anchor strop
- ladder; short restraint lanyard
- Telephone; emergency services
- Extra MEWP, to transfer
- rescue kit
-
Is your rescue plan adequate?
-
Any Different Rescue Plans Please State?
Tools and Equipment Checklist
-
I have taken the following hand tools onto the crane?
Tools
-
Hand Tool list:
- tool-bag
- screwdriver
- spanner
- socket set
- hammer
- pipe wrench
- mole grips
- tape measure
- rule
- spirit level
- chisels
- wedges
- Stanley knife
- pliers
- cutters
- jack
- drills
- taps and dies set
- laser level
- bearing pullers
- cir-clip pliers
- feeler gauge
- callipers
- micrometer
- spray paint
- brush
- file
- scribe
- marker pen
- engineers square
- hacksaw
- jnr hacksaw
- crimpers
- scribe
- multimeter
- voltmeter
- meter
- pat tester
- labels
- adjustable spanner
- boot lace ferrel crimpers
- magnet
- plumb line
- centre punch
- punch set
- socket set
- ratchet spanners
- adjustable spanners
- soldering iron
- bearing pullers
- torch
- headlight
- megger
- punch
- saw blades
- test leads
- impac driver
- Allen keys
- bearing pullers
- PVC tape
- torch
- pen
-
List any items not listed above please?
-
Total Quantity of hand tools?
-
I have taken the following power tools onto the crane?
Power Tools
-
Power Tools / Machine list:
- battery drill
- spare battery
- mains drill
- mag drill
- angle grinder
- battery angle grinder
- extension lead
- transformer
- chop saw
- Pat Tester
- generator
- welding set
- burning tackle
- enerpac jack
- toe jack
- press
- task light
- light
- impact gun
- torque wrench
- torque multiplier
- chain hoist
- winch
- load cell
- lifting equipment
- cable jacks
-
List any items not listed above please?
-
Total Quantity of power tools?
-
I have taken spares / parts onto the crane?
Spares
-
Spares / consumable list:
- traywork
- trucking
- lug kit
- fixing kit
- fuse kit
- steel
- unistrut
- brakes
- motor
- buffers
- c track
- limit
- cable
- stools
- rope
- axel stands
- junction box
- panel enclosure
- contactor tips
- arch shields
- contactors
- fuses
- mcb
- transformer
- terminals
- overloads
- rope guide
- springs
-
List any items not listed above please?
-
Total Quantity of spares / consumables?
Using Mobile Plant?
-
What mobile plant has been selected?
-
Daily inspection sheet of mobile plant
MEWP
-
You have read the manufactures manual and checked the Report Of Thorough Examination is in date?
-
Checked the SWL capacity to ensure you are not overloading the machine?
-
Checked all structual and other critical components are ok?
- Yes
- No
- Monitor (slight defect but safe to use)
- N/A
-
Are there any leaks present such as hydraulic fluid, engine oil, engine coolant, fuel, battery acids etc?
- Yes
- No
- Monitor (slight defect but ok to use)
- N/A
-
Check there are no leaks present (hydraulic, engine oil / coolant, fuel battery acids etc)?
- Yes
- No
- Monitor (slight defect but safe to use)
- N/A
-
Visual inspection to all tyres?
- Yes
- No
- Monitor (slight defect but safe to use)
- N/A
-
Is the key in the ground controls for the rescue plan?
-
Does the emergency system work?
-
Have Functional Checks / Pre checks done?
-
Are all safety features ok including tilt switch?
-
Is the battery fully charged?
-
You have walked the route you are travelling with the MEWP and ensured the ground surfaces are good?
-
When positioned are you 15m away from exposed electrical busbars when fully extended? (When accessing a crane they must be isolated before approaching/working near)
-
When positioned are you at safe position away as reasonably practicable on insulated Ac electrical busbars when fully extended? (When accessing a crane they must be isolated before approaching/working near)
-
Have you assessed the working area and cordoned off sufficiently?
-
Have you used this type of machine before?
-
If answer to above is no then answer this question
Familiarisation
-
Type of familiarisation? Please note if done a self familiarisation you have checked read all of the manufactures user manual?
BEFORE - carrying out the task, list any additional risks and hazards associated with the task that are not covered by the original risk assessment and actions needed to ensure safe working.
-
Are there any hazards not covered in the risk assessment/method statement?
-
Hazard / risk?
Hazard
-
Comment on hazard / risk?
-
Control measures put in place to reduce the risk enough to safely carry out the task?
-
Is it safe to proceed with the task now that measures are in place? (If no seek advice)
DURING - carrying out the task, list any additional risks and hazards associated with the task that are not covered by the original risk assessment and actions needed to ensure safe working.
-
Are there any hazards not covered in the risk assessment/method statement?
-
Hazard / risk?
Hazard
-
Comment on hazard / risk?
-
Control measures put in place to reduce the risk enough to safely carry out the task?
-
Is it safe to proceed with the task now that measures are in place? (If no seek advice)
Comments on task
-
Does the generic risk assessment need changing for future use?
-
Is new / extra equipment needed to carry out the task in future?
-
Do any hazards require further investigation?
-
Is the work area left tidy, even if it is not our mess and all safety guards have been replaced?
-
Comments for anything not covered above:
-
Add Images
-
Sketch
Completion of job on cranes / machines / work area
-
Confirmation of items removed under the "Tools and Equipment Checklist" section. Please note you have a duty of care to ensure you leave the crane safe before it goes back into production and it is your responsibility to remove any loose items even if it is not your mess.
All removed
-
Confirm all of the above items have been removed?
-
Tools have been left on crane because the task is not complete?
-
Signature of Employee checked that all items / tools have been removed from the crane / machine / work area
-
Signature of employee stating that all tools / equipment have been left on the crane / machine / work area and the equipment cannot be put back into service
-
Signature of employee stating that all tools / equipment have been left on the crane / machine / work area in a safe position and the equipment can be put back into service
Signatures
-
Clients signature if any thing has been changed from original method statement?
-
Comments for management
